Neck Pain – Wry Neck

Managing sudden neck pain on your own can be difficult. Whether you’ve had an injury or just woke up with it, physio can provide the right type treatment.

Have you ever just woke up with neck pain? Well you’re not alone. Up to 75% of the general population suffer with an episode of neck pain once in their lives.

Usually it comes on suddenly, from some non-traumatic event causing severe pain and stiffness of the neck. Which can be quite debilitating. Often occurring when waking up, if the head has been held in a prolonged position or turning the head quickly in a particular direction.

This can be particularly concerning when not being able function with your neck the normal way. The reassuring news is that it can be treated with physio and resolved using the right type of treatment, in a short period of time.

Wry Neck Symptoms

  • Neck stiffness – Your range of movement becomes severely limited. Usually locked up away from the site of pain.
  • Pain – Extreme pain localised to the centre or side of the affected area. Often radiates into the shoulder.
  • Muscle spasm – The injury usually leads to muscle spasm of the surrounding neck muscles and causes further restriction in neck movement.

Causes of Wry Neck

There are several theories of what causes a wry neck. The most common one being the small facet joints (two on each side of the vertebra) become irritated or injured when held in a prolonged position or moved quickly. This causes the increased pain, movement restrictions and muscle guarding.

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The other cause of a wry neck is an injury to the disc. Whether it be a bulge or strain of the disc wall, it can cause inflammation and place pressure on nerves that branch out of the neck. This may result in pain that radiates down the arm or cause altered sensation. If you experience this altered sensation it is important to seek professional advice. Discogenic neck pain might take longer to recover than a facet, but still responds well to physiotherapy.

Treatment Options

The good news is that a wry neck can be treated conservatively with physiotherapy treatment techniques and exercise. Physiotherapy can offer manual therapy techniques to loosen the stiff joints and soft tissue release for the muscle spasm. Dry needling may also help with reducing the muscle spasm and strapping can help during the acute pain.

Once the pain has gone and movement has returned, it will be important to consider prevention in the future. Strengthening and postural correction exercises for the neck, along with advice on ergonomics for your work environment may be needed.

Ideally seek treatment within the first 24 hours to start with the right advice for dealing with this injury. After a thorough assessment you will receive the best treatment and appropriate exercises to help you recover from your neck pain.

For an appointment, call on 095290990 

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

What’s wrong with my knee?

Knee injuries are very common during sport and at work. For a faster recovery see your Dr or Physio to understand what structure you have damaged and how to rehab the injury effectively.

A knee sprain managed correctly will allow the tissue to heal fast and strong. Getting you back into what you enjoy most.

The knee is one of the most common joints injured in the body. A joint that absorbs a huge amount of force when running, jumping and lifting. Fortunately the femur and tibia are surrounded by many structures, but it’s usually these supporting structures that take the stress when we have an injury.

What could I have damaged?

Ligaments: About 40% of injuries to the knee involve ligaments either by a sprain or tear. These structures help give extra stability to the knee. When it has been put under excessive tension it damages the fibers. This results in pain, swelling and instability.Ligament injury knee

Patellofemoral: 24% of injuries are involving the knee cap. The patella sits within a small channel and if not guided correctly from surrounding muscles and ligaments pain can develop. This becomes particularly sore when squating, running and even basic functions like climbing stairs and sitting.Patella dysfunction

Meniscus:  11% involve the meniscus. It is fibrocartilage that sits within the knee, providing a level of stability to the ligaments and an element of shock absorption when weight bearing. This can cause a lot of swelling, pain and restrictions. In some cases the knee may lock in certain positions.

Knee injury meniscus

Other Injuries: The remaining 25% consists of fractures to knee, dislocation of the patella, Iliotibial band syndrome, hamstring and quads strains/tears etc.

What to do if I’ve injured my knee?

Firstly if you’ve just injured your knee and struggling with weight-bearing seek medical attention, where a Dr may consider an Xray, prescribe medication and will likely refer you to a physiotherapist. If the symptoms are not too severe, but you’re still concerned, come straight to physio. At Fundamental Physio Newmarket I can provide you with the following:

  • A detailed assessment of your knee using a range of tests to identify the structures involved, also looking at the mechanics of the hip and ankle.
  • Manual therapy to encourage normal movement and faster rate of healing.
  • A personalised exercise program for your identified weakness’. This may involve strength exercises, stretches and balance exercises.
  • Biomechanical assessment and correcting movement dysfunctions that may delay your recovery.
  • Providing you with an understanding of the structures affected and a treatment plan to meet your overall goals.
  • If recovery is slower than expected referrals can be made for Xrays/scans to sports or orthopaedic specialist.

Fundamental Physio Newmarket is supported by ACC. If you have hurt the knee during an accident, whether it was at home, work or on the sports field you will receive treatment cover for the injury.

For an appointment, call on 095290990 

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty

Trigger points – what are they?

Trigger points are the most common source of muscle pain. There are many factors that affect a trigger point and for best results they should all be identified.

I’m going to put a wild bet out there that everyone has a trigger point in at least one muscle of their body. Some have more than others. Who of you are regularly rubbing their shoulders or elbows? More and more we are sitting at the computer or looking down at our phones (sorry for writing this blog) causing prolonged tension on muscles around the neck and shoulder, resulting in the development of trigger points.

What is a Trigger point?

It is defined as a hypersensitive palpable nodule in taut bands of muscle fibers. Meaning very small bundles of muscle fiber have become contracted/”knotted” due to a chemical imbalance within the tissue.  The area is very painful and can cause you to jump or cramp on palpation. It can cause referred pain, weakness and restriction through movement. Which makes doing normal activities and training difficult.

Triger Point diagram
Diagram of trigger points within a muscle

Trigger points of individual muscles have a very specific referred pain pattern and can mimic other problems. For example pain in the forearm and wrist can be referred from Infraspinatus, a shoulder muscle. Without a detailed assessment and clearing other areas this could be misconceived as a tennis elbow.

What causes a trigger point?

A TP can be brought on in a number of ways. 

  • Poor postures held for a prolonged period, causing certain muscles to work harder while trying to support structures like the head, eventually causing TP’s.
  • Repetitive strain on muscles from overuse over multiple days, weeks and months. How many clicks of the mouse or typing are your doing? How much swiping of the smartphone? These repetitive movements take their toll.
  • Emotional stress and poor sleep can cause muscle tension. Particularly the neck and shoulder muscles.
  • A lack of movement will develop TP’s when sitting or on bed rest for a prolonged time.
  • Heavy lifting can cause the development of TP’s when the muscle is placed under excessive loads which it is not familiar with.
  • Trauma to a muscle, either as a reflex to pain or overcompensating for the weak and injured structure. This is quite common with car accidents or sports injuries.

Our muscles sit within a biochemical “soup” of  hormones, nerve transmitters and chemicals, all affecting the PH and Oxygen levels of the tissue. Your body knows the perfect recipe to keep everything balanced, but when we overload it with one or more of the above, it causes changes to the recipe, resulting in a drop in PH (becoming more acidic) and reduces the oxygen supply. This leads to the development of TP’s.

How do we treat a trigger point?

Your desire to change must be greater than your desire to stay the same. 

The following treatments for trigger points will help settle them down, but if we provide the same environment they will return.

  • Trigger point release – sustained manual pressure applied to the trigger point causes increased blood flow to remove toxins from the area, interrupts the pattern of pain and spasm and encourages the production of natural pain relieving endorphin’s.
  • Trigger point dry needling – There is a growing evidence base for trigger point dry needling. The needling causes local twitch responses which are a central nervous system reflex. This helps disrupt the pain feedback loop but also reset the acidic biochemical “soup” the muscle is sitting in, back to its normal levels.
  • Myofascial release – the surrounding tight myofascial tissue that feeds into and over the trigger points could also be restricted, causing further exacerbation of the area. Using this technique will give some length back to these structures and can alleviate the trigger point.

Once the hands on therapy has been applied it is not the end of treatment. The muscles with the TP’s will need to be stretched to help prevent their return. Postural correction and stability exercises for surrounding muscles may need to be followed. Changes ergonomically may need to be enforced to prevent falling back into poor habits. Also looking at ways of alleviating stress through improved sleep, meditation, breathing techniques and increase of general exercise.

All of these factors will need to be considered to provide long lasting benefit and avoid their return.

  1. Travell & Simon (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual
  2. Shah et al (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies
  3. Simons, (2008), New Views of Myofascial Trigger Points: Etiology and Diagnosis, Archives of Physical Medicine and Rehabilitation

Myofascial Release

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

What is Myofascia?

Fascia is the largest system in the body with the appearance of spider’s web. Fascia is very densely woven from the top of the head to our toes, covering and interpenetrating every muscle, bone, nerve, artery and vein, all our internal organs including the heart, lungs, brain and spinal cord. In this way, you can begin to see that each part of the body is connected to every other part by the fascia, like a fitted suit.

How would it affect me?

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

I’d like you to try something. Reach behind your back with your right hand, grab a handful of the shirt/top in the middle of your back. Now try and lift your left hand above your head, it will likely be restricted and wind up in certain areas. Think about the tightness and restriction you might feel doing an overhead lift or in the back when squatting, it could be the fascia pulling on these areas.

One study has shown that tightness in the posterior neck muscles can cause a significant decrease in hamstring length and strength. (1)

What causes it to get tight?

Postural adaptations, trauma, inflammatory responses, and surgical procedures create myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, MRI scans, etc.)

What does Myofascial release involve?

The MFR technique appears quite light as it puts a slow sustained shearing force on the superficial layer of fascia that lies beneath the skin. The superficial layer taps into other deeper structures within muscle and other systems of the body. There is no oil used as it allows for more feedback detecting for fascial restrictions into the therapist’s hands. There is extensive evidence that shows myofascial release is an effective tool in improving flexibility and reducing pain (2,3,4,5)

How does it differ from a deep tissue massage?

With DTM this is more directed to muscle tissue that has adhesions or is tightened and needs deep pressure to bring back some length and lower its tone. Although the deep pressure can be painful depending on how sensitive the tissue is and pain tolerances of the individual.

 

  1. McPartland et al (1996) Rectus capitis posterior minor: a small but important suboccipital muscle, Journal of Bodywork and Movement Therapies
  2. Hsieh et al,  (2002) Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine.
  3. Wong, K.-K. et al, (2016) Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men – a study of dynamic ultrasound. Physiotherapy
  4. LeBauer et al, (2008) The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther.
  5. Ajimsha et al (2012) Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch. Phys. Med. Rehabi.
  6. Ajimsha, M.S. et al, (2014) Effectiveness of Myofascial release in the management of chronic low back pain in nursing professionals Journal of Bodywork and Movement Therapies