Category Archives for "Neck Pain"

Wall Angels – Postural Neck and Back Pain

The wall angel is a simple exercise to open up your shoulders and strengthen the postural muscles of your back. It will also help improve shoulder rotation, normalize activation of muscle patterns in the upper back, scapular mobility, front of the shoulders and chest areas.

Start by standing tall with you butt, shoulder blades and head touching the wall. Keep your head up and your chin slightly tucked in and lower back from over arching. Bring your forearms up against the wall with the elbows bent. Then slide them up and down in the comfortable range making wall angels for 10 repetitions doing 3 sets each day.

If you’re unsure about the exercise or have any uncertainty about what you’re doing, consult your local Physiotherapist before continuing.

Whiplash Associated Disorder – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. Insync has been voted over and over best physiotherapists in Vancouver as voted by their customers. And Adam's an expert in all sorts of things. And today we're going to talk about whiplash associated disorder. What the heck is this? 

Adam: So whiplash associated disorder is basically in its classic form a hyperextension injury of the neck. But really it's just a rapid movement of the neck, which causes some strain of the very deep muscles inside of the neck that connect to some of the vertebraes.

Classic example is after motor vehicle accidents. So people get rear ended and they're neck hyperextends and then some of the muscles and stabilizing tissues in the front of the neck may get stretched and it's considered a very wide spectrum of injuries. So, yeah, that's basically whiplash.

Mark: So I'm sure it happened in many other things. If you're falling, in different sports or if you fall rock climbing and get it hyperextended backwards or skiing or hockey checked into the boards from behind, soccer, et cetera, et cetera. So, how do you treat it? 

Adam: So it really is quite complex. And that's the thing, you said it exactly. It doesn't have to come from a motor vehicle accident. It can come from a sports injury, any sort of rapid motion in the neck. And because the force, which is acting on the neck or the direction where the neck was moving, can cause particular muscles to be strained. And so overall the presentation is quite complex and it's case specific. 

Today I was going to talk about one case in particular where someone was T-boned, and they were hit from the side, so their neck was whipped over to the right side. And so they had experienced a whole bunch of pain just rating down onto the left shoulder and neck. So how did we treat it? Good question. 

The first thing we did was, we had to check some of the secondary injuries. So the assessment was quite complex because this person also received a bruised rib from the seatbelt and was experiencing what we call cognitive fog, which is a sign of a concussion. So when we assessed it, we want to make sure we weren't missing anything.

And so we ruled out a lot of the red flags that might occur. We did that through a thorough cranial nerve assessment, and we also looked at some of the ligaments in the neck to make sure that the neck was stable. We found that it was stable and then we could move on to the proper safe orthopedic treatment.

Mark: So, what does that consist of, safe orthopedic treatment? What do you actually do? 

Adam: Good question. So for this person in particular, it involved a little bit of manual therapy, so making sure that we could relax some of the tone of the muscles in the area. So in particular, the way I describe this, is that you have stabilizer muscles and these are posture muscles that help to make sure that we can move in a controlled manner.

And then we have moving muscles. This is an oversimplification, but, in general, those are the ones that we use for lifting and for moving. And in particular after this type of injury, I find that a lot of the muscles that are moving muscles really, really tense up and they try to take on the role of the posture muscles.

So the first thing that I found pretty effective is once we found this person was safe and physiotherapy was the right option, was to just kind of get those muscles to relax and then work on some of the deep neck flexors. So these are muscles that are really, really, really deep into the spine that you can't palpate or feel. And we work on stabilizing those. 

So we teach them an exercise where really we're just rocking the neck back and forth, quite gently in the pain free range. We do it in a way where we're not tensing up all the other muscles that would cause more injury. So that's the start of the treatment.

When we're talking about how we progress treatment from there, we have to deal with some of the other injuries that this person also suffered. So they had a bruised rib. So we worked on basically mobility in the chest area or the thorax. And we started eventually doing some basic concussion exercises, which would involve some eye tracking or vestibular movements.

And then from there, once we had strengthened the neck and we were able to gain more active range of motion, like mobility through the chest and through the neck, we were able to start some strengthening. 

Mark: So that's the protocol basically you followed, what's the general prognosis and in this case, how long did it take to get better, but what's more typical?

Adam:  So this was a complex case. So it took a little bit longer, took about, I'd say 12 weeks. Because it was a motor vehicle accident. It was an ICBC claim. So we actually were able to get a vestibular therapist to assist with some of the concussion related symptoms. And that can take a long time. So depending on how severe or significant of a concussion it is, it can take a year or two. But in this case, we were able to get that person's pain under control within 12 weeks and their range of motion back up to normal. And their concussion had subsided after about eight weeks. So that's the outcome of the case. 

Mark: And more typically with other folks?

Adam: Whiplash associated disorder is usually broken down into four categories. So the first category is just pain. The second category is range of motion and pain deficits. The third category is if there's actually a nerve injury, this person didn't have a nerve injury. So they were whiplash associated disorder two. And whiplash associated disorder four is actually like a fracture. So again, when we look at the categorization, she was a whiplash associated disorder two. And that was like a big spectrum. And I would say, you know, 12 weeks is quite typical, but if someone is a very minor whiplash associated disorder, it can be, you know, eight weeks, six weeks, four weeks. It's really a big spectrum. 

Mark: There you go. If you've had a whiplash injury in recent times, which is the best time to address any kind of injury. Or if it's been something that's been nagging and bothering you and you need some help, you want to get rid of that pain. Insync Physio, ask for Adam Mann. You can book online  at insyncphysio.com. They have two offices, Vancouver and North Burnaby. So if you want the Vancouver office, you want to talk to a human being (604) 566-9716 to book, or in Burnaby (604) 298-4878. Thanks Adam. 

Adam: Hey, have a good day.

Neck Injuries, Neuropathies

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. Repeatedly voted one of the best physiotherapy offices in Vancouver and Wil has just been voted one of the top three physiotherapists in Vancouver. Congratulations Wil. How you doing? 

Will: Yeah, I'm doing great, Mark. Thanks, and that was a total surprise. It's always great to be recognized. And I really obviously appreciate that. Things are definitely going great on my end. Can't complain. 

Mark: Let's talk about neck injuries, that's what we have on the agenda today. Neuropathies, what's a neuropathy?

Will: So first of all, I think the easiest way to kind of get into it is, looking at a client that came in, that that actually presents with that. So, we had this 57 year old woman, who's a golfer, that walked into our clinic and she presented with some interesting symptoms. The first thing she said to me, "Hey, I've got this pain going down my arm in my hand and my wrist, and it's been going on since April. So, the last four months, four and a half months, and it's just not going away. I've been seeing a chiropractor and massage makes it worse." 

And she actually saw her family doctor and her family doctor diagnosed her with carpal tunnel syndrome. It was interesting in that I was you know, taking her history, kind of dived into the questioning of what was going on, you know. 

She's, like I said, she's a golfer, she's retired, but she ran a successful business where she  was on the computer lots. And so there's a lot of sedentary stuff involved. And so it turns out she has this thing called the neuropathy going on in her whole upper extremity and relating to her neck.

What it is essentially is basically a malfunction or dysfunction of the nerve, that causes a lot of hypersensitivity. The word hypersensitivity is the medical term that they used for when a nerve is not functioning properly. It's just basically over firing for whatever reason and it's usually due to a minor injury, right. 

A minor irritation and that irritation, it turned out that it was coming from the woman's neck because she definitely didn't have the range. And her specific joints in the neck were fixated and a lot of the muscles in her neck and leading down to sort of the shoulder area, which is all related, were shortening to the extent where they were basically causing a lot of alignment issues.

 There's specific tests that we do that are able to help us diagnose, is this a neuropathy? And so with the hypersensitivity, there really isn't a major injury going on and you do scans on it and you do whatever x-rays, and stuff like that, and it won't necessarily show much going on.

You do these other different tests and adds up to what we would call neuropathy in terms of the hypersensitivity of these nerves. And that's basically what it is. 

Mark: So what kind of treatment protocol did you initiate with her?  

Will: Looking at what her impairments were. There were three major things going on, right? So with her neck, she had limited mobility because of the neck joints, and that was causing a lot of other mobility issues. This is chronic, too. So other thing that as you're ascertaining this, and we're assessing this, that this isn't something that just happens overnight or the span of two weeks. She's been having symptoms since April, it's been going on way longer than April.

Because of that and her neck issue, it's causing a lot of this type of immobility or lack of mobility, not just in the joints, in the range of motion of her neck itself, but also the nervous system and the nerves related dermatomal myotomal spread of what was giving her symptoms down into her hand and her wrist.

So we did three major things. We helped to restore her mobility and her neck, a combination of manual therapy and then some exercises to reinforce that mobility. And then number two, we assessed her neurodynamic system. So that's a bit of a mouthful there. So what that means is we assessed how her nervous system and her nerves are moving and functioning and we mobilized it. We used some hands on therapy to increase the mobility of that. So it was very specific techniques. And then we gave her some exercises to reinforce that mobility. 

The third thing was, is really applying something. So her muscles were like this, and looking at how can we actually help to relieve that tension and that compression in all those multiple segments, so that way things can move better overall as a whole. One of the really effective treatment techniques was using something called IMS, and IMS stands for intramuscular stimulation. What it is is the application of acupuncture needles that basically restores these neuropathies and releases these is the spasms in these tight muscle bands, so that way it relieves pressure on the joints and allows things to move better. 

Essentially it allows like sort of a reset if you wanted to describe it, for that whole neurophysiological system. And then the last, actually major component of the treatment - so those are the three main areas, but then you have to actually look at helping the client understand the actual dysfunction or the issue and what this is, because the education component is actually one of the key things. Educate her about what neuropathy is and how we can fix it.

So those are the key things. And we do all these things and they make it a little bit better, but they're not going to get 100% better. They're not going to also understand how to prevent this from happening, because as much as I want to keep treating her, you know, lots and lots and lots, I don't like that actually.

What I want to do is I want to actually be able to help her in three visits. After the first visit, she no longer had any more of those symptoms, and all I did was treat her neck. It wasn't even carpal tunnel syndrome. 

Mark: So what was the final outcome of the treatments? 

Will: Basically she came in for third session earlier this week and she was pretty much she went from coming in to see me. She was like at 55, 60% over overall functioning and impairment to like almost a hundred percent. And she like hadn't played golf and then she would go and play golf this weekend for the first time.

Mark: Nice. So there you go. If you have a problem with your neck or any kind of phantom pains that are suddenly turned chronic, it's been a few months, the guys to see our Insync Physio. You can reach them at Vancouver office (604) 566-9716. They're on Cambie Street really convenient to find or in North Burnaby, (604) 298-4878. You can book online as well at the website. Insyncphysio.com - both offices. You have to call and book. They're always busy. They're always popular. They're always helping people and they will help you get better and moving freely. Thanks Wil.

Will: Great. Thanks Mark. Hope that helps.

Neck Strain Injuries – Thoracic Mobility Lunge Reach Up Rotates

Each vertebrae in your back work together to support the overall functional movement throughout your entire spine. Having improved functional mobility in your thoracic spine, or your upper back is important for the full recovery of your neck.

Start by lunging forward with your right foot and twist your body to the right while reaching straight up above your head with your left arm and hand. Keep your low back in neutral position and your inner core muscles below the belly button pulled in and engaged.

When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Avoid having your knee fall into the mid line of your body or going past the front of your toes. Push back up to the start with the forward foot while unwinding the back and bringing the arm back down. Repeat this for 10 repetitions doing 3 sets for each side.

If you’re unsure about the exercise or have uncertainty about where you’re at with your neck strain or injury, consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Ball Core Stability Strength Progression 5

​Here’s another great way to strengthen the core stability muscles for your neck. Roll out on your stomach onto a big ball with only your hands and feet touching the floor. Avoid your chin tilting out or extending your neck backwards. Press the tip of your tongue up against the roof of your mouth and raise both arms straight up and shoulder width apart with your thumbs pointing towards each other.

Make sure the slack in the elastic band is taken up. Maintaining constant tension in the band and angle the left hand downwards to the left side of the floor. Then slowly raise the right hand with resistance, bringing the arm out for 5 seconds and then slowly bring it back again to the start position, again taking 5 seconds to complete the movement for your first repetition. Complete 5 repetitions, doing 3 sets, two times daily on each side.

This exercise continues to strengthen the deep neck stabilizing muscles of your neck in conjunction with your upper and lower quadrant core strength.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing.

Neck Strain Injuries – Ball Core Stability Strength Progression 4

Here’s yet, another great way to progress the core strength for your neck to help with the recovery in your functional activities and sport.

Begin by rolling out on your stomach onto a big ball with your hands and feet touching the floor only. Avoid tilting your chin out or extending your neck backwards. Press the tip of your tongue up against the roof of your mouth and raise both arms straight up and shoulder width apart with your thumbs pointing towards each other.

Make sure the slack in the elastic band is taken up. Then slowly abduct the arms out for 5 seconds and then slowly bring them back again to the start position, again taking 5 seconds to complete the movement for your first repetition. Complete 5 repetitions, doing 3 sets, two times daily.

This exercise progressively strengthens the deep neck stabilizing muscles of your neck in correspondence with your upper and lower quadrant core strength. If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Ball Core Stability Strength Progression 3

Here’s another great way to progress the core strength for your neck to help with the recovery in your functional activities and sport.

Begin by rolling out on your stomach onto a big ball with your hands and feet touching the floor only. Avoid tilting your chin out or extending your neck backwards. Press the tip of your tongue up against the roof of your mouth and raise both arms straight up and shoulder width apart with your thumbs pointing towards each other. Then slowly abduct the arms out for 5 seconds and then slowly bring them back again to the start position, again taking 5 seconds to complete the movement for your first repetition. Complete 10 repetitions, doing 3 sets, two times daily.

This exercise progressively strengthens the deep neck stabilizing muscles of your neck in correspondence with your upper and lower quadrant core strength. I

f you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Core stability Strength Progression 2

Progressing the core strength for your neck is important for the recovery in your functional activities and sport.

Begin by standing tall in neutral spine posture. Avoid tilting your chin up or extending your neck backwards. Press the tip of your tongue up against the roof of your mouth and raise both arms straight up and shoulder width apart with your thumbs pointing towards each other. Make sure the slack in the elastic band is taken up.

Then slowly lift your right arm diagonally upwards and lower your left arm downwards diagonally at the cadence of 5 seconds and then slowly bring them back again to the start position, again taking 5 seconds to complete the movement for your first repetition.

Complete 5 repetitions at this angle and then alternate the angle so that the right hand is pulling down for 5 reps as well for a total of 10 repetitions. Do 3 sets of this two times daily.

This exercise progressively strengthens the deep neck stabilizing muscles of your neck with angled arm movements in a functional standing position. If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Core Stability Strength Progression 1

Progressing the core strength for your neck is important for the recovery in your functional activities and sport.

Begin by standing tall in neutral spine posture. Avoid tilting your chin up or extending your neck backwards. Press the tip of your tongue up against the roof of your mouth and raise both arms straight up and shoulder width apart with your thumbs pointing towards each other. Make sure the slack in the elastic band is taken up.

Then slowly abduct the arms out for 5 seconds and then slowly bring them back again to the start position, again taking 5 seconds to complete the movement for your first repetition. Repeat this for 10 repetitions doing 3 sets, two times daily.

This exercise progressively strengthens the deep neck stabilizing muscles of your neck in a functional standing position. If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Core Stability Strength

Doing some basic core strengthening is important for a better recovery of your neck strain injury. Begin by standing tall in neutral spine posture. Avoid tilting your chin up or extending your neck backwards.

Press the tip of your tongue up against the roof of your mouth and raise your hands with both arms straight up and shoulder width apart with your thumbs pointing towards each other. Then slowly abduct the arms out for 5 seconds and then slowly bring them back again to the start position, again taking 5 seconds to complete the movement for your first repetition. Repeat this for 15 repetitions doing 3 sets, two times daily.

This exercise begins to rehab your neck strain injury by strengthening the deep neck stabilizing muscles of your neck in a functional standing position.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your neck, consult your local Physiotherapist before continuing. 

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