Kidney Belts for Lower Back Pain: Yay or Nay?

One of the most common questions I get is whether kidney belts are useful to reduce back pain particularly in forklift or truck drivers and people handling goods.

It’s a good question.  I often think of the image of the weight lifter with his kidney belt.  They must know something?

To simplify the science, a lot of lower back pain can be contributed to spinal tissue failure from prolonged or recurrent high compression or shear forces through the spine that occur when:

  1. Lifting heavy weights
  2. Lifting lighter weights using poor posture e.g. with arms stretched out in front  (functionally increasing spinal compression and shear forces) or with high repetition.
  3. Sustaining postures that reduce the lumbar curve (such as bending or slouch sitting)
  4. Being exposed to whole body vibration through sitting in a vehicle for more than 3 hours per day.

(1-4).

Is there anyway that we can reduce this spinal loading without changing our handling techniques?

Yes: if you hold your breathe for a few seconds, this raises the pressures in your abdominal cavity which  reduces spinal loading by relaxing the spinal muscles (the back muscles increase spinal loading when they work) (5-7).  However, you can’t hold your breathe forever and this advantage is lost.  So not really a workable solution.

What about kidney belts? Research found that kidney belts can slightly lower spinal muscle contractions (8-11%) and limit the amount of forward bending during lifting and encourage squat lifting, therefore reducing spinal loading in this scenario (6), however,  kidney belts tended to increase spinal muscle contractions in forklift drivers and make them more likely to experience back pain than forklift drivers who didn’t wear them (6,8).

References:

  1. Chaffin DBPark KS (1973). A longitudinal study of low-back pain as associated with occupational weight lifting factors. Am Ind Hyg Assoc J. 34(12):513-25
  2. Freivalds AChaffin DBGarg ALee KS (1984). A dynamic biomechanical evaluation of lifting maximum acceptable loads. J Biomech. 17(4):251-62.
  3. Adams MA, McNally SDChinn H, Dolan P (1994). Posture and the compressive strength of the lumbar spine. J Biom. 27(6):791-791.

  4. Nachemson AL (1981). Disc pressure measurements. Spine. 6(1):93-7.

  5. Arjmand, N.; Shirazi-Adl, A. (2006). Role of intra-abdominal pressure in the unloading and stabilization of the human spine during static lifting tasks. European Spine Journal. 15:1265–1275.
  6. McGill, S. M.; Norman, R. W.; Sharratt, M. T. (1990). The effect of an abdominal belt on trunk muscle activity and intraabdominal pressure during squat lifts. Ergonomics. 33:147-160.
  7. Daggfeldt K, Thorstensson A (1997). The role of intra-abdominal pressure in spinal unloading. J Biomech. 30:1149–1155.
  8. McGill SM, Norman RW, Sharratt MT (1990). The effect of an abdominal belt on trunk muscle activity and intra-abdominal pressure during squat lifts. Ergonomics. 33:147–60.

Is your monitor positioned too far?

I most often hear people blame their chair when they’re uncomfortable at their computer workstation, but in reality, a common cause for their actual discomfort, is the incorrect placement of their monitor, particularly when the monitor is placed too far.

Monitor positioned too far away causing forward leaning slouching postures. Very bad for neck pain, headaches and back pain.

A monitor position that is too far from the user causes people to lean forwards away from the backrest to lean in towards the monitor.

This causes prolonged slouching and poking chin postures, creating pressure on joints in the upper neck causing headaches, and over activation of the upper trapezius muscles leading to neck pain as well as high compression on the lumbar spinal discs leading to back pain.

So, how do we fix this? Buy a new chair? Of course not. If you’re sitting badly, always check that when leaning backwards against your chair, if you place your arms in front of you like Frankenstein, your fingers touch the screen. If they don’t, bring your screen closer.

Lean backwards in your chair and reach your arms forward like Frankenstein to find the correct distance that your monitor should be positioned at.

At the same time, ensure that your forearms are supported either on your desk, or on your armrests. This will differ depending on other factors in your setup.

This is what good sitting posture should look like. Always ensure that your chair is inclined sufficiently backwards and NOT upright.

Please join the conversation, ask questions, make comments or share with friends and colleagues if you found this helpful.

How to setup your laptop for a home office

Working from home has become the new normal and even when life returns to the “old normal” at some point, many people will still continue to work from home, if not full time, then certainly for a portion of a working week.

Week 1: Working from home...

“Week 1: Working from home…” by Mish Mish is licensed under CC BY-NC-ND 2.0

This has meant that kitchen tables amongst other things have become the new working desk with a definite uptick in neck and back pain and headaches.

The point of this post is to explain how to sit comfortably at the kitchen table or other desk while working at your laptop, especially without accessories, since most people don’t have them.

There are 4 main elements of your sitting posture that you need to be aware of to reduce any body discomfort especially neck and back pain as well as headaches:

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  1. Keep your head in a neutral position i.e. looking straight ahead at your screen. This may mean dropping your chair so that your head is at the same height as the laptop screen or choosing a lower chair.
    • Looking down for too long will give you neck pain as well as a stiffer neck which long term could lead to pain in the arms.
    • Looking up at a screen will quickly give you both neck pain and headaches.
  2. Keep your elbows at an open angle above 90 degrees.
    • If your elbows have an angle less then 90 degrees and close to your body, it causes your upper trapezius muscles to contract and after time you will end up with neck pain.
  3. Make sure that your screen is arms’ length away when sitting back in your chair and not further, unless your spectacles require it.
    • With your screen too far away, when you concentrate you will find yourself leaning forwards to look at your screen resulting in slouching and poking chin postures.
    • Result: back pain, neck pain and headaches.
  4. Don’t let your legs hang even slightly off the ground.
    • If your legs are hanging even slightly, you will either lean forwards and slouch to get your feet to touch the floor or leave them hanging uncomfortably. Both end in back pain.
    • Find a firm box or ream of paper to put your feet on. Anything that caves in will strain your body and reduce your concentration.

Join the conversation, Questions? Comments? Useful? Please share with someone who you think this could help.

COMPANIES HAVE UNTIL JUNE 2021 TO COMPLY WITH THE NEW ERGONOMICS LEGISLATION

The new ergonomic legislation requires employees in summary to:

  1. Perform ergonomic risk assessments of all jobs that may pose an ergonomic risk to staff before the commencement of work, by a competent person. From this assessment, a hierarchy of ergonomic risks must be drawn up to be attended to as well as the plan to manage these risks according to the hierarchy of controls. These assessments must be repeated at least every 2 years; or earlier in the event of an incident or injury, if the controls in place are failing or are outdated or if the work process or environment has changed.
  2. All employees must be trained on the new legislation, the current ergonomic risks in their workplace and the affects this could have on their health. The training also needs to include information on the current control measures in place and the steps staff need to take to report any further ergonomic hazards. It should also cover the importance of medical surveillance and ergonomic risk assessments in controlling these risks.  
  3. Refresher training must occur at intervals determined by the health and safety department.
  4. All personnel who are deemed to be exposed to high ergonomic risks must be placed under medical surveillance which needs to commence within 30 days of employment and is monitored no less than every 2 years. An exit medical examination is required for all staff leaving employment who were undergoing medical surveillance.
  5. Records must be kept for a minimum of 40 years.
  6. Employees themselves are compelled by the legislation to comply with any instruction given by their employer or employer’s representative regarding actions to follow pertaining to ergonomic risks and their control. They are also required to report any ergonomic risks to their employer, attend any medical surveillance deemed necessary, to attend and comply with all ergonomic related training and to assist in the ergonomic risk assessments as required by the competent person.

To read the full draft of the legislation click on the link below.

Ergonomics-Regulations-42894-6-12

Lower Back Pain and Spinal Loading

Lower back pain is a very complex problem and may have many causes.  One cause is when spinal tissue failure occurs as a result of high compression forces applied through the spine leading to spinal injuries.  High spinal compression forces may lead to micro fractures in the vertebral endplates, compression fractures of the vertebral bodies and damage to the spinal discs (1-3).

Activities which cause high spinal compression forces include:

  • Lifting heavy weights.
  • Lifting lighter weights in weak postures which increase the functional weight of the object and thus the load on spinal tissues (e.g. lifting from the floor or above shoulder height).
  • Sustained spinal bending postures (with or without a load in the hand).
  • High repetition spinal bending postures (with or without a load in the hand).
  • Exposure to whole body vibration in vehicles that experience vibrational acceleration including shocks between 2-6g (11).

(1-4,11).

Certain body postures also create higher compression forces through the spine than others.  For example, bending the spine while lifting, increases the pressures on the spinal discs by more than 100%.   Spinal bending combined with twisting increases spinal disc pressures by more than 400%.  On the other hand, when people recline backwards in a chair, even while adopting a slouching posture, spinal disc pressures reduce by 50-80% – a posture most of us adopt when we’re getting tired during extended bouts of sitting.  Sitting up straight in a chair actually creates twice the spinal compression compared with reclining backwards in a chair – something to tell your granny or your teacher when they criticize your reclined slouching posture!

(3,4).

In 1979, it was noted that when heavy lifting was performed while holding one’s breath (for a few seconds), the intra-abdominal pressure was raised, the spinal extensor muscles activity reduced and both led to reduced compression loading on the lumbar spine, reducing the risk for spinal injury.  However, if the heavy lifts extended for longer than a few moments, the breathe was released and the intra-abdominal pressure fell to much lower levels, reducing this spinal support mechanism substantially (5).  This reduction in spinal compression due to raised intra-abdominal pressure was supported by research published in 2003, 2006 and 2010 and showed that the greatest benefit occurred when the body was in flexed (bent) postures (6-8).

The question arises as to how raised intra-abdominal pressure reduces spinal compression and helps to protect the spine from spinal compression failure leading to spinal injury and lower back pain.

Both abdominal and spinal extensor muscle contraction cause an increase in the spinal compression forces.  However, the abdominal muscle contractions (0- 40% MVC) also assist in raising the intra-abdominal pressure, and when doing so, the net forces on the spine result in reduced spinal compression.  In these circumstances it was also found that there was a reduction in the activity of the erector spinae muscles, with a greater reduction in these muscles’ activity corresponding to a greater increase in intra-abdominal pressure (8).

Furthermore, a 2013 published study revealed that chronic lower back pain sufferers who were experiencing a remission from their pain still exhibited lower levels of agonistic abdominal muscle activity and higher levels of antagonistic paraspinal muscle activity when compared to healthy individuals when performing spinal flexion (stooping/bending) with or without handling a load.  This alteration in their abdominal and spinal muscle recruitment activity/ patterns could result in increased spinal loads (not measured in their study) and possibly contribute to the recurrence of lower back pain in individuals where these altered recruitment patterns have become the norm (9).  On the other hand, research published in 2011 showed that activation of the core muscles showed no improvement in spinal stability, casting doubt on the mechanism in which core muscle rehabilitation is used to assist in the treatment of chronic lower back pain (10).

 

References:

  1. Chaffin D.B.; Park K.S (1973). A longitudinal study of low-back pain as associated with occupational weight lifting factors. Am Ind Hyg Assoc J. 34(12):513-25.
  2. Freivalds A.; Chaffin D.B.; Garg A.; Lee K.S. (1984). A dynamic biomechanical evaluation of lifting maximum acceptable loads.  J Biomech. 17(4):251-62.
  3. Adams M.A.; McNally S.D.; Chinn H.; Dolan P. (1994). Posture and the compressive strength of the lumbar spine. J Biomech. 27(6):791-791.

  4. Nachemson A.L. (1981). Disc pressure measurements. Spine. 6(1):93-7.

  5. Hutton, W. C.; Cyron, B. M.; Stott, J. R.R. (1979). The compressive strength of lumbar vertebrae. J Anatomy. 129(4): 753-758.
  6. Daggfeldt, K.; Thorstensson, A. (2003).  The mechanics of back-extensor torque production about the lumbar spine. J Biomech. 36(6): 815-823.
  7. Arjmand, N.; Shirazi-Adl, A. (2006). Role of intra-abdominal pressure in the unloading and stabilization of the human spine during static lifting tasks. European Spine Journal. 15:1265–1275.
  8. Stokes I.A.; Gardner-Morse M.G.; Henry S.M. (2010). Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism. Clinical BiomechanicsNov;25(9):859-66.
  9. D’hooge, R.; Hodges, P.; Tsao H.; Hall L.; MacDonald D.; Danneels L. (2013). Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J of Electromyograhy and Kinesiology. Feb;23(1):173-81.
  10. Stokes I.A.; Gardner-Morse M.G.; Henry S.M. (2011). Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clinical BiomechanicsOct;26(8):797-803.
  11. Bazrgari, B.; Shirazi-Adl, A.; Kasra, M. (2008). Seated whole body vibrations with high-magnitude accelerations—relative roles of inertia and muscle forces. Journal of Biomechanics. 41:2639-2646.

Neck Pain and Your Elbow Angle

It’s strange thing to think that your elbow angle is possibly related to your neck pain.  But, it’s true.  Well, more specifically, it’s true in certain situations.  Read on:

Neck pain is sometimes caused as a result of tension or spasm in the upper trapezius muscle. The upper trapezius muscles are the upper fibers of the large diamond shaped trapezius muscle that covers the back of your neck and middle back, illustrated below.  As you can see, the upper fibers connect the neck and the shoulder, and it’s normally in the mid belly region of these upper fibers that people experience neck pain.

"Trapezius muscle" by Användare:Chrizz under Licence CC BY 3.0
“Trapezius muscle” by Användare:Chrizz under Licence CC BY 3.0

Why does your upper trapezius muscle become inflamed or go into spasm and create your neck pain?

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Well, one common reason is because of stress (which can cause inflammation of the trapezius muscle in the absence of trigger points and muscle spasm).

Read my article about Stress and Neck Pain.

Another reason is because of fatigue of the upper trapezius muscle.  When your upper trapezius muscle fibers are made to work under low loads for extended periods of time, they become fatigued and you are then likely to experience pain in the presence of spasm.

What causes the upper trapezius muscle to fatigue while you sit behind your computer and work?

"Overview of the new office for The Team" by Phil Whitehouse under Licence CC BY 2.0
“Overview of the new office for The Team” by Phil Whitehouse under Licence CC BY 2.0

There are a number of factors surrounding your computer workstation that can cause your upper trapezius muscle to fatigue and create neck pain for you.

Read my post on 4 Computer Monitor Positions that can Cause Neck Pain.

One of the least well known reasons to creating fatigue of your upper trapezius muscle and hence your neck pain, is the angle of your elbow while you work.  

A very interesting study found that when you work on your keyboard and mouse, the angle that you keep your elbow at will determine the level of your upper trapezius muscle activity and your neck pain.  Keeping the angle of your elbow greater than 90 degrees, helps to reduce the fatigue of the upper trapezius muscle fibers and reduces neck pain.

This elbow angle position is important when it comes to where you position your keyboard and mouse as you work at your desk.  As I’ve mentioned before in other posts, your screen needs to be arms length away from you when you’re leaning backwards against your chair’s backrest.  In contrast to a closer position of the computer monitor than most people tend to adopt, the keyboard and mouse need to be positioned further away and not too close to yourself.

As you sit and type and mouse, your elbow angle must be open (i.e. greater than 90 degrees and up to about 120 degrees).  Working on a desktop computer, this elbow position may be more intuitive, however, be more aware of your elbow angle when you work on your laptop as well.  People often work on laptops in constrained positions and places, with the laptop quite close to you.  Learning how to setup your computer workstation correctly is important to help reduce or prevent the common aches and pains us modern workers experience.

Where do you position your keyboard and mouse when you work? And do you suffer from neck pain?

References:

Gawke J.C., Gorgievski M.J., van der Linden D. 2012. “Office Work and Complaints of the Arms, Neck and Shoulders: The Role of Job Characteristics, Muscular Tension and Need for Recovery.” Journal of Occupational Health 54: 323–330.

Bansevicius D., Westgaard R.H., Stiles T. 2001. “EMG activity and pain development in fibromyalgia patients exposed to mental stress of long duration.” Scandinavian Journal of Rheumatology 30 (2): 92-98.

Marcus M., Gerr F., Monteilh C., Ortiz D.J., Gentry E. et al. 2002. “A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders.” American Journal of Industrial Medicine 41: 236-249.

Acute Injury Management – RICE

If you’ve recently experienced a soft tissue injury, go see your doctor or physiotherapist as soon as possible to determine how serious your injury is and to find out how to allow swift and proper healing to occur.

In addition, the first 24-48 hours are very important following a soft tissue injury.   What you do or do not do in this time may or may not prevent unnecessary secondary tissue damage following the original injury.

"Yep... Ik ben erg goed in voetbal..." by Jan-Joost Verhoef under Licence CC BY 2.0
“Yep… Ik ben erg goed in voetbal…” by Jan-Joost Verhoef under Licence CC BY 2.0

When tissue damage has occurred, the cells of the affected tissue break open releasing their contents into the surrounding area.  This causes a whole set of inflammatory chain reactions that result in an increase in the blood supply to the area, further inflammation and swelling.  A certain amount of inflammation is necessary for your healing to occur, however, too much inflammation, bleeding and swelling cause more damage than the original injury alone.

If the principles of RICE are not applied quickly following a soft tissue injury, too much bleeding, inflammation and swelling will occur.  The side effects of this is that the swelling will cause compression of the surrounding tissue and reduce its oxygen supply.  This in turn can lead tissue damage of this surrounding tissue increasing the general weakness of the area.

Generally speaking, the principles of RICE should be applied to prevent this unnecessary extension of your soft tissue damage:

 

R – Rest

One of the most important things to do when you have an injury, is to rest the affected area immediately and to reduce your general activity as well.  This helps to reduce the general circulation of your body and in the injured area thus reducing the bleeding and swelling around your injury, helping to prevent secondary tissue damage.

Then, following your initial injury, you need to continue to rest the injured area through possibly restricted weight bearing and/or movement as determined by your doctor or physiotherapist according to the degree of your injury.

This is important since your body can’t heal if you keep straining your injured tissue.  Think of a bridge that has collapsed and is being repaired.  How helpful is it if people want to keep driving cars across it until it’s structurally sound again?  Tissue damage in the body is a lot like that metaphor.  If you place undue strain on a body part that hasn’t fully healed yet, you will cause mechanical failure of the injured tissue, placing you back at square one and possibly creating more damage.

The general guide to healing of injured tissue is 6 weeks to 50% healing and 3 months to 70-80% healing.  This is true for both bone and soft tissue.  Remember that ligaments and tendons also play a structural role in your body, so if you have injured 30%, 50%, 70% of your ligament or tendon, this will determine how much the rest of the remaining tissue will be available to take over the function of your damaged tissue.  This will also determine how much you need to rest it, if you need crutches, strapping, a brace etc.

 

I- Ice

Ice should be applied immediately following a soft tissue injury.  The application of ice helps to cause constriction of the blood vessels and limit further damage.  The ice will also lower the metabolic rate of the tissue that you apply it to, thus reducing the demands of oxygen and nutrients in the area.  This is useful since the circulation which is crucial in the function of tissue metabolism would have been damaged to some degree.

Another benefit of applying ice is that as it reduces the inflammation and swelling in the area, it will also reduce your pain and therefore any muscle spasm that would’ve occurred as the body tries to protect itself from unwanted movement.

Be careful not to apply ice directly to the skin or to use it for too long, you don’t want to  create ice burn.  The general recommendation is to apply the ice for 15-20 minutes every 1-2 hours.  Apply it less often over the 48 hr period following your injury as your swelling and inflammation reduces.  People who have poor circulation or a poor nerve supply to the area such as diabetics, smokers, people with paralysis, Raynaud’s disease, peripheral vascular disease etc. need to be careful when they use ice to avoid ice burn and tissue damage.

 

C – Compression

Compression of the injured area helps to reduce bleeding and swelling and the resulting secondary tissue damage if too much bleeding and swelling occurs.  It also helps in part to provide structural support to the injured tissue .

The trick with compression is not to apply it too tightly which can severely reduce blood supply to the area altogether and also result in tissue damage.

The skin should not be white, tingly or blue (all indications that the compression bandage is too tight).  The compression bandage should be placed in layers that partially overlap each other (about 50% overlap layer upon layer) and not in layers positioned directly over each other.  If the bandage is applied in the latter scenario, it is likely that the bandage will cause too much direct compression and substantially reduce the bloody supply to the area.

There are special strapping techniques to create support for certain ligaments and tendons that are damaged until they are healed that your physiotherapist can teach you.  If you’re not comfortable strapping, it might be better to buy an ankle support which won’t require you to know the intricate strapping methods and is more likely to be safe.  Just make sure that you buy the correct size for your joint.

 

E – Elevation

Again , elevation is there to help with the circulation.  Elevating the injured area helps to reduce the blood flow to the area, and thus the swelling.  It also helps to encourage the return of venous blood and lymph into the general circulation which helps with tissue healing.

 

Reference:

Khan K., Bruckner P., (2011).  Clinical Sports Medicine 4th Edition.  Australia. McGraw-Hill Australia

4 Steps to sit comfortably in your chair

If you’re one of the millions of Covid19 home office workers in the world, you will appreciate being able to sit comfortably for long hours at your desk.

The chair is the centre of your workstation.  Everything pivots around it.  To sit comfortably follow these 4 steps:

1. Elevate Your Chair to the correct Height

The first thing that you need to do is to set the height of your chair correctly.  How do you know if your chair height is correct?  It is not whether your feet touch the ground or not.  If you use this as your guide, you are likely to set your chair too low, which will result in you shrugging your shoulders to reach your desk and your keyboard.  Shrugging your shoulders for long periods at your desk puts you at a high risk of neck pain.  Neck pain is very common among office workers and a low chair position in relation to one’s desk is one of the reasons why that this is so common.

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Read my post on 4 monitor positions that cause neck pain.

So, to find the correct height for your chair, lean backwards against your backrest and elevate your chair until you are able to work at your desk and your keyboard with your shoulders relaxed.  If your feet dangle, don’t lower your chair back again, rather get a footrest.  If there is no money for a footrest, use some books or even reams of paper to support your feet.  Don’t rest your feet on your chair base, this will strain your back.  Also, don’t ignore it if your feet don’t firmly touch the ground.  It makes a greater difference than you think to use a support for your feet, even if it’s only a slight elevation that is necessary for you to be comfortable at your desk.

“Using a footrest is important to set your chair height correctly”

2.  Bring Your Chair Closer to Your Desk

You might also need to bring your chair close enough to your desk.  You need to bring your chair a lot closer to your keyboard and desk than you think you do.  If you don’t, you will find yourself leaning forwards away from your backrest, which can lead to lower back pain.

Read my post about the importance of your spinal posture and the s-curve of the spine.  

If the armrests are a problem and preventing you from bringing your chair close enough to your desk because they are fixed, get someone from maintenance to remove them.  If you have adjustable armrests, first try to lower them, but if the correct height of your chair causes them to knock against your desk, then raise them slightly to slide just over your desk.

 
“Recline your chair backwards to about -8 degrees” by CS Body Health cc. All Rights Reserved. 2016

3. Incline Your Backrest Backwards to -8 Degrees:

Some people believe that if their chair is upright, they are sitting in good posture and sitting correctly.  Good posture for the spine is maintaining the s-curve of the spine while reclined approximately -8 degrees.  

Sitting too upright places higher loads on the spine than if it is reclined backwards.  If you sit too upright, you will fatigue faster.  Think about it, when you are tired from sitting for too long, you scoot your bum forwards in your chair and lean backwards.  You naturally do this to offload the spine and rest.  Recline your chair and set your desk around the reclined position to be comfortable.  

4.  If Your Chair has an Adjustable Backrest

If your chair has an adjustable backrest, you need to make sure that the curve of the backrest is placed in the small of your back.  This is to ensure that the s-curve of your spine is supported while you sit for long periods at your desk to help reduce lower back pain through reducing loads on your spine.

lumbar support
“Correct position of the chair’s lumbar support” by CS Body Health cc. All Rights Reserved. 2016.

So there you have it, 4 easy steps to sit more comfortably.  Any comments or questions?  Please let me know and I’d be happy to help.

Why Neck Pain May Cause You to Fall Over

Neck pain is a common problem for at least 30-50% of the population at some point in their lives.  Neck pain, however, isn’t the only problem that some people may encounter.  Some people suffering from neck pain may also experience the bizarre phenomenon of feeling off balance or even falling over in association with their neck pain.  Why is this?

If you are experiencing these added symptoms (and more – e.g. dizziness, problems with vision etc.), you would quite understandably be concerned that something more sinister might be at play. To rule this out, I highly recommend that you go see your doctor for further tests.  This is especially important if you’ve recently been in any falls, car accidents, suffer from rheumatoid arthritis or any other systemic illness or cancer (to name just a few things that may contribute to structural weakness in the neck area – there are more things that can, but discussing this is not the point of this article).

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Once you have been cleared of anything sinister, the question to ask is, why are you stumbling around, losing your balance or even falling over like a drunk person?

" Schematic of mammalian muscle spindle" by Neuromechanics under Licence in the Public Domain

” Schematic of mammalian muscle spindle” by Neuromechanics under Licence in the Public Domain

There is a structure called a muscle spindle that is a key element in this phenomenon, which is found in an incredibly high density in the upper region of the neck (200 muscle spindles per gram of muscle in this area).  It is also found in other parts of the body, but not in quite the high proportion that it occurs in the upper region of the neck (for example, there are only 16 muscle spindles per gram of muscle in the pincer muscle of the thumb).

The importance and function of the muscle spindle is that it detects changes in the length of the muscle fiber.  This in turn helps the body part associated with those specific muscle spindles, to determine where it’s positioned in space.  It also helps to set the resting tone (the resting degree of muscle contraction) of the muscle concerned as well as playing a protective function for the muscle.  The protective function occurs through the feedback the muscle spindle provides when the muscle is overstretched, resulting in immediate contraction of the muscle to prevent overstretching and injury.

In the upper region of the neck, these muscle spindles play an enormous role in the postural control of your whole body and your overall ability to balance through their function in association with other systems found in the inner ear, eyes and central nervous system.

Something that we as therapists know, is that the whole body follows the head.  In other words, if your head turns right, your body will follow and also lean towards that direction.  Think about when you’re driving the car and you turn to look at something in the road, if you’re not careful, before you know it, your car too has veered off in that direction.   This is all due to these muscle spindles in the upper region of the neck and their complex interaction with your other balance and positioning sensing systems in your inner ear, your eyes and your central nervous system.

I will always remember a knee patient I was rehabilitating years ago following his ACL surgery.  He was absolutely useless at any balance exercise and made very poor progress despite practice.  When I finally made him stand up straight to check his standing posture, I discovered that his resting position for his neck was tilted slightly to one side.  To him, this felt absolutely normal and upright!  Once I had corrected this so that he could sustain a proper upright standing posture, he found any balance exercises a whole lot easier and his rehabilitation, especially the balance and control elements, improved rapidly from there on out.  This again illustrates the importance of these muscle spindles in the upper neck muscles!

So, one of the reasons your neck pain may be causing you to stumble, lose your balance or even fall over, is that you may have some malfunction of these upper neck muscle spindle fibers and their interaction with the associated balance and positioning sensing systems of your inner ear, eyes and central nervous system.

This can be due to a few things:

  1. Damage of the muscle spindles, possibly as a result of a whiplash accident (where overstretching of the muscle may have occurred without your ability to have prevented it).
  2. Inhibition and fatigue of the upper neck muscles and their muscle spindle fibers as a result of your neck pain itself.
  3. Atrophy of the upper neck muscles resulting in less muscle spindles.
  4. Degenerative changes in the upper neck muscles such as fatty deposits in the muscle, or changes in the muscle where muscle tissue becomes a more fibrous tissue with less muscle spindles.
  5. Lastly, the effect of pain can also change the sensitivity setting of the muscle spindle fibers, making them fire more or less easily.  This in turn will change your postural control and balance so that you would over or undershoot a balance related movement.

What can you do about it? Your OMT specialised Physiotherapist has a number of techniques to assist you.  If you click on the link, you can find someone close to you to help.

References:

Guzman J., H. E.-J. (2008). A new conceptual model of neck pain linking onset, course and care: The bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine, 33(4S), S14-S23.

Guzman J., H. S.-J. (2009, February). Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Journal of Manipulative and Physiological Therapeutics, 32(2S), S227-S243.

J. Treleaven. (2008).  Masterclass: Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.  Manual Therapy, 13, 2–11.

D. Falla. (2004).  Masterclass: Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy, 9, 125–133.

Member of the Ergonomics Society and Health Professions Council of South Africa