Category Archives for "Neck Pain"

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, insyncphysio.com. 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.

Concussion and Whiplash with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner, the chief physiotherapist at Insync Physiotherapy, sports physiotherapy in Vancouver, BC on Cambie Street. And we're going to talk about concussion and whiplash. Are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks Mark. Yeah, so quite often when people get a concussion, like whether it's like from a sports injuries, you know it's quite common with contact sports, and you get a neck injury related with that. And quite often that concussion can be missed. Or, you know, it could be so mild. 

Another area that right now that we're seeing sort of the combo of concussions and whiplash is motor vehicle accidents. And so I guess really to look at a concussion is essentially a brain injury. And what that means is that you've had like a force that's imparted in the skull, or, you know, your brain gets rattled. And you're essentially you have a injury to your brain. It's really hard to classify and it's hard to classify because a lot of the times you can have these symptoms and you do all these different tests like you know, an MRI or scans and all that stuff, and it can be negative. Because the brain is so complex. 

But the fact of the matter is that, you know, quite often when you have a concussion, you don't want to rule out a neck injury or whiplash. And in fact, quite often when you're able to treat the symptoms related to whiplash, because sometimes they can sort of overlap. Then you can actually also be helping the concussion type of stuff too.

Mark: So someone comes in and they think they've had a concussion or they have some symptoms. How do you go about diagnosing? 

Wil: Yeah. The biggest thing is you know, when I'm working with a sports team or with athletes and if it happens like in the moment or on the field of whatever at the time, then we run through a concussion screen test. And then there's all these things that we take them through. And then also in terms of subjectively, they tell us what's going on and we can sort of ascertain that we think that they might've sustained a concussion. 

And then when they come into the clinic and they're still feeling certain symptoms, you know, that they're having and we can do certain tests too, as well and to help measure that as well objectively. But ultimately those tests are definitely a good screening tool. So there's definitely a battery of tests from questions that we ask specifically. So the subjective exam is really important. And then also looking at a few objective tests and exams that we go through.

Mark: And how does that tie in with whiplash? What's different about diagnosing that? 

Wil: Well, so this is where there's a lot of similarity. Like for example, one of the biggest complaints with concussion that people get is that they may feel headachy, or they may feel like just the biggest one, you know, they're sensitive to light, sound you know, all that kind of stuff.

And those are sort of the more common types of head injuries that you can get where the symptoms overlap with a whiplash. So with whiplash, there's also different degrees of it, obviously. But like when you're looking at sort of where it starts to kind of overlap in terms of the symptoms, definitely those are the biggest ones.

And a large part of that too, if you also just think of the nervous system and the nerves that come out from the brain to the spinal cord, out to the neck, they are interconnected. And then also with the specific areas of the neck, with the muscles, and if you injure the muscles and the joints and then you have the nerves firing around those areas, and then they go back up into the spinal cord and the brainstem, then sometimes can be very confusing.

And you're not really sure what's causing what, because like a headache could be something related to the concussion. Or something related to your whiplash or your sprained neck or whatever that you've had going on. Cause you can get like also the muscle type of what we call a cervicogenic type of headache where it's coming from your neck.

Mark: So what kind of treatment protocols would be typical? 

Wil: Yeah. So there's specific stuff that is related to concussion treatment. But then when we're looking at treating the neck and if it's whiplash related, we're looking at specific things that are related with the mobility and the movement and function. So when I say function of the neck what we're we're talking about is how the muscles are moving and the way that they help the joints move. So you want to restore that joint mobility. But also that functional mobility that joint or joints, you're in respect to how the musculature are working together.

So if you have a whiplash injury where your joints are sprained, then quite often you get a lot of muscle spasming along with that. And so you get all this sort of a sequela things going on. So you want to try and normalize that. So you want to try and get some more normalized mobility.

And one of the biggest important things to do is that you're not increasing the bad symptoms that you're getting, where it stays even longer. Like you want to be gentle with it. So in an acute situation, you probably do want to let it rest a little bit. Because if it's an acute injury, you got to give that time to allow that acute aspect of it to settle right down.

And then once that part settled down a little more, then you can start to work on the mobility. And there's actually some research to show that there is actually some good results when you activate and you start to get things mobilized and moving to the neck to get it better, faster, and also in the long-term. And then also some correlation with working on whiplash and the whiplash symptoms in relation to the concussion. 

 Mark: And what would the typical healing protocol timeframe be? 

Wil: Oh, that's kind of a loaded question because, you know, with a concussion it's difficult. And then also it's hard to classify. Like there's just so many iterations of how the sports physiotherapy and the sports medicine and the medical community I've been trying to classify acute concussions. There was one point where the classified as mild and complex, well, you know, they don't really do that anymore.

And a lot of it is based on after the fact than the symptomology. And like what they're experiencing and how well they're recovering, like, Oh, okay well that was a complex concussion is what they classified it before, when they used to use that kind of a grading system. So it's really difficult.

And I think with whiplash, I think it's a little bit easier, you know, like if it's just an isolated whiplash, but then when you have whiplash and concussion it really depends on how they're presenting with those concussion and brain injury symptoms and dysfunctions.

So it can be really debilitating where they can't even like go out daylight. And stare at a screen for more than five minutes kind of thing. And those are cognitive processes. Like those are a lot of things that really affect you know, especially present day function, like we're on a screen. People are working on a computer a lot these days.

And so that's huge. And so then when you're looking at those factors and then also, there's this sort of research done on the visual aspect and the visual cortex and how that's been affected. So it's a really difficult question to answer. And I think that what we need to do is look at some of the things that we can address, like the dysfunctions in the neck. And because there can be relationships where there's, you know pain and stiffness and mobility in certain parts. That I have a direct connection with symptoms similar to concussions. 

So the headaches, like I was saying, for example and that can be sometimes mediated by working on mobility and restoring that functional mobility. So not just at the joint level, but the muscle level, and then even just doing some specific concussion rehab stuff as well. And I think this is an area that's just so rich to really you know, still continue to explore on the rehab level. But I think it's been shown that it's good to work on both and make sure that you address both the whiplash and the concussion.

Mark: So if you've had a concussion or you suspect you've had a concussion or you've got some neck pain, you suspect maybe you've had a whiplash, a car accident, you've been playing soccer, you've been playing football, hockey, et cetera. Something happened where you bonked the old coconut. Get ahold of Wil. Book online at insyncphysio.com or call the office at (604) 566-9716. You have to call and book ahead. He's booked up, but he can get you feeling better, fast. Or any of the other physiotherapists that Insync Physio. Get in there. Get after it. Get feeling better as soon as possible. Thanks Wil. 

Wil: Thanks Mark.

Neck Pain – Heather Camenzind

Mark: Hi, it's Mark from Top Local. I'm here with Heather Camenzind of Insync Physio in Vancouver. And we're going to talk about neck pain. Are you seeing a lot of neck pain these days, Heather? 

Heather: Yes, I'm seeing quite a bit of it actually. So I'm seeing one person in particular, she's coming in for a lot of neck pain. Due the pandemic, she's working from home. So we've been working a lot on her home set up just including trying to raise her computer up a little bit for her. Not working on the couch in a slouch position. So she's trying to create a desk, like situation for her. 

But we're also talking about just trying to increase her movement quite a bit and trying to build in ways that she can do that throughout her day. 

Mark: So what does that look like? 

Heather: Yeah. So I think just with people working from home a lot, and we get stuck in this work, work, work mode. And we're forgetting that when we were going to the office, how much movement, just that in itself builds in throughout the day. 

The act of getting yourself ready. The traveling to your workplace, walking from the train or your car, to the amount that you've actually looked and turned around and moved your neck and head. And now people are, we're waking up. We're probably looking on our phones for the news or something in the morning, and then we're plugging into the computer. We're not really actually moving quite as much as we want to. 

And a lot of people are doing exactly what we're doing. We're Zoom or talking video conference. So a lot of people are in, and they're describing these meetings to me. And some people say they're all day they're six hour meetings that people are on their computers and they're looking straight ahead. 

If you were in your office, you would turn and look at people and maybe you would stretch, get up for a glass of water. And all of that movement that was built in throughout our day is lacking now. So we're trying to develop strategies with clients that they put a timer on for themselves. To remembering that they get up and they move around their apartment or house, something that they're moving half an hour or every hour, at least every hour. Encouraging people to get up, do some stretching, just stretch your neck, doesn't even have to be a big stretch. Just move your neck, twist your neck, look over your shoulder.

And then also I've been encouraging people to reach over their heads. This is so good. It gets your shoulders going, gets your mid back moving. That gets really kind of rounded and hunched. So just reaching overhead. It actually feels really good to just reach overhead. And just to give your body a little kind of movement and some shape because we're so forward these days. 

So it strategies like that, just it's nothing simple. It's just remembering to do it. And we were getting in this work, work, work mode that we feel like we have to be on all the time, I think. And we want to change those habits for people. That you don't get that like, couple of minutes chit chat with people that you used to when you were going to get your water, your coffee or something like that. Those things are lacking these days.

Mark: So when someone comes in with neck pain like that, how do you diagnose it? And then what's the protocol to get them feeling less neck pain. 

Heather: That's a great question. So a lot of it's just history kind of figuring out what could be contributing to their neck pain. Some people have a history of a prior car accident or a ski accident or something like that.

So knowing people's histories of what could be potentially contributing to something is key. So we do a detailed history. As well as then we just talk about what your day looks like in general. When you experience the neck pain? Is it in the morning or is it in the evening? Is it all day long? Could that neck pain be contributing to headaches that people get. A lot of neck pain refers up and contributes to headaches for people. So detailed history is very important. 

And then we go into just a basic assessment. So looking at how people move. Can they rotate? Can they twist? How do they do that? Also looking at their shoulder mobility, kind of like I referenced earlier, reaching up over your head. And also their mid back. So a lot of neck pain can be contributed to stiffness in the shoulders as well as through like the chest and the thorax. So your mid back. So we want to make sure that those things can move and have the ability to move as well. 

Mark: So, how do you actually treat for that? Is that all manual manipulation, like getting in there and loosening things up? Is it the horrors of needles? How do you actually get it loosened up?

Heather: It's often a combination. So you chat with people about what they're comfortable with. Often some manual therapy, so hands-on therapy. So working on the joints, getting those moving can be something as simple as like massage, just some, some muscle release and fascial release a little bit in there.

Some people, or actually a lot of people respond well to needles. It doesn't have to be needles though, but IMS is a great way to release muscle tension. And then From there, it's teaching the client, talking to them about movement strategies. Like I referenced earlier. 

They can only see me so much. They can see me probably for about half an hour in the week and the rest is up to them. So we try to kind of use the analogy as I'm their coach. We kind of talk about the strategy and they kind of go and try to implement the strategy. So moving and then a lot of it's stretching. So teaching them how to stretch properly.

And then also sometimes it involves some strength. So just getting your mid back muscles stronger, but a lot of it I find we can get with just implementing some movement strategies or stretching on a daily basis. 

Mark: And how often, or how much of a contributor is, are these evil devices that we tend to want to spend way too much time staring down at. 

Heather: Yeah. So I think it's all a big portion and we're actually seeing younger and younger people come in and start to complain about neck pain. And it's because we're on devices so much and often the way they are it's like as you said, you're looking down all the time. And so it's contributing to, people just kind of this like head, we call it head forward posture. So it's kind of this chin poke. So teaching people to sit up tall. And it doesn't mean it has to be like strong military posture that makes our backs really sore really quickly.

So it's just imagining, something's just pulling you up tall and you don't have to be perfect posture, but just upright posture, is key. 

Mark: Perfect, and how long to relieve kind of this sort of neck pain that you're seeing a bit of a epidemic of these days. 

Heather: Yeah, it varies on everybody. It depends on what would be the contributing factors. Sometimes just teaching people to move more. And if they're compliant and they actually do what they should do, they can alleviate their neck pain quite quickly. They find the movement really helps. Some people, it takes a little bit longer.

If there's something else that maybe is underlying there. You talk to a lot of people and they're having an acute moment of neck pain. But you start to talk to them and they do have a history of kind of a chronic neck pain. You're like, yeah every once in a while, it kind of, people say, goes out.

Can get a kink in the neck. You wake up funny and you can't move. So those people tend to maybe take a little bit longer. So if it's just something acute, like just, you woke up with something and it's your first time of neck pain, or you are having just this kind of epidemic, as you say, of lots of neck pain, just from people working at home.

If they elicit strategies at home, they can be quite successful and maybe it takes a few weeks, maybe a month to kind of make those changes. It takes time to change habits but maybe a month to six weeks. And then sometimes if it's something else that's a little bit more complicated would take a little bit longer.

Mark: If you have neck pain, if you have a pain in the neck, divorce him. Yeah. Other than that, call Insync Physio. You can book an appointment to see Heather at insyncphysio.com. Or you can call the office on Cambie Street, (604) 566-9716. Book your appointment. Get in there, get your neck pain solved. Thanks Heather.

Heather: Thanks, bye.

Neck Pain & Injuries – Raise the Roof!

Loop the band around your hands and have your elbows bent at 90 degrees by your side. Keeping your palms facing downwards towards the floor, spread your palms so that the hands are in line with your shoulders.

Driving through the elbows, and keeping your hands shoulder width apart, slowly elevate your hands to the level of your face and up over your head. Do not lose the parallel alignment of your hands and arms and do not bend your elbows (flexing your biceps).

You should be feeling this work through the back of your shoulders, and the back part of your neck and upper back.

This is a great exercise to build more core strength in your neck if you are recovering from chronic neck pain or a neck injury. If you have pain or problems doing this exercise consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Core Neck Strength Moderate Rows

This rowing progression exercise is a great way to build more core stability strength to help you rehab your neck strain injury. Using a looped band, make sure it’s anchored to a sturdy object. Wrap the first band around yourself & it should be around your shoulder blades and in line with the back of your shoulder and armpit.

Then have a second band anchored & hold that second band in your hands. Ensure you have your arms on the inside of the first band. Press the tip of your tongue up against the roof of your mouth to engage the deep neck core stability muscles.

With your knees slightly bent, begin to row or pull your shoulders and elbows back. Focus on pulling your shoulders and shoulder blades back against the resistance of the band.

Repeat this for 10 repetitions doing 3 sets daily. 

Neck Strain Injuries – Core Neck Strength Basic Rows

A successful rehab regime for your neck injury means being able to get stronger in your upper quadrant and scapular muscles with your core neck stability strength. This is a good exercise to help with that.

Using a looped band, make sure it’s anchored to a sturdy object. Then wrap the band around yourself, the band should be around your shoulder blades and in line with the back of your shoulder and armpit. Ensure you have your arms on the inside of the band.

Press the tip of your tongue up against the roof of your mouth to engage the deep neck core stability muscles. With your knees slightly bent, begin to row or pull your shoulders and elbows back.

Focus on pulling your shoulders and the shoulder blades back against the resistance of the band. Repeat this for 10 repetitions doing 3 sets daily. 

Relieve Chronic Neck Pain – Upright Row

This rowing exercise can help relieve chronic neck pain by strengthening muscles to support a more neutral spine posture.

Using a looped band, make sure it’s anchored to a sturdy object. Wrap the band around yourself & it should be around your shoulder blades and in line with the back of your shoulder and armpit.

Ensure you have your arms on the inside the band. With your knees slightly bent, begin to row or pull your shoulders and elbows back. Focus on pulling your shoulders and shoulder blades back against the resistance of the band.

Repeat this for 10 repetitions doing 3 sets daily. 

Neck Pain and Stiffness – Small Ball Release

This is a great exercise to help relieve neck tension.

Grab a soft or moderately hard ball, ideally the ball should be about 3-3.5 inches in diameter. Lie down with the ball behind your head. Then slowly rotate your head side to side, gently massaging the base of the head and your neck.

If you require more pressure, simply place your hands on your forehead. You do not need to push down with your hands; the weight of your hands should be more than enough. 

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.