Cervical spine retraction. A home treatment tool. A diagnostic tool for neck pain and dysfunction.

Cervical Retraction.

Catherine presented today with chronic neck pain. She has a C5/6 and C6/7 stenosis with disc protrusions at both levels.  Catherine has radiculopathic pain to the Left hand, however the pains have changed side intermittently in the past.  I am treating Catherine for directional preference today. I asked to see her again in three days to review her progress.  


Cervical retraction is one the best movements for both treatment and the diagnosis of neck pain and dysfunction.  In this example I have used retraction as a diagnostic tool for this patient to treat her nerve impingement (radiculopathic pain) to her Left arm.

Cervical retraction is also a great movement even if you do not usually get neck pain, but may have bad posture, or are just conscious of improving your posture.  Try these a couple of times per day and get great results.

As you can see my patients head glides straight back without tilting up or down.  This movement takes pressure off the lower discs of the neck, and if the direction (of the movement) is correct, also takes pressure off the nerves of the neck.  This will therefore relieve any arm pains and sensations a patient may be having.

There are some rules however…. 1//  If after trying this movement a couple of times and your arm pain is worse when you finish you should cease the movement and consult your treatment provider.  2//  If when doing the movement the arm pain is worse during, but when you stop the pain reduces, or remains no worse you can continue. 3// And if when you are doing the movement there in no pain in the arm you can continue the exercise…

I usually recommend doing this movement 4 – 6 times per day for 10 repetitions.  Initially you do not have to hold the movement in the retracted position, but this is not always the case, sometimes holding the movement for 10 – 30 seconds can be beneficial.

If nothing changes your pain, or you don’t feel you are getting benefit from this exercise, you may be doing it wrong, so seek advice from your rehabilitation provider..

Also… if when doing the movement there is neck pain this can also be Ok, as long as your arm pain remains no worse, or better afterwards.

This is known as directional preference in which I will explain in another blog…



Frozen Shoulder (Adhesive Capsulitis) – What is it???

 

There’s a heap to know so let’s keep it brief….

 

A frozen shoulder (or adhesive capsulitis) is a gross loss of movement in the shoulder.  It occurs due to the inner capsule (the tissue around the two joining bones that make the shoulder (see figure 1)) becoming inflamed, scarred and shrinking around the shoulder joint.  When this occurs the two bones are no longer able to move independently, they are now stuck and move as one.  Hence why you are unable to move your shoulder -this is why it is commonly called “Frozen Shoulder”….

 

Essentially there are three phases.

 

1/ Pain: Typically some pain on movement.

2/ Freezing: Loss of movement.

3/ Thawing: Increase of movement and function

 

The cause of Frozen Shoulder is not known.  It usually occurs after a shoulder injury.  However it can occur for metabolic reasons such as diabetes…

 

Unfortunately Frozen shoulder usually lasts for between 18 – 24 months.

 

I am yet to find a successful treatment protocol that works for frozen shoulder.  As a matter of fact I believe now one else has found it either… There are many modalities to claim to help such as acupuncture, mobilization or surgical intervention.  I have not seen a lot of success with any of these. 

In my experience I have found the best treatment is gentle range of motion exercises, done consistently over and beyond the life of the frozen shoulder.  Hydrotherapy in a warm pool is effective with gentle exercise.  Also icing and heating have been effective for relieving the pain.  Which will work best for you is up to you to trial them both and decided.  We are all different so what works for one will not necessarily work for the other.  I have also found Surgical intervention not to be successful.  The only surgical intervention that I would recommend would be an injection into the shoulder capsule to try and alleviate the inflammation.

 

Essentially the main treatment for this condition is to be patient and ride out the 18 – 24 months in which you will have the condition. Keep your exercises up, even when it seems as if are getting nowhere. And remember – more is NOT better for this injury. Don’t overdo it and give your shoulder the rest it needs. 

 

 

 

 

 

 

 

 

 



Radiculopathic Pain

What is Radiculopathic pain???

 

 

Radiculopathy is referred pain that starts at the spine and refers to areas such as the hands or feet. So radiculopathy is not a condition, but a cause of a symptom. 

Radiculopathy occurs when the nerves of the spine get caught or impinged and this in turn sends pain down the length of the nerve.  These nerve patterns are called Dermatomes (which will be discussed in the next blog).

The area in which the nerve gets caught is the “existing nerve root”.  The exiting nerve root is where the nerve branches off the spinal cord and moves through the bony spinal vertebrae into the body to it’s designated area.

Usually disc protrusions can cause nerve impingement.  However bony growths can also cause irritation on the exiting nerve root.  Also, but in less cases cancer or infections can also cause radiculopathic pains. 

The symptoms are usually pins and needles, numbness, tingling, loss of feeling and loss of function.  Most patients will have sharp pains that are made worse with incorrect movements or heavy lifting.  Severe Radiculopathy can also result in extreme pain in the distal area (the area being effected – usually the upper back, arm or somewhere in the leg).

However, not all distal pains need be radiculopathic pains.  Myofascial problems such as trigger points (discussed soon), vascular problems, metabolic problems (such as diabetes) or other nervous system related issues can also cause referred type pains. 

A range of treatments can be used to resolve radiculopathic pains. And like always what’s works for someone may not work for others….  And lastly – an active recovery (not slouching on the lounge) will assist in resolving these types of injuries.



Disc Herniations

What is a herniated disc?

We have all heard of someone who has suffered from a disc herniation.  But do we know exactly what it is?  Not usually…  Inter vertebral discs are the soft portions of the spine that run alternately between the bony vertebra.  The discs consist of two parts: an outer portion which is the annulus fibrosis and an inner portion which is called the nucleus pulposus.  The disc acts as a shock absorber, especially the nucleus pulposus.

The inner portion (nucleus) of the disc is variable in that it has the ability to move somewhat.  If you place to much pressure on one side of the disc the nucleus can move (or be forced) in the opposite direction.  Kind of like pressing a tube of tooth paste at one end.

A Disc herniation occurs when then nucleus presses against the annulus fibrosis (outer wall) or breaks through it. When the nucleus breaks through this tough outer layer it can press against the spinal cord or spinal nerves.  This causes localized pain, radiating pain down arms or legs, numbness, tingling and/or pins and needles.  It can also cause loss of function, loss of feeling, deceased muscle mass and loss of control of the effected area.

Essentially there are 3 types of herniation’s.  This first is when the nucleus compresses the outer layer but has not broken through it.  The second is when the nucleus has broken through the outer layer and can compress nerves.  And the third is when the nucleus breaks though the outer layer and a portion breaks off causing a fragment to float near nerves and the spinal cord.

Treatment options generally depending on the degree of herniation that one has, ranging from conservative rehabilitation through to surgery.