Almost everyone will experience lower back and/or neck pain at some point in their lives, even if just in the form of a slight neck twinge after sleeping in an odd position. Spinal pain of the thoracic region (the upper & middle part of your back) is less common, however you might be surprised to discover how important this part of the body can be when it comes to pain and injury.
What is it?
The thoracic region refers to the part of the spine that is surrounded by the rib cage. It consists of 12 vertebrae with discs that sit between each of them. The thoracic spine isn’t an area that you might associate much with movement, however, this area can account for a surprising amount of flexibility, particularly in rotation.
With joint attachments both between each side of the 12 vertebrae and a rib on either side, the thoracic spine has almost more individual joints than you can count. If each of these joints is not regularly moved through their full range they can tighten up and lose flexibility. This stiffness can become quite significant over time.
Why is it important?
Many people may not even notice this lack of movement, primarily because the neck and lower back provide much more range and can usually compensate for any loss of thoracic flexibility to complete everyday tasks.
When there is no movement occurring in the thoracic region, this means that the structures of the joints in other regions are pushed closer to their limits of range, particularly during rotation. This results in more compression and stress on these joints and the structures surrounding them, such as nerves, blood vessels and muscles.
Thoracic stiffness can be a significant risk factor for neck and lower back pain. This can also reduce the mobility of the chest wall, which can result in less efficient breathing mechanics and, in extreme cases, even reduced exercise tolerance. Thoracic spine movement is aslo important for normal shoulder function, as well as maintaining good posture.
How can physiotherapy help?
Your physiotherapist is able to assess your thoracic mobility and help you with treatments to improve your range, both with manual therapy and home exercises. They may even help improve your thoracic flexibility as part of a treatment plan for neck and lower back pain.
If you've been unlucky enough to suffer from chronic or persistent back pain, chances are that at some stage you've had scans to capture what is happening inside your spine. Magnetic resonance imaging (MRI) is an incredible technology that can provide valuable insights into tissues that otherwise can't be seen.
Unfortunately, there are some common misconceptions around what that information means, which can sometimes be unhelpful and even harmful to recovery. Here are a few things you might not realise that can help you understand your MRI...
Not all tissues show up on every scan.
Muscle, fascia, or other irritable tissues may not show up on your scan, meaning you may experience a lot of pain but have a completely normal scan. Not all parts of your anatomy will show up from every scan's perspective and some tissue changes might only be evident in certain postures.
Age-related changes are normal and may not be related to your pain.
Results such as arthritis, disc bulges, and small tears can be concerning. However, it's helpful to note that people who have no painful symptoms can have similar, if not more, age-related changes and these signs may not be related to your pain at all.
Severe pain may not be related to severe changes on MRI.
Pain is a complex experience, influenced by multiple factors including the sensitivity of the tissues involved, what the brain believes about the pain and what it means, and how long it has been present. MRI is helpful for ruling out severe pathology such as infection, fracture, or malignancy, but it is not always an accurate guide to the source of symptoms. The results of an MRI should always be taken into account as a small part of a bigger clinical picture when guiding treatment.
Talk to your physiotherapist for advice on any imaging results you have and what they might mean for your treatment and prognosis. None of the information in this article is a replacement for professional medical advice. Always consult a medical professional for advice on your condition.
What is it?
Headache is a generic term for any pain in the cranial region. They can be caused by a variety of factors and there are many different types. A severe headache can stop you in your tracks and be severely debilitating. One kind of headache that is commonly treated by physiotherapists is cervicogenic headache or a headache that originates from the neck.
What are the symptoms?
The pain of a cervicogenic headache is usually unilateral (on one side), and often described as a dull or aching pain that can be felt in the neck, head, face or even behind the eyes. It can also be accompanied by other symptoms such as neck stiffness, limited range of motion in the neck, and tenderness in the neck or scalp.
How does it happen?
Cervicogenic headache is an example of referred pain, where dysfunction of the structures in the neck cause pain to be felt in a different location. The most common reason for this pain to be felt are joint and muscle stiffness around the cervical spine.
Tight muscles can develop trigger points that refer pain into the cranial region in a typical pattern. Headaches can also be caused by irritated nerves that originate in the spine and travel into the head. Whiplash following a trauma such as a car accident is known to be a cause of ongoing neck-related headaches.
How is it diagnosed?
Diagnosis of a cervicogenic headache can be difficult as it needs to be differentiated from other forms of headache such as migraine, tension headaches and sinus headaches. Your physiotherapist will perform a thorough assessment to determine the origins of your headaches. Some signs that headaches are caused by cervical dysfunction include muscle tightness, joint limitations, concurrent neck pain and poor posture.
What is the treatment?
Treatment for neck-related headaches is aimed at correcting any dysfunction, restoring movement and flexibility to stiff joints and muscles and addressing any postural issues.
Travel can be one of the most enjoyable aspects of life. However if a trip away comes with the risk of increased pain and soreness, the excitement can be thoroughly diminished. Some people may avoid travel altogether if their symptoms are exacerbated too much by long periods of sitting in a car or aeroplane. If you are unlucky enough to fall into this category, here are a few tips from your physiotherapist that might help make long trips a little more comfortable, particularly if you tend to suffer from lower back pain...
1. Adjust the seat angle.
If you are able, tilt the seat slightly down towards your feet, not towards your hips. Ideally, your knees should be level with your hips, or even slightly lower. A footrest to lift your knees can also help.
2. Lift the height of the whole seat.
This will assist with tip number 1 by lifting the whole body away from the floor. When your hips are less flexed, it is easier for your back to sit comfortably in an upright position.
3. Use a lower back support.
Many cars nowadays come equipped with in-built lumbar supports. Often this support is a generic design and not fitted for your specific shape or height. A proper lumbar pillow, or even a rolled towel in the small of the back, can be more effective in maintaining the natural arch of your spine. This eases pressure on your intervertebral discs, spinal ligaments and muscles.
Neck discomfort is easier to improve when tips for lower back are implemented first. Some other simple tips to reduce neck pain are as follows...
1. Use a travel pillow.
If travelling on an aeroplane, try wearing the pillow backwards or sideways. This assists in supporting the head in a slightly better position when you rest or sleep, which helps to reduce the stress placed on the muscles, ligaments and joints of the neck.
2. Every hour, perform 10 chin tucks.
This is easiest to perform correctly if you sit tall and press your chin straight backwards, lengthening the back of your neck. Do not tuck the chin to the chest. This exercise stretches the small postural muscles at the base of the skull, helping to relax them.
If you find these tips helpful, continue performing them throughout your travels and enjoy your time away!
For most of us, screen time and sitting go hand in hand and both are only increasing as our lives move more online. While short periods in any posture aren't harmful, a lack of movement combined with long periods spent in hunched positions can lead to spinal pain, headaches, shoulder pain and more. If you're needing to spend more time in front of a screen, here are a few tips that can help you to keep flexible and avoid pain.
Set movement breaks
Posture in itself isn't always a problem. Spending long periods of time in these postures without taking breaks is the problem. When your body is so used to one position, muscles may become shorter and joints stiffer, making it harder to move out of this posture without pain and discomfort.
You can break up your day by setting a timer to move and take a break every 20-30 minutes. Using these short breaks for movement is a great way to both help focus at work and keep your body more flexible.
Setup your work and home environment properly
Adjusting your work station or setting up a place to relax at home where to you can avoid a hunched posture can help you to reduce time in the same posture. Your physiotherapist can give you tips for how to setup your home and office environment correctly.
Take stock of your time spent sitting
Time in the car, time on your computer and time on the couch can all quickly add up without you realising. By accounting for the amount of time you spend sitting, you can find more ways to move. For example, if you notice that you're sitting down as soon as you get home, try swapping out watching an episode on TV to going for a walk while listening to a podcast.
Ask your physio for specific stretches
If you can identify the posture you spend the most time in, your physio can help you to develop a specific exercise and stretching program to counteract these positions most directly and keep you strong and flexible.
For most of us, the hours we spend sleeping are simply a time for rest and recovery. However, you might be surprised to learn that your sleeping position can have a significant impact on your body, particularly if you already have an injury. Here are some tips to help to stay pain free overnight.
Back pain tips:
For sufferers of back pain, finding a comfortable position at night can be difficult. The natural curves of the spine need to be maintained and supported throughout the night. Ideally, your body should be held in a position of minimal stress while sleeping. This means that all your joints and muscles are resting in a neutral position
A mattress that is too soft might feel comfortable to begin with, but over time will let you sink into it too much, meaning the curve of the lower spine will be lost. Waking up with a stiff or sore back could be a sign that you are using the wrong mattress. A mattress that is too firm can also mean your spine is held in a flattened position, which is both uncomfortable during the night and when you wake up.
For many people, sleeping on their side keeps their spine in a more natural alignment than sleeping on their back, especially if they put a pillow between your knees. If you do sleep on your back, placing a pillow under your knees can help to maintain your lumbar spinal curve throughout the night. This can also help to reduce hip and knee pain.
Neck pain tips:
The neck is often the most vulnerable part of the body if your sleeping setup is not ideal. Side sleepers may let their neck fall excessively to the side with a pillow that is too low or have their neck elevated too much by having their pillows too high.
If you find yourself putting your arm under your pillow while you sleep, it is likely that your pillow is too low. Having your shoulder in this position overnight can put unnecessary stress on the structures around the shoulder joint and should be avoided if possible. Stomach sleeping can also put additional pressure on your neck as it is turned to the side for long periods.
Hip pain tip:
Side sleepers often spend their nights with one leg crossed over their body. This can place extra pressure on the structures on the side of the hip, such as tendons and bursa and can impact the health of these tissues as the compression reduces the blood flow to the area. Placing a pillow under your knee while sleeping on your side in this position can help to maintain a neutral alignment of your hip.
Speak to your physiotherapist for more advice on how to improve your sleeping posture and find out if your sleeping setup is right for you.
What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is a type of inflammatory, autoimmune arthritis that primarily affects the spine. It is characterised by intermittent pain and progressive stiffness due to the inflammation and eventual hardening of the ligaments that surround the spine. The classic early symptoms of AS are pain and stiffness of the sacroiliac joints, the joints connecting the pelvic bones to the sacrum in the lower back. In the more severe, final stages of the disease, the entire spine can become fused and rigid, often in a flexed, forward posture.
As this is an inflammatory disorder, many other systems and joints can also affected. A significant number of people with AS also suffer from irritable bowel syndrome and inflammation of the eye.
What causes it?
The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition. Genetics, chronic stress and frequent gastrointestinal infections are among the predisposing factors. Men are affected more often than women and symptoms usually begin between the ages of 17 and 45 years.
What are the signs and symptoms?
Intermittent back pain and progressive stiffness are the two most common symptoms of Ankylosing Spondylitis. Other tendons and ligaments may be affected, including those in the hands, feet and ribs. Symptoms tend to be worse following periods of rest, particularly first thing in the morning and improve following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.
Some people with AS may experience mild discomfort in the spine from time to time, while others may experience severe and debilitating symptoms at frequent intervals with minimal time in remission. Long term issues with AS include breathing difficulties due to thoracic and rib cage stiffness and severe spinal pain and immobility. Medical treatment focuses on reducing inflammation and slowing the disease process.
How can physiotherapy help?
Physiotherapy treatment aims to manage pain during flare-ups and maintain optimal posture as the disease progresses. Your physiotherapist will assess your spinal movement and posture as well as strength. If your hands, feet, hips or shoulders are affected, they will also provide you with specific exercises to help maintain mobility and strength in those joints. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck.
Why are workplace injuries so common?
The nature of work is that we are often required to complete the same task for hours. We can also find ourselves faced with time constraints and deadlines that lead to poor postures and taking shortcuts, simply to get the job done.
How can they be prevented?
Workplace injuries can happen suddenly, through an accident like a fall or by lifting something too heavy. However, just as many workplace injuries occur over time due to repetitive tasks. Often these conditions begin slowly and take many months to resolve. Here are a few tips to keep yourself pain free in the workplace.
It's important to assess any risk before you start. Do you need to ask for help or use an assistive device? Your legs are the strongest part of your body, so ideally you should use them to power your movement, rather than your arms or back.
Bending and twisting when lifting is also a common mechanism for injury. It is much safer to lift, then step to turn before putting an object down again rather than twisting on the spot. Also, pushing is a more efficient movement than pulling and is always preferable if you have a choice. Try to push at waist height and keep resistance as close to your body as possible.
Overuse injuries can occur by always using the same side of your body rather than alternating sides. Practise using both left and right hands for taking phone calls and using your mouse.
Be aware of your posture. Good posture isn’t just about having a rigid and upright spine, it’s about being able to let your spine sit comfortably in its natural curves and be able to move in and out of this easily. Stretching can help to counteract positions you find yourself in for long periods, and remember, there's no substitute for regular movement. Set an alarm on your computer or phone every 30 to 45 minutes to stand up and move.
A physiotherapist is a great person to speak to about preventing injuries in your workplace, be it about heavy manual work or repetitive, sedentary office work.
Many of us spend more time at our desks than any other place in our waking hours. While the risk of injury from sitting down can seem very unlikely, spending hours in a poorly set up workspace can place a lot of pressure on your body and lead to overuse injuries or postural pain. Below are a few tips that can help you set up your workstation better.
The height of your chair is a good place to begin. Ideally, your feet should be flat on the floor, and if you can adjust the height of the chair, your thighs should be parallel to the floor. If your chair has armrests, they should be low enough to allow your elbows to sit comfortably between 90-110 degrees of bend and rest by the side of your body. A small cushion or rolled-up towel may be added to the back of the chair to add support to the lower back to help prevent slouching.
If you are unable to adjust your chair and it is too high, you can use a footrest to allow your feet to rest comfortably.
The height of your desk should be set so that your arms can rest comfortably at the keyboard and hands, wrists and forearms can sit in a neutral position, parallel to the floor. Where possible, put everything you need within easy reach and alternate days using your mouse and phone with different hands on different days (if you can do this with your non-dominant hand!).
The height of your computer should be raised so that the top of the screen is around eye level. Allowing your neck to rest in a neutral position can help to prevent neck pain and headaches. Ideally, if you can set the screen to be 20-40 inches away from your face, this will reduce strain on your eyes while reading.
Some other tips
Being comfortable is extremely important for productivity and focus. If you are struggling with pain, your work will often suffer. Even joint stiffness and muscle tightness can disrupt your workflow, so taking the time to adjust your workstation can save you countless hours in the long run and prevent painful overuse injuries.
Taking active breaks from sitting to move and stretch can help to maintain muscle and joint health, which can be compromised from being in the same posture too long. You can set a timer or make the effort to take phone calls and video meetings standing, rather than always sitting.
You can speak to your physiotherapist for more personalised advice on your workplace setup.
Have you ever woken up with a stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. Most wry necks are classified as one of two different types – facet (joint) or discogenic wry neck.
Facetogenic Wry Neck:
Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to strain, tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about facetogenic wry neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week.
Discogenic Wry Neck:
The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain.
The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In these cases, it can be challenging to find a comfortable position, and it is more likely for pain or tingling to travel into the arm.
Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.