Providing patients with self-care tips and the correct tools that they can perform with at home will help ensure that the relief that the therapist provided won't be so quickly undone.
Whether the patient's condition is mild or severe, if the patient doesn't change his poor posture, the chances of healing and long term relief are limited.
When my daughter was eight years old, she came to me with a mild headache and neck pain and asked me how long it would take to get better. I looked at her neck and rest of the spine and told her it would take about two to three treatments and a change in her sleeping posture. After 3 treatments she came to me and told me that her headaches are better but neck pain was still present. I asked her if she had changed her sleeping posture (I knew that she didn't) she answered me that she would not do it because she loved to sleep on her stomach. She did continue to sleep on her stomach and after 2 weeks her neck pain got worse and headaches came back. When she came to me with the tears in her eyes because of her pain I knew she was ready for change. A couple days later she was much better because she had changed her sitting and sleeping habits. Soon after, she came back to me and told me I was right, that her headache and pain was better and asked me if she would always have to sleep on her back.
I often use this story with my clients as a metaphor for the importance of client self-care.
Very often, therapists do excellent work toward healing a client's condition, but the client goes home and sleeps on his stomach, bends the wrong way, uses the wrong type of pillow or sleeps on a soft mattress, use poor posture at work, negating the work that's been done. To prevent this situation from happening, giving patients self-care advice for when they are at work and at home is critically important. This is most certainly true with neck pain, headaches-migraines, lower back pain, shoulder pain and other musculoskeletal conditions.
Many activities of daily life, whether they are at home or on the job, involve working down in front of our body. Examples include reading a book on our lap, working on a cell phone, writing or typing on a keyboard, and tending to a baby. The problem is that if we bring our head and neck into flexion to look down at what we are doing, the center weight of our head is no longer balanced over our trunk. Instead, the weight is now hanging in thin air, imbalanced, and our chin falls to our chest, bringing our neck all the way into flexion. To prevent this, our posterior neck extensor musculature isometrically contracts. When we add up how many hours we are in this position, it's no wonder that we overuse and abuse these muscles! The key, whenever possible, is to bring what we are working on up to our eye level instead of flexing our head/neck down. Note: The same concept is true when reading a book. Instead of reading with a book placed on our lap, we should place reading material at eye level, using a bookstand if the book is heavy.
Similar to a bent neck posture, this condition involves flexion of the lower neck with extension of the upper neck and head. This posture also places the center of weight of our head anteriorly over thin air, resulting in prolonged isometric contraction of the posterior extensor musculature.
The key to lessening this posture is to remind our self to tuck in the chin and extend our lower neck back over the trunk.
This is a good example which includes working with a computer mouse or keyboard that is too far away.
To prevent this type of posture, it's important to bring our work closer to our body.
Even if the bag is empty and very light, the natural slope of the shoulder means we're going to have to elevate the scapula/shoulder girdle with contraction of the upper shoulders and neck to prevent the bag from sliding off. This isometric contraction overuses and abuses these muscles of the neck. If the bag is heavy, it's even worse because a more powerful muscular contraction is needed, and the strap of the bag digs into the musculature of our shoulder, causing direct physical irritation and cutting off local blood circulation. It's better to either wear the bag across the body or to use a backpack.
Examples include carrying a computer bag, heavy purse, suitcase or other travel bag, or even a sack of groceries. Holding a weight of any kind in the hand creates a traction force on the upper extremity that pulls the shoulder girdle down toward the ground. This action must be countered by contraction of the upper shoulder, neck and mid back muscles. Preventive measures include transporting heavier weights in a bag with wheels or a backpack (especially one that distributes the weight to the hips). When this isn't possible, it's better to split the weight between the two hands to even the load.
Holding a phone between your neck and shoulder requires lateral bending of the neck and elevation of the shoulder girdle. Holding this posture requires isometric contraction of all muscles of the neck and upper shoulder. An alternative to this habit is to hold the phone with the opposite-side hand, which leaves one hand free if writing is necessary. Even better than holding your phone in your hand is using a headset or bluetooth.
Given that the average person sleeps between six and eight hours per night, we literally sleep between one quarter and one third of our life. An unhealthy sleeping posture can greatly add to a client's neck condition. If the patient sleeps on their stomach, their neck is forced into a posture of neck rotation for the entire night.
If the patient sleeps on their back or side with a pillow that is too thick, their neck is forced into excessive flexion or lateral flexion respectively. The healthiest sleep posture is either on the back with a small pillow that supports the normal curve of the neck, or on the side with a pillow that supports the head and neck in a neutral posture.
Note: The Tempur peudic pillows shown in "c" and "d" are “cervical pillows” that have a depression in the middle, allowing the head to rest down in a neutral anatomic position.
Michael Pys NMT, Dipl. OMT
Hands-On Solutions to Headaches and Pain
2150 Pfingsten Rd. Suite 2200
Glenview IL 60025