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Neck & Back Care
Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist Practice Director
Http://www.painrelief.sg
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SPEAKER PROFILEMichelleKwong.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
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SPEAKER PROFILEMichelleKwong.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.
http://www.painrelief.sg
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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.
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SPINE FACTS
5 sections Cervical (7 vertebrae) Thoracic (12 vertebrae) Lumbar (5 vertebrae) Sacral (5 fused vertebrae) Coccyx (4 fused
vertebrae)
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Spine Structure
Lumbar vertebrae Intervertebral disc Nerve roots Ligaments Muscles
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VertebraeVertebrae
• Skeleton framework
• Support for muscles & tissues
• Protection of vital organs
• Storage of minerals & immature blood cells
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Joints
Allows movement between bones
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Intervertebral Disc
The intervertebral disc is a jelly like substance, which consists of annulus fibrosis and the nucleus pulposus. Acts as a shock absorber.
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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.
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Ligaments
Ligaments are fibrous bands or sheets of connective tissue.
They link two or more bones, cartilages, or structures together.
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Muscles
Muscles attach to the spinal column, pelvis, and extremities.
They serve to support the spine
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Core Muscles
Deep trunk muscles- acts as stabilisers
‘Power House’
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Causes of Neck & Back Pain
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PoorPoorCarrying PostureCarrying Posture
PoorPoorSitting PostureSitting Posture
Causes of Neck & Back Pain
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PoorPoorSleeping PostureSleeping Posture
PoorPoorWorking PostureWorking Posture
Causes of Neck & Back Pain
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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
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Common Problems Neck & Back Pain
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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
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Compression Fracture
Usually due to trauma
(very hard pressure or fall)
Higher risk for osteoporosis/ elderly
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Disc Herniation
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.
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Effects of position on disc
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‘Slipped’ Disc
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Spondylosis
Degeneration
(Wear and tear) Age related Activity related Previous injury/trauma
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Lumbar Spondylosis
Normal 58 yrs old
Degenerative Changes 83 yrs old
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Nerve Root Irritation
• Shooting pain down the leg
• Constant pain
• Numbness
• Weakness
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Signs and Symptoms
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SIGNS & SYMPTOMS
Localised pain in the neck/ back Diffused pain over a wide area Pain radiating to the lower limb
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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
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MANAGING PAIN
- Self Management- Doctor- Physiotherapy- Surgery
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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
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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
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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.
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Physiotherapy
Goals of Treatment relieve pain improve joint function maintain flexibility Strengthening weak muscles Achieve a healthy lifestyle
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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
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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:
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Physiotherapy
Education on lifestyle modifications Avoid prolong activities Avoid strenuous activities Avoid heavy load Avoid squatting/kneeling prolonged Avoid stairs climbing
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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.
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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.
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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.
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SurgeryIn 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
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Prevention of Neck & Back Pain
PREVENTION IS BETTER THAN CURE!
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Prevention of Neck & Back Pain
Adopt good body mechanics/posture
Adopt correct lifting technique
Exercises for a healthy back
Healthy Lifestyle
Stress Management
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Strengthening Exercises
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Healthy Lifestyle
Mobility
Aerobic Endurance
Flexibility
Strength
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Healthy Lifestyle
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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.
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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
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Neck Rotation Turn head from side to side as far as possible Slow, repeat 8-10 times
Neck Mobility Exercises
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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
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Neck Strengthening Exercises
Isometric Neck Side-Flexors
Place hands on side of the head and push head against hands resistance
Hold 10seconds, 8-10reps
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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
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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
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Back Stretching ExercisesLower 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.
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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
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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
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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
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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
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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!
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QUESTIONS & ANSWERS
If you have any queries, please feel free to email Michelle at [email protected] call 67355368.
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THANK YOU Presented By:
Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist Practice Director
World Malayali Clubhttp://groups.yahoo.com/group/worldmalayaliclub/
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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.