Category Archives for "Neck Pain"

Rock Climbing Neck Injury Rehab Resisted Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees with 4 feet Resistance bands tied diagonally from opposite thumb webspace to ankles.

As you place one hand forward bring your opposite foot forward as well. Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

This is a great progressive core stability muscle strengthening exercise for your neck after sustaining an acute or chronic type of injury. 

Rock Climbing Neck Injury Rehab Belly Ball Dribble

Lie on your stomach on top of a built up mat 5-8 inches high. Keep your feet wide apart with toes to the ground, with your face and chin clearing the mat and your arms straight and wide grasping a large exercise ball on the ground.

Dribble the large exercise ball with both hands while you keep your front lower core engaged and lower back straight and so you prevent it from going into extension. Activating the lower quadrant core muscles will enhance and optimize your strength and movement patterns to your full potential. Repeat this for 10 seconds doing 10 reps 2sets daily.

This exercise can be progressed by increasing your dribbling up to 20 seconds for 5 reps 2 sets and ultimately to 30 seconds for 3 reps 2 sets.

If you have any bad or questionable pain or discomfort discontinue this exercise and consult your local physiotherapist before continuing. 

Neck Pain and Headaches with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. We're going to talk about neck pain and headaches. How are you doing Wil? 

Wil: I'm doing great, Mark. 

Mark: So what kind of, obviously your neck or your head is going to be hurting, so what other symptoms might people have or why would they want to come and see you about this?

Wil: Yeah, so these types of headaches that are neck related are 20% and it usually is followed by, you know, it can be non traumatic, so not followed by an injury, but is most common followed by an injury.

And the main symptom is that it's usually on the same side that you have the headache but it can be on both, but it's usually on the same side. Particularly when you have problems with movement or postural issues that bring on the pain in the neck, which will also bring on the headache pain.

Mark: So those are the causes. So it could be, you've been in an accident or fallen or been hit somehow in playing sports. Jarred some way and that's caused a neck problem, but then that radiates up into your head or you don't even feel the neck necessarily. It just suddenly you have a headache. 

Wil: No, usually it's related to neck pain and it's usually on the same side. And the other really important thing to understand too, is that if it's sort of this like unusual type of headache and is not related to any neck pain and especially if it's like all of a sudden and it's unrelenting. Then I strongly, we strongly recommend seeing a medical practitioner and getting a medical diagnosis for it.

It could be something else that's a little bit more serious. But when it comes to related to the neck pain, the neck pain and the headache. It's definitely something that is correlated when you have an issue, like if you're moving and you have postural issues related to bringing it on and it will normally elicit that headache. So they usually go hand in hand. 

Mark: So those posture issues could be from how you're sitting, while you're working, for instance, if you're at home on your laptop or how you slept that night kind of thing, are those also possible causes? 

Wil: Yeah, absolutely. And then what ends up happening sometimes too, like you're talking about posture, like if you're on the computer too long, like, you know, we're just with what we've kind of shifted over to now with working at home now more these days. That you have a lot of imbalances that can occur. Or then you have a lot of muscles that are then always on and then your core stability muscles that are now really basically down trained. And that need to be strengthened a little bit more. 

Mark: So when someone comes in with this, how do you go about diagnosing it? 

Wil: Yeah, so first you need to rule out a bunch of other things just to make sure. And so with this type of headache related neck pain, the common term is called cervicogenic. And really this cervicogenic type of headache, there's really a few main causes that we already talked about briefly. We're looking at whether or not is a joint related, is it muscle related or is it ligament related. And so we can ascertain and really determine whether or not it's coming from one of those three areas. And that's when it usually is correlated with a headache. 

Mark: And based on what you found then, does that determine what the course of treatment is going to be? 

Wil: Yeah, there's really good research studies and good clinical basically results shown that combining manual therapy, so manipulations of the joints. And also movement of the joints with what's called mobilization techniques with using your hands. And also soft tissue techniques that open up the soft tissue to allow things to move a little bit better combined with specific exercises. Are really good for basically helping with these types of syndromes and dysfunctions.

Mark: So that would be the typical course of treatment as you get a little bit of lovely massage and movement, but also then you have exercises that you do in office and then go home with and continue to do. Is that right? 

Wil: Yeah, because the idea is that you want us to reset things a little bit more in the muscular system as well. So things that are really like tight and imbalanced in that way, that are not letting go, you want to reset that, let that to relax, and then you need to work on training the movement pattern function of other muscles that are just not working properly. And so that way that compliments them and gives you a more optimal posture and movement in the neck.

Mark: So, of course it depends on the injury, but how long would it normally take to have some relief of the pain, whether it's in the neck, head or both? 

Wil: It really depends. Like the studies have shown that it can be fairly immediate, like within a couple of sessions. And then if it's like something that's long standing, it's a chronic issue you know, if there's more going on in the joints. Then it could take a little longer and it could be sort of a longstanding thing. So really depends. But in our experience, you know, working with clients that have this issue, if it's not an issue that's involving a lot of things in the joints, then it really can take as little of even one session I've seen, up to like a few sessions, you know, and it's completely gone. But the hardest part is retraining the whole muscle movement patterns and the whole optimizing the movement function. 

Mark: So, if you want to get headache free and neck pain free, the people to see in Vancouver or North Burnaby are Insync Physio. You can book online at or you can call the Vancouver office to book 604-566-9716 or in North Burnaby 604-298-4878. Get in there and get feeling better and moving properly. Thanks Wil. 

Wil: Thanks Mark.

Rock Climbing Neck Injuries 4-Point Neck Extension Core Strength Reaches

Start in 4 point position on your hands and knees with 4 feet Resistance bands tied diagonally from opposite wrist to ankles. Keep your posture in neutral with your low back core engaged and prevent your shoulder blades form collapsing.

Begin with a neck warm up by flexing your head and neck down by bringing your nose to your sternum. Slowly bring your head back up extending your neck and rotating it to the left side. Repeat this for 5 reps to warm up for both sides.

Then after your 5 reps for each side add left finger, hand and arm reaches with right hip heel extensions. Repeat this for 10 reps on each side for 3 sets daily.

This is a great functional core neck strengthening exercise for rock climbing training and performance. It’s designed to help you retrain and optimize your best neck movement and strength patterns.

If you have any bad or questionable pain or discomfort, discontinue this exercise and consult your local physiotherapist before continuing. 

Rock Climbing Neck Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto he's the owner of the chief cook and bottle washer. Not really. He's the big chief at Insync Physiotherapy in Vancouver and North Burnaby. And we're going to talk about rock climbing neck injuries today. How are you doing Wil? 

Wil: I'm doing well. Thanks. And I have actually washed bottles for a job once before, so. 

Mark: Me too actually. So, rock climbing neck injury. So this doesn't seem like it would be a very common thing. How common is injuring your neck while rock climbing? 

Wil: Well, you know, it's interesting, it's more related to sort of the chronic issue and I guess you could classify it as repetitive strain. And there's a couple of different aspects to it.

So one of the common ones that you know, if we put a label to it, we call it the belayer's neck. So for people who like basically, you know, belay and they climb like this, and they're always basically shortening up those muscles. Now there's a few aspects of belayer's neck. And then just in general, people who are like climbing really hard, but aren't doing a lot of mobility work to really make sure that they're recovering the full mobility of their neck and their spinal joints and their associated areas that around the neck. Because there's a lot of muscles that attach from the neck to the shoulder and then from the neck to the upper back and all that stuff.  

Mark: So the symptoms would be pain, I would assume. 

Wil: Pain and stiffness. Those are the biggest ones. And occasionally it can get bad enough where you have like a radiating pain or nerve pain. So that's where it gets a little bit more extreme where there's like a sort of a pinched nerve. 

Mark: And the causes are basically, like you said, it's chronic it's from looking up all the time or maybe not having great biomechanics for other things because you haven't worked on it. And so you're using your neck in a way that it's not really meant to be, or trying to compensate using your neck muscles. Is that. 

Wil: Yeah. So what happens is that there's an imbalance once again. And you have a lot of tightness in certain muscles, and sometimes it's tight in the front too. And obviously really tight in the back. And so what ended up happening is that you don't get the proper extension in your neck and you're actually pinching in and only moving in limited joints and extension through the neck when you should be extending throughout every segment in your neck.

So that's important to understand because then when you're looking at the muscles that they get really tight. Then it contributes to that effect. And so what we need to really help people understand, like climbers understand you know, the mobility work to get that moving, even when it doesn't feel symptomatic is really important to do. Especially if you're an avid climber or especially if you're a competitive climber and someone is looking at increasing your training level to really hit personal goals. 

Mark: So someone comes in. They're a rock climber. They've got neck problems. How do you diagnose it?

Wil: Yeah. So one of the main things, I was saying earlier that you know, that you can get from like limitation and the movements and the mobility, and the pain could also be coming on a little bit more where it's more than just stiffness and soreness. Now it becomes like, Oh, pain, I can't even like look up. To even like radiating pain down the arm where they may not even have pain in the neck. So we need to differentiate and figure out which one of those are, right. So we have to look at, is it coming from the joint? Is that why you're getting the issue. 

Most likely, it's a combination of that with the imbalances in the muscles. And then if it's a pinched nerve, we have to figure out okay, which areas. And then start to alleviate that. Because we want to make sure that we start to get that moving properly as well, so it alleviates that.

Mark: So depending on what the diagnosis is, that determines what the course of treatment is going to be. 

Wil: Absolutely. And then just a little bit more on the whole, like radiating pain and the nerve pain, you know, if we find something that's a little more serious, something that we think that requires more medical diagnosis or getting to have your family physician to take a look at it. It's important because maybe there's some going on there where it's affecting the nerve health. And so when we assess that and examine it we can determine how much is it being affected in the nerve. 

Mark: And in terms of, because climbers want to get back climbing right away again, how soon can they get back to it typically?

Wil: Pretty soon. I mean like you can still keep climbing. Like I'm treating a climber right now, who's had a past history of a pinched nerve. But no longer has that, but presents with some symptoms of weakness related to the pinched nerve, which he doesn't even know about, which is interesting. And still climbing. Still training hard and addressing this issue. So that's an example from one that I'm treating right now who had that. 

Another example, I'm treating someone who it hurts just to look up and then we look at his movement is so stiff that even when he brings his arms up you know, he can barely bring his arms up to here. How can you even possibly climb? And it's been sort of gradually building up. It's interesting. He's just noticing how he's more stiff and more stiff. And he tries to do things that stretch it out before he climbs and really open things up more forcefully and it's just, he's so compressed.

He doesn't realize that, you know, the more that he's climbing right now, the more he's making it worse. And he has definitely sort of a lot of weakness in a lot of other areas that are most likely related to the nerves in the neck. So here are we going to tell him reign it in a little bit and let's just give it a week's rest and then we'll get you back climbing in a week. And then we've got to do more of a gradual step approach. And this is quite common, too. I see a lot of people that are like that. 

And then we have another example of another climber who doesn't have any radiating pain. Doesn't have any weakness. It's just stiff and they can keep climbing as normal as well. So two, three treatments and they were good. And got him on an exercise program, building on manual therapy, mobilization techniques to work the joint. Keep them moving and get the muscles that needed to be strengthened and really work on, you know, relaxing and resetting those muscles that are really tight. That way things work more properly. 

Mark: How important is it that the climbers follow the exercise program you give them, in terms of how well they're going to, over the long-term not have this problem recur? 

Wil: It's pretty important. And I think it's funny because you know, we take them through maybe a couple of treatments, and then give them the exercises, they're doing and they feel great. But then I'll see them again in a year or maybe a couple of months, they've increased the training more and ask them well, what's different other than the training.

Oh, I haven't done my exercises that much. And so it's important because the exercises that we give you are individualized to what's going on. So we look at what needs to be targeted and what needs to you know, really be emphasized in terms of even like warm-ups and stuff. And so when those aren't being done and you figure a climber and you're like pushing and increasing the intensity, then it's an obvious recipe for something to happen in the future. If you're going to continue climbing, at an avid level and especially at a competitive level.

Mark: If you're a rock climber in Vancouver with some neck issues, stiffness pain, you want to get it fixed. The guys to see are Insync Physio. You can reach them in Vancouver at 604-566-9716 they're on Cambie and King Edward or in North Burnaby, 604-298-4878 to book. Or of course you can book online at Thanks Wil.

Wil: Thanks Mark. 

Neck Injury Rehab Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees. As you place one hand forward bring your opposite foot forward as well.

Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

This is a great progressive core stability muscle strengthening exercise for your neck after sustaining an acute or chronic type of injury. 

Neck Injury Rehab Horizontal Ball Catches

Start on your knees and lie with your belly on a balance ball while you engage your core stability muscles of your lower back to keep your posture in neutral.

Hold a lacrosse ball in your hand with your elbow up and knuckles pointing down. Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand without letting the ball fall to the ground. It’s important to only pivot through the elbow and not the entire arm and shoulder. Repeat this for 30 seconds doing 3 sets for each side daily.

This exercise can help rehab the functional core strength of your upper quadrant when recovering from a neck injury. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Dizziness from Neck with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum from Insync Physio in Burnaby. He's the clinical director director of the North Burnaby office. Insync has two offices in Vancouver and in North Burnaby. And today we're going to talk about dizziness from your neck. From your neck? How do you get dizzy from your neck?

Iyad: That's a good question, Mark. So basically the way you find yourself when you're walking, when you're moving, when you're doing all kinds of stuff is your brain gets signals from all over the body. And then it puts them together and in a way, processes them. And then you get this kind of thing where you're able to sit up straight and, you know, walk in a straight line and all that stuff. So some of the feedback that we get comes from our neck. And our neck's, really a rich area when it comes to all these kinds of little sensory nerves that send lots of signals to our brain to interpret. 

So sometimes we get people who, let's say a hockey player who, you know, smacked really hard into the boards. And they get diagnosed with a concussion and then a few weeks on, a few months on, they're still experiencing some headaches and some dizziness. 

So I know like last week, my colleague, Heather filmed an excellent video with you about headaches that could originally I guess started from the neck where the neck gets really sensitized and it can kind of give you these fake symptoms that look like you have head symptoms, face symptoms.

And this is really no different. The way you want to think about it is this, we have our vision that tells us what's happening. So you get to see what's in front of you. You could tell what's straight and what's not. We have our inner ear, which helps us figure out where our head is moving. So that's the vestibular organ. And then you have our neck.

So for example, imagine if you have a mismatch in those three signals, so your eyes are telling you you're facing straight ahead, your inner ear is showing you facing straight ahead and you're not moving. But your neck is kind of perceiving a movement, slightly different. So it says maybe you're a bit on your side or you're a little bit there.

So that mismatch is basically what could produce some feeling of unsteadiness and most people just label it dizziness which this general vague term. But really it's just a confusion between your senses. 

Mark: So the symptoms are dizziness. Is it more from when you're moving? You would notice, because that's sometimes I think we talked about that the last time. Is that a movement thing or is it you're still and you just you're like you described your one spot and you're feeling dizzy suddenly. How does it manifest? 

Iyad: Yeah. Most people will feel it when they're moving. And that's when they'll tell you, like, you know, I turn my head and I get this and they think, you know, you go on your Google and you think, oh, I got this loose crystal that's in my inner ear that's causing this. And you know, that very well could be a thing. But most people will feel that with movement. If in really sensitive cases where it's like super aggravated, you will sometimes feel it at rest, but you'll feel just a bit off. You know, that's kind of the sensation, they'll say, oh, I feel like I'm on a boat. I'm just kind of, things are rocking a bit slowly here. 

So yeah, most people, I would say it's an impairment with movement and, you know, that's, I think if you think about that, that's the whole purpose of rehab is to kind of help you get more comfortable with movement. And that's where I guess a treatment program will be very helpful. 

Mark: So how do you go about diagnosing this?

Iyad: There's quite a few tests. So what we will do usually in an exam is we will do a neck exam. If we suspect a concussion, we could do some kind of tolerance test where we get the heart rate up a bit to see if just a spike in heart rate will cause this symptom. So that's one potential reason. 

The other thing is we'll do an assessment to the vestibular system where we try to kind of challenge some of those reflexes that our inner ear is responsible for. So usually it's a bit of a process of elimination. It's not this. It's not this, it's not that. And then we have some specific tests for the neck where we basically test how well you can locate centre with your eyes closed, for example, and we have these tests that test for joint position error. We get you to close your eyes, perform a task, and then turn your head one way and come back and see how well do you land on the centre again. 

That could be again, another tool that we can use to figure out if there is something coming from the neck. And we'll find it in most people is it's never just an either or. You can also have these overlapping things. Like you could have a concussion and you can also have neck symptoms from the impact. For example, if the hockey player into the boards.

So it tends to be you know, we worked through the impairments one by one, and that's kind of how we figure out exactly what contribution is coming from. Just the general system to the neck to the inner ear. So there's lots of treatment options, which is great. But some, you know, manual therapy to the neck, it can be very, very helpful in some cases. 

You know, manual therapy is not just for loosening up joints and loosening up muscles and improving movement. It also gives us a lot of, because these areas are so rich in sensory nerves and you pay a lot of attention to your neck, the neck serves your five senses really, if you think of any treatment delivered there can actually enhance your awareness of the area. So you'll get a temporary improvement sometimes just with one treatment of like a hands-on technique to the neck. 

And, you know, our therapists are experienced in different styles of treatments, but they all seem to work pretty well in this population. The other one, which is really important is there's some exercises that are specifically targeted towards that. There is no one size fits all because you're going to get people with different impairments. 

Some people who have an issue only when they're standing and turning their head. Some people when they're sitting and turning their head. And some people when they turn their body, but their heads stay still. So like think of a swimmer who's swimming and just rotate their torso while their head still basis forward. So you try to kind of target the exercise approach to fit the impairment, instead of just giving this handout sheet that, you know, here you go, this is what you do in case of a headache or dizziness case.

So yeah, it tends to be a bit of a mix of some balance and control of the neck, which is something that a lot of people don't think about, but the neck, like any other joint needs to move well. You need to have good strength around it and you need to have good control around it. 

Mark: And what's the typical course of treatment. I know it's going to obviously be very individual, but what's the more typical timeframe?

Iyad: So initially let's say we would assess if there's any loss of range of motion, we would try to get that going. There's usually a lot of fear based around moving the head. Cause you're kind of worried about triggering an episode of dizziness.

So it tends to be a small exposure program almost. Where we try to kind of get people to practice moving with or without different cues. We would do a neck strengthening program as part of this. But yeah, the sequence of progression tends to be, let's say if you're really low functioning at this point, because it's so symptomatic. We would start very minimal and kind of progress you onto that.

And that could go anywhere from a four week treatment program, to six months, depending on how sensitized everything is and how much is at play here. And how long has it been a play? 

In some cases it could be on the faster side where, you know, they're fairly high functioning and they only get this kind of episode when they're doing something very specific. Like when their other senses are very challenged, like imagine walking on a tight rope and then turning your head, you know, well, that's going to challenge your balance system quite a bit more than if you were just sitting still and turning your head. And the reason is, we have amazing senses in our body that can compensate that.

Like your vision. So often that's just kind of covering a lot of those deficits and you know, your inner ear is so good at that, the vestibular organ. So it'll depend on what's involved. But yeah, it could be anywhere from four weeks to six months. And you know, the idea is you would need reassessment for you to actually figure out what timeline we're looking at because it's never going to be, oh, we know exactly from the first day, how long are you going to be.

 So it's more like we judged the improvements week to week, and then that'll give us a better idea because we have more data to judge how you're going to progress through your treatment. 

Mark: If you having some dizziness, you've had some neck issues of some sort, perhaps. Turning your head is causing you to feel a little bit loopy, perhaps call Insync Physio. You can book online at You can call a North Burnaby location to make your booking as well 604-298-4878 or in Vancouver, 604-566-9716. Get it looked after. The sooner you start, the sooner you're going to be feeling better and a little bit more oriented well in space and time. Thanks Iyad. 

Iyad: Thanks Mark. Appreciate it.

Headaches from Neck with Heather Camenzind

Mark: Hi, it's Mark from TLR. I'm here with Heather Camenzind in from Insync Physio in Vancouver. We're going to talk about headaches from your neck. 

Heather: Yes. 

Mark: How're you doing Heather? 

Heather: I'm good. Thank you. So yeah, we're going to talk about headaches that can be driven from the next. So talk briefly, I guess, about a case study. I've been seeing a client they're mid twenties and they've been cycling a lot this summer.

And so you can imagine, especially with road cycling, so they're over quite a bit. And then just to be able to see you're looking up. So you're in that, kind of chin poke position quite a bit. And over the summer she just started to notice that she started to develop more headaches in general. And the headaches for her sat kind of right at the back of the neck, but they also kind of wrapped up around her head and a little bit into her eyes. 

What brought her in is that she started to notice headaches. First thing in the morning, she'd wake up with a headache. So it wasn't necessarily driven from just cycling anymore, which is how it started. It started to get a headache after she go for her ride and then had gone long enough that then she starting to wake up and have these headaches very consistently on a daily basis. And that's what brought this client in. 

Mark: Sure. So maybe to, and I'll just kind of guess here a little bit, having your head out like that all the time, I used to race bikes, is like having a 10 pound weight on the end of your arm and you're trying to hold it. For who knows, if you're training a lot, it could be a hundred miles. That's a lot of weight hanging out there all the time. So that's a lot of tension.

Heather: Exactly, yeah. Once you have the helmet on, and then you just, the position that you're in for so long that it's a long time to hold your head in that position. And the longer you ride yet, the more time, exactly you're holding that weight in that position. So things can start to get a bit tight and sometimes the joints can get a bit stiff or stuck. 

Mark: And you're not noticing it when you're riding because you're working on your cardio, you're working on your legs. That's what you're focused on is hammering as hard as you can or keeping a cadence. You're not paying attention to your neck at all. 

Heather: No, often you're not you're. You're focusing on other things. You're not necessarily focusing on the position of your head. Or even just worried about the strength or the mobility of your neck. You're probably more concerned about the strength and mobility of your legs, which is common for a lot of cyclists. But sometimes we have to work on the upper body a little bit too, to help just to strengthen position-wise into the shoulders as well. 

Mark: So when you see this come in and, I've got a headache. Okay. Well, there's probably, like you mentioned earlier, when we were talking about this, maybe a hundred different kinds of headaches, possible causes. How do you start to diagnose or determine what's the cause of this? 

Heather: Yeah, so it comes down to history. So we have to ask a lot of questions. How do the headaches feel? Where do they sit? Are they changing? Sometimes they have a pattern that can change throughout the day and just general questions. Overall health screening is important with that. Vision testing too. Sometimes if you're having vision problems that can precipitate some headaches as well. 

So you have to kind of just ask all these generalized questions to kind of start to narrow in on that you think this is more treatable by a physiotherapist. That it is within our scope, that it's appropriate. And then the second thing that we do is our assessment. So that would be more looking at range of motion. We test things, we're getting in and feeling the joints, feeling the muscles and testing. 

So those two things combined, that can help us narrow in on that, yes, we do think that this is appropriate for a physiotherapist to treat. And the second is that that we can do something about it for them and that we don't need to then refer on or go get something else checked first that may be contributing. 

Mark: Right. So once you've determined that it's a problem with the actual tension, too much tension in the neck and not enough mobility kind of progressing, what's the typical course of treatment?

Heather: So the first couple of treatments will be, well, one education. Is that we're kind of teaching them what's going on in their body. Then how are we going to fix it? And then there'll also be a lot of manual therapy. So working with our hands, the therapists, working with their hands to maybe release a tight muscle or get a joint that might be a little bit stiff moving again, help the person move. Often they're stuck in this kind of chin poke position. So how do we teach them and get them to promote, to tuck their chin in a little bit. 

So it's a lot of manual therapy to work on that. Sometimes you can do some IMS to release the muscle tension. And then it will be followed up with like an exercise program. So lots of stretching. And then also strengthening in through the neck and teaching the person, how do we get your chin tucked down, to get the joints and the muscles at the top of the neck moving, if, and that was what this client had presented with. Was that they were stiff into the top of their neck. That was our focus. 

Mark: So does strengthening, like any particular exercises, like against resistance. Is that part of it? Did I miss that? 

Heather: No, it can be. A lot of it is actually strengthening the deep neck flexor. So those are the muscles at the front of the neck. And so we're doing more like a chin tuck, almost like you're giving yourself a double chin and learning to strengthen there.

A lot of the time we actually are quite strong, especially cyclist into the extension because that's where you are a lot of the time and we actually need to strengthen the front of the neck. Analogy is the core muscles of the neck. So with low back pain, we're often strengthening the core. With this, we are again, strengthening the core muscles of the neck and that's to give our head that support in that position.

And sometimes it's just education too, but where to hold their head is to not allow themselves to fall into that kind of poking position, is be strong through the shoulders and have that chin in. And then to try to look up with the eyes rather than always falling into that hyper extended position. 

Mark: And how long till somebody usually because it's always individual, but how long till they usually are going to see a reduction in symptom?

Heather: Often people can notice a difference quite quickly. So probably within a few weeks, they'll start to notice the headache won't be gone completely, but they'll start to notice a decrease in the frequency of the headaches. 

So this client in particular, we've worked with her for two weeks. So she came in for two sessions and then with some home exercises and some manual therapy, she noticed a decrease that she wasn't waking up daily with headaches.

So she noticed it quite quickly, and then we just continue to work on the strengthening piece and getting rid of the headaches that she was getting towards the end of the site, like her sessions. And that was more a strength piece for her. And that just takes a little bit more time.

So some people like her, she was very, it was very nice. You responded very, very quickly. Other people that can take up to maybe four to six weeks to start to notice a bigger change for them. 

Mark: If you're having headaches from your cycling or from any kind of physical activity. Or just headaches period, and you need somebody and you can't get into the doctor, but you want somebody to maybe help. Maybe diagnose it a little bit before you get to the level, you might still need to see the doctor and get x-rays and go through all that. Go see Insync Physio. You can reach them at to book. They have two locations, one in Vancouver, one in Burnaby. You can call them in Vancouver, (604) 566-9716. Go see Heather. She'll help you out. Thanks Heather. 

Heather: Thank you, bye.

The Pain in Your Neck, Is it Your Shoulder?

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. And we're going to talk about the pain in your neck. Is it really your shoulder? How are you doing Wil? 

Wil: Hey, I'm doing great. Thanks, Mark. Yeah. So the pain in your neck, is it coming from your shoulder? So it's a really interesting topic because, you know, I've been seeing a lot of this and especially during the pandemic. But even like before the pandemic, I see this a lot too. And so the common thing is people come into the clinic, even actually, you know, my athletes that I treat, they come in or they come up to me and they say, yeah, I've got this pain right here.

You know, I'm not sure if it's coming from my shoulder and what's wrong with my shoulder and, you know, and really like upon closer examination and also history taking in terms of asking them some more questions, it's actually coming from their neck. 

Mark: So what would the typical symptoms be? 

Wil: So, first off a lot of it is a restriction in range in motion. That's huge, in terms of like their inability to turn and usually it's painful, and stiff, soreness, and it can be like a constant dull type of pain. That's a low grade. And it can also be aggravated a little bit more with the movement that's restricted.

And then even like, and this is the thing can throw them off too why they think it's shoulder possibly because they may try to raise their arms and reach for something in the cupboard up above their head and it causes some stiffness and pain. And that's because the muscles around that shoulder blade, which is technically part of the shoulder is connected to your neck.

Mark: So what are some of the possible causes? 

Wil: So I think strain is number one. And so what do I mean by that? So strain being like, if you over exert those muscles they get really tight. And then you can start the feel the muscles around there being really, really super locked up and basically that can restrict the motion and that can cause that pain that you're feeling or tightness.

Usually it's kind of more of a tightness feeling, which when it gets really tight like that, the other symptom that I didn't mention was you can also present with like a touching type of headache. And the other cause is if you have like a lot of stress, so a stress in your life, that can basically you know, start to manifest up into that area. So the reason why stress is a big factor and this will play into like, if they've also had an injury, is because your fight or flight in your nervous system, those nerves that actually, you know, cause you to get into that fight or flight mode, they basically connect in with the spinal cord and then they have the same connections that kind of come back out to give that flow of feedback back to the muscles that basically cause everything will be tight. 

So when we get stressed, we also noticed that, you know, you tend to do this. And you're like, oh, I'm really tight. That's where our stress tends to manifest, is in those areas. And then you add an injury on top of that. So say you get into a car accident, and you get whiplash or something like that, then that can compound that. 

But for somebody who's never had trauma and like, say it's just something that's gotten like tight in there just from repetitive strain of bad posture. So that's another really good example of a, another way that they can injure it without actually doing anything. Because it's a repetitive sustained motion. So their posture may be off, or maybe it's not even off. If you're sitting all day long, it's just that mere posture of sitting and it can cause a little bit of a more non-optimal activation of those muscles, especially on a laptop or a computer all day long. 

Mark: I guess, as we get into more and more, maybe the Fall, the fires will calm down and people are getting outside more. Maybe falls would be another thing that I know that's one of the places like if you have an extended fall, like you can get that and that can happen in any sport pretty much. 

Wil: Oh, definitely, absolutely. So any kind of trauma, obviously, for sure where you get whiplash, so you're describing classic type of whiplash type of stuff going on. So you don't have to just be in a car accident and you can even just actually be bumped. I treated a rock climber once who was climbing up what's called lead climbing with his rope and he fell and hit the wall. He didn't hit his head on the wall, it was his body, but then he had a bit of a whiplash from that as a result. And he had some neck pain and stiffness. 

Mark: So typical course of treatment? 

Wil: Well typical course treatment, you know, what we find on the diagnosis and the assessment portion of what we go through. And so this is actually really important, when someone comes in with this type of pain and syndrome and they complain about this. We've got to figure out, you know, what's causing it. Is it just a muscle thing going on. Or is it also muscle related with some nerve stuff related to the neck. Quite often it could also be like a conjunction of muscle and shoulder. So the two things combined. So we have to address both. 

So is that pain the shoulder pain, the shoulder issue? Sometimes it can drive it, so we have to do a a proper assessment and really look at it and see what's causing it. So that really varies in that point of view.

And so we do Manual Therapy to really address what parts, in terms of the joints. So from the neck, from the middle part of the neck to the top part of the neck, or is it the bottom part? So there's all these different sections that we have to assess or is it the mid back. Because tightness in the mid back, you know, if that's not moving well, it basically translates to more usage and your upper neck taking more of the load. So that's important to realize as well. So even though you may not feel pain down in the mid back area, that's another issue. 

So there's all these things that we look at in terms of mobility. In terms of the joints. And then obviously the muscle mobility, because then now you're looking at the muscles that are causing the stiffness in the joints.

So they work hand in hand. There's the joint mobility and the muscle mobility. So then we want to do things to release the muscles. So we do manual therapy techniques to release that. We do IMS, which is a dry needling technique, which works really good for things that have sort of a nerve muscle connection relationship.

And when I say that it's a nerve muscle connection relationship, you know, it's basically a different type of tightness, than say if it's been overused muscle kind of thing. So there is a differentiation. And then obviously we would want to make sure we reinforce proper mobility patterns.

So there's specific things that we woud do to personalize and individualize an exercise rehab program to make sure that you're reinforcing like your optimal movements. So that's important, retraining the movement pattern and then to strengthen what's weak. And then to make sure that we keep whatever is like really tight, joint and the muscle aspect to be able to be more mobile.

And then lastly, you know, the most important thing is education. You know, just teaching you if you're coming in with a neck pain, that maybe is the shoulder, you know, about different things that are going on. And this is where we need to get a little bit more and extract more information from the history about, you know, what do you do for work? Oh, you're on the computer all day long, or, you know, maybe we need to get a sit to stand workstation for you, and maybe we need to change the keyboard, get a wireless keyboard on your laptop. So that's one aspect of it. 

And then maybe it's looking at like, okay, well, what are you doing like physical activity wise, like maybe there's something that you're doing in your workout routine and your training routine or running. Now here's a big one. Like a lot of people don't think that running can actually impact your neck, but that's a form of impact loading on your spine. And from your head all the way down to your tailbone and your pelvis is considered your spine.

So you want to make sure that you've got good proper mechanics when you're running. So if you're not actually you know, utilizing proper form and you're running with your technique off, that can effect the impact loading and that travels all the way up to your neck. So it all really depends on what's going on.

Like, if you're a rock climber, and you're like really, you know, gripping on things and your core is really weak because, your strong arms, you've got Popeye arms, but your core is just not even there. Then you're going to have lots of problems in that neck related to that, which then can actually lead to more peripheral stuff. So, yeah, it's a really good question, but it's like lots of stuff sort of related with it. 

Mark: Why you need to see a professional, get a professional diagnosis from somebody who knows what they're doing and finds the root cause. So what's the treatment? The treatment course of therapy to get, back what's the typical timeframe it takes? 

Wil: Yeah. So that's another good question. It all depends on how long this is going on for. So, because if you're moving patterns are like very chronic and you've developed a lot of non optimal movement patterns of the muscles and some are just like this and it takes a bit of time to retrain that. Takes a bit of time to try and break that pattern and reset that. And then get the joints moving properly in the muscle, and mobility moving properly. And then strengthening. Like I would say like, if someone that has had this problem for, I dunno, like very briefly, you know, it's something that's very fixable within four to six weeks.

And it's hard to say, like sometimes people just started developing the problem, but they've actually aren't aware of the symptoms. And then they've actually had the problem though with the movement dysfunction for years, but they've just gotten away with it without being symptomatic. So that's another issue to consider.

So it may only take, like I said, four to six weeks or sometimes it may take like, you know two sessions I've had that before too. And they're able to make all those changes that I suggest and then I get them going on an exercise routine and you reset things and it's like, boom. It's like amazing.

And then other times it takes like a good four to six months. And it also depends on whether or not there's other stuff going on related with that neck pain in relation in the shoulder, if there's anything else that radiates down into the elbow or arm. 

Mark: Would it be fair to say shoulder, neck is probably the most complex area of the body you treat. In terms of musculature, nerves. How it all chains together, has to fire in the right order, all that stuff. 

Wil: Yeah. I would say it's pretty complex. Primarily because there's just so many different, like connections related to the neck, mid back and the shoulder and how they all play together. And think it's a very complex area to really treat, but it's also very fun, for me a really fun sort of areas of the body to really work on. A lot of it is because I do a lot of sports and I've looked at these areas as specialties to really work with that. 

Mark: If you're having some neck pain, it might be your shoulder. Call Insync physio. You can reach them at 604-566-9716 to book an appointment, or you can book online, There's two locations, one in Vancouver on Cambie Street, or in North Burnaby. The phone number there for the Burnaby location 604-298-4878. Check them out. They'll get you feeling better quickly. Thanks Wil. 

Wil: Thanks Mark.

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