Here is some of the information I recently shared in my July newsletter. Each newsletter has a specific focus. This month is focused on neck pain and injuries. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
TABLE OF CONTENTS
STUDIES and ARTICLES
I receive a weekly update on anything published anywhere on the internet that includes information about neck pain, injuries, and treatments. I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: email@example.com
1. A study titled Pillow preferences of people with neck pain and known spinal degeneration: a pilot randomized controlled trial, published in European Journal of Physical and Rehabilitation Medicine in Sep 2019, enrolled 117 people. Each tested latex pillows polyester pillows and their usual pillow for 28 days. The polyester pillow significantly increased side flexion on waking. The latex pillow did not perform well on any outcome measure.
2. An article titled Prevalence of neck pain among dentists, published in Drug Invention Today in Aug 2019 indicates that 56% of dentists surveyed suffered from neck pain for 10-15 years. The study concluded that the majority of dental practitioners acquired the development of cervical spondylosis.
3. A study titled Effect of isometric exercises on pain and disability in patients with chronic neck pain, published in the European Journal of Physical Education and Sport Science in 2019, concluded: our study showed that physical therapy and neck isometric exercises and cervical joint opening exercises together with stretching exercises of back extensors were effective in chronic neck pain.
4. A study titled Effects of Thoracic Mobility Exercise on Cervicothoracic Function, Posture, and Pain in Individuals with Mechanical Neck Pain, published in Physical Therapy Korea in Sept 2019 focused on “individuals with mechanical neck pain showing biomechanical and neurophysiological changes, including cervical spine muscle weakness. As a result of deep muscle weakness, it causes stability disability and reduced upper thoracic spine mobility, which finally leads to functional movement restriction such as limited range of motion and dysfunction." Conclusion: Thoracic mobility exercises during 6 weeks might be an effective intervention to improve the functional level, posture feature, and QVAS pain rating for managing individuals with mechanical neck pain.
5. A study titled Short-term effects of kinesiology taping in the treatment of latent and active upper trapezius trigger points: two prospective, randomized, sham-controlled trials, published in Scientific Report in Oct 2019, concluded: results of this study do not support the use of the space correction KT technique to treat patients with latent or active myofascial trigger points in the upper trapezius muscle.
6. A study titled Effect of Kinesiology taping and posture stabilizing exercise on pain, cranio-vertebral angle, proprioception in adults with forward head posture, published in the Journal of International Academy of Physical Therapy Research in 2019, concluded: the application of posture setting exercise could decrease pain, proprioceptive error and increase craniovertebral angle on forward head posture.
7. A study, titled Neck muscle activation and head kinematics when using a smartphone while walking, published in Sage Journals in Nov 2019 evaluated the neck muscular load of smartphone use while walking. The results indicate two-handed texting while walking poses a larger muscular load to the neck extensor muscles compared to when conducting one-handed browsing while walking due to the larger head tilt angle.
8. A study titled Adding Temperomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: a randomized clinical study, published in the Journal of Bodywork and Movement Therapies in April 2020 concluded: adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up.
9. A study titled The relationship between forward head posture and neck pain: a systematic review and meta-analysis, published at SpringerLink in Nov 2019 concluded: adults with neck pain show increased forward head posture when compared to asymptomatic adults and that forward head posture is significantly correlated with neck pain measures in adults and older adults. No association was found between forward head posture and most of neck pain measures in adolescents.
10. A study titled Effect of Dry Needling Injection and Kinesiotaping on Pain and Quality of Life in Patients with Mechanical Neck Pain, published in Pain Physician in Oct 2019, concluded: both methods were found to be effective on pain, mood, and quality of life and Kinesiotaping was found to be superior to dry needling in Mechanical neck pain in terms of increasing ROM and decreasing disability.
Here is some of the information I recently shared in my December newsletter. Each newsletter has a specific focus. This month is focused on upper crossed syndrome and text neck information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
STUDIES, ARTICLES, and RESOURCES
I receive a weekly update on anything published anywhere on the internet that includes information about neck problems. I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: firstname.lastname@example.org
1. A review article, titled Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration, published in Spine J in Dec 2016, concluded: our review…suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.
2. A study, published J Manipulative Physiol Ther in Oct 2016, titled The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline concludes: a multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.
3. A study published in J Bodyw Mov Ther in April 2017, titled The local and referred pain patterns of the longus colli muscle found: the pain referral pattern during deep massage and needling of the longus colli was primarily local, with referral to the ipsilateral ear and lateral to the ipsilateral eye. Some subjects reported pain on the contralateral side of the neck.
4. A study, Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial published in J Manipulative Physiol Ther in Jan 2017, concluded: both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.
5. A study, Comparison of isometric cervical flexor and isometric cervical extensor system exercises on patients with neuromuscular imbalance and cervical crossed syndrome associated forward head posture published in Biomed Mater Eng in 2018, concluded: compelling, mechanistic evidence as to how Isometric cervical extensor system exercise is more beneficial for the restoration of neuromuscular imbalance than isometric cervical flexor system exercise in individuals with cervical crossed syndrome.
6. A study, Effectiveness of the Pilates Method in the Treatment of chronic mechanical neck pain: a randomized controlled trial published in Archives of Physical Medicine and Rehabilitation In Sept 2018, concludes: this trial demonstrated the effectiveness of the Pilates method for the treatment of chronic mechanical neck pain, resulting in improvement of pain, function, quality of life, and reduction of the use of analgesics.
7. A study published at ScienceDirect—Annals of Physical and Rehabilitation Medicine, titled The effectiveness of kinesio taping on pain, range of motion and disability in patients with chronic neck pain: A randomized controlled study concluded: kinesio taping in addition to conventional physiotherapy provides additional benefits in chronic neck pain.
8. A study in International Journal of Basic and Applied Research titled Immediate effect of muscle energy technique for upper trapezius muscle on neck pain concludes: Statistically, muscle energy technique was found to be significantly effective in reducing pain and increasing cervical range of motion.
9. A study in Middle East J Rehabil Health Stud, Oct 2018, titled Muscles recruitment Pattern in People with and without Active Upper Trapezius myofascial trigger points in the standing posture concludes: latency in the onset of muscles activity and altered muscles recruitment patterns. The altered muscles recruitment pattern may lead to changes in motor control strategies and poor control of movement. Finally, these changes can cause a poor control of movement and increase the possibility of damage to the shoulder and cervical muscles in patients with an active myofascial trigger point in the upper trapezius
10. A study, published in Complementary Therapies in Clinical Practice and uploaded to ScienceDirect in advance of publication Feb 2019, titled The effects of qigong on neck pain: A systematic review concludes: Qigong might have a beneficial effect in some individuals with neck pain, although not necessarily more effective than therapeutic exercise.
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific bodywork topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The seven main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, cupping/lymphatic drainage, adult learning and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
1.In a brief article by Erik Dalton, he reminds us that “the occipitoatlantal (O-A) joint is the uppermost weight-bearing synovial joint in the body, it is the final junction for adapting to asymmetry and dysfunction from below. And because it is attached to the brain stem, which controls all basic body functions (including breathing and heartbeat), poor alignment may have widespread consequences.”
2. The Brugger Test can be used to determine if suboccipital spasm is the result of head and neck positioning or compensations below the neck. To perform the Brugger Test, use one hand to brace the client’s forehead and the index finger and thumb of your other hand to gently palpate and hold the area with the most knotty spasm. While holding this hand position, ask the client to sit. If the spasm decreases when the client sits, it suggests asymmetry in the lower body rather than head and neck compensation.
3. The website, The RMT Education Project, has a great article titled Massage Therapy and Post-Concussion Headaches which discusses the effectiveness of massage for these types of headaches. There is also a good short video explaining what happens with a concussion.
4. Whitney Lowe gives a very clear and concise explanation of the steps of The Slump Test and how to use it to determine where impingement might be created. The article can be found at Academy of Clinical Massage website.
5. A study, published in J Phys Ther Sci in 2013, titled Impact of longus colli muscle massage on the strength and endurance of the deep neck flexor muscle of adults, concluded: Massage of the longus colli muscle, which is the deep neck flexor, was shown to improve in strength and endurance, which are measures of neck stabilization.
6. Round Earth Publishing: Introduction to Head Pain offers some insight into common symptoms (other than muscular pain) that can be manifested through trigger points in muscles in the neck and face.
1. A review article, titled Neck Proprioception Shapes Body Orientation and Perception of Motion, in Frontiers in Human Neuroscience, concluded: tonic neck-proprioceptive input may induce persistent influences on the subject’s mental representation of space. These plastic changes might adapt motion sensitiveness to lasting or permanent head positional or motor changes.
2. A study, published in Manual Therapy, Manual therapy for mechanical neck disorders: a systematic review concludes: for mechanical neck disorder with or without headaches, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective.
3. A study, Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized controlled cross-over trial published in the Journal of Rehabilitation Medicine, concluded: Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain.
4. A study, Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain, published in J Rehabil Med, concluded: Manual therapy and stretching were effective short-term treatments for reducing both spontaneous and strain-evoked pain in patients with chronic neck pain. It is possible that the decrease in pain reduced inhibition of the motor system and in part improved neck function. However, the changes in neck muscle strength were minor, showing that these treatments alone are not effective in improving muscle strength.
5. A study, Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain, published in Ann Fam Med, concluded: Multiple 60-minutes massages per week more effective than fewer or shorter session for individuals with chronic neck pain.
In the Alternative Health Care Arena
1.A study published on PlosOne, Efficacy of abdominal acupuncture for neck pain: a randomized controlled trial, concluded: Abdominal acupuncture is an effective alternative treatment for neck pain.
2. A study, Immediate Effects of high velocity low amplitude thrust manipulation of the thoracic spine on mechanical neck pain, disability and cervical range of motion, published in Int J Physiother Res in 2017 concluded: HVLA thrust of the thoracic spine was effective in immediately reducing mechanical neck pain and improving cervical range of motion.
3. A study in J Back Musculoskelet Rehabil in Sep 2017 titled Effectiveness of kinesio taping in addition to conventional rehabilitation treatment on pain, cervical range of motion and quality of life in patients with neck pain: a randomized controlled trial concluded: a protocol of manual therapy and physical exercises significantly improved pain and mobility in patients with neck pain. We obtained no evidence of additional benefits from the of application of KT in this population.
4. A study on Science Direct titled Effects of yogic exercise on nonspecific neck pain in university students concluded: the yoga group showed significantly decreased neck pain scores compared with those of the control group. These findings indicate that yogic exercises could reduce neck pain in university students.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
My client suffers from pain in the neck, upper back and shoulders. He finds himself hunched over and has lost two inches in height over the last few years. He would like relief for the pain and help in improving postural distortion.
The case study is relevant in a wider context, because many clients come with identical complaints. In our society, a hunched over posture is very common due to standard daily activities - most clients spend lots of time on smartphones or computers, drive a car for at least an hour or two per day and sit at a desk for work. Even those who do not sit at a desk often do some type of work that involves rolling the shoulders inward to "do work" in front of them (landscapers, chefs, cleaning personnel, cashiers...the list is endless). Holding the body in this posture keeps the muscles of the neck, chest and back in constant contraction or elongation, a condition for which the body arguably was not designed. This can cause pain and spinal distortions and can lead to other conditions as a result of the dysfunctional posture.
Client complaining of pain in neck, in sub-occipital region, in back of shoulders, upper back and rhomboid area, as well as headaches, jaw pain and periodic numbness or tingling in the arms and hands.
During the client interview, I discover that the client has had multiple car accidents, shoulder and ankle injuries, all or some of which may be contributing to the postural distortion. He often feels as if "his head were on wrong". All of this may need to be addressed in a long-range plan.
1985 (age 4) - was involved in a car accident in a pickup truck with a front bench seat, during which the truck was hit head-on by a drunk driver driving 60mph. The seat belt broke so the client fell down toward the floorboard and hit his head on the dashboard. The client suffered a concussion, an injured pelvis (numbness in pelvis, hip imbalance later in life) and neck injuries. A chiropractic evaluation at the time determined that C1 and C2 were out of alignment. The client reported anxiety later in life, which he believes is related to the accident.
2016 (May, age 35) - the client was involved in a rear-end collision. His car was hit from behind, with the other car going approximately 20 mph. Immediately after the accident, the client reported a stiff neck. He was treated the same day by a chiropractor, who realigned C1 and C2. Over the next few days, his previous whiplash symptoms resurfaced: pain and swelling in the sub-occipitals, blurry vision, followed by depression and anxiety for 6 weeks, hands continually going numb and the inability to concentrate.
2016 (July, age 35) - the client was involved in another rear-end collision. His car was hit from behind, with the other car going approximately 30 mph. This time he did not seek medical treatment, but reported similar symptoms; swelling in sub-occipitals, headaches, blurry vision, TMJ and depression.
2010m - Crossfit, while performing overhead squat with 135 lb bar, his arms overhead with elbow locked, his right shoulder gave out. His elbow bent and the client felt pain around the superior lateral border of the scapula. He has been a basketball player for all of his life, but after the injury feels a stabbing pain when he releases the ball. The pain is not as he lifts the arm in shoulder flexion, but specifically when he extends the lower arm from the elbow to push the ball, on the right side.
The client recently used a very heavy garden tool to break up sod while gardening and felt pain with a similar movement. He felt the pain while driving the tool downward as opposed to up, specifically when extending lower arm to drive tool down into the soil.
My observations: There could be a problem with the supraspinatus tendon from the original injury or possibly a triceps tendon impingement. The client reports pain when I press in both of the tendon areas.
1995-1999: Various muscle sprains playing basketball, torn cartilage in right knee
1999: Grade 3 sprain and fracture to right ankle, subsequent grade 2 sprain and fracture to same ankle; later grade 2 sprain to left ankle
2000: Grade 2 sprain and fracture on both right and left ankles
2001: Grade 2 sprain and fracture on right ankle
While all of these injuries and accidents have clearly contributed to the postural distortion, I will begin by addressing the basic structural dysfunction that is generally believed to cause head forward syndrome. This will address his original complaint of pain in the shoulders and neck, his hunched over posture and some of the other symptoms I observed, like the limited range of motion in his head and the shallow breathing.
Head forward posture is widely credited to have been discovered by Dr. Vladimir Janda in 1979. He defined what is now known as "Upper Crossed Syndrome." It is a muscle imbalance pattern denoted by tightness in the chest and back of the neck and weakness in the front of the neck and lower back. Clinically, there is a crossing pattern through the shoulder that looks like this: tightness in the upper trapezius, levator scapula and suboccipitals on the dorsal side, crossed with tightness in the sternocleidomastoid, pectoralis major and pectoralis minor on the ventral side.
Since the tight muscles are continually contracting, the weakened muscles are in a perpetual state of stretch. As they are trying to hold the body up against the force of the tighter muscles, they are in a constant state of eccentric contraction. A widely accepted theory states that trigger points develop in muscles such as these which are continually contracting, which causes the client to feel pain in these areas and areas of referred pain.
My client reports pain in many of the areas designated as trigger points and referred pain areas for Upper Crossed Syndrome, including the side of the face, jaw, sub-occipital region, upper back and rhomboids. He also displays several symptoms indicative of Upper Crossed Syndrome, including shortness of breath, decreased range of motion of the head and hand numbness.
The plan is to stretch the muscles which are locked short, combined with releasing some of the trigger points and later activating the muscles that are locked long. Exercise at home will be critical to activating those muscles.
Over the last few massages, I have been warming and massaging the pectoralis muscles first to release them, including skin rolling, deep effleurage, compression and passive stretches. In addition, I have been working on releasing the sub-occipital muscles through positional release, deep friction and compression. I have also incorporated some passive stretching of the neck, focusing slightly more on the right side, as that side appears to be more contracted. The upper trapezius has also been a focal point for deep effleurage and compression.
I have also made sure to massage the trigger points in the muscles that are lengthened, specifically the rhomboids and lower trapezius. After addressing the trigger points, I massage these muscles with effleurage strokes in the direction of their origins in order to avoid further elongating them. Finally, I have given my client some exercise suggestions in order to strengthen and reactivate these muscles.
The goal is for my client to get some relief from his pain and to slowly begin to release the tightened muscles. As he is able to do this, the overstretched muscles should be able to slowly return to their original length; doing the exercises at home should help him strengthen them, which will help the healing process.
According to research, manual manipulation of the tissues is not as effective as manual manipulation combined with exercise. In randomized trials, it has been found that the use of these multiple modalities has resulted in a decrease in pain and increase in client satisfaction.
After multiple massages, the client has slightly increased range of motion in his neck and his shoulders. He reports a decrease in his pain symptoms, and his chest appears slightly more elevated with the shoulder slightly less protracted. The change is subtle, but noticeable both to me and my client.
We will continue to address his Upper Crossed Syndrome, while slowly adding in therapies to address the related issues of whiplash and the shoulder injury.
Burns, Michelle, BSRN, BSAltMEd, LMT, Regaining Healthy Posture: Tools for Relieving Upper Crossed Syndrome, 2014
Gross, A., Kay, T., Hondras, M., Goldsmith, C., Haines, T., Peloso, P., Hoving, J. Manual Therapy for Mechanical Neck Disorders: A Systematic Reviw., Manual Therapy, 2002.
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
Tips & Tidbits
Studies, Articles, and Resources