2005-09-30 / Columnists

Eye On Physical Therapy

By Dr. Tim Rohrs, DPT

When neck or back pain rears its ugly head, it can be emotionally taxing and physically fatiguing. While an acute episode of pain is usually associated with some recent traumatic event such as a motor vehicle accident, slip, fall or lifting something, chronic pain is usually different. Chronic pain that lasts months or even years often started off as an intermittent ache that slowly progressed with increasing intensity and starts occurring more frequently. Often, there was never an exact moment in time when the pain officially started.

When an injury occurs, the events are recent and pretty clear: “I lifted the couch and felt a sharp pain,” “I bent over to pick something up and felt a pain shoot down my leg.” When these injuries happen, the treatment is somewhat easier to plan. The injured tissue, muscle, ligament, tendon is usually obvious and treatment is directed there. With chronic pain, the treatment may be directed at the site of the pain, but often times it is not. Pain that has been slowly progressing is a different animal. As I have mentioned in other columns, pain is more often than not associated with joints that have either aberrant motion or excessive motion.

A person starts having neck soreness. They apply heat and start doing some stretches to loosen the muscles. Maybe they start twisting their neck to get it to “pop”, which provides some temporary relief. Over time, the pain is getting sharper and they are “popping” their neck more and more, finally not getting any relief. They seek treatment. From my perspective, the initial treatment may have been directed elsewhere.

Cervical motion not only involves the seven vertebrae of the cervical spine but up to three to four vertebrae of the upper thoracic spine. These vertebrae are notorious for being stiff and lacking fluid motion. The attachment of the ribs provides extra stability and restricts the motion. Treatment to increase the mobility of the upper thoracic spine would have increased the neck mobility and decreased the tension on the cervical musculature. Instead, more and more motion was gained in the cervical spine by overstretching and “popping” it. These segments that are over stretched, are used more and more by the person, thus becoming more and more painful from overuse. Most likely, at some point in the future those discs may deteriorate quicker than the others, or they may bulge of even herniate.

All the vertebrae should be working together to allow the motion that is considered “normal”. While driving, you need all 10 or 11 of the highest vertebrae to turn to look over your shoulder. If four or five are not moving, the remaining ones must pick up the slack and move even more than normal to get the head to turn all the way. I like to use the analogy of 11 people rowing a boat. If all 11 work together, everything is fine. If five decide not to row, the remaining six that are rowing are going to start complaining. They will complain about soreness, being overworked and will soon give out.

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