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Always seek medical advice first. Consultation with an orthopedist or neurologist, and imaging studies such as MRI's or CT scans are crucial when dealing with neck and/or back pain; and even more so if pain radiates down arms or legs and/or there is tingling, numbness, weakness in arms or legs, or bladder or bowel control issues. Severe nerve root or spinal cord impingement needs more than exercise or any of the passive therapies.

Overcoming Chronic Neck Pain: When Surgery Isn't Indicated and Other Treatments Don't Help

I am a former pain patient, not a health care professional. My neck pain history began at age 21 with a severe neck strain from doing head swings for a dance step. What followed were 30 years: of neck pain, and trying to avoid the activities that triggered neck pain. I had to be careful using my arms, especially my left arm—for lifting, pulling or pushing anything—actions you pretty much have to do with 3 young children. I self-treated with soft-collars and ice and heat packs. Sometimes they worked and sometimes they worsened the pain.

For many of those years the pain came and went, with relatively pain-free days in between. But eventually every day was pain-filled. That's when I saw an orthopedist. He ordered an MRI that showed how bad the arthritic changes in my neck had become. All the discs between the vertebra had dehydrated, and at 3 levels, the discs were flattened. At the edges of the discs, bone spur complexes poked into my spinal canal close to the spinal cord. In other cross-sections, bone spurs narrowed the spaces through which nerve roots exited the spinal cord, which was the cause of the radiating nerve pain in my left arm.

It seemed obvious that there wouldn't be a miracle cure, yet I was hoping for some pain relief. So my quest began and over the next six years I saw two neurologists, three spine surgeons, a neurosurgeon, two pain doctors, a professor of rehabilitative medicine, a rheumatologist, four physical therapists (for neck, shoulder and back), and an acupuncturist. Treatments included four courses of physical therapy for my neck, two for my torn rotator cuffs, one for my back and one for hips and knees; six weeks of acupuncture; repeat MRI's; a CT scan; numerous epidurals, facet joint and trigger point corticosteroid injections; steroid dose packs, three months of oral low-dose corticosteroids; pain medication; antidepressants; muscle relaxants etc. Some treatments brought temporary improvement, but by the end of six years of going full bore trying to find relief, my neck still wasn't much better, and now I had unresolved pain and limitation in both shoulders, my back, hips and knees. All I'd managed to do was spend tens of thousands of my insurance company's money plus thousands in co-pays from my own pocket.

The pain doctors and at least one, if not all of the physical therapists, believed my next step was neck fusion surgery. But all three spine surgeons said that surgery was a last resort and because my spinal cord wasn't obviously compressed in the MRIs—even though from C4-C-7, the bone spur complexes were large enough to push against the lining (thecal sac) of the spinal canal and at C5-6 pushed against the spinal cord. I also did not have arm weakness from the severe narrowing at the left C-5 nerve root, though I had abnormal muscle electrical (EMG) readings in my upper arm, and long-standing radicular pain down my arm into my thumb. (See my MRI report)

So I was not a candidate for surgery, but I was still in pain and still a "neck cripple." What else was left to try? I'd had the usual therapies except chiropractic, which the first spine surgeon wouldn't prescribe because my cervical arthritis was too severe. Besides, I couldn't tolerate any direct work on my neck. The pain ramped up severely with any kind of neck massage or manipulation, and also with any exercise using my neck or arms.

Hopeless. Anytime I used my arms, even to lift a dinner plate or change the bed sheets, my neck spasmed. Getting through each day took huge effort. Add to that, back pain caused by the only sleeping position—motionless on my back—that didn't leave me with a worse neck in the morning; then the lingering shoulder pain from torn rotator cuffs, which I didn't know what happened to cause them. On top of that was hip and knee pain. And then while the neck/shoulder/back thing was on-going, I caught a stomach virus from a family member that turned into a serious long term illness that partially paralyzed my stomach (gastroparesis). For over 2 years I had severe heartburn, stomach pain, limited ability to eat, weight loss, and weakness... like having stomach flu, 24/7. Then came a three month course of oral prednisone for my neck pain/stiffness followed by a COX 2 non-steroidal anti-inflammatory (Nsaid) and that jump–started a mast cell activation disorder (MCAD) with episodes of anaphylaxis and.... Oh yeah, I really was a total hopeless mess.

But the wheels were turning and one day, as I happened to look at my profile in the fold–out mirror (which was opposite a wardrobe mirror) in my bathroom, I had an epiphany—not that I could cure my neck pain—but that I needed to look better; I needed to stand up straighter and stop looking like a tired, hunched over, old woman. I pulled back my shoulders and was reminded of an exercise a physical therapist had shown me months before, not for my neck, but for my torn rotator cuffs. He called it "Fixing the Shoulder Blades." I had done the exercise when the physical therapist was touching the right spot on my upper back, but I couldn't get a feel for it on my own, so I didn't continue it. But now, in front of a mirror and able to visualize my back, I could see exactly what my shoulder blades were supposed to be doing. I turned to look at my profile as I did the exercise and was amazed at how much better and younger I looked: shoulders back, chest higher, neck over my shoulders instead of out front. Even my head seemed easier to turn, almost as if the joints were oiled.

I did the shoulder blade exercise several times every day—and didn't just go through the motions, but worked hard at gaining control. I held the "pull-down" as an isometric exercise to get the surrounding muscles to tense and "pop out." Very importantly, I reminded myself to straighten my mid-back and lift my chest—not just a few times a day but all the time, every day. (Even now, I find it hard to believe I had that much motivation. But it was me, not my mother or anyone else, telling me to change.)

It was about two or three months later that I realized....not only did I look better and feel better, but surprise, surprise...my neck pain was GONE. So were the headaches, the strange facial pains and twitching, and the crunching in my neck when I turned my head. And best of all, I was able to use my arms again to carry most anything I wanted without my neck going into spasms. I could pull down the lift-gate of my van, grocery shop on my own, carry a purse on my shoulder, go back to gardening. And as long as I took breaks, I could sit at my computer and get work done ...without pain. And finally, I was able to lie on my side to sleep, instead of rigidly on my back; and my morning back pain was gone. FOR THE FIRST TIME IN OVER 6 YEARS, I COULD DO THINGS, EVERYDAY ORDINARY THINGS, WITHOUT PAIN!!!

A simple exercise and a decision to improve my posture. And finally, my chronic neck pain was gone.

flat back postureSounds too easy, doesn't it? But it did take determination. Along the way, I also found I needed to work on my lower body posture. There is supposed to be an inward curve (lordosis) in the lower back that shifts the upper body slightly back and over the hips for support. But my low back was flat (see image), which caused my entire upper body to lean forward, not just my head. I had assumed that my flattened back was from arthritic degeneration because the MRI of my lumbar spine looked almost as bad as the ones of my cervical spine; but all it took was hamstring stretches to release my pelvis, which had been "locked" into a tucked under/flat butt position by short, tight hip extensor muscles (the hamstrings). With my lordotic curve returned, my upper body was squarely over my pelvis—the ideal position of support. Of course not everyone has a flat back, and other specific exercises are needed depending on the particular type of faulty lower body posture. See Effect of Pelvic Tilt and Hip/Knee Hyperextension on Lower Body Posture.

"The best doctors teach their patients" — James Salwitz MD
   ...and so should the best physical therapists!

Why this web site? Well, aside from the usual reasons...whatever those are. I'm astonished and kinda angry that such a simple, basic fix eluded me for so long and also the many medical professionals I went to, especially the physical therapists. If they had evaluated me for what turned out to be faulty posture alignment of my entire body and treated me for the resulting muscle imbalances during the first course of physical therapy, my neck pain would have been fixed, and the torn rotator cuffs, the back, hip and knee pain would never have happened. Neither would the 6 years of daily pain and limitation, the tens of thousands spent by my insurance company, my thousands in co pays, all the paper work—the insurance company's, and the thick binders that PT's filled with evaluations, treatment plans and progress reports. Not that others don't benefit from those same treatments, many do, but they were wasted on me. All I ask of medical professionals, especially the physical therapists, is that when treatments aren't working, stand back and really look at me, at my specific deficiencies. If my posture is terrible, tell me, and explain why it is important to correct it and then what will help me. (Don't assume I know the extent of my poor posture, I need to be shown how bad it is. And don't assume that I could easily change my posture if I wanted too, because it isn't easy to maintain with muscle imbalances that take months to correct. And since posture change takes great effort, I need to know why I should change, I'm hard-headed that way.) Don't keep throwing out the usual one–size–fits–all treatments without getting at the root cause of the problem. (Maybe physical therapists would say they are only allowed to do treatments the doctor orders. Well give the doctor feedback. You, the PT, are the one who received in depth training in recognizing and treating postural imbalance and the physical problems it leads to. And likely one of your textbooks was the classic reference — Muscles: Testing and Function with Posture and Pain by Kendall et al. (5th edition, 2005) — which details much of what you needed to help me. If the doctor's prescription needs changing to do what needs to be done, get it changed! Take the initiative!)

Why this web site, part 2. My neck situation seemed hopeless and as hard as I tried, I could not find the help I needed. Oh, I had plenty of "healthcare"; I was "practiced on" by the "best." Or maybe I was "the zebra" with the rarely encountered problem; and the treatments I received work for 99.9% of neck pain patients, and I just happen to be in the insignificant 0.1%? If so, maybe no one else needs to read any further. But just in case there are others out there like me—in the same seemingly hopeless situation—maybe some of the information I have to share will help.

Please remember, as with all information, no matter how competent or assured the messenger appears, always take with a large dose of skepticism. Everyone's situation is unique and no one solution works for all. Ultimately, each person takes from all the advice and all the possible therapies, and assembles his or her own solution. As well, there are severities of neck injury, degenerative disc disease, and orthopedic problems beyond the scope of any strengthening exercise or correction in posture.

Recommendation #1: Make the most of physical therapy for neck and/or back pain. Ask the doctor to include postural assessment, and treatment if imbalance of postural muscles is found. Ignoring poor posture will delay or prevent healing of both traumatic and overuse neck, shoulder and back injuries. Improving poor posture will also help prevent other posture-related injuries, such as rotator cuff impingement from forward rounded shoulders, and toe/foot pain from forward-shifted center of gravity (more weight borne on the forefoot).
— In my experience, physical therapy for neck pain will not give lasting relief unless hunched upper body posture and weakness in upper back muscles, especially those stabilizing the shoulder blades, is addressed early on.
Recommendation #2: Since faulty posture creates imbalances in muscles that stabilize and move shoulder, hip, and knee joints, physical therapy for these should also include a posture assessment and treatment. Treatment without addressing postural misalignment is counter-productive and a misuse of healthcare dollars. See "Fix the Posture"
May we all be works in progress forever, and celebrate the fact that we are—Marc and Angel Hack Life

Index:

*Fix the Shoulder Blades — The exercise that fixed my neck pain. Why it works and how it's done.

Fix the Posture: Upper and Lower Body — Upper Body Posture in side view; Fand lower body in profile and from the front and back; Handedness posture; Role of pelvic tilt, and angle of hip and knee joints. Wall-standing exercise. Types of faulty posture and specific corrective exercises to rebalance postural muscles.

Posture Types in Profile — Ideal or Balanced Posture, Flat Back Posture, Sway Back Posture, Kyphotic-Lordotic Posture, Kyphotic Back: and exrcises for correction.

Posture and Pain — Pain in Neck, Shoulder and Upper Back Muscles; How Forward Head Causes Pain; How Destabilized Shoulder Blades Cause Neck and Upper Back Pain; How Poor Posture Causes Worsening of Radicular Pain; Cervicogenic Headaches, Shoulder Pain: Rotator Cuff Tears and Frozen Shoulder; Thoracic Outlet Syndrome – Numb Fingers, Hands and More; Aggravation of Big Toe Arthritic Pain and Arthritis; Chronic Pain Worsens Posture

Posture and More — Restricted breathing, Tendency of body to lean forward, imbalance of hip muscles, weakness of abdominals, Slouched Sitting Posture, and the best sitting positions to reduce neck and back pain. The Aging Disc, Degenerative Disc Disease, Mechanics of Spinal Injuries, Effect of Posture on Discs, Slouched Posture into old age. Loss of the normal lordotic curve of the neck.

Articles...Rear and Side View Car Mirrors, comment on Todd Hargrove's "Is "Efficient" Movement Unsafe? My First Fitness Class, the good and the bad. Habit Formation, Exercise and Posture, Neck Pain from Cell Phones and Tablets, About Pillows and Mattresses, Yoga Injuries, Do Glucosamine and Chondroitin help arthritis?  References for two studies on Surgery versus Nonoperative Treatment for Sciatica and Lumbar Spine Stenosis.

Fight Inflammation-Induced Pain — Reducing body–wide inflammation may lessen arthritic  inflammation. The 4 pillars of anti-inflammation: Diet, Exercise, Sleep and Stress Reduction. Mast Cell Activation and release of inflammatory mediators. Histamine Intolerance.

Food Intolerances — More detail on specific food intolerances that may increase body–wide inflammation. Possible connection between dietary lectins specific for acetylglucosame and arthritic and intestinal inflammation. Other specificities of lectins, sulfites/sulfates, processed oils and methods of cooking and AGEs. Oxidized polyunsaturated oils and sulfites, histamine intolerance.

References for Advanced Glycated End Products (AGEs) — Links to abstracts and journal articles about the connection between AGEs and Inflammation, Aging, Chronic Illness, high levels in diabetics and also found in foods etc.

Links — Links to References and books, includes excerpts and comments.

The Clues Were Always There — My Neck Pain History

 

 

 

 

 

© 2017 Rochelle Cocco