Neck Pain (Full Version)

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lizandcarlo -> Neck Pain (September 11, 2007 5:45:38 PM)

I have neck pain for 4 months now and was diagnosed to have MPS of bilateral trapezius muscles. The management I had were TENS with HMP * 2 minutes ultrasound, MPS release, AROM of neck muscles, Calliet exercises, and Neck extensor strengthening exercise, I have forward head posture and I doubt the management I had. I believe I should have had stretching of neck extensors, that could have alleviated the pain I am still having. MPS release massage could have added to teh muscle spasm of my traps. Please enlightn me of the correct management I should be receiving. Should I always have the combo of TENS, HMP and US to alleviate pain?



ginger -> RE: Neck Pain (September 12, 2007 4:55:12 AM)

you are right to doubt the management you are getting. find someone with good hands and encourage him/her to mobilise your neck joints. At the very least, get treatment from someone who is willing to use their hands, rather than modalities.  Electrotherapies won't fix anything, just reduce the pain temporarily from a condition  that will respond  to someone with skill.



OAK -> RE: Neck Pain (September 12, 2007 11:37:46 AM)

quote:

ORIGINAL: lizandcarlo

I have neck pain for 4 months now and was diagnosed to have MPS of bilateral trapezius muscles. The management I had were TENS with HMP * 2 minutes ultrasound, MPS release, AROM of neck muscles, Calliet exercises, and Neck extensor strengthening exercise, I have forward head posture and I doubt the management I had. I believe I should have had stretching of neck extensors, that could have alleviated the pain I am still having. MPS release massage could have added to teh muscle spasm of my traps. Please enlightn me of the correct management I should be receiving. Should I always have the combo of TENS, HMP and US to alleviate pain?


This post seems a bit suspect.  You sure have good knowledge of PT terms and modalities.  Do you have medical training?



jlharris -> RE: Neck Pain (September 12, 2007 6:12:19 PM)

Extensive modality use is suspect.  As ginger said, hands on treatment should be included.  Question need for extensor stretching as a fwd head results in lengthening (and relative weakening) of the extensor muscles.  Anterior muscles could be stretched and an emphasis on postural strengthening for home program would seem appropriate with info provided.



Shill -> RE: Neck Pain (September 13, 2007 9:33:09 AM)

Should I always have the combo of TENS, HMP and US to alleviate pain?

Take this with a grain of salt, as we do not know the whole story.  However....

My answer would be no.  You will get as much (temporary) relief from using moist heat alone, and you can do this on your own.  If an insurer looks at your case, and sees the multiple modality treatments done routinely, it can raise questions towards reimbursement, because piling on modalities makes it impossible to know which are helpful, and, if you were to get an adverse effect, which was harmful. Did you actually say 2 minutes of Ultrasound?  This is a bit suspect as well.  It it hard to believe that anyone would do 2 minutes of US. 

I would tell you, as Jason did, that your inkling to stretch your extensors is incorrect, and perhaps the opposite of what you need, as your forward head positioning is essentially stretching your extensors all day long, and potentially one of the reasons you hurt to begin with.

If you feel your treatment is not what it should be, you should discuss this with your therapist.  If the answers you receive do not satisfy you, perhaps you should then seek a different therapist.



lizandcarlo -> RE: Neck Pain (September 17, 2007 3:41:57 PM)

Thanks  for all the replies.



spaniard -> RE: Neck Pain (September 26, 2007 2:35:43 PM)

There are a couple good articles about the isometric strengthening of the longus colli for situations like yours (I believe in the Journal of Manipulative Therapy, 2006). I use a blood pressure cuff for this, set it at 20 mmHG (just like the article indicates) and ask for cervical a chin tuck to created up to 24 mmHG. You are right, I don't think extensor strengthening is the way to go. Lose the US, the heat and the TENS since you are at it; most likely useless. Is your 1st rib elevated?  Are there segmental mobility restrictions in the OA and AA? Interesting case.



jonathan_PTRP -> RE: Neck Pain (February 27, 2008 3:39:47 AM)

the management is ok.. but a better manual therapy can do.. you better not stretch your neck extensors but you should strengthen it.. because you have forward neck posture meaning your neck extensors are weak they cant hold your head back.. better strengthen it..



Sebastian Asselbergs -> RE: Neck Pain (February 27, 2008 7:48:58 AM)

"because you have forward neck posture meaning your neck extensors are weak they cant hold your head back.. better strengthen it.. "

jonathan, I did not think he was going around with his chin on his chest? I think you may want to review the biomechanical aspects of head forward position....



TexasOrtho -> RE: Neck Pain (February 27, 2008 1:39:44 PM)

Sebastian...c'mon mate.  It IS possible to offer an opinion without kicking someone in the hojos.



Sebastian Asselbergs -> RE: Neck Pain (February 27, 2008 4:20:45 PM)

[:D]  Well, Rod. I was offering a polite suggestion, based on the information provided in post #3. Maybe I am reading it wrong, but it seems to say that head forward is a sign of weak extensors;  especially in head forward posture, the extensors are the only things keeping the chin from going "boink" on the sternum (or on the 2nd, 3rd or 4th chin).
jonathan, my legs aren't long enough to reach your hojos...even if I was aiming at them - which I wasn't.....



bobmfrptx -> RE: Neck Pain (February 28, 2008 1:33:12 PM)

The supoccipital muscles are overworked in FH posture.  They are busy holding the occipput so the patient can see forward without running in to walls. Anterior throat and upper chest is usually tight.
There is a ggod article from Darnell in PT journal 1983 Proposed chronology of Forward head Posture....
Try to locate it and read it...
Also, check the pelvis I would be willing to bet there is an increased LS angle, apparrent Right leg longer,  Weight bearing more on the balls of feet and on one leg > than other.  Also, Calcaneal valgus probably present.
Treat the whole body folks...you'll be glad you did!!!!!!!



Shill -> RE: Neck Pain (February 28, 2008 1:55:35 PM)

Don’t get so excited, here is a comment on the lack of validation to any proposed biomechanical fault leading to dysfunction.  I believe one can interchange the term tendon to most other tissue when traveling down this slippery slope.
 
From
Biomechanics and Pathophysiology of
Overuse Tendon Injuries. 
Sports Med 2004; 34 (14): 1005-1017
 
The traditional view of a tendon overuse injury as a result of tensile overload appears plausible. However, although this view is widely accepted, the clinical and scientific bases for this concept do not stand close scientific scrutiny. Without a prospective design and adequate control groups, any conclusion regarding the aetiological role of factors such as training errors, poor technique, inadequate equipment, inflexibility and muscle imbalance remains speculative. Only a few studies have attempted to study these factors in a controlled, prospective manner and have shown conflicting results.[77-83]
 
 



kiwi PT -> RE: Neck Pain (February 28, 2008 4:31:07 PM)

quote:

ORIGINAL: bobmfrptx

... I would be willing to bet there is an increased LS angle, apparrent Right leg longer,  Weight bearing more on the balls of feet and on one leg > than other.  Also, Calcaneal valgus probably present.



Bob,
Are you just a gambling man, or is there another reason from the pt's post that you "bet" there is a right sided apparent LLD?

Kyle PT



bobmfrptx -> RE: Neck Pain (February 29, 2008 8:06:03 AM)

Right apparrent LLD is the most common above the equator, as high as 8 out of 10....Apparently in chille, according to Rocabado, the left is more involved.  Hence the wager. 



jlharris -> RE: Neck Pain (February 29, 2008 9:22:08 AM)

If it's common, then why would it be a problem.  It's like having an irishman with neck pain and saying "check for red hair.  It's a common to have and irishman with neck pain that has red hair".

C'mon, if your going to make outrageous claims, give us something that back it up besides anecdotal beliefs.



Kaden -> RE: Neck Pain (February 29, 2008 1:38:37 PM)

Jason, just b/c it's common does not mean it cannot be a problem.  However, I do agree that making anectodal claims about 8/10 with right LLD lacks of clinical evidence.
I just get tired of therapists that imply b/c something is the norm or more common it can't be a problem that needs treatment.  A FHP is the norm in our society, as are degenerative change of the lumbar spine, etc.  These both can create signficant biomechanical faults and lead to pain.  The key is not to ignore something b/c it might seem like the norm, the key is to figure out which people are actually being affected by such a "norm". 



steve -> RE: Neck Pain (February 29, 2008 3:13:40 PM)

Kaden,

Interesting perspective, how would you reliably identify those patients who are being affected by the "norm" and how would it meaningfully change your intervention?

Steve



Kaden -> RE: Neck Pain (February 29, 2008 3:32:41 PM)

Steve,

Good question.  Maybe I should not have said the key but rather the hard part is figuring out if the person with FHP or LLD or  other "norm" type findings is truly being affected by the norm. 

Now, I am not going around throwing a lift in 8/10 patients righ shoe b/c that is the norm.  However, if someone has a leg length discrepency I will not simply blow it off as the norm.  That was the point I was trying to make.  It it is the "norm" then true it is most likely not the source of pain/problem.   But, that doesn't mean it couldn't be the source.

Instead of looking at LLD look at FHP.  In our socieity in can be almost the norm and we have all had patients that respond with decreased pain with postural correction - among other things.

Remember, it may be the norm but it could also be pathological.



bobmfrptx -> RE: Neck Pain (February 29, 2008 5:34:01 PM)

quote:

ORIGINAL: Kaden

Maybe I should not have said the key but rather the hard part is figuring out if the person with FHP or LLD or  other "norm" type findings is truly being affected by the norm. 


The question is when will it become a problem.  Degenerative changes associated with compensatory mechanisms of the body likely will occur if not abolished by allowing the client to return to as near a physiological state of rest posture as possible.  Walking on an unlevel base with the body reading S2 as COG will lead ot head tilt, via optical righting, and mid foot collapse due to the bodies attempt to level the pelvis and S2.
We can manually correct these conditions via gentle handling techniques designed to restore proper neurodynamics or let the medical doctors read studies like this:
http://www.newsmax.com/health/Acupuncture_Back_Pain/2007/09/25/35438.html
and lose our referral base.


quote:


Now, I am not going around throwing a lift in 8/10 patients righ shoe b/c that is the norm.  However, if someone has a leg length discrepency I will not simply blow it off as the norm.  That was the point I was trying to make.  It it is the "norm" then true it is most likely not the source of pain/problem.   But, that doesn't mean it couldn't be the source.
Remember, it may be the norm but it could also be pathological.

I propose it will become pathological in the majority of cases at some point.  It is the degree of disability which is in question.
Prevention is key to promoting future health and well being.  Also, limiting the economic impact to the nation due to missed work days, increased comp monies wasted, premiums out of control etc.
When I studied with  Rocobado, he was concerned with all the above.  He also felt that the unlevel pelvis led to TMJ dysfunction seconadary to lateral shift of the mandible. He wanted everyone to last relatively painfree for one hundred years.

I think a good research project would be to see when the leg length descrepency becomes the norm.  Do 3 year olds have balanced pelvis?
How bout 17 y.o. after driving for one year?
When if ever does it lead to pathology? All good questions, and would require a large sampling for a long time.  Lets change the norm.
As Kaden wrote the norm is not always normal. (paraphrasing)

anyone locate the Darnell article? I see it cited in several studies, but can't locate it online.  I have a copy.
Since this is about neck pain and forward head.  I have allowed the neck resting position and ROM to return to normal without even touching the neck.  Leveling the pelvis with a lumbosacral decompression followed by a stretch of the anterior chest does wonders. You decide the mechanism, I'm tired of that arguement.
Good day folks
bob



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