Neck pain generally has been treated with a profusion of approaches and modalities, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen; pain relief medications (analgesics) such as acetaminophen; low dose tricyclic antidepressants such as amitriptyline for chronic problems; physical therapy (a.k.a. physiotherapy in British-derived cultures) which utilises a wide range of techniques and modalities; spinal manipulation from osteopaths, manipulating physiotherapists and doctors; massage; muscle strengthening programmes including gyms and Pilates; postural approaches such as the Alexander Technique; stretching approaches such as yoga; ergonomic approaches including setting up desktop computers correctly and frequent breaks; and surgery for severe structural problems such as osteophytic impingement on the cervical nerve roots and cervical disc herniation. A biomechanical analysis of the<unk>  indicates its standard, logical development from much flexed activity and its multi-factorial character. (See Pathogenesis above.) A composite approach which covers each component of the problem is therefore likely to be most successful and lasting. Most of the general treatment approaches to neck pain cover only one aspect. A logical response should include as a minimum: * Strengthening, especially of (1) the middle and lower back support muscles and scapula retractors, and (2) the longus colli and the deep neck flexor muscles. * Stretching muscles that cause neck protrusion, especially of the upper fibres of the trapezius muscle. *Lower cervical flexors: sternocleidomastoid, anterior and middle scalene muscles. *Upper cervical (capital) extensors: semispinalis capitis, longissimus capitis, splenius capitis, suboccipital muscles Strengthening muscles that cause neck retraction: *Lower cervical extensors: splenius cervicis, semispinalis cervicis, longissimus cervicis *Upper cervical (capital) flexors: longus capitis, Rectus capitis anterior, Suprahyoid muscles * Massage, to loosen adhesive fibrotic tethering of the posterior neck and upper trapezius muscles. * Unlocking of the hypomobile (frozen) facet joints of the thoracic spine and stretching of the shortened collagen reinforcing the excessive kyphosis<unk> . A sufficiently tight patch of thoracic spine cannot be freed up solely by patient exercises, stretches or movements. This is due to leverage – with any general exercise, the segments of the spine that are moving well will tend to move more, reducing the leverage on the hypomobile segments. A sufficiently localised external force is then necessary, such as specific hands-on spinal mobilisation or manipulation. A randomized clinical trial by Cleland et al. showed manipulation of the thoracic spine reduced neck pain immediately. * However unless the surrounding shortened collagen also receives sufficient stretching, collagen rebound will tend to freeze up the facet joint again rapidly. Collagen is stronger by weight than steel wire and is best stretched by a sufficiently long, strong, localised, passive stretch. In practical terms this may be achieved by the<unk> ed patient lying back on a spinal fulcrum device, which uses the upper body weight to provide the external force, localised over the fulcrum.
IHunch
DICOM
OHVIRA
Ices
AURA
Pomp
Stimson line
DrawMD