Neck Pain Support Blog

What are patients with Chronic Neck Pain doing about it ?

Many patients suffer from chronic neck pain. In fact the figure is 30% to 50% of adults in the general population. What types of treatment are they seeking? A recent Duke University and University of North Carolina (UNC) study reports in the November issue of Arthritis Care & Research that drugs and diagnostic testing are overused in treating chronic neck pain. The findings indicate clinicians may overlook more effective treatments for neck pain, such as therapeutic exercise. According to reviews cited in the study, evidence to support the effectiveness of therapeutic exercise in treating chronic neck pain is good, yet only 53% of subjects were prescribed such exercise. This information was based upon reported data from a representative sample of North Carolina residents.

Roughly 50%-85% of those patients who suffer from neck pain do not find their symptoms completely resolve, with some experiencing chronic, impairing pain. Chronic neck pain, like lower back pain, often does not respond to the treatment provided and can have similar economic impact in terms of lost work time and higher healthcare costs.

For the current study, Adam Goode, PT, DPT, and colleagues from the UNC Cecil G. Sheps Center for Health Services Research used data from a 2006 telephone survey of 5,357 North Carolina households. The researchers analyzed responses from 135 non-institutionalized adults over 21 years of age who had chronic neck pain. In this study, chronic pain is defined as pain and activity limitations nearly every day for the prior three months, or greater than 24 episodes of pain the previous year that limited activity for one or more days. More than half the participants were women (56%) and most were non-Hispanic white (81%).

Results indicate that the prevalence of chronic, impairing neck pain weighted to the North Carolina population was 2.2%. The researchers reported the average duration of chronic pain was 6.9 years, with subjects seeing roughly five different types of healthcare providers and 21 ambulatory care visits.

The study reported that participants received 1.6 diagnostic tests such as

• spinal radiographs (45%)
• magnetic resonance imaging (MRI-30%)
• computed tomography (CT-24%) scans

In the prior year, subjects who received X-rays of the spine had an average of two different sets taken which the authors noted to be inconsistent with clinical decision-making guidelines for diagnostic imaging. "For patients with such a long disease duration, the likelihood that imaging techniques would offer clinically important inferences may decrease," explained Dr. Goode.

With regard to healthcare utilization, 79.3% had consulted at least one provider for their neck pain during the previous year, and among these patients, more than 90% had seen a physician:

• Primary care physician, 72%
• Orthopedic surgeon, 31.6%
• Neurosurgeon, 29.1%
• Neurologist, 22.8%

In addition, 40% saw a chiropractor, 35.2% consulted a physical therapist, and 41% visited an alternative medicine specialist such as a massage therapist.

Frequent consultation with multiple types of providers was common, with an average of five providers per patient and 21 visits.

More than 56% of subjects in the study used over-the-counter medications (non-steroidal anti-inflammatory drugs), 29% reported taking strong narcotics (MS contin, oxycodone), and 23% used weak narcotics (codeine, propoxyphene) for their chronic neck pain. The authors reported that medical evidence on the effectiveness of medications in the treatment of chronic neck pain is quite limited, based on systematic reviews published in The Cochrane Library and The Bone and Joint Decade (BJD) 2000 – 2010 Task Force on Neck Pain and Its Associated Disorders: Noninvasive Interventions for Neck Pain.

According to Dr. Goode, "Rehabilitation conditioning and acupuncture studies have shown to be effective treatments that were less frequently used by patients with chronic neck pain,"

The most commonly used treatments by study participants were

• superficial heat (57%)
• prescribed exercise (53%)
• cold (47%)
• spinal manipulation (36%),
• therapeutic massage (28%).

"Our sample population had a high degree of disability, despite using a number of diagnostics and treatments. Based on current evidence, several treatments were over-used, and some effective treatments were under-used," concluded Dr. Goode.

Source: Goode A, et al "Prevalence, practice patterns and evidence for chronic neck pain" Arthritis Care Res 2010; DOI:10.1002/acr.20270

High Resource Use Found for Chronic Neck Pain

Additional Reading Resources:

• Michael Jackson: Another Celebrity Taken by Prescription Medications?
• 6 Ways to Get A Better Nights Sleep Naturally
• Severe Neck Pain From a Herniated Disc: What are Your Treatment Options?
• Neck Exercises
• Which Neck Pillow Should I Purchase?

Student Syndrome: Forward Head Posture

Looking at the Books or down on the Laptop

When you’re a student or at a job that requires a lot of time in the books or at the desk, watch out for forward head. What happens is that constantly having your head down at the desk or down to the laptop on your lap etc … starts to get to your neck.

This is how neck alignment starts to change. If everyday you are reading with your head down your posture will start to shift that way. Hence the reason we see so much forward head posture out there today- reading, head down at the laptop, hours in the car or at the computer- your head starts to shift forward.

The Problem:

Forward head means your neck alignment is shifting and you may have lost some of the neck curve. This, in turn, means possible nerve pressure.

The Solution:

Keep posture on your mind, working to correct bad posture. Also, take regular breaks when working, utilizing neck stretches and neck exercises to keep your neck mobile.

Another helpful thing when reading or studying is to use a book end or book stand to prop your book on. This keeps you looking forward versus downward. When I was a student studying in the library a lot of us used to grab a metal bookstand from one of the shelves and use it to put our book or notes on. Then I noticed shortly after the bookstore even started to sell one!

Cartoon source: CartoonCrunch.com

Additional Reading

• The Dreaded "Hunchback" - How To Correct That Area Of Your Upper Back That Pops Out And Looks Funny!
• Improving your Neck Posture
• Choose the Right Neck Pillow for Comfort and Support
• Can Forward Head Posture Cause Pain?
• The Top 10 Ways to Improve Your Neck Posture & Get Rid of Neck Pain
• Cervical Supports and Neck Traction

6 Ways to Improve Neck Posture

1. Postural Exercises- for example, one of the most common postural misalignments is forward head posture. A great exercise to combat this is head retractions.
2. Use a neck pillow- for forward head correction and neck pain relief I like the “cervical traction neck pillow.”
3. Reduce bad neck posture and uncomfortable, awkward neck positions; especially for long periods of time.
4. Take breaks when on the computer or laptop for long periods. The same goes for reading with your head down and even driving for long periods.
5. Stop looking down all the time. Roll you shoulders back and be cognizant of when your head is slouched forward.
6. Try a serious neck traction device. Something like the “Pronex” or “posture pump” which really works to correct neck alignment.

More Reading Related to Neck Posture
• Understanding Neck Posture
• Which Neck Pillow is Right for my needs?
• End Neck By Improving Your Posture- an Ezine Article
• The Best Neck Exercise to Correct Forward Head Posture!
• The Neck Pain Relief Kit- Downloadable e-book or Buy the printed version of this kit.

How to Get Restful Sleep When You Are Suffering with Neck Pain

I get this question a lot on the neck pain support blog from patients who are having trouble sleeping at night because they suffer from neck pain. The neck pain may be due to a whiplash type injury, a herniated or bulging disc, a neck sprain/strain or because of bad neck posture during the day or at work.

In this post I want to go over some best practices regarding contoured neck pillows and sleep, that will help you if you suffer from neck pain.

• Your neck posture while sleeping with a proper pillow is VERY IMPORTANT! Sleeping positions that are recommended include: lying on your back and both sides. Sleeping on your stomach is not recommended as it causes rotation in the neck.
  
  You want to get a pillow that allows the neck to remain “neutral” or, maintain its normal curve that is present when standing. The pillow should not be too thick or too thin. Too thick and your head is going to be jutting forward, and too thin, you are not going to get the support that you need in the cervical spine. Since the neck is generally skinnier than our head, a “neck-friendly” pillow should be thicker on the edge so that it fills in the space between the neck and bed and thinner under the head. This is true whether we lay on our sides or back but the amount of space varies with age, gender, and your body type: thin, medium or heavy-set. Here are some contour pillows you may consider:
  • Arc4life’s Cervical Linear Traction neck Pillow
  • Linear Gravity Neck Pillow (available in small, medium or large size)
  • The Tri Core Orthopedic Neck Support Pillow- This one comes in a gentle or firm (standard). Keep in mind that they pillow is more firm overall (both the gentle/firm) than the cervical traction neck pillow. So if you are looking for a more firm pillow, go for the tri core family of pillows. The tricore family of pillows also include the midcore support pillow and also the petite core pillow.
  
  
  There are many contoured or “shaped” pillows available that are thicker on the outside edges and thinner in the middle. Some of these include foam pillows of different densities, air pillows, water pillows, memory foam pillows, feather pillows, and others.
  
  The Neck Pain Relief Shop even carries a pillow based on the measurement between the neck and the point of the shoulder. This allows an individual to pick the pillow size best suited for their neck size. The Cervical Alignment Neck Pillow is available in three lobe sizes to perfectly fit the size of your neck. You can measure from the bottom of your ear to your shoulder with a standard ruler or tape measure to determine which size provides the best personal fit for you.
  • Measurement of 4" or less, use the 5” Lobe
  • Measurement of 4 to 5" = use the 6” Lobe
  • Measurement of 6" or more= Use the #7 Lobe)
  
  
  It’s important to note that it can take about a week to get used to the “new shaped” pillow so, “BE PATIENT!” Since we spend 6-8 hours of time in bed sleeping (that’s 1/3 of our life is spent sleeping!), neck pain may be PREVENTED by using a proper contoured pillow and, it’s easier to get used to the new shape when you don’t hurt so take advantage of getting a contoured pillow when you are feeling good.
• Avoid caffeine at least 2-3 hours before bedtime
• Exercising too close to bedtime is not helpful.

Source:Glastonbury Chiropractor Dr. Bellingers October 2010 Newsletter
Picture Source: Wellness.Weblog.com

Additional Reading:

• When Lack of Sleep Can Be Deadly
• The Cost of Not Getting A Good Nights Sleep
• Which Sleeping Position is Best for You?
• Which Neck Pillow is Right for my needs
• Neck Posture

Sleep to Wake up Beautiful each Morning: Beauty Sleep- Is it all that its Cracked up to be?

We’ve all heard the expression “beauty sleep,” but perhaps you didn’t realize that there is a lot of truth in that statement. Sleep is a time for the body to heal and rejuvenate itself. This rejuvenation takes place at a cellular level, including the delicate facial tissue. When you wake up with wrinkles and sleep creases all over your face, it’s a sign that you haven’t achieved that full potential of “beauty sleep.”

These sleep creases over time can even become wrinkles. If you sleep in the same position on your side or on your stomach, those sleep creases you see each morning in the mirror could become permanent wrinkles.

To get the most out of your sleep, the best option is to train yourself to sleep on your back with a pillow under your knees for support. If you are a side-sleeper or a stomach-sleeper, this may seem difficult, but with time you can change your habits. Just return to sleeping on your back if you wake in the night on your side or stomach. If you must use a pillow against your face, consider using a pillow with a satin material that will minimize wrinkles in the morning. It keeps the hair in place too!

A good trick to help keep you in place is to get a good cervical pillow. It will help to hold your neck in perfect neutral position so you will be less likely to toss and turn. With these tricks, you’ll be waking up well rested and looking good in no time.

Picture Source: Art By Shano

Additional Reading Resources

• 1001 Beauty Secrets-Let Your Body, Mind & Spirit Shine With Magnetic Personality! Secrets on makeup tips, body, hair, hand, legs & skin care, Also beauty recipes, weight-loss, nutrition, exsercises and more.
• Positioning Pillow
• Luxurious Satin Contoured neck pillow- A Neck Pillow that minimizes wrinkles on your face while sleeping.
• Choose the right pillow for comfort and support
• What is this “Boney Hump” in my back and how do I get rid of it?
• How Can I Stop Sleeping On My Stomach?
• Sleep Like A Baby and Wake Up Feeling Refreshed !

What is this “Boney Hump” in my back and how do I get rid of it?

Another question is often: what is a "dowagers hump" or a "buffalo hump"?

This is a hump in the back of the neck most likely due to posture. Typically when you have forward head your cervical spine shifts forward and the upper back follows; this creates the hump. Worst case scenario it's like "ego" from "Frankenstein". To correct it, start doing head retraction exercises and use something like the traction pillow to restore posture. A true neck tractioning device may work much faster.

When it is severe it’s often called a “Dowager’s Hump”. This is often sometimes associated with spinal degeneration in the form of osteoporosis or osteopenia. These essentially mean a weakening of the bone. Fracture associated with this can be common too. What often happens is that the bones weaken, collapsing in the front (sometimes referred to as wedge fractures). This then forces the neck into forward head or even a reversed curve (khyphosis), and the upper back into an accentuated curvature that will appear as a boney hump in the upper back.

If your doctor thinks true neck traction at a therapist’s office or a home will be too much for you to handle due to severe arthritis or degeneration, use a traction pillow. This traction will be much more gentle and help to restore neck and upper back posture.

Additional Reading Resources

• How does Loss of the Neck Curve cause Problems and Neck Pain?
• Pinched Nerve in the Neck
• Neck Posture
• What is the Burning Sensation between my Shoulder Blades?
• Arc4life's Cervical Linear Traction Neck Pillow for Proper Neck Sleeping Position
• 7 Seconds of Pain Relief- Techniques for Back, Shoulder & Neck Pain Relief
• The Dreaded "Hunchback" - How To Correct That Area Of Your Upper Back That Pops Out And Looks Funny!