Latest / The Driven Athlete / Spinal Neck Pain & Treatment Strategies | Ep 62

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Spinal Neck Pain & Treatment Strategies | Ep 62 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: I want to spend a deep dive a little bit on the neck and referred pain.
• 0:16
  Speaker 1: Okay, so the neck, the cervical spine, the cervical vertebrae are the top seven vertebrae in the spine spinal column.
• 0:26
  Speaker 1: The top seven vertebrae make up your neck, all right, the first one is called the atlas and it's C1, cervical vertebrae one and that's the very top one and it's very small and your occiput, your head, rests on top of that small and your head, your occiput, your occiput, your head, rests on top of that.
• 0:44
  Speaker 1: The second one is your axis and, uh, it's a unique vertebrae, um, and it's built for rotation so it rotates um underneath C1.
• 0:54
  Speaker 1: So C2, cervical vertebrae one.
• 0:56
  Speaker 1: Two, sorry, cervical vertebrae number two rotates underneath cervical vertebrae number one.
• 1:01
  Speaker 1: The axis rotates underneath the atlas and it's built for rotation and 50% of the neck rotation comes from those top two vertebrae, c1 and C2.
• 1:15
  Speaker 1: So if somebody is limited in rotation in their neck and they have neck stiffness and neck pain, their upper trap is tight, their muscles are tight.
• 1:21
  Speaker 1: I'm sure people we hear this all the time.
• 1:23
  Speaker 1: My massage therapist told me I'm very tight.
• 1:25
  Speaker 1: I bet my question would be why are those muscles tight?
• 1:29
  Speaker 1: They don't just get tight for no reason and the muscle tightness isn't the problem.
• 1:34
  Speaker 1: They follow suit and are the tertiary problem to the primary problem and the secondary problem.
• 1:41
  Speaker 1: The secondary problem is muscle.
• 1:43
  Speaker 1: The muscle guarding is tertiary.
• 1:44
  Speaker 1: The secondary problem is joint irritation and joint inflammation.
• 1:49
  Speaker 1: Right, the joints are lit up and hypersensitive and irritated.
• 1:51
  Speaker 1: That joint irritation, what do you think?
• 1:54
  Speaker 1: If they're chronically irritated and lit up, what do you think?
• 1:57
  Speaker 1: The muscles that connect to those joints are going to be like, very tight, very guarded, very tense.
• 2:03
  Speaker 1: They're hanging on for dear life and they're protection mode.
• 2:06
  Speaker 1: So they're going to be very protected all the time.
• 2:08
  Speaker 1: And if they get very protective and very guarded in a quick, rapid way from a quick muscle action, we would call that a muscle spasm.
• 2:18
  Speaker 1: Right, muscle spasm is from chronic guarding of a muscle tissue that's connected to a joint that's irritated and chronically lit up.
• 2:26
  Speaker 1: Why is that joint chronically lit up?
• 2:27
  Speaker 1: That comes from repetitive movements and microtrauma a little bit all the time, all day, every day, from repetitive movements over and over and over again and prolonged postures, the positions people put themselves in for work, sleep positioning, every day, all the time.
• 2:45
  Speaker 1: The repetitive movements and compensatory movement patterns that light things up a little bit all the time, and then positions they put themselves in also contribute to it being lit up and irritated all the time.
• 2:57
  Speaker 1: Those are the two primary problems that we have to fix.
• 3:00
  Speaker 1: Can we control posture and positioning?
• 3:03
  Speaker 1: Yes, can we control sleep positioning and posture?
• 3:06
  Speaker 1: Yes.
• 3:07
  Speaker 1: We just have to intervene with the right way and be willing to do something that you're not used to over a long enough time horizon to change the pattern.
• 3:17
  Speaker 1: It can be done, I promise.
• 3:18
  Speaker 1: So.
• 3:19
  Speaker 1: Changing sleep position, changing work positioning and ergonomics 100% can be changed.
• 3:23
  Speaker 1: Talking on the phone with your ear on your shoulder, chronically having your neck bent for every phone call you do, that can definitely be changed.
• 3:30
  Speaker 1: How about a hands-free Bluetooth speaker on your phone, right?
• 3:35
  Speaker 1: Or just earphones plugged in your phone as an option, right?
• 3:38
  Speaker 1: So the joints get irritated and if somebody is lacking rotation and they have a stiff neck, the anterior, middle and posterior scalenes are going to be guarded and lit up the levator scapulae and the upper traps, semispinalis services, longissimus services, all the suboccipital muscles, all those muscles connect to C1 and C2 and those occiput C3, c4, all the they connect at least somewhere up and down the chain and it definitely at C2.
• 4:04
  Speaker 1: What do youput?
• 4:05
  Speaker 1: C3, c4, they connect at least somewhere up and down the chain and definitely at C2.
• 4:06
  Speaker 1: What do you think those muscles are going to be like if somebody is chronically getting lit up and irritated in those joints?
• 4:12
  Speaker 1: They're going to be guarded and they're tight.
• 4:13
  Speaker 1: So if I chronically just like massage somebody, what do you think that looks like over a long enough time horizon?
• 4:20
  Speaker 1: It feels better for a little while and it comes back.
• 4:23
  Speaker 1: We hear that very often.
• 4:24
  Speaker 1: It feels better for a little while and it comes back.
• 4:26
  Speaker 1: We hear that very often it's because they're not addressing their underlying joint dysfunction and the underlying movement pattern and compensatory movement pattern through their neck and their shoulder blades, their scapulas, their upper ribs and their shoulder joint with functional daily life movement stuff right and a lack of postural endurance and postural stability for the neck muscles on the front part of the neck the anterior cervical stabilizers are the main stabilizers for the neck.
• 4:48
  Speaker 1: So C1, c2, that's where the main at least 50% of the rotation range of motion in the neck comes from those two vertebrae.
• 4:56
  Speaker 1: So if somebody is limited to that motion.
• 4:58
  Speaker 1: That's the first thing we're going to check.
• 4:59
  Speaker 1: What does C1 and C2 look like going each direction?
• 5:01
  Speaker 1: And if it's limited and stuck, which purposeful testing that we can do and isolate those joints, then we're going to intervene.
• 5:11
  Speaker 1: We can manually intervene to improve the joint mobility at those at those, uh, at that joint um going left or right, and then we can follow up with corrective exercises to improve the compensatory movement patterns and muscle recruitment.
• 5:21
  Speaker 1: Stability, postural endurance, scapular stability that plays a huge role with the neck for functional movements and shoulder stability those things play a role and that type of intervention over a long enough time horizon will lead.
• 5:34
  Speaker 1: I'm very confident, as long as I don't F things up over and over again or make things worse consistently with the things they're doing daily without knowing them, knowing that they're doing that unbeknownst to them.
• 5:42
  Speaker 1: There have been messing it up all the time.
• 5:45
  Speaker 1: If we eliminate that, those stressors, significantly, I'm very confident that somebody will get better.
• 5:50
  Speaker 1: It just takes a little bit of time on the right things.
• 5:52
  Speaker 1: We have to improve the musculature recruitment.
• 5:55
  Speaker 1: We have to prove the joint mobility disparities and fix the compensatory moving patterns and also their, their prolonged posturing right, their positions, they put themselves all the time Also, their prolonged posturing right their positions.
• 6:06
  Speaker 1: They put themselves all the time, okay, moving down the chain C3, 4, 5, and 6.
• 6:12
  Speaker 1: So those are the more typical cervical vertebrae C3, 4, 4, 5, 5, 6.
• 6:17
  Speaker 1: That's the mid cervical, those are the mid cervical articulations and joints the joint between C3, 4, the joint between C4, 5, the joint between C5, 6.
• 6:27
  Speaker 1: The one that gets the most commonly broken down in arthritic changes noticed on imaging is C5, 6, followed by C4, 5.
• 6:36
  Speaker 1: Okay, it indicates to us as clinicians, as movement specialists, that would suggest if somebody has neck pain and they have arthritic degenerative changes, narrowing of the disc space, degenerative disc disease is commonly things that would hear stenotic changes, stenosis at C4-5 or 5-6, and they're in their 50s or 40s.
• 6:59
  Speaker 1: That would indicate to us that they were hypermobile and compensating through those specific joint articulations at the cervical vertebrae for many, many, many years.
• 7:08
  Speaker 1: That leads to those bony changes.
• 7:10
  Speaker 1: Bony changes like that don't happen like fast, right.
• 7:12
  Speaker 1: They don't happen in one go, one event, one injury.
• 7:15
  Speaker 1: Those bony changes happen over a long, long time of repetitive stress and microtrauma on those particular joints.
• 7:22
  Speaker 1: So if that's the case and somebody is lit up and painful and the pain came about maybe three months ago or six months.
• 7:30
  Speaker 1: It just happened, right, I don't know.
• 7:31
  Speaker 1: I didn't fall or get in a car accident.
• 7:33
  Speaker 1: This non-traumatic neck pain kind of developed out of nowhere.
• 7:37
  Speaker 1: I'm not sure what I did.
• 7:38
  Speaker 1: That's what, that's our wheelhouse and that's what we work with.
• 7:41
  Speaker 1: Usually people got that point go to get an image and get an x-ray, just to rule things out, which is understandable.
• 7:46
  Speaker 1: And they come back and they have evidence of arthritic degenerative changes at those particular joints, at two or three joints, right, but they weren't in pain five months ago because the pain started three months ago.
• 7:59
  Speaker 1: That they can recollect, maybe even eight months ago, right, but those bony changes take a long time to develop.
• 8:05
  Speaker 1: The bony changes aren't causing the pain because that imaging and the evidence of bony changes was already present eight months ago.
• 8:17
  Speaker 1: And were you in pain eight months ago?
• 8:19
  Speaker 1: No, the bony changes didn't change between eight months ago and now, three months ago, five months later, right?
• 8:25
  Speaker 1: So the bony changes are the same.
• 8:28
  Speaker 1: If you had an image and an x-ray eight months ago, before you had pain, compared to now when you do have pain, the x-ray would look the same and the MRI would look the same, but one was non-painful and one is painful.
• 8:42
  Speaker 1: If you looked at both of them side by side, which person's in pain?
• 8:46
  Speaker 1: And it's the same image.
• 8:46
  Speaker 1: You're like I don't know exactly right, you don't know who's in pain or not.
• 8:52
  Speaker 1: The structural abnormalities and the structural imaging changes.
• 8:56
  Speaker 1: They don't dictate symptoms, prognosis or functionality.
• 8:59
  Speaker 1: They don't dictate pain or functionality.
• 9:01
  Speaker 1: So then why do search immediately and seek out structural intervention, which is surgery or meds and injections, if the structural changes aren't the dictators for pain?
• 9:16
  Speaker 1: Because we know that those bony changes take a long time.
• 9:19
  Speaker 1: And those bony changes were evident, the same as they are now, eight months ago, before you had pain but nothing changed.
• 9:24
  Speaker 1: But now you have severe pain, then the structure isn't the problem.
• 9:29
  Speaker 1: Things get irritated and lit up and we can't neglect that.
• 9:32
  Speaker 1: The muscles that connect those joints that are irritated are going to be guarded and tensed for sure, and they contribute to pain totally.
• 9:39
  Speaker 1: We can intervene there with soft tissue work, but it's not going to solve any problems.
• 9:43
  Speaker 1: It can make things feel relieved for a little bit, but it's not going to solve any problems for the long term.
• 9:47
  Speaker 1: And unfortunately there's no quick pill or quick fix for this type of intervention and fix, but it will lead to longer changes and longevity, improved longevity over time.
• 9:58
  Speaker 1: I promise you we do this stuff, this is our career, this is what we do, I'm not just blowing smoke.
• 10:05
  Speaker 1: I promise so the soft tissue changes will help relieve some stuff totally.
• 10:12
  Speaker 1: But we have to intervene with improving the joint mobility disparities throughout the rest of the cervical spine.
• 10:16
  Speaker 1: All the vertebrae have to move enough and equally and disperse the mobility requirements to not just compensate through one specific joint all the time.
• 10:25
  Speaker 1: And joints get irritated because of that.
• 10:27
  Speaker 1: And there's one other thing that in there that also gets very irritated and that's nerves.
• 10:32
  Speaker 1: You got bones, you got ligaments, you got tendons, you got discs, you got muscles, all those things.
• 10:37
  Speaker 1: But you also have nerves and nerves are very, uh, hypersensitive, they're very, um, they have great memory, right they're.
• 10:47
  Speaker 1: They hold grudges for a long time and they take forever to settle down.
• 10:58
  Speaker 1: And creating more irritation with movement patterns and compensatory patterns and sleeping positions and postures during the day, compensations during exercise, and that creates more muscle guarding, that creates the joint to stay irritated, that makes the nerves stay irritated and send signals down the neck or down the shoulder, down the arm, and that would be referred pain and we call it radiculopathy or radiculitis referred pain it's just referred pain from increased nerve irritation and nerve signaling.
• 11:25
  Speaker 1: That's indicating to us something's lit up With.
• 11:29
  Speaker 1: That being said, the route to go for a long-term change is we have to settle those things down.
• 11:36
  Speaker 1: Settle down the muscle tissue, improve the joint mobility disparities throughout the cervical spine and then stabilize the heck out of it and improve the movement compensatory patterns.
• 11:47
  Speaker 1: And that's what sets people up for success for long term.
• 11:51
  Speaker 1: And implementing that and intervening and prioritizing that over a long enough time horizon for, like, the rest of their life as in like from now on.
• 12:00
  Speaker 1: This is how I live, like I'm going to be mindful of my positioning when I sleep and mindful of my positioning when I work, and I'm going to implement these exercises when I work out.
• 12:08
  Speaker 1: Here's my warmup right.
• 12:10
  Speaker 1: It includes these types of exercises.
• 12:12
  Speaker 1: That's going to set things up for success and not have as much compensatory movement patterns throughout the rest of my life and my exercise right.
• 12:18
  Speaker 1: Otherwise it's going to reinforce the same movement patterns and that just creates more pain.
• 12:25
  Speaker 1: So, that being said, nerves get lit up and irritated for sure.
• 12:27
  Speaker 1: Having a pinched nerve or a pinched nerve.
• 12:29
  Speaker 1: It doesn't sound as accurate as what it portrays, because nothing structurally has changed significantly from a year ago to now, with herniated discs, degenerative disc disease or arthritic degenerative changes that cause inflammation and surrounding joint irritation and nerve irritation and muscle guarding, whatever.
• 12:51
  Speaker 1: So the structure hasn't really changed, that's not the problem.
• 12:53
  Speaker 1: But nerves are irritated.
• 12:54
  Speaker 1: So how are we going to fix it right?
• 12:56
  Speaker 1: We know that motion is lotion and that whole recipe I just laid out before and ultimately that helps nerves settle down and not chronically irritating them over and over again with the same things.
• 13:06
  Speaker 1: We have to eliminate that.
• 13:08
  Speaker 1: I'm very, very confident that neck pain can be severely improved and the pain can be decreased.
• 13:16
  Speaker 1: We've done it a bunch.
• 13:17
  Speaker 1: This is my career.
• 13:18
  Speaker 1: We've done this a lot.
• 13:19
  Speaker 1: So I'm very confident that improvements can be decreased.
• 13:21
  Speaker 1: We've done it a bunch, it is my career.
• 13:22
  Speaker 1: We've done this a lot.
• 13:22
  Speaker 1: Just so very confident that improvements can be made.
• 13:23
  Speaker 1: He's got to intervene with the right way and the mindset to that too.
• 13:27
  Speaker 1: It's like this You're not going to feel like the goal is to feel better when you leave day one.
• 13:32
  Speaker 1: We need that test, retest, improvement, like day one should feel better and there are good days and bad days, but not jumping off a cliff when there's a not a great day and also not celebrating for joy when you have a good day.
• 13:51
  Speaker 1: We can moderate that level of emotional roller coaster and expect some days to not be great, right, and then over a long enough time horizon, we're going to see improvements consistently until we're back to doing or intervening and implementing more intense activity that a person wants to do, like shoulder press or exercise and pushups and throwing a football on the beach, or like playing tennis, playing pickleball, playing golf, all that stuff.
• 14:16
  Speaker 1: We have to wean back into that with the right interventions.
• 14:19
  Speaker 1: So I'm very confident it can be improved.
• 14:22
  Speaker 1: The last thing I wanted to suggest before I wrap this up referred nerve pain.
• 14:26
  Speaker 1: It's just nerve irritation sending signals Okay, and medical intervention like injections and medication, can definitely improve symptoms, but it doesn't solve any problems.
• 14:40
  Speaker 1: It can help resolve symptoms temporarily and maybe allow someone to not live in agony and have some good sleep and work well at their career, their job, and then also maybe exercise like start moving again and then intervene with some like sports, physio, work right Physical therapy like we're doing, and tolerate it better.
• 14:58
  Speaker 1: It's going to facilitate changes that are good, but it's not going to be the fix and long-term dependency is only going to create more problems, and that's just the mindset going into it.
• 15:06
  Speaker 1: But anyway, what I was going would say is nerve irritation and muscle guarding.
• 15:15
  Speaker 1: That's like imagine a fire alarm was going off in a building.
• 15:17
  Speaker 1: Right, there's a fire alarm going off.
• 15:17
  Speaker 1: Those are the symptoms.
• 15:18
  Speaker 1: Right, it's letting us know there's an issue.
• 15:21
  Speaker 1: Right, it's smoke Us only taking meds and injections is like muffling the fire alarm with a pillow and shoving it against the fire alarm and duct taping it there because the fire alarm is less noisy.
• 15:39
  Speaker 1: Now it's muffled, it's not as bad, it's not blazing loud, it's not glaring so loud anymore, great.
• 15:46
  Speaker 1: But eventually that pill's going to fall and meanwhile the fire is just intensifying until the pillow falls off and now the alarm is even worse.
• 15:54
  Speaker 1: We see that all the time, and so we didn't actually put the fire out.
• 15:58
  Speaker 1: Why not just like address the fire.
• 16:00
  Speaker 1: Let's put out the thing that's causing the problem in the first place, right, and that's all that stuff I laid out before compensatory movement patterns, joint irritation, joint mobility disparities and compensating through certain joints repetitively and taking the brunt of movement all the time Muscle guarding and muscle tension causing pain.
• 16:18
  Speaker 1: That's connecting to the joints that are irritated.
• 16:20
  Speaker 1: And then when nerves get involved, it amplifies symptoms and nerve referred pain Down the arm, the shoulder, down the hand, down the neck tightness, all the time.
• 16:29
  Speaker 1: Let's solve what causes that in the first place and that's that recipe we talked about.
• 16:34
  Speaker 1: So if you have any questions, we're always open to helping.
• 16:36
  Speaker 1: We want to help.
• 16:36
  Speaker 1: Neck pain is something we help a lot of people with.
• 16:38
  Speaker 1: And one more controversial statement before I exit this herniated discs are very common and the research is finding there's a lot less weight held on herniated discs as the problem.
• 16:52
  Speaker 1: So then, why pursue surgery to debris discs if somebody is battling non-traumatic neck pain?
• 17:02
  Speaker 1: That just came about a couple months ago, I'm just gonna throw that out there.
• 17:05
  Speaker 1: The disc isn't the problem.
• 17:07
  Speaker 1: That from what the empirical evidence is showing.
• 17:10
  Speaker 1: Just saying.
• 17:12
  Speaker 1: But anyway, if you have any questions, reach out.
• 17:13
  Speaker 1: We're always open to having conversations and chat.
• 17:15
  Speaker 1: The best way to reach us is probably our phone number at 561-899-8725.
• 17:21
  Speaker 1: We're here at a clinic in West Palm Beach, in Jupiter, so don't hesitate to reach out.
• 17:24
  Speaker 1: We'd love to chat.