Neck Pain: Part 1


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My neck hurts!

Since Sycamore Health opened, we’ve treated hundreds of patients with neck pain. Some of the conditions we’ve had great results with include:

  • general day-to-day neck tension
  • acute wry necks (stiff and painful necks with a quick onset - commonly after a bad sleep)
  • whiplash injuries
  • osteoarthritis of the neck
  • neck mediated nerve conditions of the upper limb
  • impaction injuries (landing head first)
  • sports-related neck injuries
  • neck mediated (cervicogenic) headaches

"Our bodies respond well to progressive loading!"

However, a few things are important to remember when it comes to neck pain:

  1. Posture is poorly correlated to pain (O’Sullivan et al., 2011). 
    • Pain is complex and involves a number of factors including physical anthropometrics (physical variation between people), posture, psychosocial factors and physical activity. Those with forward head postures are no more likely to have neck pain (Richards et al., 2016). Perfect posture doesn’t exist and neck pain is more than simply physical loading on the spine.
  2. Sitting in a flexed posture is not hard on the neck!
    • Studies that look at spinal loads and muscle activity show insignificant differences between upright and slumped positons (Caneiro et al., 2010). In fact, sitting erect can actually increase spinal loads (Rohlmann et al., 2001). So relax and sit however feels comfortable.
  3. You were made to bend your neck
    • That’s what they were designed to do. Humans have been bending their necks for as long as we’ve had necks! There’s a lot of outrage in the media about text-neck (bending your neck when texting) (Wilson, 2018), but where’s the outrage against knitting, playing chess, looking at the ground as you walk or reading the paper?
  4. Our bodies can adapt!
    • This is how people can bench press 200kgs. Our bodies respond well to progressive loading. Think about sports that place ‘high’ loads on the neck (cycling, heading a soccer ball, headstands, golfing etc.). Your neck is stronger than you think and can adapt over time and become resilient.


Now, you’re thinking, “But how do I actually fix my neck pain!?”

Good question! We need to see you in clinic to accurately assess the specific cause of your neck pain. Nevertheless, exercise is usually a good starting point! And there’s good evidence that theraband exercises can help decrease pain and improve function from as little as two minutes per day! (Andersen et al., 2008, 2011; Bertozzi et al., 2013)

But what exercises? 

Why, these ones!

1. Monkey Shrugs and Overhead Shrugs



Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


References:                                 
Andersen, L. L., Saervoll, C. A., Mortensen, O. S., Poulsen, O. M., Hannerz, H., & Zebis, M. K. (2011). Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain, 152(2), 440-446. doi: 10.1016/j.pain.2010.11.016
Andersen, L. L., Kjaer, M., Sogaard, K., Hansen, L., Kryger, A. I., & Sjogaard, G. (2008). Effect of two contrasting types of physical exercise on chronic neck muscle pain. Arthritis Rheum, 59(1), 84-91. doi: 10.1002/art.23256
Bertozzi, L., Gardenghi, I., Turoni, F., Villafane, J. H., Capra, F., Guccione, A. A., & Pillastrini, P. (2013). Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther, 93(8), 1026-1036. doi: 10.2522/ptj.20120412
Caneiro, J. P., O'Sullivan, P., Burnett, A., Barach, A., O'Neil, D., Tveit, O., & Olafsdottir, K. (2010). The influence of different sitting postures on head/neck posture and muscle activity. Man Ther, 15(1), 54-60. doi: 10.1016/j.math.2009.06.002
O'Sullivan, P. B., Smith, A. J., Beales, D. J., & Straker, L. M. (2011). Association of biopsychosocial factors with degree of slump in sitting posture and self-report of back pain in adolescents: a cross-sectional study. Phys Ther, 91(4), 470-483. doi: 10.2522/ptj.20100160
Richards, K. V., Beales, D. J., Smith, A. J., O'Sullivan, P. B., & Straker, L. M. (2016). Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther, 96(10), 1576-1587. doi: 10.2522/ptj.20150660
Rohlmann, A., Arntz, U., Graichen, F., & Bergmann, G. (2001). Loads on an internal spinal fixation device during sitting. J Biomech, 34(8), 989-993.
Wilson, J. (2018). Your smartphone is a pain in the neck. Retrieved from https://edition.cnn.com/2014/11/20/health/texting-spine-neck-study/index.html

What you need to know about pain: Part 10


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You don't need to be "fixed" before you start to "do"

This blog series has been trying to show you that:

  • Pain is an alarm system not a damage report
  • Our alarm system can become too sensitive: sometimes it’s too good, goes off too soon, too easily, too much and for too long!
  • Pain is poorly related to damage: either can exist without the other!
  • Pain is poorly related to “altered functioning”: there is no perfect way to move, you have options for moving - be a movement optimist!
  • Pain is context-dependent: lots of things influence pain - not just the “usual” things we think of: tissue damage, poor posture, asymmetry etc.
  • You are stronger than you think!
  • If you’re alive and breathing, you can adapt positively (it’s not over for you!)

"The latest evidence suggests that active treatments promote recovery."

If you’ve had pain for a while, you’ve probably been told a lot of different things by friends and therapists about why you’re hurting and how to fix it. Their advice will all vary depending on their experience and their journey. Sometimes their advice will conflict and this can be frustrating. However, one thing we commonly hear from patients of Sycamore Health is that they’re damaged goods - things are out of place, fragile, misaligned and broken! These patients have been told that they need to be “fixed” before they can start “doing” again.


Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


What this blog series has tried to show is that this is not true! Oftentimes, these things really aren’t that important. You don’t have to stop doing the things you love. I know that can be hard to believe, but it’s true! The latest evidence suggests that active treatments promote recovery. Understanding pain helps reduce pain, you can explore different ways to move (you have options!), you can begin to make plans to improve fitness, and you can gradually do the things you love again! For the most part there may be nothing that is off limits. Sure, you may have a flare-up occasionally, but there's no need to stress about that! It just means you're still a bit sensitised. What we’ll look at is (1) how much you can do, (2) what your beliefs are about returning to these activities and (3) how you approach doing these things again. The bottom line? You can adapt and start to slowly do the things you love again.

If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

Would you like to know more about pain? Here are 10 Life-Changing Truths About Pain and 10 Low Back Pain Takeaways from the world's leading back pain researchers. Remember, learning about why things hurt helps things hurt less

What you need to know about pain: Part 9


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You deserve a tailored approach - assumptions help nobody!

Altered function is poorly related to pain. I know this may sound strange, but pretty much every assumed “dysfunction” (poor posture, tightness, weakness, degeneration, stiffness, muscle knots, scar tissue, muscle imbalances etc.) can exist in people without pain. Weird right? Now, this doesn’t mean that they’re irrelevant or that they shouldn’t be addressed. Sometimes they should! But many of the biomedical explanations for pain often fall well short of explaining your symptoms and have limited scientific research behind them.

"...we would love to help you get to the bottom of what’s worrying you."

Moreover, many of the things that help one person can have nothing to do with the pain of another person. At Sycamore Health, we won’t automatically assume that altered function is the root of the issue. That’s not evidence-based. Besides, oftentimes you set yourself up for failure if you think that you must change these things to recover.


Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


If you’re worried about some “dysfunction” mentioned above, don’t hesitate to contact us. You deserve to know what’s going on and we would love to help you get to the bottom of what’s worrying you. At Sycamore health, we will consider all the things that make you, you! We will listen to your story and tailor our assessment and treatment to your specific needs. You deserve better than a cookie-cutter approach to your pain. To perform at your peak and to get the most from your life, it is critical that your body is performing as best as possible!

If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

Next part in this series: What You Need To Know About Pain: Part 10

What you need to know about pain: Part 8


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You can respond positively to stress

I know it seems strange that we as physiotherapists want to start stressing your body. I get it. But stressing the body is very important for recovery and wellbeing! Your body is not like a building that slowly wears down over time as it’s exposed to stress. In fact, it’s the opposite! Your body can respond positively to stress and become stronger and adapt. Perhaps some examples will help!

  • After a total hip replacement (THR) or total knee replacement (TKR), physios get patients up and walking as soon as possible! Yes, there’s still a lot of damage around the joint – it was just operated on after all! Yet, we know that appropriate loading and movement, while very painful, is nonetheless great for healing! Don’t take my word for it – just ask some of our patients who’ve had THRs and TKRs!
  • Patients who have undergone heart surgery or who are at risk of heart disease are both told to exercise. Appropriately stressing the heart is a vital component of recovery. Exercise asks the heart to pump faster and do more work, yet the heart actually responds well to this. It adapts, heals and gets stronger.
  • In patients who have osteoporosis (weakening of the bones), a crucial component of their treatment involves stressing their bones! Their bones need to be loaded - think gym exercises, rather than swimming in the pool. They don’t need to rest! Yes they need recovery time, but that is after appropriately loading the bones up to remodel to tolerate more and more load. It’s the stress on the bones that stimulate them to adapt and stay strong.

"What’s heavy for you to lift today may be light for you to lift in a year."

If you’ve followed me this far, let me take you one step further. Pain is often similar to the above examples. Sure, it’s not as simple as just getting stronger, but the principle is the same. As you’re exposed to different types of stress (physical, vocational, emotional, relational etc.), you can slowly adapt to them. Over time we turn down our pain alarm system because the stressors become less threatening. (Lehman, 2017)


Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


Reducing pain involves multiple changes in many different systems of your body. One way to create changes in those systems is to stress yourself in positive ways. For example, if you want to get strong muscles, you have to go to gym and exercise (stress) them by exposing them to heavy loads. What’s heavy for you to lift today may be light for you to lift in a year. Similarly, if you have a stressful job, you may notice that what stressed you out 5 years ago is now relatively easy. You have adapted to vocational stresses and increased your resiliency. Recently, James went on a trek to Mt Everest base camp. To prepare for this, he spent time slowly increasing his tolerance to walking and climbing by regularly scaling the Glasshouse Mountains.

If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

Next part in this series: What You Need To Know About Pain: Part 9

References:
Lehman, G. (2017). Recovery Strategies. Retrieved from http://www.greglehman.ca/pain-science-workbooks/

What you need to know about pain: Part 7

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You're stronger than you think

Your body is strong and capable of handling huge amounts of loading, bending, stretching, pulling and twisting. Most physical things you do are well below the threshold at which tissue damage happens! Consider the following:

  • The average spine can withstand more than 2000 lbs of pressure!?


Changing how you view your body, from viewing it as fragile and weak, to strong and capable of adapting, can help with your pain experience.

  • You went through adaptations to get in pain and you can go through adaptations to get out of pain!


Your pain alarm system can get turned up and become overly sensitive. But it can also change back and desensitise. This is because we are ‘bioplastic’. It is biologically implausible to think you’re stuck with your pain – it can change!


Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


  • You aren’t dead!


I know that because you’re reading this blog post! And if you aren’t dead, you can adapt and build up your tolerance to aggravating activities.

  • Lots of different things can sensitise our pain alarm system


Think of your pain like a big bucket with lots of different taps dripping into it. There’s a work tap, a relationships tap, a sleep tap, a physical activity tap, a money tap etc. When life’s going great, our bucket may be half full – we can handle life’s stresses! However, sometimes our stress taps are turned on full-bore and our bucket overflows giving us pain.

  • You can become more sensitive to life’s stressors


Continuing the analogy above, you aren’t stuck with your bucket size. It can get bigger or smaller. Sometimes the taps are only dripping slowly, but your bucket is tiny and overflowing already. In this case, your pain alarm system is overly sensitive and tasks that were once easy are now challenging and painful. For lots of us, simply resting and avoiding activity or those stressful settings makes our sensitivity worse. Your threshold for feeling pain and tolerating stress is lower. Your bucket becomes smaller.

  • You can become more resilient to life’s stressors


However, things like exercise, movement, resuming meaningful activities, learning about pain and addressing the aggravating activities in your life can increase your bucket size. Small gradual exposure to stressors can help to build up your resiliency and turn down your sensitivity. In essence, you’re gradually building a bigger bucket. However, if you’ve had pain for years, you’ve slowly adapted for years. Therefore, you may need some patience knowing that progress may be gradual. (Vachon-Presseau, 2013)

If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

Next part in this series: What You Need To Know About Pain: Part 8

References:
Vachon-Presseau, E. et al., (2013). Acute stress contributes to individual differences in pain and pain-related brain activity in healthy and chronic pain patients. Journal of Neuroscience, 33(16), 6826-6833.