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Spine

Acute Wry Neck 急性落枕 (瞓厲頸)

Definition

Acute wry neck is a very common type of neck pain. Pain occurs suddenly after sleep, which is accompanied by restricted neck movements. This protective mechanism may also reflect other potential neck problems.

Causes and Risk Factors

There is no specific cause of acute wry neck, but most people suddenly develop symptoms after sleeping. The most common causes are improper posture during sleep or improper softness and thickness of the pillow.
The physiological structure of the cervical spine allows the neck to flex, extend, and rotate to a large extent. Once the neck is injured, such as disc herniation or facet joint and ligaments over-pulled, inflammation will be caused, like a rusted door hinge jams the door. This causes pain and forms a protective mechanism of muscle tightening.

Risk Factors

Anyone may suffer from acute wry neck, but it is clinically more common in young people. Also, people who have long-term poor posture and chronic neck problems will prompt to have acute wry neck due to high neck muscle tension and neck stiffness.

Common Symptoms

  • The neck pain and tightness mostly appear on one side, sometimes with head tilt to one side.
  • When you suddenly move your neck, you get a "stuck" feeling.
  • Usually, pain is accompanied by movements, and in a few severe cases, the pain will radiate to the head or upper limbs.

Management

After examination, if other severe neck symptoms are ruled out, an acute wry neck is a disorder that is difficult to worsen. Most people recover within 48 hours spontaneously, although some patients suffer from pain for more than a week. The manual techniques for releasing soft tissue tightness and joint stiffness can effectively increase the range of motion after loosening the joints and muscles. In terms of self-management, hot pad and mild stretching exercises are effective in reducing pain and muscle tightness.

Recommendations

Spinal Stenosis 椎管狹窄症

Definition

The spinal canal is the inner space containing the spinal cord and nerves in the spine. Owing to soft tissue changes (such as ligamentum flavum thickening, herniated intervertebral discs, etc.), space inside the spinal canal becomes narrower. As a result, the spinal cord or nerve roots are compressed and causing different neurological symptoms and spinal stenosis.

Causes and Risk Factors

  • Spinal degeneration, thickening of ligaments and joint capsules, instability of the spine, post-surgery and etc
  • Prolapsed Disc
  • Facet joint arthritis or degeneration

Risk Factors

  • Physical labouring or poor posture
  • Congenital factors: congenital spinal stenosis, scoliosis or previous spinal injuries
  • Aging: after aged 50 with general degeneration and lack of muscle flexibility

Common Symptoms

  • Intermittent claudication (No resting symptoms, but leg pain, weakness, and numbness appear after walking for a short distance and disappear after a short rest)
  • Leg cramps, tingling, pain, numbness, or even sensory deficit
  • Symptoms worsen over time and may occasionally recur. It is usually aggravated by standing or walking, but relieved when sitting, leaning forward, or lying on bed

Management

Although acute or severe pain requires adequate rest, this does not mean that complete bed rest is the fastest way to recover. Electrophysical therapy, hydrotherapy, acupuncture, joint mobilization can help reduce pain and its radiation to the extremities. Also, using nonsteroidal anti-inflammatory drugs (NSAID) can reduce inflammation. We should pay more attention to maintain a correct posture in daily life and avoid prolonged sitting or walking without rest or stretching. When the acute stage has overcome, specific deep core muscle strengthening, soft tissue stretching, neurodynamic stretching can speed up recovery.
If the pain is still severe (seriously affects walking and daily activities) without significant improvement after months of rehabilitation, surgery may be indicated. Surgeries like laminectomy reduce neural stress and tension. A spinal fusion may be needed to fixate the spine and restrict movements in the most severe cases.

Preventive Measures

  • Maintain good posture when carrying heavy objects, and one can use lumbar support to protect the spine
  • Heavy items should be stored at waist level for easy transfer
  • Exercise regularly, which helps maintain the strength and flexibility of our spine, joints and ligaments
  • Avoid from over-extending our back

Recommendations

椎間盆脫出 Prolapsed Intervertebral Disc

Definition

Intervertebral disc is a disc-shaped fibrocartilage structure connecting two vertebrae, allowing spine movement. It is composed of elastic fibrous rings and semi-liquid nucleus pulposus, which can cushion the pressure and impact on the spine. When the annulus fibrosus wears out, the nucleus pulposus protrudes outward through the fissure which causes prolapsed disc, and may squeeze directly to the related nerve and cause limb pain.

Causes and Risk Factors

The nucleus pulposus contains more than 80% of water. When the fibrous annulus gradually has cracks due to degeneration or external impacts, the water content continues to decrease. The elasticity and cushioning capacity also decrease. In addition, prolonged bending of the spine or carrying heavy objects while bending down, or a sudden twist or high impact injury due to a car accident are factors causing the disc to prone to prolapse.

Risk Factors

Poor posture or prolonged back flexion might increase the pressure of the intervertebral disc. Intervertebral disc injuries mostly occur in people who usually sit or require heavy labor to carry heavy objects, such as office workers, drivers, and porters.

Common Symptoms

  • Lower back pain and back stiffness
  • Difficult to change posture while staying in the same posture for a long time
  • If the nerve is compressed at the same time, it can cause pain or numbness in the buttock and lower limbs
  • In severe cases, it can cause upper or lower limbs weakness

Management

Although acute or severe pain requires adequate rest, this does not mean that total bed resting is the fastest way to recover. Electrophysical therapy, hydrotherapy, acupuncture, joint mobilization, and traction can help reduce pain and its radiation to the extremities. Depending on one's condition, Mckenzie spinal therapy can effectively differentiate and treat the cause of this disease. It can make prolapsed intervertebral discs easier to recover or return to their original alignment. We should pay more attention to maintain a correct posture in daily life, and do not sit for more than an hour without stretching. If necessary, a backrest cushion can be added to support the back curvature. When the pain is relieved, targeted deep core muscle strength, endurance training, and stretching can improve the chance and speed of recovery.

Preventive Measures

In addition to paying attention to the daily posture, if your work nature needs a lot of manual lifting procedures, you should pay attention to the correct lifting posture to reduce the chance of back injuries. Moreover, a regular core muscle exercise regime can greatly reduce spinal stress.

Recommendations

Spinal Dysfunction & Poor Posture

Definition

Due to spinal muscle weakness or long-term poor posture, the spinal muscles lose elasticity. Excessive strain causes spinal pain. It is usually uneasy to find the painful region after a full rest or warm-up, but symptoms such as pain and numbness occur after work or a prolonged static posture.

Causes and Risk Factors

Spinal muscles include back and abdominal muscles, both of which are used to support the spine. If either group of muscles is too tight and the other group is too weak, the normal physiological curvature of the spine cannot be maintained. When the spine is abnormally pressurized for a long time, pain will occur. Bad postures, such as habitual "belly out" and "kyphosis", will often make the above situation worse and form a vicious circle.

Risk Factors

Sitting or standing for a long time at work, wearing high heels, overweight (especially big belly) etc. will also increase the curvature of the back and the pressure on the spine.

Common Symptoms

  • Back pain, soreness, and stiffness, but not losing actual mobility
  • The longer the same posture is maintained, the more obvious the symptoms are, but no specific movement causes pain
  • Repeated movements may not elicit more pain, whereas may alleviate the pain

Management

Soft tissue release (such as therapeutic massages) and manual joint mobilization therapy are effective in relieving acute pain. But under normal circumstances, passively relying on the physiotherapist's manual therapy may often relieve most of the symptoms only. Improving the spinal muscle imbalance and maintaining a good posture is the solution to the root causes. Do stretching exercises to keep your spine and back muscles flexible. Train your brain to re-adapt a good posture in daily life. You can add lumbar support to the back of the chair to help maintain physiological curvature. In addition, proper strengthening of the back and abdominal muscles is also very important. This is the most effective way to treat this symptom in root causes.

Preventive Measures

With proper stretching and exercise regime, most can improve and effectively prevent neck and back pain. In addition, more whole-body aerobic exercise, and more breaks during work can reduce accumulation of fatigue.

Recommendations

Degenerative Spine 脊椎退化

Definition

Human spine is made up of 33 vertebrae in total. There are intervertebral discs, facet joints and many strong ligaments connect to the vertebrae, allowing us to perform movements such as bending, extending and twisting. It can also maintain the stability between the vertebrae. As we grow older, in addition to the gradual degeneration of the intervertebral discs, the other important structures that maintain spinal stability will gradually lose their original strength and elasticity too. The stability and loading capacity of the spine will gradually deteriorate and even develop chronic inflammation, collectively referred to as degenerative spine.

Causes and Risk Factors

The formation of osteophytes is caused by degeneration. It is hoped that the osteophytes will cover the intervertebral discs or facet joints to restore a certain extent of their stability. This process is a normal aging process. However, if the degeneration of the intervertebral segments is too fast, or only limited to one or two vertebral segments, it may cause some very uncomfortable spinal pain and deteriorate to some kinds of pathology such as:
- Disc herniation
- Spinal stenosis
- Spondylithesis
- Degenerative scoliosis

Risk Factors

  • Manual work nature
  • Long-term poor posture
  • People with spine injury history

Common Symptoms

  • Back pain during movement
  • Neurological claudication caused by compression on nerves (need to take rest after walking for a while before you can continue)
  • Sciatica (numbness along the lower extremities along the sides of the buttocks, going to posterior thighs to the lower legs and feet)
  • Symptoms of back pain and soreness when standing for a long time or changing posture

Management

In terms of management, if it is a non-complex spinal pain and is not associated with a structural problem (such as displacement) or nerve compression, the case then can be treated based on the symptoms for functional and postural improvement. Taking non-steroid anti-inflammatory drugs (NSAID) can relieve spinal inflammation; maintaining the correct posture and short-term use of lumbar support can give proper rest to the inflamed spine; in the long term, weight control, aerobic exercise and physiotherapy can strengthen the back and abdominal muscles, effectively reduce stress and improve functions of spine.

Preventive Measures

  • Maintain good posture when carrying heavy objects, and one can use lumbar support to protect the spine
  • Avoid carrying heavy objects by your own
  • Heavy items should be stored at waist level for easy transfer
  • Pay attention to spine alignment and posture. Get up from bed by sideway approach
  • Proper exercise regime includes stretching and strengthening of spine

Recommendations

Back and Neck Soft Tissue Strain 頸腰背肌肉扭傷或拉傷

Definition

Acute back or neck sprain are mostly caused by excessive tension in the soft tissues such as the ligaments or muscles around the spine. Acute low back sprain is more common in physical labour and athletes. Another common symptom of neck sprains is acute wry neck. The so-called “overused spine” is not the real back and neck strain mentioned here. Those are degeneration of the spine and the stiffness of the joints.

Causes and Risk Factors

Most acute neck and back pains are caused by muscle strain or tendon injuries, which are caused by acute external impacts (such as car accidents) or sprained neck (such as muscle strain caused by incorrect sleeping posture or lifting heavy objects. Afterwards, severe pain occurs immediately, followed by spine stiffness and low mobility. However, there are also many patients who only feel sore and weak when they are injured, they find severe pain when they wake up on the next day.

Risk Factors

  • Chronic overloading and overuse of cervical and lumbar spine
  • Incorrect posture

Common Symptoms

  • Stiff neck or back
  • Neck or back pain appears, and soreness radiates to arms, hands, legs, or toes
  • Feeling uncomfortable when sleeping even after changing several pillows
  • When turning in beds, sitting up or standing, one needs to move carefully with your support of hands against thighs or furniture.

Management

Physiotherapy treatments such as ice or hotpad, ultrasound, electrophysical therapy and acupuncture can alleviate neck and back pain. Patients should avoid high-impact sports such as vigorous running and jumping, and avoid maintaining the same posture for a long time, such as driving long distances and watching TV. Appropriate neck and back stretching exercises can improve the flexibility of the neck and trunk. Generally, the pain will be greatly relieved after about one week of physiotherapy. In the later stage, improving the muscle strength of the neck and trunk and learning the correct posture and movement can help reduce the chance of recurrence.

Preventive Measures

  • To correct bad postures of neck and back
  • To prevent sprains when bending by avoiding vigorous low back movement
  • To do more spinal exercises for strengthening the core muscles. This can increase the spinal stability, reduce the internal load and protect the disc.
  • Do not maintain the same posture for too long while working

Recommendations

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