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2. Cervicalgia & Tech-Neck…How a PT can help
“Heads up”
Reboot your posture
Cervicalgia & Tech-Neck…How a PT can help
Leah Tobey PT, DPT,
Cert. DN

3. How to join our poll questions:
Grab your cell & open a new text
Text the number 22333
In the message line, type LEAHTOBEY999 (not case sensitive)

4. Objectives What is cervicalgia?
Treatment options for patients with cervicalgia
Tips to reduce improper mechanical load of patients with cervicalgia
Review corrective ergonomics

5. Cervical Functions Supports the skull & protects the spinal cord
#1 Primary purpose of the neck is to optimize the head position & create equal weight distribution of the head to minimize overload to the stabilizing muscles
By nature, the C-spine has diverse motion thus is at risk for injury due to the flexibility.

6. Cervicalgia defined
General term for pain along the posterior cervical spine that does not radiate
Symptoms: neck pain, stiffness, spasms in neck muscles, impaired neck movement (ROM), tenderness in shoulders, headaches, dizziness or nausea
Severity of pain is dependent on extent of injury; most cases cause mild discomfort
Common medications prescribed: NSAIDs, muscle relaxants, narcotics

8. Cervicalgia Causes
AAOS (American Academy of Orthopaedic Surgeons) reports common causes as:
Inflammatory condition (such as RA)
Degeneration of cervical spine/disc i
An injury stemming from an incident (such as MVA, sports injury or fall)
An infection or tumor
Commonly known causes:
Poor posture or long periods with neck at awkward angle
Long-term stress causing mm guarding of neck & shoulders, leading to a strain on the neck
Bone conditions: arthritis, osteoporosis (age is a risk factor)

9. Tech-Neck (aka Texting Neck):
Overuse syndrome involving the head, neck and shoulders
A position with rounded shoulders where the neck is strained protracted at an uncomfortable angle
Usually results from excessive strain on the spine from looking in a forward & downward position at any hand-held mobile device
Examples: cell phone use, laptops, books or e-readers, video games, etc…

10. Improper loading through spine
Tight sub-occipital mm & tight pectorals
Neck pain
Inability to take deep breaths
Neural tension in arms or legs (N&T)

11. How do I know if I’m suffering from Tech Neck?
4 signs you might be spending too much time staring at your screen:
Poor posture
Holding your device at chest hip level?
Persistent neck pain
If it occurs on a daily or even weekly basis
N&T in fingers
Without intervention, TOS symptoms can develop
Headaches & Migraines
For every inch you lean forward, you’re “adding” weight

12. Lit review estimates neck pain affects 30-50% of adults/year
Of those, 50-85% do not have full resolution of symptoms
Like LBP, chronic neck pain can be unresponsive to treatment & very costly
*Caroll L.J. et al, “Course and prognostic factors for neck pain in the general population.” Spine 2008.

13. https://www. polleverywhere

14. Literature Review
“Prevalence, practice patterns, and evidence for chronic neck pain” Adam Goode, et. al (Duke University School of Medicine & University of North Carolina)
5,300 households with 9K participants
35 minute phone survey
Individuals with chronic cervicalgia were middle-aged (mean 48.9 yrs)
56% women
Mean of 5.21 provider types & mean of 21 visits
Therapies reported: electrotherapy stimulation (30.3%), corsets or braces (20.9%), massage (28.1%), U/S (27.3%), heat (57.0%) and cold (47.4%).

15. Saw provider, % (95% CI)
Mean visits (95% CI)†
Range of visits
Provider type
 Primary care physician
71.9 (62.1–80.0)
3.4 (2.4–4.5)
1–30
 Orthopedic surgeon
31.6 (22.6–42.2)
5.2 (1.3–9.3)
1–40
 Neurosurgeon
29.1 (20.5–39.6)
3.0 (1.88–4.2)
1–12
 Neurologist
22.8 (14.9–33.3)
3.1 (1.7–4.5)
1–20
 Rheumatologist
3.2 (1.1–8.9)
3.1 (1.2–5.1)
2–5
 Anesthesiologist‡
13.3 (7.6–22.4)
2.9 (1.5–4.4)
 Physiatrist
13.4 (7.5–22.8)
6.5 (0.3–12.8)
1–24
 Physical therapist
35.2 (25.7–46.0)
17.2 (7.7–26.8)
1–100
 Chiropractor
40.4 (30.3–51.5)
16.5 (9.0–23.9)
1–150
 Psychologist or psychiatrist
3.9 (1.3–10.7)
4.1 (2.5–8.3)
 Acupuncturist‡
3.9 (1.4–10.3)
7.9 (0.18–16.0)
2–18
 Massage therapist
28.1 (19.3–39.0)
8.4 (4.7–12.1)
1–50
 Pain clinic
11.4 (6.2–19.9)
3.8 (1.6–6.0)
Saw medical doctor
91.7 (84.3–95.8)
7.7 (5.3–10.1)
1–52
Saw alternative care provider
41.4 (31.2–52.3)
N/A
Mean no. of providers seen
5.2 (4.8–5.6)
Total no. of provider visits
20.8 (14.5–27.0)
Saw >3 providers
77.4 (68.3–84.5)
*Caroll L.J. et al, “Course and prognostic factors for neck pain in the general population.” Spine 2008.

16. *77% sought 3 or more providers for pain management

17. Comparative analysis of common interventions for neck pain compared with the utilization of care seekers (n = 113) in our study
Treatment
Use, % (95% CI)
No. of treatments received, mean (95% CI)
Efficacy or effectiveness studies in the BJD (19)
Cochrane
Medications†
 NSAIDs (OTC)
56.3 (45.7–66.3)
N/A NR
+/− (33)
 Weak narcotics
23.1 (15.0–33.7)
 Strong narcotics
28.8 (20.0–39.5)
 Muscle relaxants
31.5 (22.4–42.4)
+/−
Physical treatments‡
 Traction
17.7 (10.7–27.7)
Not asked
+/−§
+/− (34)
 Corset or brace
20.9 (12.7–32.4)
 Used TENS unit
21.8 (13.9–32.6)
+/− (35)
 Spinal manipulation
36.8 (27.13–47.6)
12.7 (6.7–18.7)
+ (36)
 Injection¶
18.6 (11.7–28.2)
2.4 (1.5–3.3)
+ (33)
 Rehabilitation conditioning/work hardening program
2.7 (0.78–8.7)
+ (37)
 Prescribed exercise
52.6 (42.2–62.8) +
+ (27)
 Electrostimulation during visit
30.3 (21.1–41.4)
20.8 (8.8–32.8)
 Heat
57.0 (46.2–67.1)
23.2 (13.9–32.6)
 Cold
47.7 (36.9–58.7)
20.7 (9.6–31.7)
 Ultrasound
27.3 (18.6–38.1)
9.2 (4.2–14.3)
 Acupuncture¶
3.9 (1.4–10.4)
7.9 (0.18–16.0)
+ (38)
 Therapeutic massage
28.1 (19.3–39.0)
8.4 (4.7–12.1)
+/− (39)
Total no. of treatments, mean#
15.6 (10.9–20.4)
No. of different treatment types, mean
3.9 (3.3–4.5)

18. Results
Based on the current evidence for best practice, our findings indicate overutilization of diagnostic testing, narcotics, and modalities, and underutilization of effective treatments such as therapeutic exercise.
The use of treatments among subjects with chronic impairing neck pain varied substantially.
The most commonly used treatments were superficial heat, cold, exercise, massage, and manipulation.
Of these treatments, exercise and manipulation had moderate to good evidence of effectiveness for patients with neck pain according to both of the systematic reviews referenced for this study.
*Caroll L.J. et al, “Course and prognostic factors for neck pain in the general population.” Spine 2008.

19. Take home Tid-Bits Prevention is key
How should I sit?
Maintain a gentle inward curve to create normal lordosis: helps align the spine when seated and lets your head rest in tall, neutral position
Perform gentle exercises:
Chin tucks
Lay flat on your back with no pillow
Place a folded hand towel (lengthwise) (~2-4” diameter roll) under the base of your skull (the bumps).
Gently and slightly nod your head yes as you exhale
Repeat times for up to 3-5 minutes
Scapular retraction:
Squeeze shoulder blades together, hold 5 seconds, + resistance as tolerated

21. Keep your upper back (thoracic spine) flexible & strong
Manual, orthopedic therapy may be recommended
The biggest service you can do to relieve your neck pain is to be mindful of your neck position during the day
Rolling on a foam roller or small ball all through your thorax to promote good alignment of your neck from below.
Shoulder strengthening exercises include retraction & depression as well as RC strengthening to support your neck.

22. Kate
Kate is a 27 y/o F currently in grad school to become a mental health therapist. PMHx of cervical tightness and pain with c/c of migraines since age 15. She reports HA 2-5 days/wk and most are severe. Family History: aunt and older brother have migraines. Allergies include NSAIDs & Tylenol (hives, facial & tongue swelling). Referred to PT by her neurologist.
Pain localizes to either L or R side of her head, associated with light, sound; odor sensitivity, nausea and occasional vomiting, poor concentration. She may occasionally note blurry spots in her vision as the migraine begins.
She has tried: nortrtiptyline, amitriptyline, topamax, Lexapro & robaxin
Current medicine regimen: alternates between sumatriptan and rizatriptan and takes 5-6 tabs per day.
Neurologist provided education regarding ‘analgesic rebound headaches & the importance in limiting this class of medication.’

23. Kate’s Diagnosis & PT Eval Tid-Bits
Two diagnoses given: Analgesic overuse headache & chronic migraine without aura intractable
She was on her new pain medication regimen for about 1 month when I evaluated her in PT; Baclofen had been added
C/o migraines & shooting pains along her upper traps, described as "constant right there." She denies N&T.
T&Ms: observation-FHRSP with dowager’s hump; palpation- hypertonic B up traps; ROM- 75% B rotation & SB; 50% cervical flexion (greatest pain!)
Assessment: Poor postural habits, hypomobility noted: C1-2, C7-T4; DNF endurance was weak <10”; poor study/ergonomic habits: laptop-couch
Results: 12 visits over 2 month period
Average HA (when present) improved from 8/10 to 5/10; improved concentration & no longer had visual changes
NDI improved minimally from 15/50 to 13/50 *of note: “belief my pain is improving”
WNL mobility through cervical and thoracic spine
Indep with gym and home ex programs

24. Kate’s treatment plan Put your head on your body
Postural retraining
Proprioception retraining
Recognition of postural habits
Bring your work closer to you
Ergonomics of work and home environments changed
Instruction to keep neutral spine
Pain cues, visual/mirror cues
Support your lower back when sitting
Morbidly obese & her chair didn’t fit her well
Lumbar support pillow behind her back to achieve neutral pelvis (WB through pelvic floor not her sacrum)
Perform gentle neck stretching & exercises
DNF strengthening
Cervical retraction/chin tucks in supine *keep pain free
Isometrics: cervical spine all planes, scapular retraction resistance with therabands & pulley system
Keep your upper back flexible & strong
Manual therapies medically needed (joint mobilization, dry-needling upper traps (endogenous opioid, endorphins)
Foam rolling for self-mobilization (daily)

25. Do ergonomics matter?

26. Healthy Ergonomics
Don’t perch—Sit all the way back in your office chair
Bring your work station to you
Raise your monitor to face height
Rest your forearms on the armrests of your chair
Use an ergonomic keyboard & mouse (build-ups with mousepad for example)

27. 5 PT Tips: Put your head on your body Bring your work closer to you
Support your lower back when sitting
Perform gentle neck stretching & exercises
Keep your upper back flexible & strong

28. Do yourself a service…avoid tech-neck

29. UAMS Physical Therapy Clinics: 501-296-1500
Spine Center
Institute on Aging
Autumn Clinic*
Colonel Glenn*
* Free standing Outpatient Clinics

30. UAMS Occupation Health and Safety department
Consultation Request for ergonomic set up

31. Questions about the Topic
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