1. Neck & Back Care Michelle Kwong Http://www.painrelief.sg
B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist
Practice Director

2. SPEAKER PROFILE MichelleKwong.com
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

3. SPEAKER PROFILE MichelleKwong.com
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.

4. 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.

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

6. Spine Structure Lumbar vertebrae Intervertebral disc Nerve roots
Ligaments
Muscles

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

8. Joints
Allows movement between bones

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

10. 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.

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

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

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

14. Causes of Neck & Back Pain

15. Causes of Neck & Back Pain
Poor Carrying Posture
Poor Sitting Posture

16. Causes of Neck & Back Pain
Poor Sleeping Posture
Poor Working Posture

17. 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

18. Common Problems Neck & Back Pain

19. 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

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

21. Disc Herniation 1 Disc Degeneration
Stages of Disc Herniation 1
Disc Degeneration
Chemical changes associated with aging 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 or Sequestered Disc
The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.

22. Effects of position on disc

23. ‘Slipped’ Disc

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

25. Lumbar Spondylosis
Normal 58 yrs old
Degenerative Changes 83 yrs old

26. Nerve Root Irritation Constant pain Numbness Weakness
Shooting pain down the leg
Constant pain
Numbness
Weakness

27. Signs and Symptoms

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

29. 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

30. Self Management Doctor Physiotherapy Surgery
MANAGING PAIN
Self Management
Doctor
Physiotherapy
Surgery

31. 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

32. 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

33. 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.

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

35. Physiotherapy Pain relief treatment Postural Correction
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

36. - Advanced high tech Traction
ADVANCED TREATMENTS:
 COLD LASER THERAPY
- Stimulates immune system
- Generate healthy cells & tissues
- Promotes faster healing
Spinal Decompression Therapy
(DTS)
- Advanced high tech Traction
- Proven to reduce most neck/back
symptoms >86%
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

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

38. 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.

39. 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.

40. 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.

41. 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

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

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

44. Strengthening Exercises

45. Healthy Lifestyle
Flexibility
Mobility
Aerobic Endurance
Strength

46. Healthy Lifestyle

47. 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.

48. 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

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

50. 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

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

52. 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

53. 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

54. 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.

55. Strengthens Transverse Abdominus
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

56. 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

57. 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

58. 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

59. 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!

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

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

62. 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.