Neck &
Back Care
Michelle Kwong
[Link](Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist
Practice Director
Http://[Link]
SPEAKER PROFILE
[Link]
Qualifications
Graduated with Bachelor of Health Science (Physiotherapy) in
University of Sydney
Australia Certified Clinical Pilates Instructor
Certified Aquatic Physiotherapist
Member of Singapore Physiotherapy Association
Experience
More than 7 years of clinical experience in:
Physiotherapist
Clinical Pilates Instructor
Ergonomics Consultant
Personal Trainer in Prehabilitation/Rehabilitation
SPEAKER PROFILE
[Link]
Achievement
Awarded GOLD Service Excellent by SPRING Singapore 2003
Principal Physiotherapist and Director of Physiotherapy Clinic
THE PAIN RELIEF PRACTICE
[Link]
Vision
Highly committed to help people with musculoskeletal pains to speedily
recovery with latest clinically proven physiotherapy technologies &
success in mastery of good health and fitness.
TOPICS COVERED
Structure of the Spine
Common Spinal Condition
Causes of Spinal Pain/ Conditions
Pain Management
Prevention of Neck/Back Pain
Exercises for Neck/Back muscles.
SPINE FACTS
5 sections
Cervical (7 vertebrae)
Thoracic (12 vertebrae)
Lumbar (5 vertebrae)
Sacral (5 fused vertebrae)
Coccyx (4 fused
vertebrae)
Spine Structure
Lumbar vertebrae
Intervertebral disc
Nerve roots
Ligaments
Muscles
Vertebrae
• Skeleton framework
• Support for muscles & tissues
• Protection of vital organs
• Storage of minerals & immature blood cells
Joints
Allows movement between bones
Intervertebral Disc
The intervertebral disc is a jelly like substance, which
consists of annulus fibrosis and the nucleus
pulposus. Acts as a shock absorber.
Spinal cord
& Nerves Roots
- Nerve roots exit through
holes in the bone of the
spine (foramen) on the
right side and left side.
- Branch out at each level
of the spine.
-The nerve roots innervate
different parts of body.
Ligaments
Ligaments are fibrous
bands or sheets of
connective tissue.
They link two or more
bones, cartilages, or
structures together.
Muscles
Muscles attach to the
spinal column, pelvis,
and extremities.
They serve to support
the spine
Core Muscles
Deep trunk
muscles- acts as
stabilisers
‘Power House’
Causes of
Neck & Back Pain
Causes of Neck & Back Pain
Poor
Carrying Posture
Poor
Sitting Posture
Causes of Neck & Back Pain
Poor
Sleeping Posture
Poor
Working Posture
Causes of Neck & Back Pain
Overuse e.g. repetitive bending, static posture
Overstress e.g. heavy object, excessive turning
Degenerative changes i.e. Wear and tear
Trauma e.g. fall
Genetic predisposition
Physical inactivity
Mental Stress
Tumor
Common Problems
Neck & Back Pain
Common Conditions of
Neck & Back Pain
Joint sprain e.g. locked joint syndrome
Muscle and Ligament injuries
Degenerative changes e.g. spondylosis,
osteoarthritis, spondylolisthesis
Prolapsed Intervertebrae disc (‘slipped’
disc)
Nerve roots irritation
Fractures
Compression Fracture
Usually due to trauma
(very hard pressure or fall)
Higher risk for osteoporosis/ elderly
Disc Herniation
Stages of Disc Herniation
1 Disc Chemical changes associated with aging
Degeneration causes discs to weaken, but without a
herniation.
2 Prolapse The form or position of the disc changes
with some slight impingement into the
spinal canal. Also called a bulge or
protrusion.
3 Extrusion The gel-like nucleus pulposus breaks
through the tire-like wall (annulus
fibrosus) but remains within the disc.
4 Sequestration The nucleus pulposus breaks through
or the annulus fibrosus and lies outside the
Sequestered disc in the spinal canal.
Disc
Effects of position on disc
‘Slipped’ Disc
Spondylosis
Degeneration
(Wear and tear)
Age related
Activity related
Previous injury/trauma
Lumbar Spondylosis
Normal 58 yrs old
Degenerative Changes 83 yrs old
Nerve Root Irritation
• Shooting pain down the leg
• Constant pain
• Numbness
• Weakness
Signs and
Symptoms
SIGNS & SYMPTOMS
Localised pain in the neck/ back
Diffused pain over a wide area
Pain radiating to the lower limb
SEVERE SYMPTOMS
Numbness/ Pins & Needles in the upper/ lower limb
Weakness
Constant pain
Difficulty sleeping/ awaken by pain
Unsteady with walking
Inability to control bowel / bladder
To seek early medical doctor/ physiotherapist advice if
presence of severe symptoms
MANAGING PAIN
- Self Management
- Doctor
- Physiotherapy
- Surgery
Acute Pain Self Management
ACUTE PAIN (1st – 2nd day)
Apply ‘RICE’
R: Rest for 24-48hours (NOT Complete Bedrest!)
I: Ice for 15-20mins,every 2-3hrs interval
C: Compression with bandage
E: Elevate
Avoid ‘HARM’
H: Heat
A: Alcohol
R: Running
M: Massage
Pain Management Advice
Avoid activity that may cause pain especially:
- Strenuous activity
- Prolonged activities, repetitive movement
- Heavy loads
Neck/ Back Support for acute severe pain.
(Not advisable for chronic pain.)
Heat
Gentle stretching when pain reduced
Pain Management Advice
When self management does not work, SEEK HELP
EARLY especially if you are suffering from any
neck/back pain and radiating pain down arms/legs.
The longer your pain condition, the harder for
doctor/physiotherapist to treat, the longer the time for
recovery and more medical fees involved.
Physiotherapy
Goals of Treatment
relieve pain
improve joint function
maintain flexibility
Strengthening weak muscles
Achieve a healthy lifestyle
Physiotherapy
Pain relief treatment
Heat (Ultrasound, Hotpack, Shortwave)
Electrical (Interferential, TENS, microcurrent)
Joint mobilisation/ manipulation
Massage
Traction
Postural Correction
Sports Taping/ Kinesio Taping
Core/ Back Therapeutics Exercises
Return back to sports/work
ADVANCED TREATMENTS:
COLD LASER THERAPY Spinal Decompression Therapy
- Stimulates immune system
- Generate healthy cells & tissues
- Promotes faster healing (DTS)
- Advanced high tech Traction
- Proven to reduce most neck/back
EM SIGNAL THERAPY symptoms >86%
- Activate & Regenerate cells
- Bone & Cartilage Repair
- Significant pain reduction
ELECTROACUPUNCTURE
- Non-invasive
- Effects of electrical & acupuncture
therapy to reduce pain & promote
recovery
Physiotherapy
Education on lifestyle modifications
Avoid prolong activities
Avoid strenuous activities
Avoid heavy load
Avoid squatting/kneeling prolonged
Avoid stairs climbing
Medications
Medicines doctors use to treat osteoarthritis include:
Acetaminophen, which may help relieve pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs), which
reduce inflammation and relief fever.
Corticosteroid injections in the joint (intra-articular),
which reduce inflammation.
Hyaluronan injections, which may relieve pain.
Opioids, which may relieve moderate to severe pain.
Supplements
Chondroitin & Glucosamine sulfate
natural substances found in the joint fluid.
chondroitin is thought to promote an increase
in the making of the building blocks of
cartilage (collagen and proteoglycans) as well
as having an anti-inflammatory effect.
Glucosamine may also stimulate production of
the building blocks of cartilage as well as
being an anti-inflammation agent.
Supplements
CH Alpha (Collagen hydrolysate)
Only product with a U.S. patent for cartilage
regeneration
Clinically proven to stimulate specialized cells called
chondrocytes. Chondrocytes control the rate of cartilage
regeneration in joints and detect changes in the
composition of the cartilage. They respond to these
changes by growing more cartilage.
Studies have shown that CH-Alpha increases the
concentration of collagen and proteoglycans through this
stimulatory effect on chondrocytes.
Surgery
In some cases surgery is necessary, more often it is not
necessary.
Another 6-8 weeks of physiotherapy, at 3 to 5 times per
week.
Lower rate of success, dependent
- Pain
- Increased danger from anesthetic
- Increased danger from possible infections
- Possible post operation complications
(eg pneumonia, DVT, delayed union/nonunion, spinal cord
injury)
- Noticeable scars
Prolonged recovery time, generally 6 to 8 weeks
Prevention of
Neck & Back Pain
PREVENTION IS BETTER THAN CURE!
Prevention of Neck & Back Pain
Adopt good body mechanics/posture
Adopt correct lifting technique
Exercises for a healthy back
Healthy Lifestyle
Stress Management
Strengthening Exercises
Healthy Lifestyle
Flexibility
Mobility
Aerobic Strength
Endurance
Healthy Lifestyle
PRACTICAL
Neck Mobility Exercises
Neck Strengthening Exercises
Back Mobility Exercises
Back Strengthening Exercises
DISCLAIMER:
Exercises shown should be done with caution especially for people
suffering in pain or previous condition. In case of doubt, check with
your doctor/physiotherapist with regards to your condition.
Neck Mobility Exercises
Neck Flexion/ Extension
Tilt head forward and backward
as far as possible.
Slow, repeat 8-10 times
Neck Side Flexion
Tilt head toward shoulder keeping
shoulder stationary
Slow, repeat 8- 10 times
Neck Mobility Exercises
Neck Rotation
Turn head from side to side as far as
possible
Slow, repeat 8-10 times
Neck Strengthening Exercises
Deep Neck Flexors
Tuck in Chin
Hold 10 seconds, 8 -10reps
Isometric Neck Extensors
Giving resistance with clasped hands at
back of head, push backwards with head.
Hold 10 seconds, 8- 10 reps
Neck Strengthening Exercises
Isometric Neck Side-Flexors
Place hands on side of the
head and push head
against hands resistance
Hold 10seconds, 8-10reps
Back Stretching Exercises
Bent Over Stretch
Hold the back of a chair with your
arms shoulder-width apart.
Walk backwards as you bend
forward from the hips and
straighten out your arms.
Keep your feet together, your back
straight and your head between
your arms in line with your spine.
Hold for 10 – 30secs
Back Stretching Exercises
BACK EXTENSION & SHOULDER
BLADE PINCH
Stand with feet apart & lean
backward to the point of tension with
arms reaching back.
Tighten shoulder blades and lower
back muscles.
Feel a mild stretch on your
abdominals.
Hold for 10-30secs
Back Stretching Exercises
Lower Back Stretch
Stand with feet hip-width apart.
Come into a squat position by bending
your knees and pushing your buttocks
backwards. Place your hands on your
thighs.
Pull belly button toward your spine as
you tilt or curl your pelvis under.
Return to starting position.
Stomach Hollowing
Strengthens Transverse Abdominus
Breath out and relax your stomach muscles
Pull lower part of stomach inwards and upwards
Hold 10 seconds and perform 8-10reps
Crook lying, sitting, standing
High Plank
Strengthens the chest, shoulders, triceps,
buttocks, hamstrings & trunk.
Start on your hands and knees. Arms should be
directly under your shoulders.
Extend one leg back at a time until your body weight is
supported on your arms and toes.
Hold for 5-10seconds, perform 8-10 reps
Back Strengthening Exercises
Bridging Exercises
Lie on the floor with your knees bent, feet flat.
Tighten the muscles of your lower abdomen and
buttocks.
Slowly raise low back and buttocks from the floor
Hold for 5-10 seconds, do 8-10reps
Back Strengthening Exercises
Low Back Extensors
Lie face down on a mat with your arms beside you and
your legs together.
Lift your head and shoulders off the mat by squeezing
the muscles in your lower back. Keep your feet on the
floor.
Slowly lower to the mat.
Hold for 5-10 seconds, do 8-10reps
Summary
Prevention is better than cure.
When self management does not work,
SEEK HELP EARLY if you are suffering
from any neck/back pain or any radiating pain
down arms/legs.
LIVE A PAIN FREE LIFE!
QUESTIONS
& ANSWERS
If you have any queries, please feel free to email Michelle at
michelle@[Link]
Or call 67355368.
THANK YOU
Presented By:
Michelle Kwong
[Link](Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist
Practice Director
World Malayali Club
[Link]
Disclaimer
The Pain Relief Practice Educational Material is for information
only. This information is not intended to diagnose, treat, or
cure any medical/health condition. It is not a substitute for
formal, real world medical or physiotherapy care, and should
not be considered as such. The Pain Relief Practice is not in a
position to independently evaluate any of the advice or claims
on behalf of any particular therapy. Any information or
suggestions we provide should be discussed with your doctors
or physiotherapist in real person when treating your condition.
Our discussion of possible pain treatments are just options
which may be significantly limited by the incomplete full
physical examination of a doctor/physiotherapist.
