Neck &

Back Care
Michelle Kwong
B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist
Practice Director
Http://www.painrelief.sg
 SPEAKER PROFILE
MichelleKwong.com
 Qualifications
 Graduated with Bachelor of Health Science (Physiotherapy) in
University of Sydney
 Australia Certified Clinical Pilates Instructor
 Certified Aquatic Physiotherapist
 Member of Singapore Physiotherapy Association
 Experience
 More than 7 years of clinical experience in:
 Physiotherapist

 Clinical Pilates Instructor

 Ergonomics Consultant

 Personal Trainer in Prehabilitation/Rehabilitation

 SPEAKER PROFILE
MichelleKwong.com
 Achievement
 Awarded GOLD Service Excellent by SPRING Singapore 2003
 Principal Physiotherapist and Director of Physiotherapy Clinic

THE PAIN RELIEF PRACTICE

http://www.painrelief.sg
 Vision
 Highly committed to help people with musculoskeletal pains to speedily
recovery with latest clinically proven physiotherapy technologies &
success in mastery of good health and fitness.
TOPICS COVERED
 Structure of the Spine

 Common Spinal Condition

 Causes of Spinal Pain/ Conditions

 Pain Management

 Prevention of Neck/Back Pain

 Exercises for Neck/Back muscles.

SPINE FACTS

5 sections
 Cervical (7 vertebrae)
 Thoracic (12 vertebrae)
 Lumbar (5 vertebrae)
 Sacral (5 fused vertebrae)
 Coccyx (4 fused
vertebrae)
Spine Structure

 Lumbar vertebrae
 Intervertebral disc
 Nerve roots
 Ligaments
 Muscles
Vertebrae

• Skeleton framework
• Support for muscles & tissues
• Protection of vital organs
• Storage of minerals & immature blood cells
 Joints

Allows movement between bones

Intervertebral Disc

The intervertebral disc is a jelly like substance, which

consists of annulus fibrosis and the nucleus
pulposus. Acts as a shock absorber.
Spinal cord
& Nerves Roots
- Nerve roots exit through
holes in the bone of the
spine (foramen) on the
right side and left side.

- Branch out at each level

of the spine.

-The nerve roots innervate

different parts of body.
Ligaments

Ligaments are fibrous

bands or sheets of
connective tissue.

They link two or more

bones, cartilages, or
structures together.
Muscles

Muscles attach to the

spinal column, pelvis,
and extremities.

They serve to support

the spine
Core Muscles

 Deep trunk
muscles- acts as
stabilisers
 ‘Power House’
Causes of
Neck & Back Pain
Causes of Neck & Back Pain

Poor
Carrying Posture

Poor
Sitting Posture
Causes of Neck & Back Pain

Poor
Sleeping Posture

Poor
Working Posture
Causes of Neck & Back Pain

 Overuse e.g. repetitive bending, static posture

 Overstress e.g. heavy object, excessive turning
 Degenerative changes i.e. Wear and tear
 Trauma e.g. fall
 Genetic predisposition
 Physical inactivity
 Mental Stress
 Tumor
Common Problems
Neck & Back Pain
Common Conditions of
Neck & Back Pain
 Joint sprain e.g. locked joint syndrome
 Muscle and Ligament injuries
 Degenerative changes e.g. spondylosis,
osteoarthritis, spondylolisthesis
 Prolapsed Intervertebrae disc (‘slipped’
disc)
 Nerve roots irritation
 Fractures
Compression Fracture

 Usually due to trauma

(very hard pressure or fall)

 Higher risk for osteoporosis/ elderly

Disc Herniation

Stages of Disc Herniation

1 Disc Chemical changes associated with aging

Degeneration causes discs to weaken, but without a
herniation.
2 Prolapse The form or position of the disc changes
with some slight impingement into the
spinal canal. Also called a bulge or
protrusion.
3 Extrusion The gel-like nucleus pulposus breaks
through the tire-like wall (annulus
fibrosus) but remains within the disc.

4 Sequestration The nucleus pulposus breaks through

or the annulus fibrosus and lies outside the
Sequestered disc in the spinal canal.
Disc
Effects of position on disc
‘Slipped’ Disc
Spondylosis
 Degeneration
(Wear and tear)
 Age related
 Activity related
 Previous injury/trauma
Lumbar Spondylosis

Normal 58 yrs old

Degenerative Changes 83 yrs old
Nerve Root Irritation

• Shooting pain down the leg

• Constant pain
• Numbness
• Weakness
Signs and
Symptoms
SIGNS & SYMPTOMS

 Localised pain in the neck/ back

 Diffused pain over a wide area
 Pain radiating to the lower limb
SEVERE SYMPTOMS

 Numbness/ Pins & Needles in the upper/ lower limb

 Weakness
 Constant pain
 Difficulty sleeping/ awaken by pain
 Unsteady with walking
 Inability to control bowel / bladder

 To seek early medical doctor/ physiotherapist advice if

presence of severe symptoms
MANAGING PAIN

- Self Management
- Doctor
- Physiotherapy
- Surgery
Acute Pain Self Management

ACUTE PAIN (1st – 2nd day)

 Apply ‘RICE’
 R: Rest for 24-48hours (NOT Complete Bedrest!)
 I: Ice for 15-20mins,every 2-3hrs interval
 C: Compression with bandage
 E: Elevate
 Avoid ‘HARM’
 H: Heat
 A: Alcohol
 R: Running
 M: Massage
Pain Management Advice

 Avoid activity that may cause pain especially:

- Strenuous activity
- Prolonged activities, repetitive movement
- Heavy loads
 Neck/ Back Support for acute severe pain.
(Not advisable for chronic pain.)

 Heat

 Gentle stretching when pain reduced

Pain Management Advice

 When self management does not work, SEEK HELP

EARLY especially if you are suffering from any
neck/back pain and radiating pain down arms/legs.

The longer your pain condition, the harder for


doctor/physiotherapist to treat, the longer the time for
recovery and more medical fees involved.
Physiotherapy
Goals of Treatment
 relieve pain
 improve joint function
 maintain flexibility
 Strengthening weak muscles
 Achieve a healthy lifestyle
Physiotherapy

 Pain relief treatment

 Heat (Ultrasound, Hotpack, Shortwave)
 Electrical (Interferential, TENS, microcurrent)
 Joint mobilisation/ manipulation
 Massage
 Traction
 Postural Correction
 Sports Taping/ Kinesio Taping
 Core/ Back Therapeutics Exercises
 Return back to sports/work
ADVANCED TREATMENTS:

 COLD LASER THERAPY Spinal Decompression Therapy

- Stimulates immune system
- Generate healthy cells & tissues
- Promotes faster healing (DTS)
- Advanced high tech Traction
- Proven to reduce most neck/back
EM SIGNAL THERAPY symptoms >86%
- Activate & Regenerate cells
- Bone & Cartilage Repair
- Significant pain reduction

 ELECTROACUPUNCTURE
- Non-invasive
- Effects of electrical & acupuncture
therapy to reduce pain & promote
recovery
Physiotherapy
 Education on lifestyle modifications
 Avoid prolong activities
 Avoid strenuous activities
 Avoid heavy load
 Avoid squatting/kneeling prolonged
 Avoid stairs climbing
Medications
Medicines doctors use to treat osteoarthritis include:

 Acetaminophen, which may help relieve pain.

 Nonsteroidal anti-inflammatory drugs (NSAIDs), which
reduce inflammation and relief fever.
 Corticosteroid injections in the joint (intra-articular),
which reduce inflammation.
 Hyaluronan injections, which may relieve pain.
 Opioids, which may relieve moderate to severe pain.
Supplements
 Chondroitin & Glucosamine sulfate
 natural substances found in the joint fluid.
 chondroitin is thought to promote an increase
in the making of the building blocks of
cartilage (collagen and proteoglycans) as well
as having an anti-inflammatory effect.
Glucosamine may also stimulate production of
the building blocks of cartilage as well as
being an anti-inflammation agent.
 Supplements
 CH Alpha (Collagen hydrolysate)
 Only product with a U.S. patent for cartilage
regeneration
 Clinically proven to stimulate specialized cells called
chondrocytes. Chondrocytes control the rate of cartilage
regeneration in joints and detect changes in the
composition of the cartilage. They respond to these
changes by growing more cartilage.
 Studies have shown that CH-Alpha increases the
concentration of collagen and proteoglycans through this
stimulatory effect on chondrocytes.
Surgery
In some cases surgery is necessary, more often it is not
necessary.
Another 6-8 weeks of physiotherapy, at 3 to 5 times per
week.
Lower rate of success, dependent
- Pain
- Increased danger from anesthetic
- Increased danger from possible infections
- Possible post operation complications
(eg pneumonia, DVT, delayed union/nonunion, spinal cord
injury)
- Noticeable scars
Prolonged recovery time, generally 6 to 8 weeks
Prevention of
Neck & Back Pain
PREVENTION IS BETTER THAN CURE!
Prevention of Neck & Back Pain
 Adopt good body mechanics/posture
 Adopt correct lifting technique
 Exercises for a healthy back
 Healthy Lifestyle
 Stress Management
Strengthening Exercises
Healthy Lifestyle

Flexibility
Mobility

Aerobic Strength
Endurance
Healthy Lifestyle
PRACTICAL

 Neck Mobility Exercises

 Neck Strengthening Exercises

 Back Mobility Exercises

 Back Strengthening Exercises

DISCLAIMER:
Exercises shown should be done with caution especially for people
suffering in pain or previous condition. In case of doubt, check with
your doctor/physiotherapist with regards to your condition.
Neck Mobility Exercises

Neck Flexion/ Extension

 Tilt head forward and backward
as far as possible.
 Slow, repeat 8-10 times

Neck Side Flexion

 Tilt head toward shoulder keeping
shoulder stationary
 Slow, repeat 8- 10 times
Neck Mobility Exercises

Neck Rotation
 Turn head from side to side as far as
possible
 Slow, repeat 8-10 times
Neck Strengthening Exercises

Deep Neck Flexors

 Tuck in Chin
 Hold 10 seconds, 8 -10reps

Isometric Neck Extensors

 Giving resistance with clasped hands at
back of head, push backwards with head.
 Hold 10 seconds, 8- 10 reps
Neck Strengthening Exercises

Isometric Neck Side-Flexors

 Place hands on side of the

head and push head
against hands resistance
 Hold 10seconds, 8-10reps
Back Stretching Exercises
Bent Over Stretch

 Hold the back of a chair with your

arms shoulder-width apart.
 Walk backwards as you bend
forward from the hips and
straighten out your arms.
 Keep your feet together, your back
straight and your head between
your arms in line with your spine.
 Hold for 10 – 30secs
Back Stretching Exercises
BACK EXTENSION & SHOULDER
BLADE PINCH
 Stand with feet apart & lean
backward to the point of tension with
arms reaching back.
 Tighten shoulder blades and lower
back muscles.
 Feel a mild stretch on your
abdominals.
 Hold for 10-30secs
 Back Stretching Exercises
Lower Back Stretch

 Stand with feet hip-width apart.

 Come into a squat position by bending

your knees and pushing your buttocks
backwards. Place your hands on your
thighs.

 Pull belly button toward your spine as

you tilt or curl your pelvis under.

 Return to starting position.

Stomach Hollowing

Strengthens Transverse Abdominus

 Breath out and relax your stomach muscles
 Pull lower part of stomach inwards and upwards
 Hold 10 seconds and perform 8-10reps
 Crook lying, sitting, standing
High Plank

Strengthens the chest, shoulders, triceps,

buttocks, hamstrings & trunk.
 Start on your hands and knees. Arms should be
directly under your shoulders.
 Extend one leg back at a time until your body weight is
supported on your arms and toes.
 Hold for 5-10seconds, perform 8-10 reps
Back Strengthening Exercises

Bridging Exercises
 Lie on the floor with your knees bent, feet flat.
 Tighten the muscles of your lower abdomen and
buttocks.
 Slowly raise low back and buttocks from the floor
 Hold for 5-10 seconds, do 8-10reps
Back Strengthening Exercises

Low Back Extensors

 Lie face down on a mat with your arms beside you and
your legs together.
 Lift your head and shoulders off the mat by squeezing
the muscles in your lower back. Keep your feet on the
floor.
 Slowly lower to the mat.
 Hold for 5-10 seconds, do 8-10reps
Summary
 Prevention is better than cure.

 When self management does not work,

SEEK HELP EARLY if you are suffering
from any neck/back pain or any radiating pain
down arms/legs.

 LIVE A PAIN FREE LIFE!

QUESTIONS
& ANSWERS
If you have any queries, please feel free to email Michelle at
michelle@painrelief.sg
Or call 67355368.
 THANK YOU
Presented By:

Michelle Kwong
B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist
Practice Director

World Malayali Club

http://groups.yahoo.com/group/worldmalayaliclub/
Disclaimer
 The Pain Relief Practice Educational Material is for information
only. This information is not intended to diagnose, treat, or
cure any medical/health condition. It is not a substitute for
formal, real world medical or physiotherapy care, and should
not be considered as such. The Pain Relief Practice is not in a
position to independently evaluate any of the advice or claims
on behalf of any particular therapy. Any information or
suggestions we provide should be discussed with your doctors
or physiotherapist in real person when treating your condition.
Our discussion of possible pain treatments are just options
which may be significantly limited by the incomplete full
physical examination of a doctor/physiotherapist.