Introduction
This is a follow-up on the first article written on low back pain in which we discussed what low back pain is, the causes, types and how physiotherapy can help in the management. Low back pain is a global/universal experience and almost everyone has experienced these symptoms at some point in life. In this article, we will be discussing the basics of neck pain, as well as how physiotherapy can help with the management of both low back pain and neck pain using movement/exercise therapy.
Physiotherapists play an important role in providing a unique and individualized treatment protocol with specific goals set specific to the patient’s wants and needs. There are several benefits for anyone who wishes to restore their strength, endurance, flexibility or stability, and relieve pain following an injury to the neck or low back.

Neck Pain
Most episodes of neck pain are due to either postural issues, muscle strain or damage to the ligaments and tendons, but it can also be caused by a sudden force (for example, whiplash). These types of neck pain often improve with time and non-surgical care such as medication and physiotherapy. But if neck pain continues or worsens, there is often a specific condition that requires treatment, such as cervical degenerative disc disease, cervical herniated disc, cervical stenosis, or cervical arthritis.
Acute neck pain usually goes away within one to two weeks and in some people it comes back again in certain situations, such as after work or intensive sport activities. If the symptoms last longer than three months, it’s considered to be chronic neck pain.
Some people who have neck pain avoid doing physical activities for fear of making things worse or injuring themselves. But there is no reason to worry if there are no warning signs of more serious problems. It’s even a good idea to stay active and carry on as usual despite the pain.

Symptoms
There are two basic types of neck pain
1. Axial pain is mostly felt in the part of the spine that belongs to the neck (cervical spine), and sometimes spreads to the shoulders.
2. Radicular pain (radiates) along the nerves: This radiate up the back of the head or down into one or both arms. This type of pain is usually caused by irritated nerves.

Neck pain is only rarely a sign of a more serious condition or an emergency, but urgent medical attention is required if any of the following is seen;
1. The symptoms arise after an accident (Road traffic accident, Fall from a height, etc)
2. Stiff neck (in conjunction with fever, nausea/vomiting, unexplained fatigue/drowsiness, unusual headaches)
3. Loss of bladder or bowel control
4. Headache together with nausea, vomiting, dizziness or sensitivity to light
5. Pain that stays the same, whether you’re at rest or moving
6. Unexplained weight loss, fever or chills
7. Nerve problems and signs of paralysis such as tingling or difficulties moving your arm or fingers
8. Trouble keeping your balance when walking.

Causes of Neck Pain
1. Weak or overused neck muscles: activities that pose an undue pressure or tension around the neck increase one’s chance of developing neck pain. For instance, activities that involve tilting the head back against the neck can cause muscle and joint/spine problems in the neck region. These include things like painting a ceiling, or certain types of sports such as riding a racing bike.

2. Wear and tear on the cervical spine: Over the course of a lifetime, various normal signs of wear and tear arise in the spine. The spinal discs become flatter, and small bone growths (spurs) may form along the edges of the vertebral bodies (the front part of the bones in the spine).

3. Whiplash: This is an injury that can occur if someone drives into the back of your car in a road accident. The impact of the collision causes the head to rapidly jerk forwards and then back again causing damage at the neck.

4. Narrowing of the vertebral canal, or a slipped disc: If the vertebral canal is too narrow, or if spinal disc tissue bulges or leaks out and puts pressure on a nerve root, it can cause neck pain that radiates (shoots) into the shoulder or arm.

5. Neck pain also sometimes comes from inflammatory conditions of the spine or jaw, joint problems or severe headaches.

Management of Back and Neck Pain

In addition to several modalities that can be used to manage pain both at the neck and low back, therapeutic exercise is a great way to restore function and live a pain-free life. There are a wide variety of therapeutic exercises and each one has a unique purpose. Some of these exercises to manage both back and neck include:

1. Muscle Performance Exercises: Therapeutic exercises to increase power, endurance, flexibility and muscle strength are vital to good balance, biomechanics and stability, as well as bone and joint health.

2. Range of Motion Exercises. These exercises are aimed at increasing the range of motion at the joints and prevent soft tissues shortening. This may be done through active, passive, or assisted stretching or joint mobilization activities designed to help the joints move better with minimal or no pain.

3. Postural Exercises. Poor posture habits can lead to pain or postural deformity. What many do not realize is that posture has a direct impact on muscle strength, balance, and increased risk of injury. Postural exercises are aimed at correcting poor posture, not just when we exercise, but also in our activities in daily life, to alleviate aches and pains.

4. Relaxation Exercises. While it is important to work the muscles, joints, and soft tissues of the body, it is also important relax these tissues. Pain relieving techniques or manipulations including heat, cold, electrical stimulation, massage, or trigger point therapy, can all help the body relax, improve sleep, lower blood pressure, etc..

Best Sleeping Position for Healthy Spine
Most people sleep in several positions if they are comfortable within the short period before they fall asleep (At this point there is no more awareness of whether the position is comfortable or not in most cases). An ideal sleeping posture is one that fully in-cooperates the position of the spine at each level (cervical, thoracic and lumbar) for proper alignment.
The position in which we sleep has a direct impact on our spine health. Most of us wake up at some point in our lives with neck or back pain and oftentimes our sleeping position is the culprit. Keeping the spine neutral is the best. Neutral means that the spine is straight. This starts with the head and neck and goes all the way down.
There are several sleeping positions that can be appropriate, but the overall best that maintains the spine in its neutral position is sleeping on our back. Sleeping on our back evenly distributes weight throughout the body and avoids unnatural or unnecessary curves in the spine. Use a small pillow underneath the head and neck (not shoulders) to keep everything in alignment. this sleeping position sometimes can cause some people to snore. Another good sleeping position to manage symptoms is lying on your side. In this position it is best to have a small pillow under your head and below your waist just above the hips (unless the hips are very narrow), as well as another pillow between the knees.
Although good sleep is important, it is important to note that it is a common misconception that one should constantly rest when they are in pain around the neck or the low back. This can actually cause the muscles to weaken during the healing process, which can lead to decreased functionality and more pain in the long run.
Call in to PCA where our physiotherapists will design an individualized treatment plan for you with the therapeutic exercise program you need to alleviate your pain, strengthen the weak areas of your body, promote healing and restore function.