Hope you had a nice weekend. I know I did. But when I woke up this morning, I had a problem I haven’t had for a long time–a wry neck. Why? Well, I was doing a bit of unaccustomed activity, namely vacuuming the house. And with a bunch of cats flinging litter over the side of their boxes all the time, that’s a necessary evil more frequently than I would like.
 
Felt fine at the time. No soreness, no stiffness, no problems apparent. But this morning, as I tried to roll over and get out of bed–OUCH! Stabbing pain and spasm in my upper back, just at the base of the neck. If this were to follow the old pattern, it would gradually tighten, all throughout the day, and suddenly spasm in certain positions, like when I would try to rapidly turn my head.
 
This was a chronic recurrent problem during my surgical career. You may not think that surgery is stressful to your muscles, but you’d be wrong. Orthopaedic surgery, which often requires the surgeon to lug around some pretty large and heavy legs, is extremely physical. And the surgeon is required to get into some pretty awkward positions, to get at the parts of the joint that’s being fixed. You don’t think of that, because when you see a photo of surgery, it’s sanitized and usually features actors or models. I assure you, the reality is very physical indeed.
 
In addition to the actual physical labor involved, and this was the biggest factor for me, the near constant tension of personal responsibility for the patient. Whatever goes on, your fault or not, is your responsibility. It’s the “Captain of the Ship” concept. And it’s that subtle tension that permeates every waking moment, always in the background, always there, that makes the vulnerable neck prone to spasm.
 
I remember during my first rotation as an intern, my chief resident, Fred, asked me about some adverse effect that affected one of my assigned patients. I don’t even remember what it was, after all this time, but I protested, “It wasn’t my fault.” He replied, and this burned its way into my brain and lasted for the rest of my surgical career, “Stillwell, it ain’t your fault, but its YOOORE responsibility” (delivered in a real Southern drawl).  Indeed. From that time onward, I took that to heart. So that subtle tension was ALWAYS there.
 
In fact, when I saw some of my friends in the OR, after my retirement, almost to a person, they remarked on how relaxed I looked. First time they’d ever seen me when I wasn’t carrying that burden.
 
In addition, it seems I had a couple of bulging discs in my neck, which I’m sure played a role as well. In fact, if you ever experience stabbing pain along the upper back, just along the border of your shoulder blade (ie., medial border of the scapula) that’s a classic pattern for a C5-6 radiculopathy (pain caused by pressure on the C5-6 nerve root, as it emerges from the spine, usually a bulging or herniated disc). I can vouch for that, personally. It’s true.
 
So, what happened this time? Well, besides the vacuuming, I think I slept in an awkward position, giving those chronic discs in my neck a chance to get pinched, get inflamed and cause mischief. Given that it rarely happens these days, I should be grateful. But, hell, it HURTS. So here’s what I did, and what you can do if it happens to you.
 
First, I mobilized both my shoulders, rolling them forward and backward. Most wry neck cases (also called torticollis, in medical lingo) involve spasm of the trapezius, the large muscle that attaches to the base of the skull, both shoulder blades, and then sweeps down to the middle of the spine. So this movement helps to loosen up that muscle.
 
Then, I rolled my head slowly in each direction, again to break up spasm and loosen up the trapezius. You can actually feel the muscle stretch as you do this.
 
Then, I used a powerful vibrator to massage the site of maximal spasm. Now, to do this, you need one of the long wand-like electric vibrators, with a club-like head. The idea is to increase local blood flow to the spastic areas and relax the spastic muscles. Hand massage, by a significant other or a professional, is also very effective.
 
Local heat, local applications of magnets (yes, this DOES work) and medications and diet to reduce inflammation and relax muscular spasm are also helpful. Oddly enough, even though this regimen is for your neck, it’s effective for local inflammation and spasm anywhere, and in any joint.  This is how a sore neck is like a painful knee.

This regimen is reviewed in great detail in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN http://drbillsclinic.com/eliminate_knee_pain.html  
 
And it works. If it didn’t, I wouldn’t be able to sit and write this email. So, whether you have a wry neck or a painful knee, the principles are the same and this combination of methods will work for you. You can see for yourself and try it at http://drbillsclinic.com/eliminate_knee_pain.html 
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

April 29. 2008

 Ever wake up in the morning and notice a “kink” in your neck? I know I have. Not so much any more, now that I’m no longer subject to the constant tension of being in practice, combined with the peculiar positions you can get into when you’re trying to do surgery. But when I was working, every so often, I would awaken in the morning to find I had a stiff neck.
 
The stiff neck was bad enough. But then, it would begin to spread down to the inner border of my shoulder blade, and the trapezius muscle on that side would knot up, like it was being goosed with an electric current. And any slightly quick turn, or any other head movement, was met with a painful spasm that would take my breath away. I dreaded the rest of the day, because it would only get worse and worse, as time went on and I became more and more active. You just haven’t lived til you’ve tried doing arthroscopic knee surgery with a wry neck. Sometimes the spasms would just make me nauseated. And I couldn’t take any serious medication–hey! I was operating! Just the pits….
 
For years, I attributed this occasional problem to an odd position I must have adopted during sleep. And that probably did play a role in triggering the spasms. But it turns out, I also had a very common problem: a chronic bulging disc at the C5-6 level. I only found this out later on, when I chanced to have an MRI scan, which demonstrated the pathology, clear as a bell.
 
Of course, I should have realized what the problem was. The pattern of pain distribution is classic: C5-6 nerve root radiates to the inner border of the scapula  (shoulder blade). But like I’ve mentioned before, physicians have big blind spots when it comes to their own health conditions, and I’m no different.
 
But I did learn a few things that help, which I’ll pass on to you now. First, if possible, eliminate stress. If you can lie down with a rolled face towel under your neck, cross-wise. A bath towel is too thick and a hand towel is too small. The face towel is just right. If you have a heating pad, use it–nothing soothes like pleasant warmth. Place the heating pad under your neck and upper back. Turn it up for about 20 minutes at a time. 

If you’re sitting up, slowly bend you head forward and feel the stretch in the neck and back. Then slowly begin to roll your head from side to side, back and forth. Eventually, you will loosen up enough to roll your head around in a circle. Go five times one way, then five times the other. if you have a “knot,” a tight spastic focus that’s painful in the upper back, get someone to massage it with deep thumb pressure, until it loosens up.
 
Tylenol can be taken for some pain relief, without making you groggy, or affecting your judgment. OTC medications like Advil or Aleve not only relieve pain,  but they are really NSAID’s, that will reduce inflammation, too. Just be sure you take them WITH FOOD, to protect your stomach. Be sure you take some oral calcium, magnesium and potassium supplements to minimize muscle spasms. A glass of tonic water,
which contains quinine, will often help with spasms, too.

If the episodes become too frequent or too severe, go see a doc. Sometimes, a shot of cortisone, right into the “bullseye” of the painful spasm will break it for good and give you long term relief. So if you ever have this curse, or know someone who does, you now have a whole litany of methods to relieve it. Use them in good health! Til next time, my friend be well.

Yours for a pain-free tomorrow,

Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to  http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved