Ergonomics

 

Your body wasn’t designed to be sedentary for hours at a time.  But there are more ideal positions for your neck, arms and legs that can reduce the chance of sustaining a repetitive strain injury.  Whether you’re using a sitting desk, standing desk or are getting used to working from home, the right setup can make all of the difference. Check out the links below for a few of our posts on these topics!

 

FAMILY PHYSIOTHERAPY, ASSESSING AND TREATING PERSISTENT INJURIES AND PAINS FOR THE RESIDENTS OF THORNHILL, MARKHAM AND VAUGHAN

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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 working from home

Are you spending more time on your laptop in the comfort of your home? Many of us now do. With social and physical distancing rules in place, you may be working and studying from home.
You probably know that slouching for long periods of time can hurt your neck. It can cause shoulders to feel pain too. When you slouch, you curve your midback, placing your shoulder blades further apart and causing your shoulders to rotate in. This can create pain by putting your rotator cuff muscles on stretch. It can also lead to compression of your rotator cuff tendons, causing pain and inflammation of the tendons with movement.
That doesn’t sound good, but what can you do to avoid this?
  • as difficult as it is, do NOT use your laptop on the couch or in bed
  • invest a bit of time to set up a proper home work station
  • if you can, use a docking station and have a separate keyboard, screen and mouse
  • if you don’t have a separate screen, then place your laptop up to your eye level and use a separate keyboard and mouse so that you’re not hunching over, looking down and having your forearms unsupported
  • if you must use your laptop, as its name indicates, on your “lap”, then place a cushion underneath it, tilt the screen back to avoid looking down and support your arms with pillows under your elbows
  • take stretch breaks every 30 minutes
If changing your home work station isn’t enough to resolve your symptoms, our team of physiotherapists is also working from home and can help you. A virtual assessment respects social distancing and can get you back on track. Contact the clinic for more information!

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

Choosing the right back for you and your child shouldn’t be based on what looks good.  An appropriately sized back pack can prevent shoulder, neck and back pain. Click on the video to find out more. 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

What is a whiplash?

According to the Quebec task force whiplash injuries are defined as bony or soft tissue injuries resulting from rear-end or side impact, predominantly in motor vehicle accidents, and from other mishaps as a result of an acceleration-deceleration mechanism of energy transfer to the neck.

Are car accidents the only cause of whiplash?

In other words, whiplash results from a forceful hyper-extension (extreme bending backwards) and hyper-flexion (extreme bending forward) injury to the neck. Whiplash results when the soft tissues (the muscles and ligaments) of your neck extend beyond their typical range of motion.  Whiplash injuries may occur as a result of car accidents, falls and sports related injuries.

 

What are the symptoms of a whiplash?

If a person sustained a whiplash injury, their symptoms might not appear for a while, so it’s important to pay attention to any physical changes for a few days following any accident. Whiplash is associated with a wide variety of clinical symptoms including:

  • Neck pain and stiffness
  • Upper back, shoulder and arm pain and paresthesias (tingling and numbness)
  • Visual disturbances
  • Temporomandibular (jaw joint) dysfunction
  • Headache
  • Problems with memory and concentration
  • Fatigue
  • Psychological distress (i.e. depression, fear, anxiety, anger)

All or some of these symptoms and signs together are collectively termed whiplash associated disorder (WAD).

 

Are all whiplashes the same?

In studies and classification models, WADs are usually graded according to the objective findings during a clinical examination.  Each higher level of classification has the symptoms of the lower level plus additional findings. WAD is often classified as either:

WAD I

WAD I patients present with some muscle soreness and pain but no loss of neck range of motion (ROM).

WAD II

WAD II patients in addition pain or muscle soreness also have a loss of neck ROM.

WAD III

WAD III patients have pain, loss of ROM and objective findings of nerve root injury.

WAD IV

WAD IV patients have pain, loss of ROM, nerve root findings and a fracture or dislocation.

 

Can a whiplash result in more severe injuries?

In rare cases, there may be more serious injuries present as a result of trauma to the neck. These symptoms would be new to the patient following a traumatic event and they warrant an urgent and thorough clinical examination. The symptoms of a serious neck injury may include:

  • Drop attacks (sudden spontaneous falls while standing or walking)
  • Dysphagia (difficulty swallowing)
  • Dysphasia (difficulty producing and understanding spoken language)
  • Dysarthria (difficulty speaking/slurring speech)
  • Diplopia (double vision)
  • Ataxia (uncoordinated, staggering walking)
  • Complete inability to move neck, following a high speed trauma

 

Do I need an X-Ray to diagnose my whiplash?

Whiplash type injuries are usually not well identified during X-ray tests in an acute phase. The diagnosis is made after a thorough examination by a physiotherapist or a doctor.  This will include test of active and passive movement, neurological tests and screening tests for the painful and non painful areas. Your health provider will then give you a diagnosis based on the patient’s symptoms and a clinical exam.

 

What is the treatment for a Whiplash?

In the acute phases, recent studies suggest that early mobilization may lead to improved outcomes and that rest and motion restriction (like wearing a neck collar when not indicated) may hinder recovery. Treatment is often geared to control pain and normalize strength and range of motion and can include:

Manual Therapy

Hands on treatment by physiotherapists to mobilize (move) injured joints and muscles.

Exercise therapy

The goal of early treatment is to restore mobility at the neck, focus on muscles strength to support proper movement and restore the proprioception (sense of balance and spatial positioning).

Acupuncture

Inserting fine sterile needles in the skin to help stimulate nervous system to reduce pain and relax muscle spasm.  Click here to see our previous blog post explaining the use of acupuncture.

Electrotherapeutic modalities

Ultrasound, interferential current, TENS can be used to help control pain and inflammation and assist with healing.

Cryotherapy (ice)

One of our previous blog posts discussed the use of heat vs. ice.  Usually in the acute phase of a whiplash the use of ice is recommended.   Applying cold to the injured area will help you to decrease pain, swelling and inflammation.Your physiotherapist will decide on the best treatment plan for you, following a detailed history taking and physical examination.

 

What is my expected prognosis?

There is great amount of variability in recovery outcomes in whiplash patients. This is a source of considerable controversy. Some of the factors that have been consistently associated with delayed recovery including being older age, higher initial pain intensity, neurologic deficit and preexisting neck pain.

As mentioned previously, early and effective management of symptoms with mobility and good exercise program can help the patient suffering from whiplash-associated dysfunction optimize their chances of full recovery and return to their pre-existing level of function.

 

Will my pain become chronic?

10-25% of the patients that sustain a whiplash will experience chronic symptoms.  This is defined as symptoms present beyond the normal phase of healing, 6 months up to a year after the original injury.

One study found neck muscle degeneration in the group of patients that were involved in car accidents. The muscle fibers were replaced by fat content, which started to occur in as little as a few weeks after the accident. This muscle degeneration was not found in the group of chronic neck pain patients due to causes other than whiplash. This study also looked at whether or not this muscle degeneration can be reversed. It was found that after a 10 week neck muscle strengthening program, supervised by a physiotherapist, the fat deposits in the muscle can be reduced and the size of the muscle fibers were increased. This change in the muscle fibers was also correlated to a reduction in the painful symptoms.

In the treatment of chronic whiplash many other therapeutic interventions have been suggested over time, including but not limited to: temporomandibular joint treatment, cervical facet joint treatment.  These areas should all be assessed by your physiotherapist during the initial consultation to help prevent your symptoms from becoming chronic.  If conservative management fails to resolve your symptoms further medical treatment could include injection therapies such as intra-articular corticosteroid injections, and botulinim toxin (Botox) injections.

 

Most importantly, managing whiplash symptoms early on with targeted physiotherapy treatment, including early mobility restoration, will help greatly in optimizing the outcome of whiplash injury as well as will help to reduce possible stress and psychological changes associated with delayed recovery and lingering of pain.

 

Not Sure Where to start?

You’re not alone. There are a number of risk factors that can cause symptoms to persist with generalized approaches.  Our physiotherapists and massage therapists have the experience and training to evaluate and diagnose your current status and the tools to get you started and progressing towards better health.  Contact us to get started on your goals!

 

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Family Physiotherapy, assessing and treating persistent injuries and pains for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References:

  1. Spitzer WO, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “Whiplash” and its management. Spine. 1995;8S:1S–73S.
  2. Pastakia, K., Kumar, S. Acute Whiplash ASsociated Disorders (WAD) Open Access Emergency Medicine 2011: 29-32
  3. Borchegrevnik GE, Kaasa A, McDonagh D, et al. Acute treatment of whiplash neck sprain injuries. Spine 1998;23:25–31.
  4. Shaun O’Leary et al. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise – a pilot study. Muscle Nerve. 2015 Nov; 52(5): 772–779.
  5. Dufton JA, et al. Prognostic factors associated with minimal improvement following acute whiplash-associated disorders. Spine. 2006;20:E759–65.

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

Neck pain and headaches

The cervical spine is the region of the spine that we often refer to as the neck.  It spans the area from the head to slightly above the shoulder blades.  Changes in movement due to poor posture, muscle imbalances and past injuries often have a variety of presentations and can result in headaches, shoulder pain, mid back and altered sensation or pain in the arms.  This blog post will discuss a very common clinical presentation of poor movement and strength of the upper neck, a cervicogenic headache.

 

Anatomy of the upper cervical spine

The cervical spine is the upper region of the spine.  They are numbered from C1 (the top vertebra) to C7 (the bottom vertebra). The bony upper cervical spine consists of the upper 3 cervical vertebrae and the head.    This region is often described as the craniovertebral region.

The joint formed by the head on the C1 bone is the occipto-atlantal (OA) joint.  The joint between the C1 and C2 is the atlantoaxial (AA) joint.  Cervical discs do not appear in the upper cervical spine until the level of the C2/3 joint.  Numerous muscles attach in this area.  Some attach to one or 2 local regions of the spine whereas others have attachments into the shoulder blade, collar bone and even the lumbar and thoracic regions of the spine.  The local small upper muscles at the back of the craniovertebral region as a group are often referred to as the suboccipital muscles.

This region of the spine is  designed for movement and does not have as strong of a weight bearing capacity as the low back joints. The joints are commonly referred to as facet or zygoapohyseal (or “z” joints).  These joints differ in the upper and lower regions of the neck.  The facet joints of the OA and AA regions are oriented in a very flat plane (almost parallel to the ground when sitting or standing).

 

Movement of the craniovertebral region

Movement of the OA joint

The OA joint contributes to nodding movements (as if you are saying “yes”).  The joint surface resembles a ball sitting in a cup.

The AA joint

The AA joint when moving appropriately contributes primarily 45 degrees of head rotation to each side, allowing us to check our blind spot on either side from just this region.  The joint surfaces have resemble two tennis balls balanced on each other.  The rotational movements of the upper neck is a combination of twisting, compressing and side bending that easily occurs when the joint is flexible and muscles are not interfering with the movement.

The pattern of movement that the upper cervical spine performs causes a sideways bend in the opposite direction of a rotation movement.  For example, with a turn to the left it will cause a side bend to the right. If restriction of movement is present in this area the lower regions of the neck can make up for it with more muscle activation required and different stresses on the lower joints of the neck.

 

Posture and the craniovertebral region

An adult head weighs about 10 pounds and in a normal upright posture the weight of the head is balanced over the cervical spine and allows the shoulders to pull comfortably backwards.  Typical forward head posture results in an overuse of the suboccipital muscles making the chin poke forward in line with the chest.  With ongoing forward head posture the joints may lose the ability to move out of this posture. An increased load is now place on the muscles of the back of the neck to prevent the head from collapsing forward.

In a day to day context, consider standing and holding a 10 pound weight close to your chest compared to at arm’s reach in front of you.  The further forward the weight is the heavier it feels and the more the muscles have to do to continue to hold the position.  While this might seem to be an oversimplification, small differences in the forward position of the head are compounded for many hours over the course of our upright day and can produce similar overuse or pain patterns.

 

Headaches and the upper cervical spine

A common source of headache pain can be attributed to the muscles and joints of the upper cervical spine. Headaches from this area tend to be described as an aching pain. This pain is often localized on one side of the head but can spread to the other side.  There can also be a radiation of pain into the neck and shoulder areas.

 

 

What can cause a cervicogenic headache?

Headaches from this region can be caused by stiff joints, muscle overuse or conversely by joints with excessive amount of movement.  This can be due to current or past injuries of the area such as car accidents, facial injuries, or concussions.  They can also be secondary to compensations for injuries in other areas such as the lower neck, jaw, shoulders or low back.  Though seemingly unrelated, these areas share a similar innervation to the craniovertebral region and can cause a referral of pain or tension to these areas, a process known as segmental facilitation.

When acutely painful, aggravating movements of the upper cervical facet joints are often associated with looking up or a sidebending movement of the head in one direction and a rotating movement in the opposite direction recreate symptoms. However, in most cases pain is felt with sustained poor posture that cause overuse of the muscles and joints of the upper neck. These postures may be due to an inappropriate ergonomic setup or as a compensation for other painful areas such as the lower neck, back or shoulders.

What can ease a cervicogenic headache

Avoidance of the aggravating postures, heat or cold may assist in reducing pain. Positions that decompress the joint, such as looking down or away from the pain, generally relieve the perceived headache and pain.  If other regions are contributing to the pain reducing the strain on those areas can assist in reducing the pain from a headache area.

How are Cervicogenic headaches treated?

The first step in reducing head and neck pain is often to try and determine the factors that led to it.  These may have included poor form with working out, inefficient ergonomic setup and previous injuries to the shoulders and jaw.

If your pain is persisting and attempts to stretch out the area have not resolved your pain, the next step is often an assessment by a physiotherapist with experience in assessing and treating the neck.  A detailed assessment including history of past injuries, medication use and poor response to treatment can all give indications of underlying factors not allowing your headache to resolve.  In addition a detailed biomechanical assessment including joint hypermobility testing, patterns of active and passive movement and strength tests are often included.

Stiff craniovertebral region

Headaches from stiff joints do not always resolve with general stretching programs until the joint movement improves with targeted manual therapy techniques.  These techniques should address not just the local factors causing the headaches but the other areas that are causing stress to the area. This may include exercises for the shoulder or jaw.  A joint that has been stretched needs to have the support of appropriate conditioned muscles otherwise symptoms will persist.

 

Mobile craniovertebral region

When the source of the cervicogenic headache is excessive amounts of movement, generalized techniques such as traction and muscle stretching tend to not help resolve the problems.  Stretches may give moments of relief as the overused muscles get a break, however the support that these muscles produce result in a return of symptoms shortly after the stretch is stopped.  Commonly the headache symptom can feel worse shortly after completing the stretch.  Treatment for this type of headache may include manual therapy techniques, however they need to specifically target the stiffer surrounding regions such as the mid cervical spine and shoulders without straining the pain generating areas.  With the upper and mid cervical spine being so close in proximity, the treatment of these types often utilizes post graduate skills to ensure that symptoms resolve as stiff surrounding regions become more mobile.  Exercises that improve the endurance of the small cervical stabilizing musculature are also key to resolving symptoms, not just managing them.

Not Sure Where to start?

You’re not alone. There are a number of risk factors that can cause symptoms to persist with generalized treatment approaches.  Our physiotherapists and massage therapists have the experience and training to evaluate and diagnose your current status and the tools to get you started and progressing towards better health.  Contact us to get started on your goals!

 

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Image result for emoticon email

 

Family Physiotherapy, assessing and treating persistent injuries and pains for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

References

Edmondston et al “Influence of cranio-cervical posture on three-dimensinoal motion of the cervical spine” Manual Therapy (2005)

Jull, G.  “Characterization of the cervicogenic headache” Physical Therapy Review (1998)

Travell and Simmons Myofascial Pain and Dysfunction The Trigger Point Manual Wolters Kluer 1998

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today