CERVICAL SPINE REHABILITATION

Physical Therapy Evaluation

Once all this information has been gathered, an evaluation of your neck condition will begin.

Posture/observation:

Your physical therapist will begin by checking your posture to see if your soreness comes from poor posture.  Imbalances in the position of your spine can put pressure on sore joints, nerves, and muscles.  Postures used for a long time at school, with hobbies, or when working can change the balance of muscle strength and flexibility.  Muscles stretched over time tend to get weaker, while muscles placed in shortened positions can begin to overpower the weaker ones.  This can put added strain on areas around the neck that can cause a problem or make a sore area worse.  Helping you improve your posture can oftentimes make a big difference in easing pain.

Cervical Spine Rehabilitation Range of motion (ROM)

Next, your physical therapist will check the ROM in your neck.  This measurement evaluates the movement of your neck in different directions.  Neck movements include bending the neck forward and backward (flexion and extension), bending to either side (side bending), and turning the neck to one side and the other (rotation).  Measurements may also involve the upper back and/or shoulder movements.  Your ROM is written down to compare how much improvement you make with the treatments.

Neurological screen

Your physical therapist may need to do some tests to check the nerves of your neck.  This part of the evaluation looks at your reflexes, sensation, and strength in your neck, shoulders, and arms.  The results of these tests can help your physical therapist know which area of the neck may cause problems for you and can guide the type of treatment to help your condition.

Manual examination

Your therapist may undertake a manual examination of the muscles and joints of the neck. Your physical therapist will carefully move your neck in different positions to make sure that the joints are moving smoothly at each level of the neck.  This will help guide treatment to a tight joint (called a hypomobility) or a possible injured joint that moves too much (called hypermobility).  As your physical therapist looks at the flexibility of the muscles around your neck, he or she will move your neck.  This type of examination can help guide your therapist to identify where your soreness originates and which type of treatment will help you the most.

Cervical Spine Rehabilitation Special Tests

Additional special tests may occur if your physical therapist thinks your neck pain emanates from other areas or causes. Other areas that may need examination include:

• Thoracic outlet:  This consists of a group of nerves and vessels that make their way out of the chest cavity and travel down the arm.  Problems in this area can cause numbness, pain, or even coldness in the arms and hands.
• Temporomandibular joint (jaw):  Problems in this area can cause headaches, pain in your upper neck, and even spasms in the muscles of the neck.
• Thoracic spine:  Problems beginning in the upper back can include joints and muscles of the thorax or even in the alignment of one or more ribs, which can cause pain to radiate toward the neck and shoulder.
• Nerve tension:  Nerves of the mid and lower neck travel down the arm to service the arm and hand.  Irritation or scarring around the covering of these nerves can cause pain that radiates from the neck to the upper back or even into the arm.  By locating scarred or irritated areas along the nerve, a treatment called “neural mobilization” can free up movement in the nerve and ease the soreness you feel.
• Ergonomics:  Provides a way to look at where and how you do your work or hobby activities.  Your physical therapist may want to understand your ergonomics to figure out if your activities make your condition worse.  Sometimes even simple corrections to your hobby or workstation can make a big difference in easing neck symptoms.

Palpation

The evaluation usually ends with palpation. A palpation exam identifies the soft tissues around the neck.  This exam checks the skin for changes in temperature or texture, which could identify inflammation or nerve irritation.  A Physical Therapist also conducts a Palpation exam to find whether there are tender points or spasms in the muscles around the neck and upper back.  This too can give your therapist a good idea about which treatments will help you the most.

Cervical Spine Rehabilitation Treatment Plan

Your therapist will put together a treatment plan upon completing the examination.  The treatment plan lists the types of treatments for your condition.  It gives an indication of how many visits you will need and how long you may need therapy.  The plan will also include the goals that you and your therapist think will get your activities done safely and with the least amount of soreness.  Finally, it will include a prognosis, which summarizes how your therapist’s treatment plan will help you improve.

Physical Therapy Treatment

Easing pain

Your therapist may choose from one or more of the following tools, or modalities, to help control your symptoms:

Rest

Resting the painful joints and muscles helps calm soreness, giving your neck time to heal.  If you are having pain with an activity or movement, it should signal that irritation continues.  You should try to avoid all movements and activities that increase your pain.  In the early stages of your problem, your doctor or therapist may want you to use a soft or hard neck collar to limit neck movement nearly completely.

Specific Rest

Specific rest encourages the safe movement of the joints and muscles on either side of a painful area while protecting the sore spot during the initial healing phase.  Select exercises can encourage the safe movement of the shoulders and upper back.  If you’ve been prescribed a collar, your instructions will direct you to take it off a few times a day so you can do some gentle and controlled exercises.

Positioning

The results of the evaluation will give your therapist a clear picture of ways you can position your neck for the greatest comfort.  A special pillow called a contour pillow, may help get your neck in the most comfortable position while sleeping or resting.  A commercial neck roll, or even a rolled towel, can slide inside your pillowcase so that when you lie back, the roll fills in and supports the curve in your neck.  Other special ways to rest your head and neck may come from your therapist to help take away the arm pain that comes from your neck.

Ice

Ice makes the blood vessels in the sore area become more narrow, called vasoconstriction.  This helps control inflammation that causes pain.  Some ways to put ice on include cold packs, ice bags, or ice massage.  Cold packs or ice bags are generally put on the sore area for 10 to 15 minutes. Ice massage works by rubbing an ice cube or ice cup on a sore spot or tender point.  It’s as easy as freezing a small paper cup full of water.  Once the water freezes, simply tear off the top inch of the cup and rub the exposed ice on the sore spot for three to five minutes, or until it feels numb.

Heat

Heat makes blood vessels get larger, called vasodilation.  This action helps to flush away chemicals that are making your neck hurt. It also helps to bring in nutrients and oxygen which help the area heal.  True heat in the form of a moist hot pack, a heating pad, or a warm shower or bath provides an excellent method of heating the neck.  Hot packs are usually placed on the sore area for 15 to 20 minutes.  Special care should take place to make sure your skin doesn’t overheat and burn.  It’s also not a good idea to sleep with an electric hot pad at night.

Ultrasound

An ultrasound machine produces high-frequency sound waves that are directed toward the sore area.  Passing through the body’s tissues, these waves vibrate molecules.  This causes friction and warmth as the sound passes through the tissue.  The rest of the sound changes to heat in the deeper tissues of the body.  This heating effect helps flush the sore area and brings in a new supply of nutrient and oxygen-rich blood. Ultrasound treatments are a way for your therapist to reach tissues that are over two inches below the surface of your skin.

Phoresis

This means to “carry or transmit.”  There are two methods that therapists can use to transmit substances across the skin.  Phonophoresis uses the high-frequency sound waves of ultrasound to “push” a steroid medication (cortisone) through the skin. Iontophoresis uses a small machine that produces a mild electrical charge, which carries medicine, usually a steroid, through the skin.  The steroid acts as an anti-inflammatory medication that actually stops the pain-causing chemical reaction within the cells of the sore tissue in your body. 

Cervical Spine Rehabilitation Electrical Stimulation

This treatment stimulates nerves by sending an electrical current gently through your skin. Some people say it feels like a massage on their skin.  Electrical stimulation can ease pain by sending impulses that are felt instead of pain.  Two respected scientists discovered a theory, called the Gait Theory.  This theory says that when you feel a sensation other than pain, like rubbing, massage, or even a mild electrical impulse, your spinal column will actually “close the gate” and not let pain impulses pass to the brain.

In the case of electrical stimulation, the electrical impulses speed their way across the skin and onto the central nervous system much faster than pain.  By getting there first, the electrical information “closes the gate” to pain, blocking its passage to the brain.  Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.  Other settings on the machine can help your body release endorphins.  These are natural chemicals formed within your body that behave like a strong drug in reducing the perception of pain for up to eight hours at a time.

Soft tissue mobilization/massage

Physical therapists are trained in many different forms of massage and mobilization when treating the neck.  Massage calms pain and spasms by helping muscles relax, bringing in a fresh supply of oxygen and nutrient-rich blood, and flushing the area of chemical irritants that come from inflammation.  Soft tissue treatments can help tight muscles relax, getting them back to a normal length.  This will help you begin to move with less pain and greater ease.  Physical therapists have special training in a variety of different ways to mobilize or massage.  These can include gentle strokes, called effleurage.  Myofascial release techniques help restore better movement by getting the thick layer of fascia below the skin and around muscles to “give”.

Strain-counter-strain therapy helps when tender points are causing muscles to restrict movement.  The treatment places the muscle in a special position.  The position is held long enough to “reset” the nerve input to the muscle.   Another method occurs when your therapist places your muscle in a certain position and then directs you to use your muscles against the therapist’s force.  As you relax, your therapist will gradually “take up the slack”, stretching the muscle.

Cervical Spine Rehabilitation Joint mobilization

These are graded pressures and movements that are practiced by skilled physical therapists.  Gentle pressures help lubricate joint surfaces, easing stiffness, and helping you begin moving with less pain.  Unchecked pain can quickly escalate to an uncomfortable “cycle of pain and muscle guarding.”  In other words, the pain can make your muscles go into spasm, in which your muscles try to guard the sore joints, keeping you from wanting to move your neck at all.   

When movement stops, your brain gets an uninterrupted flow of pain sensation.  This leads to a cycle of even more muscle spasms and pain because your muscles try to “protect” you from painful movement.  By applying gentle pressures, or mobilizations, your therapist will begin to halt the flow of pain information, which helps muscles relax.  Once your muscles begin to relax, you will begin to feel other sensations than pain.  As your pain eases, more vigorous grades of mobilization will lengthen tissues around the joint to help restore better movement in your neck.

Traction

Sore joints and muscles in the neck often feel better and show relief upon traction being implemented.   Your therapist will test at first to see if you can get relief with this type of treatment.  Traction can be done in a variety of ways.  There are traction machines that allow you to relax comfortably with either a halter or cushion behind your neck.  The machine pulls on this halter or cushion for a certain amount of time and pressure. Manual traction allows your therapist to put a graded pull on your neck.  There are also traction devices that you can use at home.  The amount of pull used will depend on your condition. A gentle on/off pressure may provide early help to control pain.  If a joint appears mildly sore or tight, more vigorous traction can help take away the pain. 

Exercises for Cervical Spine Rehabilitation

Strengthening your neck

Exercise plays an important part in all stages of recovery from neck pain.  As you get better, the therapist will introduce different types of exercises.  Supporting your neck in certain positions as suggested by your therapist can take the pressure off sore or injured areas.  These positions become somewhat easier to get into by using a pillow, rolled towel, or commercial neck roll.   You may need to relax back on a recliner or mattress for the best results.  In cases of significant pain, you may receive a set of breathing exercises.  Deep, diaphragmatic breathing, helps air to reach even the lower lobes of your lungs.  Combining deep breathing with a slow relaxing count can help muscles relax while bringing much-needed oxygen to sore tissues.  Neck pain can cause physical and emotional draining.  Relaxation exercises may not correct your problem, but they can help control pain and its accompanying stress.

Movement

When your neck is still painful, movement is also important.  Careful movements suggested by your therapist can safely ease pain by providing nutrition and lubrication to injured and sore areas.  The movement of joints and muscles also signals the nervous system to block incoming pain.  Common movement exercises include an active range of motion, in which you are encouraged to move your neck in directions that don’t hurt.  Your therapist will evaluate the movements that are the safest and best for you.  In some cases, the pain will ease with the addition of pressure in one or another direction.  Again, your therapist will need to determine which movements are best for your condition.  Avoid movements that hurt or seem to irritate the soreness in your neck.

Changing Exercises

As your neck becomes less painful, the exercises will change to focus on improving the overall health of your neck.   These changes will focus on exercises for:

• Flexibility
• Strength
• Coordination
• Aerobic conditioning

Exercises that increase flexibility help to reduce pain and make it easier to keep your neck and spine in a healthy position.  Tight muscles cause imbalances in spinal movements.  This can make the injury of these structures more likely.  Flexibility exercises for the neck, chest, and upper shoulders can help in establishing safe movements.  A slow progression of stretching exercises can increase flexibility in these areas, ease pain, and reduce the chance of re-injury.

The next stage of exercise focuses on the strength of the muscles that support the neck.  These muscles help bring the spine into a safe position–and keep it there!  Trained muscles can keep your neck healthy by getting it into a better posture.  A series of strengthening exercises, called stabilization training, provides a method to get a better balance in the muscles around your neck, chest, and upper back.  These stabilization exercises help support your neck in safe positions while you are working or when you are doing other daily activities.  Strengthening and stabilization exercises are simple to do at home and don’t have to require any expensive equipment.  By practicing these exercises often, you will become comfortable keeping your neck in healthy positions and postures with all your activities.

Training Muscles

Strong muscles need to coordinate with other muscles.  As the strength of the spinal muscles increases, it becomes important to train those muscles to work together.  Learning any physical activity takes practice. Muscles must undergo training so that any physical activity occurs safely.  To control the safe movement of the spine and help reduce the chance of injury, muscles need training.  You will learn exercises to help train your neck, chest, and upper back muscles to work together in protecting your spine.

Finally, your overall fitness will be prioritized.  The word aerobic means “with oxygen”.  By using oxygen as they work, muscles are better able to move continuously, rather than in spurts. Fitness training allows the muscles to become more efficient at obtaining nutrients and oxygen from the blood.  As the muscles use up the nutrients and oxygen, chemical waste products are created that can cause pain.  Training also increases the ability of muscles to get rid of these waste products.

The Benefits of Exercise

Exercise possesses other benefits as well.  Vigorous exercise releases chemicals called endorphins into the blood.  These chemical hormones act as natural pain relievers in reducing your pain.  Picking an aerobic activity to keep you in shape will provide hours of enjoyment as well.  

Prevention and Long-Term Cervical Spine Rehabilitation for the Neck

Is this your first experience with a neck problem?  Maybe you’ve had ongoing problems for many years.  In either case, your best bet for avoiding neck problems consists of understanding what causes injuries to the neck and what can minimize any incurred future injury.  If pain strikes again, you will know how to take care of your neck early on to prevent further injury.

Posture

Using a healthy posture provides a defense shield against future neck problems.   When your joints are positioned in their safe. or neutral posture, the body works as an elegant machine.  It works safely and even more productively.  When unbalanced postures are used, problems are more likely to happen.  Prevention of neck pain and injury has a lot to do with keeping a balanced position of the spine and extremities.  When standing, this balance follows a plumb line from ear to ankle.  In a seated position, this line descends from the ear to the hip.  A rule of thumb for the extremities is to keep them in their relaxed positions.

There are three natural curves in the spine.  From a side view, the neck (cervical spine) curves slightly inward.  The mid-back (thoracic spine) curves slightly outward.  The lower back (lumbar spine) curves slightly inward. Keeping this relationship while standing, sitting, or moving provides the basis for healthy posture.  When moving, bend at the hips to avoid rounding or straightening the spine.  This keeps the spine safe during activities like lifting and walking.

Sitting Posture

For better sitting posture, sit with a good upright alignment of the spine by using a comfortable chair designed to support correct posture.  Avoid slouching by keeping your lower back against the back of the chair. Bending the head forward strains the neck and affects the nerves and arteries leading to the arms.  You should relax your shoulders, and the elbows, hips, and knees should bend at right angles (ninety degrees).  Avoid pressure on the back of the knees.  Your feet should lay flat on the floor or supported by a footrest.

Awkward posture places stress on the body, which can lead to neck pain.  Slouching with the spine or leaning the head forward puts the body out of alignment, causing the limbs to be stretched and bent.  Too much bending (flexion) or straightening (extension) in the spine increases the risk of injury.  Symptoms of pain, tingling, or numbness in the arm or hand may also come from poor neck posture.  The slight inward curve of the neck balances the head on the spine.  Avoid extreme postures, like gazing up at the stars, or bending your head down for long periods when reading a book.  Keeping a balanced posture provides a measure you can use to prevent further injury and pain in your neck.

Ergonomics

Ergonomics studies the way people do work.  What does ergonomics have to do with the ache in your neck?  It could have a lot to do with it. It’s possible that even minor changes in the way you conduct your work or hobby activities could ease the pain you feel now while preventing further neck injury or pain.

In some cases, it is best to have someone trained in ergonomics, like a physical or occupational therapist, check your workstation, and the way you do your work.  The first step will ask you some questions about your work, which makes good sense.  Since you’re the one doing the job, your expert opinion about what changes should occur provides important suggestions.  Once an evaluation concludes, the evaluator will want to watch you do the work.

Evaluation

Areas evaluated include the postures you use, repetitions to complete the task, rest time between tasks, and the amount of weight you are dealing with. For office workers, the examiner will look at the alignment of the computer monitors, chairs, desk heights, etc.  Other areas evaluated include work heights, tools of the trade, lighting, and temperature.  It’s also helpful to look at your work postures and work tasks to see if what you are doing can be done with less stress and strain on your body.

Results

When the worksite evaluation finishes, you or your supervisor will receive recommendations.  Some of these may include some of those that came up with!  Ergonomics doesn’t always have to involve expensive changes.  Even minor adjustments can make a huge difference in easing your pain and preventing further problems.

Cervical Spine Rehabilitation Workplace Strategies

These strategies are ideas of how to work with greater safety and even better productivity.  Have you ever felt stress or tension at work?   Chances are good that you wouldn’t have pain or worry if you didn’t.  They are faced with more responsibility and more deadlines to get their tasks done.  The health of your neck may be at risk with these mounting pressures.  But scientists have helped us learn that there is a defense in the face of these mounting pressures.  They have shown the importance of using the “Three R’s” to help ease tension and reduce neck pain at work. Here are the three Rs:

Rest

This includes taking frequent breaks during work hours.  It also means choosing alternate activities to get your mind ready for a new job task. Activities include deep breathing, walking, napping, or exercising.

Relaxation

Take a load off.  Lie back.  Turn down the lights, and listen to your favorite tape or CD.  Attempt to breathe slowly and deeply, allowing your abdomen to rise and fall rhythmically. Using visual imagery can also aid in relaxation.  Try to visualize each muscle relaxing one after another.

Recovery and Cervical Spine Rehabilitation

Our bodies need a chance to heal.  Repeated and prolonged activities can take their toll if the body doesn’t get a chance to recover.  Recovery helps repair these sore and achy tissues along the way, keeping them healthy.  Whether at work or at home you can use these ideas to help prevent neck pain and injury.  Here are some additional tips to use at work to avoid tension and keep your neck healthy:

• Be Relaxed.  Try to work with your muscles relaxed.  To stay relaxed, look relaxed.
• Pace Yourself.  Keep an even keel. Avoid sudden changes in your workload.  Try to avoid last-minute “panics” to meet deadlines.
• Take a Break.  Take a thirty-second “microbreak” every twenty to thirty minutes to do some deep breathing and a few exercises.  Patients should take a few minutes each hour to do some exercises, get a drink, or go bug a coworker.  Use your lunch break to take a nap or a walk.
• Change Positions. Avoid holding your neck, trunk, or limbs still for a long time. Plan ways to get the job done using different positions. Sit for a bit–then stand for a bit. Or simply readjust your approach to the task.
• Rotate Duties. Rotating or sharing your tasks can be fun by offering a new work setting while giving your body a chance to recover.
• Avoid Caffeine and Tobacco. These can heighten stress, reduce blood flow, and elevate the awareness of neck pain.

Taking Care of Your Neck for Cervical Spine Rehabilitation

If you’ve had neck pain once, there’s a fair chance you’ll have it in one form or another in the future. When pain comes back again and again, it refers to recurrent pain. Even though you may have been treated for neck pain or problems in the past, it’s not a guarantee you won’t have pain again. The question then for our patients:  Can you take care of your neck if soreness does return?

Your therapist will probably give you a thorough home program when you get done with your treatments.  Some of the exercises will be helpful to keep up with as a way to keep your neck healthy over time.  You may also be given ways to help control pain or symptoms if they don’t go completely away, or if they return in the future.  Although there are many good “home remedies”, you will want to visit your family doctor if these symptoms appear:

• Pain with no apparent injury that doesn’t go away within a week to 10 days
• Pain that doesn’t ease or change with the movement
• Waking up at night with Pain
• Pain that shoots from your neck down into your arm when you cough or sneeze
• “Visceral” symptoms of nausea, diarrhea, dizziness, blurred vision, ringing in the ears, etc.
• Numbness, tingling, or weakness in your arms or legs

If you feel achiness or pain — not associated with the red flags listed above — the following provide some home treatment ideas you may use to ease your symptoms:

Rest

When neck pain strikes, don’t do activities that make your pain worse. Remember the benefits of rest (see above).

Ice is used for Cervical Spine Rehabilitation

For the first two to three days, you may get help by applying a homemade cold pack. Simply place two parts of crushed ice in a plastic bag with one part of rubbing alcohol. This lets you reuse the bag without having it freeze solid between uses. When you’re ready to use the cold pack, wrap it in a wet washcloth. Then place it on the sore area for up to fifteen minutes a few times a day.

Contrast

On day three, you may find more relief by using a “contrast” of ice and heat. This method begins by placing a cold pack on the sore area for 10 minutes. Then place a heating pad on for another 10 minutes. You can repeat the process a couple of times, finishing with the heat.

Heat is used for Cervical Spine Rehabilitation

Once the acute symptoms become controlled (two to three days), you may get relief using a heating pad. Remember to turn off the pad before going to sleep. Check your skin regularly to make sure you are not getting too much heat.

Traction

In some cases, your therapist may learn that you get relief with neck traction.  There are several traction units for home use. Some of these work by adding water to a bag to provide traction. Others work by pumping air pressure into a neck cushion. Placing two tennis balls in a sock can provide a simple way to obtain traction at home. Lay down with the sock sideways just below the back of your head. The two tennis balls will give gentle traction, and the pressure of the balls can help relieve headaches, neck pain, and upper back discomfort.

TENS is sometimes used for Cervical Spine Rehabilitation

This stands for transcutaneous electrical nerve stimulation. If you’ve been treated in the clinic with electrical stimulation, your therapist will have a good idea if this kind of treatment helps you. If so, there are small, pocket-sized electrical stimulation units that can last up to 24 hours a day if needed to keep pain at bay. Your therapist may choose to issue one of these, but only if you can’t get good pain relief in other ways. Also, in order for a person to use one of these machines, he or she must have a prescription from a doctor.

Exercises for Cervical Spine Rehabilitation

Some exercises are designed to help take the pain away. After you have completed your physical therapy visits, your therapist will have gotten a good idea of what types of exercise help you control your pain. Your therapist will go over the exercises that will give you the best relief if you get sore again. Remember to only do the exercises in the way your therapist has instructed. Overdoing them could make your pain worsen.

Long-term strategies for Cervical Spine Rehabilitation

A good exercise regimen can help. Also, remember the benefits of good posture, ergonomics, and work habits–and use them. If you are trying to take care of your neck but you’re not getting adequate relief, you may need to revisit your physical therapist for additional help.

Cervical Spine Rehabilitation Home Program

Once your pain becomes controlled, your range of motion improves, and your strength returns, you will move to a final home program. Your therapist will review some of the ideas listed above to help take care of any more soreness at home. You will receive processes and procedures to keep working on the range of motion and strength at your home. Before completing physical therapy, a further evaluation will be performed to see how well you’re doing as compared to when you first started in therapy.

Why Choose the Southwest Scoliosis and Spine Institute?

The following are just a few of the many reasons why patients might choose us.

• Expertise in the spine: The team of specialists at Southwest Scoliosis and Spine Institute is comprised of spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, rehabilitation after surgery is a complex and multi-step procedures.  Our Southwest Scoliosis and Spine Institute doctors and surgeons, with offices in  Dallas, Plano, and Frisco, Texas, will oversee your rehabilitation program to ensure the very best recovery for any spine surgery.  We have seen over 100,000 patients and have performed over 16,000 operations.  If you or your loved one is experiencing back pain, we strongly urge you to call us for an appointment, and we will see you in less than 24 hours.