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

April 9, 2008 

Lately, I’ve been asked a lot about neck problems. Among these are muscle spasms, trigger points, the radiating pain down an arm, from cervical disc disease, and the ever popular wry neck. One guy in the fitness group, for which I have the honor to be medical advisor, wrote in to ask for help for his chronic upper back and neck pain.
 
It seems he was doing a forward bridge, with side to side neck stretches, and apparently overdid it. He suddenly got a catch, a spasm between the shoulder and the base of his neck. This was a few months ago. He’s tried massage, stretches and cable expanders for his chest, in an effort to relieve his pain. But he’s still suffering with a wry neck–limited motion, pain, sudden catching with muscle spasms, and all.
 
Believe me, I can empathize with him: “I feel your pain!” Actually, I really have felt his pain–I had this same recurrent problem for years, thanks to a chronic disc problem at the C5-6 level. I would awaken with a stiff neck and pain in one sore spot on the inner border of my shoulder blade (scapula), a typical pain presentation for a C5-6 disc. Throughout the day, the muscles would gradually get tighter and tighter in spasm. And it really sux! 

You haven’t lived until you’ve tried to operate with a stiff neck and severe muscle spasms. The pain can be so bad, that you actually feel nauseated, not to mention the sudden stabbing spasms, if you move in such a way as to stimulate a trigger point. And arthroscopic surgery, in particular, requires you to twist your head and neck around, as you manipulate the instruments.
 
Why would I operate in this condition? Well, I wasn’t really sick, or dying, I just hurt. Like Peter O’Toole, playing Lawrence of Arabia, said in the classic 1962 David Lean film, “Of course it hurts. The trick is not minding that it hurts.” My patient was depending on me to relieve his pain, the OR staff was depending on me to not screw up the schedule. And I was in SOLO private practice, no partners. So, yeah, if I could
function, I went to work.
 
Did it adversely affect the surgery? Nope. I just went a little slower than normal, in anticipation of, and attempting to avoid, triggering a painful spasm. But I only know one way to do the procedure–and that’s excellent! The patient got the very same result he would have, had I been at 100%. The point is, I  understand, first hand, what this guy is going through.
 
But he made several mistakes that have cost him a prolonged period of pain. First, he was doing a forward bridge. A forward bridge allows direct bodyweight pressure to travel down the neck bones and discs.  If you look at the neck bones, they are smaller and lighter than those of the lower back. This is a clue that they are not designed to bear weightbearing forces.  By contrast, a back bridge does the opposite: pressure goes down the back of the neck and actually stretches the spine, relieving any pressure on the discs. So, if you have neck problems, you might want to avoid the forward bridge.
 
Second, while bearing weight on his head and neck, he overdid the neck stretches from side to side. This is putting a lot of strain on the muscles and ligaments, as well as the discs, and is just asking for trouble.
 
Third, he did not mention the first thing you should do if your are injured–REST. In case of any acute neck injury (assuming it’s not very serious like a car wreck, where a fracture is possible), first STOP what you are doing, and rest your neck on a transverse rolled towel.
This places the neck in a slightly extended (ie.,gentle backward bent) position with even support, to allow the muscles to relax.
 
Local ice for 48 hours and the other anti-inflammatory measures I describe in detail (albeit for the knee) at
 http://drbillsclinic.com/eliminate_knee_pain.html   will help to relieve pain and resolve the inflammation.  This can then be followed with GENTLE head rolling exercises and GENTLE stretches, again to relax the muscles. But if there is little or no relief in a few days, you need to see a doctor, preferably an orthopaedist. You could have a herniated disc, or some other more serious problem and only a thorough medical
evaluation, with x-rays and perhaps an MRI or CT scan, can identify them.
 
Never let an acute injury become a chronic wry neck (torticollis). You’ll be sorry if you do. 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

Yesterday, we sent my bride’s new RAV4 to Southampton by an auto transport service, so she’ll have access to an all wheel drive vehicle up there. Then, she had the bright idea of packing some boxes of books, pictures and other stuff in the car, so we wouldn’t waste the trip. This had to be done the night before, so the car would be ready for transport. Guess who was tagged for this packing detail.
 
Right, the first time! “C’est Moi.”
 
You know, it always amazes me just how heavy a bunch of books really is, when you’re carrying them. Now, as a physician and an orthopaedist, I certainly know better. But when I’m not wearing my “Doctor’s Hat,” I’m just as stupid as anyone else. When faced with
the petty little problems of daily life, I tend to  just do what I need to do to accomplish my purpose, without thinking much about it.

While I appreciated the fact that the books were heavy, I was very careful, moved slowly, with good body mechanics and I didn’t feel any pain or spasm at the time. I was very pleased with myself and I thought I’d gotten away with it….
 
Nope.
 
Here it is, two days after the fact, and I’m standing in my local comic shop, looking over the latest arrivals to indulge my hobby. Out of the blue, WHAM!  I got a sudden, painful spasm in my mid-back, right over the site of my old spinal fracture, like someone stuck a knife in my spine, that took my breath away.  I was just standing there. But thanks to a phenomenon called “delayed inflammation,” I was now paying the price for my recent indiscretion. Any slight twist to the spine, any attempt to bend, even slightly,  resulted in a sharp, burning spasm, right in the center of my back. You play, you pay. Terrific.
 
To make matters worse, thinking it would be a nice outing for her, I had brought my dog, Kelly, to the shop with me (For long time readers, she is doing fine, much better than before, though her hindquarters are still not normal, and she still needs my help to get in and out of the car) and I had to help her out of the back seat. WHAM!  Another spasm hit.  Just great.
 
What I hate most about the situation is that I have to move around slowly and gingerly, like I’m walking on eggshells, anticipating a new spasm with every move. Now, in my case,  my pain and spasm are due to discogenic disease, compression and shearing forces on spinal discs, crushed in my fall.  But, more commonly, this type of presentation is due to an acute sprain, or strain of the ligaments and muscles, respectively. Or, it may result from an acute herniated disc, where the central gel (nucleus) in the center of the disc is squirted out, like toothpaste out of a tube, putting pressure on the nerve roots and causing pain and sometimes, weakness. If you have any doubt, get yourself checked by a physician, or other health care provider.
 
Besides bed rest, lie with a couple of pillows under your knees, to flex your hips and knees and flex the pelvis, flatten the spine and reduce forces across the back. To function in a sitting position, I use a NADA CHAIR–a back pad, attached to two slings that wrap around the knees, providing substantial support for the back. You can get one on the web site of the same name.
 
The usual measures to reduce the accompanying inflammation should be used (these are reviewed,  albeit in the context of knee pain, in my LITTLE GREEN BOOK, which you can order here at    http://drbillsclinic.com/eliminate_knee_pain.html),  including local heat, either heating pad, or local application of magnetic therapy (which increases blood flow) to relax muscles, and anti-inflammatories. These can be Natural, like fish oil, DHA, Lyprinol, ginger, or willow bark tea, though all except for  the last, require time to work. Or, you can use OTC  NSAID’s, like Advil or Aleve, for more rapid relief (you should take two or three times the normal dose, with FOOD or MILK, to protect the stomach from side effects, like pain, bleeding, or ulcers).
 
But when it comes to relief of muscle spasms, nothing, and I mean NOTHING, works better than VALIUM. This is an older muscle relaxant (a benzodiazepam) that was often abused as a tranquilizer. But it was designed as a muscle relaxant and works by blocking impulses
at the neuromuscular junction (that site that is where the nerve “plugs in” to the muscle). It’s the only drug that does this. All the later relaxants work in the central nervous system (ie., the brain), by  “unknown mechanisms of action,” and in my opinion, are not nearly as effective.
 
The downside is that you need a prescription from a doctor, but if you’re in severe pain and spasm, that’s a good idea, anyway. Fortunately, I AM one, so I had an emergency supply on hand. Five milligrams and the spasms settled down. Thank God. Viva Valium!  Hopefully, with all these measures, I’ll be back in action, minus the back spasms, in a day or so.  So, til next time, my friend, I wish you 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