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Neck & Back Care Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director

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Presentation on theme: "Neck & Back Care Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director"— Presentation transcript:


2 Neck & Back Care Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director

3 SPEAKER PROFILE 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

4 SPEAKER PROFILE Achievement  Awarded GOLD Service Excellent by SPRING Singapore 2003  Principal Physiotherapist and Director of Physiotherapy Clinic THE PAIN RELIEF PRACTICE 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.

5 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.

6 SPINE FACTS 5 sections  Cervical (7 vertebrae)  Thoracic (12 vertebrae)  Lumbar (5 vertebrae)  Sacral (5 fused vertebrae)  Coccyx (4 fused vertebrae)

7 Spine Structure Lumbar vertebrae Intervertebral disc Nerve roots Ligaments Muscles

8 Vertebrae Skeleton framework Support for muscles & tissues Protection of vital organs Storage of minerals & immature blood cells

9 Joints Allows movement between bones

10 Intervertebral Disc The intervertebral disc is a jelly like substance, which consists of annulus fibrosis and the nucleus pulposus. Acts as a shock absorber.

11 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.

12 Ligaments Ligaments are fibrous bands or sheets of connective tissue. They link two or more bones, cartilages, or structures together.

13 Muscles Muscles attach to the spinal column, pelvis, and extremities. They serve to support the spine

14 Core Muscles Deep trunk muscles- acts as stabilisers ‘Power House’

15 Causes of Neck & Back Pain

16 Poor Carrying Posture Poor Sitting Posture Causes of Neck & Back Pain

17 Poor Sleeping Posture Poor Working Posture Causes of Neck & Back Pain

18 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

19 Common Problems Neck & Back Pain

20 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

21 Compression Fracture Usually due to trauma (very hard pressure or fall) Higher risk for osteoporosis/ elderly

22 Disc Herniation Stages of Disc Herniation 1 Disc Degeneration Chemical changes associated with aging causes discs to weaken, but without a herniation. 2ProlapseThe form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion. 3ExtrusionThe gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc. 4Sequestration or Sequestered Disc The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.

23 Effects of position on disc

24 ‘Slipped’ Disc

25 Spondylosis Degeneration (Wear and tear) Age related Activity related Previous injury/trauma

26 Lumbar Spondylosis Normal 58 yrs old Degenerative Changes 83 yrs old

27 Nerve Root Irritation Shooting pain down the leg Constant pain Numbness Weakness

28 Signs and Symptoms

29 SIGNS & SYMPTOMS Localised pain in the neck/ back Diffused pain over a wide area Pain radiating to the lower limb

30 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

31 MANAGING PAIN - Self Management - Doctor - Physiotherapy - Surgery

32 Acute Pain Self Management ACUTE PAIN (1 st – 2 nd 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

33 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

34 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.

35 Physiotherapy Goals of Treatment relieve pain improve joint function maintain flexibility Strengthening weak muscles Achieve a healthy lifestyle

36 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

37  COLD LASER THERAPY - Stimulates immune system - Generate healthy cells & tissues - Promotes faster healing  EM SIGNAL THERAPY - Activate & Regenerate cells - Bone & Cartilage Repair - Significant pain reduction  ELECTROACUPUNCTURE - Non-invasive - Effects of electrical & acupuncture therapy to reduce pain & promote recovery  Spinal Decompression Therapy (DTS) - Advanced high tech Traction - Proven to reduce most neck/back symptoms >86% ADVANCED TREATMENTS:

38 Physiotherapy Education on lifestyle modifications  Avoid prolong activities  Avoid strenuous activities  Avoid heavy load  Avoid squatting/kneeling prolonged  Avoid stairs climbing

39 Medications Medicines doctors use to treat osteoarthritis include: Acetaminophen, which may help relieve pain. Acetaminophen Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relief fever. Nonsteroidal anti-inflammatory drugs Corticosteroid injections in the joint (intra-articular), which reduce inflammation. Corticosteroid injections Hyaluronan injections, which may relieve pain. Hyaluronan injections Opioids, which may relieve moderate to severe pain. Opioids

40 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.

41 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.

42 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

43 Prevention of Neck & Back Pain PREVENTION IS BETTER THAN CURE!

44 Prevention of Neck & Back Pain Adopt good body mechanics/posture Adopt correct lifting technique Exercises for a healthy back Healthy Lifestyle Stress Management

45 Strengthening Exercises

46 Healthy Lifestyle Mobility Aerobic Endurance Flexibility Strength

47 Healthy Lifestyle

48 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.

49 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 times

50 Neck Rotation  Turn head from side to side as far as possible  Slow, repeat 8-10 times Neck Mobility Exercises

51 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, reps

52 Neck Strengthening Exercises Isometric Neck Side-Flexors  Place hands on side of the head and push head against hands resistance  Hold 10seconds, 8-10reps

53 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

54 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

55 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.

56 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

57 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

58 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

59 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 Back Strengthening Exercises

60 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!

61 QUESTIONS & ANSWERS If you have any queries, please feel free to Michelle at Or call

62 THANK YOU Presented By: Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director World Malayali Club

63 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.

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