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Physiotherapy


Neck pain

Introduction
Neck is the second most common regional pain syndrome site next to backache. It is also an occupational related problem especially after advent of computers. The neck disorders usually interfere with neurovascular structures of upper limb producing referred pain and motor symptoms.

Causes
•    Neck pain may occur due to  Fracture of cervical vertebrae, Dislocation of the cervical joints, Ligament sprain, Abnormal tear of ligaments, Herniated disc, Degenerated disc, Rear-end car collisions, Pinched nerve, Skiing accidents, Sports injuries, Shaken baby syndrome and many more.
Symptoms
•    Pain, Swelling, Tenderness, Stiffness in the back and sides of neck that increase with movements of neck.
•    Radiating pain, Numbness and Weakness in the shoulder, outer forearm and hand.
•     Decreased range of neck movements.
•    Occipital Headache (at back of the head).Sore throat, Giddiness.
•    Irritability, Fatigue, Difficulty in sleeping and concentration.

Diagnosis

•    CAT scan, MRI scan, Myelogram, Electromyography, Nerve conduction velocity test.


Treatment

NOTE: The treatment to the fractures, severe pain and post-operative cases should be followed by the advice of the doctor.

Pain Management

1.    Rest is given to the neck area by using cervical collar. Cervical collar - Two types of collars are prescribed and are not to be used for longer periods.
               Soft Collar -    Used during night times to prevent awkward position of the neck
                                   during sleep.
               Firm Collar -   supports neck and relieves pain during traveling and in work.
 
2.    Ice application at the pain area for 15 min, every 2-3hrs for few days.
3.    Heat application should be avoided in the early stages of the injury because heat will increase the circulation and increase swelling.

      •    Analgesics, Anti-inflammatory drugs, Cortisone injections given under doctor’s supervision.
      •    Joint mobilization, Soft tissue massage, Electrotherapy modalities done by the physiotherapist
      •    Cervical Traction - Traction is a mechanical device, which supports the head and chin. It is used to relieve the nerve compression by a bone. (Done under physiotherapist supervision). Cervical traction manually and mechanically.

Position of relaxation

1.    While lying flat on your back.
      A thin firm pillow under the head, second one under the shoulder and third     under knees.
2.    While sitting
      Head, neck and shoulder are to be straight with high back supported chair and a small pillow at lower back. Feet supported on low bench. Arms are to be kept on arm rest of the chair.
3.    Don’t stay in a position that increases pain.

•Stretching, Isometric and Strengthening exercises are to be done within pain-free limits.
 All the exercises should be done in comfortable position (either sit/stand).”Stop the particular exercise if it causes pain”.

1.    Neck flexion

Bring your head   forward. Chin should touch the chest and face staring down at floor. Do it slowly five times. Slightly stretch the structures of back of cervical spine, which will be in tight position in normal day to day postures.

2.    Neck extension

Slowly move your face upwards till the face looks directly at the ceiling. Over doing this exercise might increase your pain. Rest the neck for few seconds and get back to normal position. Old people if they feel Dizzy while doing this exercise can stop the exercise immediately.
3.    Side stretches
Move your head slightly to one side, bringing your ear closer to your shoulder (Keep your shoulders in normal position). Relax and hold for 5-10 seconds.
4.    Turning
Turn your head slowly to one side keeping shoulders in normal relaxed position. Relax and hold for 5-10 seconds. Stop if pain is increased or has moved into the arm or towards the hand.
5.    Chin tuck
Get your shoulder blades together. Move your chin back in line with shoulder and hip. Look straight (Don’t look up/down). This is a very small movement of your head. Do not push back too hard. Keep your shoulders down and then relax and hold for 5-20seconds.

6.    Shoulder shrugs

Move your shoulder up and down slowly and easily.

7.    Shoulder bracing/retraction

Slowly bring your shoulders to the front as if you are trying to meet at the middle of your chest and then pull them back getting your shoulder blades together.
Prevention

•    Do the exercises regularly. 
•    Avoid bad roads, if travelling by two or four wheelers. 
•    Do use firm collars while traveling.
•    Do not sit for prolonged period in stressful postures.
•    Do not lift heavy weights on head or back.
•    Do not turn from your body but turn your body moving your feet first.
•    Do turn to one side while getting up from lying down.
•    Do use firm mattress, thin pillow or butterfly shaped pillow while sleeping.
•    Do not lie flat on your stomach.                                                                                                 
•    Don’t participate in sports without warming up (stretches).

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