Neck Back Care Michelle Kwong B HSciPhty MSPA

Neck & Back Care Michelle Kwong B. HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director Http: //www. painrelief. sg

SPEAKER PROFILE Michelle. Kwong. com n Qualifications Graduated with Bachelor of Health Science (Physiotherapy) in University of Sydney ¨ Australia Certified Clinical Pilates Instructor ¨ Certified Aquatic Physiotherapist ¨ Member of Singapore Physiotherapy Association ¨ n Experience ¨ More than 7 years of clinical experience in: n Physiotherapist n Clinical Pilates Instructor n Ergonomics Consultant n Personal Trainer in Prehabilitation/Rehabilitation

SPEAKER PROFILE Michelle. Kwong. com n Achievement ¨ Awarded GOLD Service Excellent by SPRING Singapore 2003 ¨ Principal Physiotherapist and Director of Physiotherapy Clinic THE PAIN RELIEF PRACTICE http: //www. painrelief. sg n Vision ¨ Highly committed to help people with musculoskeletal pains to speedily recovery with latest clinically proven physiotherapy technologies & success in mastery of good health and fitness.

TOPICS COVERED n Structure of the Spine n Common Spinal Condition n Causes of Spinal Pain/ Conditions n Pain Management n Prevention of Neck/Back Pain n Exercises for Neck/Back muscles.

SPINE FACTS 5 sections ¨ Cervical (7 vertebrae) ¨ Thoracic (12 vertebrae) ¨ Lumbar (5 vertebrae) ¨ Sacral (5 fused vertebrae) ¨ Coccyx (4 fused vertebrae)

Spine Structure n n n Lumbar vertebrae Intervertebral disc Nerve roots Ligaments Muscles

Vertebrae • Skeleton framework • Support for muscles & tissues • Protection of vital organs • Storage of minerals & immature blood cells

Joints Allows movement between bones

Intervertebral Disc The intervertebral disc is a jelly like substance, which consists of annulus fibrosis and the nucleus pulposus. Acts as a shock absorber.

Spinal cord & Nerves Roots - Nerve roots exit through holes in the bone of the spine (foramen) on the right side and left side. - Branch out at each level of the spine. -The nerve roots innervate different parts of body.

Ligaments are fibrous bands or sheets of connective tissue. They link two or more bones, cartilages, or structures together.

Muscles attach to the spinal column, pelvis, and extremities. They serve to support the spine

Core Muscles n n Deep trunk musclesacts as stabilisers ‘Power House’

Causes of Neck & Back Pain

Causes of Neck & Back Pain Poor Carrying Posture Poor Sitting Posture

Causes of Neck & Back Pain Poor Sleeping Posture Poor Working Posture

Causes of Neck & Back Pain n n n n Overuse e. g. repetitive bending, static posture Overstress e. g. heavy object, excessive turning Degenerative changes i. e. Wear and tear Trauma e. g. fall Genetic predisposition Physical inactivity Mental Stress Tumor

Common Problems Neck & Back Pain

Common Conditions of Neck & Back Pain n n n Joint sprain e. g. locked joint syndrome Muscle and Ligament injuries Degenerative changes e. g. spondylosis, osteoarthritis, spondylolisthesis Prolapsed Intervertebrae disc (‘slipped’ disc) Nerve roots irritation Fractures

Compression Fracture n Usually due to trauma (very hard pressure or fall) n Higher risk for osteoporosis/ elderly

Disc Herniation Stages of Disc Herniation 1 Disc Degeneration Chemical changes associated with aging causes discs to weaken, but without a herniation. 2 Prolapse The form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion. 3 Extrusion The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc. 4 Sequestration or Sequestered Disc The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.

Effects of position on disc

‘Slipped’ Disc

Spondylosis Degeneration (Wear and tear) n Age related n Activity related n Previous injury/trauma n

Lumbar Spondylosis Normal 58 yrs old Degenerative Changes 83 yrs old

Nerve Root Irritation • Shooting pain down the leg • Constant pain • Numbness • Weakness

Signs and Symptoms

SIGNS & SYMPTOMS n n n Localised pain in the neck/ back Diffused pain over a wide area Pain radiating to the lower limb

SEVERE SYMPTOMS n n n Numbness/ Pins & Needles in the upper/ lower limb Weakness Constant pain Difficulty sleeping/ awaken by pain Unsteady with walking Inability to control bowel / bladder To seek early medical doctor/ physiotherapist advice if presence of severe symptoms

MANAGING PAIN Self Management - Doctor - Physiotherapy - Surgery -

Acute Pain Self Management ACUTE PAIN (1 st – 2 nd day) n Apply ‘RICE’ R: Rest for 24 -48 hours (NOT Complete Bedrest!) ¨ I: Ice for 15 -20 mins, every 2 -3 hrs interval ¨ C: Compression with bandage ¨ E: Elevate ¨ n Avoid ‘HARM’ H: Heat ¨ A: Alcohol ¨ R: Running ¨ M: Massage ¨

Pain Management Advice n Avoid activity that may cause pain especially: - Strenuous activity - Prolonged activities, repetitive movement - Heavy loads n Neck/ Back Support for acute severe pain. (Not advisable for chronic pain. ) n Heat n Gentle stretching when pain reduced

Pain Management Advice l When self management does not work, SEEK HELP EARLY especially if you are suffering from any neck/back pain and radiating pain down arms/legs. The longer your pain condition, the harder for doctor/physiotherapist to treat, the longer the time for recovery and more medical fees involved. l

Physiotherapy Goals of Treatment n relieve pain n improve joint function n maintain flexibility n Strengthening weak muscles n Achieve a healthy lifestyle

Physiotherapy n Pain relief treatment ¨ ¨ ¨ n n Heat (Ultrasound, Hotpack, Shortwave) Electrical (Interferential, TENS, microcurrent) Joint mobilisation/ manipulation Massage Traction Postural Correction Sports Taping/ Kinesio Taping Core/ Back Therapeutics Exercises Return back to sports/work

ADVANCED TREATMENTS: COLD LASER THERAPY - Stimulates immune system - Generate healthy cells & tissues - Promotes faster healing «EM SIGNAL THERAPY - Activate & Regenerate cells - Bone & Cartilage Repair - Significant pain reduction ELECTROACUPUNCTURE - Non-invasive - Effects of electrical & acupuncture therapy to reduce pain & promote recovery «Spinal Decompression Therapy (DTS) - Advanced high tech Traction - Proven to reduce most neck/back symptoms >86%

Physiotherapy n Education on lifestyle modifications ¨ ¨ ¨ Avoid prolong activities Avoid strenuous activities Avoid heavy load Avoid squatting/kneeling prolonged Avoid stairs climbing

Medications Medicines doctors use to treat osteoarthritis include: n n n Acetaminophen, which may help relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relief fever. Corticosteroid injections in the joint (intra-articular), which reduce inflammation. Hyaluronan injections, which may relieve pain. Opioids, which may relieve moderate to severe pain.

Supplements n Chondroitin & Glucosamine sulfate natural substances found in the joint fluid. ¨ chondroitin is thought to promote an increase in the making of the building blocks of cartilage (collagen and proteoglycans) as well as having an anti-inflammatory effect. Glucosamine may also stimulate production of the building blocks of cartilage as well as being an anti-inflammation agent. ¨

Supplements n CH Alpha (Collagen hydrolysate) Only product with a U. S. patent for cartilage regeneration ¨ Clinically proven to stimulate specialized cells called chondrocytes. Chondrocytes control the rate of cartilage regeneration in joints and detect changes in the composition of the cartilage. They respond to these changes by growing more cartilage. ¨ Studies have shown that CH-Alpha increases the concentration of collagen and proteoglycans through this stimulatory effect on chondrocytes. ¨

Surgery In some cases surgery is necessary, more often it is not necessary. Another 6 -8 weeks of physiotherapy, at 3 to 5 times per week. Lower rate of success, dependent - Pain - Increased danger from anesthetic - Increased danger from possible infections - Possible post operation complications (eg pneumonia, DVT, delayed union/nonunion, spinal cord injury) - Noticeable scars Prolonged recovery time, generally 6 to 8 weeks

Prevention of Neck & Back Pain PREVENTION IS BETTER THAN CURE!

Prevention of Neck & Back Pain n Adopt good body mechanics/posture n Adopt correct lifting technique n Exercises for a healthy back n Healthy Lifestyle n Stress Management

Strengthening Exercises

Healthy Lifestyle Flexibility Mobility Aerobic Endurance Strength

Healthy Lifestyle

PRACTICAL n n Neck Mobility Exercises Neck Strengthening Exercises Back Mobility Exercises Back Strengthening Exercises DISCLAIMER: Exercises shown should be done with caution especially for people suffering in pain or previous condition. In case of doubt, check with your doctor/physiotherapist with regards to your condition.

Neck Mobility Exercises Neck Flexion/ Extension n Tilt head forward and backward as far as possible. n Slow, repeat 8 -10 times Neck Side Flexion § Tilt head toward shoulder keeping shoulder stationary § Slow, repeat 8 - 10 times

Neck Mobility Exercises Neck Rotation § Turn head from side to side as far as possible § Slow, repeat 8 -10 times

Neck Strengthening Exercises Deep Neck Flexors § Tuck in Chin § Hold 10 seconds, 8 -10 reps Isometric Neck Extensors § Giving resistance with clasped hands at back of head, push backwards with head. § Hold 10 seconds, 8 - 10 reps

Neck Strengthening Exercises Isometric Neck Side-Flexors § § Place hands on side of the head and push head against hands resistance Hold 10 seconds, 8 -10 reps

Back Stretching Exercises Bent Over Stretch n Hold the back of a chair with your arms shoulder-width apart. n Walk backwards as you bend forward from the hips and straighten out your arms. n Keep your feet together, your back straight and your head between your arms in line with your spine. n Hold for 10 – 30 secs

Back Stretching Exercises BACK EXTENSION & SHOULDER BLADE PINCH n Stand with feet apart & lean backward to the point of tension with arms reaching back. n Tighten shoulder blades and lower back muscles. n Feel a mild stretch on your abdominals. n Hold for 10 -30 secs

Back Stretching Exercises Lower Back Stretch n Stand with feet hip-width apart. n Come into a squat position by bending your knees and pushing your buttocks backwards. Place your hands on your thighs. n Pull belly button toward your spine as you tilt or curl your pelvis under. n Return to starting position.

Stomach Hollowing n n Strengthens Transverse Abdominus Breath out and relax your stomach muscles Pull lower part of stomach inwards and upwards Hold 10 seconds and perform 8 -10 reps Crook lying, sitting, standing

High Plank Strengthens the chest, shoulders, triceps, buttocks, hamstrings & trunk. n n n Start on your hands and knees. Arms should be directly under your shoulders. Extend one leg back at a time until your body weight is supported on your arms and toes. Hold for 5 -10 seconds, perform 8 -10 reps

Back Strengthening Exercises Bridging Exercises n Lie on the floor with your knees bent, feet flat. n Tighten the muscles of your lower abdomen and buttocks. n Slowly raise low back and buttocks from the floor n Hold for 5 -10 seconds, do 8 -10 reps

Back Strengthening Exercises Low Back Extensors n Lie face down on a mat with your arms beside you and your legs together. n Lift your head and shoulders off the mat by squeezing the muscles in your lower back. Keep your feet on the floor. n Slowly lower to the mat. n Hold for 5 -10 seconds, do 8 -10 reps

Summary n Prevention is better than cure. n When self management does not work, SEEK HELP EARLY if you are suffering from any neck/back pain or any radiating pain down arms/legs. n LIVE A PAIN FREE LIFE!

QUESTIONS & ANSWERS If you have any queries, please feel free to email Michelle at michelle@painrelief. sg Or call 67355368.

THANK YOU Presented By: Michelle Kwong B. HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director World Malayali Club http: //groups. yahoo. com/group/worldmalayaliclub/

Disclaimer n The Pain Relief Practice Educational Material is for information only. This information is not intended to diagnose, treat, or cure any medical/health condition. It is not a substitute formal, real world medical or physiotherapy care, and should not be considered as such. The Pain Relief Practice is not in a position to independently evaluate any of the advice or claims on behalf of any particular therapy. Any information or suggestions we provide should be discussed with your doctors or physiotherapist in real person when treating your condition. Our discussion of possible pain treatments are just options which may be significantly limited by the incomplete full physical examination of a doctor/physiotherapist.