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Introduction
Weliveinanageofinactivityandrepetitivemotions.Thisisparticularlytruefordentalprofessionals.Dentistscommonlyexperiencemusculoskeletalpainduringthecourseoftheircareers.Painoccursnotonlyintheirlowerbacks,butalsotheirnecksandshoulders.Suchsymptomsdonotoccurovernight;theydevelopalmostimperceptiblyatfirst.Then,theybecomeincreasinglyobvious.Youmaynotbesufferingfromthesesymptomsatpresentbutpreventionisalwaysbetterthancureandtheearlieryourecognisethecausativefactors,theearlieryoucanstartapreventionregimethuspreventingthepossibilitiesoflong-terminjuries.
Inthisarticle,acloserlookwillbetakenatthesecondmostcommonmusculoskeletaldisorderandcomplaintamongstthedentalteam,whichisneckpain.Luckily,researchhasshownthatcorrectiveexercises,intheformofneckstrengthening,stretchingandproprioceptiveactivities,cansignificantlydecreasetheriskandimprovethesymptomsofneckpain1.
Thecervicalspine
Theneckisawell-engineeredstructureofsevenvertebrae(C1-C7),nerves,muscles,ligamentsandtendons.Thecervicalspineisnotonlydelicate,housingthespinalcord,butatthesametime,flexible,allowingmovementindifferentdirections.Thecervicalspineistheweakestandmostflexiblepartofthespinalcolumnanditisalsothemostsusceptibletoinjuries.
Overviewofneckpain
Disordersrelatedtothecervicalspinecanpresentaplethoraofsignsandsymptomsduetothemanytissuesandsystemsassociatedwiththisregion.Forinstance,thenervoussystem,includingthespinalcord,nerveroots,peripheralnervesandsympatheticchain;thedigestivesystem(thepharynx
1 NASM - Essentials of Corrective Exercise Training , Chapter 16, pg 375
‘It’sapainintheneck…’NeckpainanddentistryDrJamesTang,CES,MBA,BDS,LDSRCSGDP,NASMCorrectiveExerciseSpecialist,Level3PersonalTrainer(REPregistrationnoR1045463),SportsNutritionist,&Level3SportsMassageTherapist,withspecialinterestinposturaldysfunctionandlowerbackproblems
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andesophagus);therespiratorysystem(thetracheaandsuperiorapexofthelungs);aswellastheskeletal,vascularandmuscularsystems.
Neckpaincanbeacute(lastsforlessthanthreemonths),orchronic(lastslongerthan3months).Therearemanystressesthatcanbeplacedontheneck,forinstance,traumatotheheadandneckregionorevensimpledailyactivities;thecervicalspineisthereforevulnerabletoconditionssuchas,degenerativediscdisease,herniateddisc,stenosis,osteoarthritis&musclestrainresultinginapainfulorstiffneck.
Thevastmajorityofneckstrainandstiffneckarerelatedtomuscleimbalancesandformationoftriggerpointsasaresultofposturaldysfunction.Thistypeofneckpainusuallygetsbetterwithtime,evenwithouttreatment.Thereare,however,afewsymptomsthatarepossibleindicationsofmoreseriousconditionswhichrequirefurthermedicalattentions.
• Progressiveneurologicalsymptomssuchasweakness,numbnessorlackofcoordinationinthelimbscouldimplicatenervedamage.
• Ifthepainispersistentformorethansixweeks,isconstantlypainfulorisgettingworse,orthepainisaccompaniedbylackofappetite,unanticipatedweightloss,vomitingorfever,therecouldbeaspinaltumororinfection.
Duetotheimmensecomplexityoftheneckandthehugevarietyofcausesinneckpain,theauthor,anexerciseprofessional,willonlyconcentrateonthemusculoskeletalcausesandhowtonegatetheadverseeffectsofthetypicaloccupationalposturesofdentistryinthisarticle.
Thebasisofmusculoskeletalneckpain
Pleaseberemindedthatthehumanmovementsystem(HMS)consistsofthemuscularsystem,theskeletalsystemandthenervoussystem.Throughoutyourbody,musclesworkinsynchronyandrarelydoesasinglemuscleworkwithoutothermusclescontributing,forinstance,thebonesoftheshouldergirdleprovideanchorsformusclesthatattachtotheheadandneckandtheshouldergirdlemustbeeffectivelyanchoredifmusclesconnectingthecervicalspinetothescapulaaretoexertaneffect.Thisisbecausethefunctioningofthebodyisanintegratedandmultidimensionalsystemandasaresultofthis,impairmentinonesystemorcomponentsofeachsystemcanleadtocompensationandadaptationinothersystems–initiatingthecumulativeinjurycycle.
Inordertoexplainwhystaticposturesarebad,whetheryouarestandingorsitting,youneedtounderstandthatmusclesadapttothepositionsweput
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themin.Thelongerweholdtheminacertainposition,themoretissueadaptationoccurs.Musclescanthereforebecomeadaptivelyshortenedorlengtheneddependingonthepositionyouputthemin.Thisisbecauseourbodiesarenotdesignedtomaintainthesamebodypositionhoursafterhours,daysafterdays,butunfortunately,dentistsoftencannotavoidprolongedstaticpostures.Althoughthebodyisefficientinadaptingtotheneedthatyouplaceonit,theseadaptationswillleadtomuscleimbalances,predisposingtobackandneckproblems.Thesoonerwemastertheeconomicuseofmovements,aswellasaposturethatisfriendlytothespine,thegreaterthechanceofpreventingassociatedmusculoskeletalconditions.
Whyisneckpaincommonamongstdentists?
Dentistryiswellknowntobeastressfuljob;dentistsareconstantlyunderatremendousamountoftime,administrativeandfinancialpressure.Thesituationisworsenedwiththeburdenofdetailedrecordkeeping,increaseinpatients’expectationsandthelikelihoodofcomplaints.Whenyouarestressed,youautomaticallytenseupintheshoulderandneckregion.Wheneveryoutenseup,youextendthecervicalportionofthespinalcolumnforward.Ifyouaredepressed,youholdyourheaddownandbecometoorelaxedinthisarea.Thesepositionscancausemuscleimbalancesultimatelyleadingtomusculoskeletalneckpainorevenspinaldiscproblems.
OthercommoncausesofNeckStrain
• Traumaticcauses-necktraumasuchaswhiplash,orfromafallaffectingtheheadandneck.
• Posturalcauses-toomuchtimespentinawkwardpositions,suchashunchedforwardworkingoncomputersorpatients,orrestingaphoneononeshoulderforaprolongedperiodoftime.
• Lifestylecauses-Unilateralstraincausedbyhabituallycarryingheavyobjectsononesideofthebody.Sleepinginapositionthatstrainstheneck,suchasusingapillowthatiseithertoohighortoofirm.
Commonsymptoms
Mostepisodesofneckstrainresultsinastiffneckand/orpaininuppershouldermuscles.
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Posturaldysfunctionpredisposingtoneckandbackpainthatiswithparticularrelevancetodentistry-Hyperkyphosis
Thespinehas4naturalcurvesinthesaggitalplane(i.e.whenviewedfromtheside),cervicallordosis,thoracickyphosis,lumbarlordosisandsacralkyphosisandthesecurvesareessentialforshockabsorption.
Hyperkyphosisisaresultofexaggerationofthenaturalthoracickyphoticcurve.Thistypeofposturaldysfunctionistypicallycharacterisedwithexcessivethoracicspinalflexion(forwardbendingofthethoracicspine),forwardheadposture,roundedshoulderandinternalrotationoftheshoulder,predisposingtoimpingementofthesupraspinatus(oneofthefourrotatorcuffmusclesoftheshoulder)tendonduetoareductionofthesubacromialspace.
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Muscleimbalancescausedbyhyperkyphosis
Muscleimbalancessimplymeanthatcertainmusclesareshortened/tightandothermusclesarelengthened/stretched.Inbothcases,thesemusclesareweakened.Musclesaremoresusceptibletodamage,fatigueandinjurywhentheyareweak.Characteristicsofhyperkyphosis
§ Lengthenedmiddletrapeziusandrhomboids.
§ Protractedshouldersandshortenedpectorals–sotheybecometight.
• Forwardheadposture-thisoftenresultsinimbalancesbetween
musclesthatsupportandmoveyourneck,shouldersandhead.Themusclesinfrontofyourneckresponsibleforflexing/forwardbendingofyourneck(deepneckflexors–seebelow**)maybecomeweakwhiletheonesintheback(neckextensors)maybecometightandstrainedastheyneedtobeconstantlycontractedtosupporttheweightoftheforwardpositionedhead–resultinginextendedcervicalspinewithshortened/tighteneduppertrapezius,sternocleidomastoid(SCM)andanteriorscalenemuscle.Furthermore,aforwardheadpostureaccentuatestheanteriorshearforceatthecervicalspine,andthispostureresultsinthelevatorscapulaetocontractconstantlytodynamicallyminimisethisforce.Furthermore,forwardheadpostureisalsoharmfultotheinter-vertebraldisksasthispositioncompressesthediskstogetherforward,whilethepulpynucleusmovesoutofalignmentbackward.Thesituationissimilartoapostureinwhichyouholdyourheadtooneside(lateralflexionoftheneck-thisiscommonalthoughyoumaynotbeawareofthis).
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Diagnosisofforwardheadposture-Thepowerfulsternocleidomastoidmusclescaneasilybevisualisedthroughtheskinandcanthereforebeservedasanindicatorofaforwardheadposture.Thegreatertheverticalityofthesternocleidomastoidwhentheneckisviewedfromtheside,thegreaterthelikelihoodthataforwardheadpostureispresent.Thisisbecausebilateralcontractionofthismuscleisresponsiblefortheheadtobetranslatedforward.
§ Posteriorlytiltedpelvisandlumberflexion–Thesepelvicimbalancescanaffectthelength-tensionrelationshipofthemusclesthatareattachedtothelumbo-pelvichipcomplex,e.g.lengtheningofbackmusclessuchastheerectorspinaegroupandtighteningofabdominalmusclessuchastherectusabdominis,leadingtomuscledysfunctionandlowerbackpain.
Furthermore,musclesthataretightandstiffcanrestrictbloodcirculation–resultinincreasemusclefatigueandimpedethemusclerepairprocess.Allthesecangreatlyincreasethechancesofinjury.
Causesofmusculoskeletalneckpain
Themainculpritrelatestotheoperativepositionofthedentist’shead.Thehumanheadis,onaverage,8-10percentofourtotalbodyweight.
Maintainingthe‘natural’cervicallordosisisimportantbutunfortunately,inanefforttoachieveadirectlineofvisionintotheoralcavity,dentistsareoftenrequiredtoleanforward.Forwardheadposturesarethereforecommonamongdentalprofessionalsbecauseitisonlypossibletoperformdentistryina‘neutral’positionifonecarriesouttreatmentusingasurgicalmicroscope.
Inneutralposition,thespineissupportedmostlybythevertebraerestingontopofoneanother.Byholdingtheheadandneckinanunbalancedforwardpositioninordertogainbettervisibilityduringtreatment,thespineincreasinglydependsonmusclesandligamentstomaintainanuprightposition.Forexamples,theuppertrapezius,erectorspinaemustcontract
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constantlytosupporttheweightoftheheadintheforwardposture.Thisresultindevelopmentoftriggerpointsinthesemusclesleadingtoapredictablereferralpainpatterns–suchasthetensionnecksyndromecharacterisedbyheadachesandchronicpainintheneck.
Triggerpointsoftheneckandshoulder
Itisconfusingbutmostneckpainsarecausedbytriggerpointsintheupperback(e.g.trapezius)andinter-scapularmuscles(e.g.therhomboids).Triggerpointsinthenecktypicallyreferpaintotheheadcausingheadache.Forexample,tightnessofthesternocleidomastoiddoesnotcausepaininthemuscleitselfandfrontalheadacheispracticallyasignatureofsternocleidomastoidtriggerpoints.Theycaneveninitiateautonomiceyeresponsesuchaslacrimationandvisualdisturbance.Triggerpointsinthescalenemusclesoftheneckreferpaintotheback,shoulderandarms.Generallyspeaking,triggerpointstendtoreferpaintoadifferentlocationandperformingself-myofascialrelease(SMR)ontheareawhereyoufeelsymptomsusingeitherafoamroller,theracaneoralacrosseballmaynotgiveyourelief.Triggerpointsaretinymusclecontractionknotsanditmustbeemphasisedthattheyarenotthesameasmusclespasm.Musclespasminvolvesthewholemuscleandtriggerpointsinvolvesonlycertainmyofibrils.Youcanconsidertriggerpointsas‘microscopicspasm’.Thesecontractedmusclefibresarenotavailableforcontractionastheyarealreadycontractedleadingtoweaknessofthemuscleinvolved.Furthermore,thesetinycontractionknotswithinthemusclerestrictblood&lymphaticcirculationintheirimmediatevicinity,resultinginaccumulationofmetabolicby-productsanddeprivationofoxygenandnutrients.Thiscrisisofenergyproducessensitizingsubstances,suchasbradykinin,thatcancausepainbecausebradykininisknowntoactivateandsensitisemusclenociceptors.Whatcanwedowiththesetriggerpoints?-SMRisparticularlyusefulinfixingpaincausedbytriggerpointsbecauseitincreasesthecirculationthathasbeenrestrictedbytheconstrictedtissuebybreakingintothechemicalandneurologicalfeedbackloopthatmaintainsthemicroscopic‘spasms’.ThesciencebehindSMRisautogenicinhibitionbyactivatingthegolgitendonorgansthatarelocatedinthemusculotendinousjunctionsturningoffthemusclespindlesthatmaintainthemicromuscularcontractions.
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ItisbeyondthescopeofthisarticletogointothedetailsofSMRandifyourequirefurtherinformation,pleasegetintouchorconsultyourphysiotherapistorexerciseprofessional.PleasedonotattemptSMRtechniquesunlessyouhavereceivedexplicitguidancefromaqualifiedpractitioner.Ifyouhaveanymedicalissuessuchasorganfailuresorcancer,seekadvicefromyourdoctorbeforebeginningSMR.Althoughachesandpainsfromtriggerpointsarecommon,therecansometimesbeanunderlyingpathology.Itisadvisabletoalwaysseekaproperdiagnosisifyousufferfromneckorlowerbackpain.Theauthorsimplyusesthisarticlehighlightingtoyouthediversityofsymptomsthatcanbecausedbytriggerpointssothatyoucanlookoutfortheirinvolvementasadifferentialdiagnosisforyourneckandbackconditions.
Recurrence
Theacuterecoveryperiodforsymptomaticreliefofneckpaincanbeuptoeightweeksbutthelikelinessofitsre-occurrenceishigh–thisisbecausewithouttheeradicationofthecausativefactorsandpropertreatment,triggerpointssimplyturnlatentandcanbereactivatedeasilywiththeslightestoverload.
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Abriefoverviewofthemusclesofthecervicalspine
Deepcervicalflexors**
• LongusColli• LongusCapitus• RectusCapitusAnterior&lateralis
Thesedeepneckflexorsareagroupofmusclesthatliealongtheanteriorsurfaceofthecervicalspinedeeptothesternocleidomastoidandareresponsibleforflexion(bendingforward)andlateralflexion(bendingsideway)oftheneckbutmostimportantly,forsupportingtheweightoftheheadandstabilizationoftheneckduringdynamicmovementsagainsttheeffectsofgravity(theirroleissimilartothatofthetransversusabdominisincorestabilisationofyourtorso).Theanatomicalactionofthelonguscapitisandlonguscolliistonodthechin.Iftherecruitmentofthesedeepmusclesisimpaired,thebalancebetweenthestabiliseronthefrontandthebackoftheneckwillbedisrupted.Thiswillcauselossofproperalignmentofthespinalsegmentsandaposturethatcouldleadtocervicalpain.
Itisthereforeimperativetomaintainthecorrectlength-tensionrelationshipsofthesemuscles(thisreferstotherestinglengthofamuscleandtheforcethemusclecanproduceatthislength).Forwardheadposturepredisposestotighteningoftheneckextensorswhichneedtoremaincontinuallycontractedtosupporttheweightofthehead.Thedeepneckflexorsbecomelengthenedand‘inactivated’duetoreciprocalinhibition,theprocessofmusclesononesideofthejointrelaxingtoallowcontractionofthemuscleontheothersideofthatjoint.Throughtheruleofreciprocalinhibition,whenonemuscleshortens,itsantagonistwillalwayslengthen.Ifyouhaveamusclethatisconstantlyshortenedinagivencontext(inthiscasetheneckextensors),theantagonist(inthiscasethedeepneckflexors)willbelengthenedwithinthatcontext.Thisisonewayofthinkingofhowatightmusclecaninhibitthefunctionofitscounterpart.Thisappliestoallmusclesonyourbody,includingthoseofyourneck.Patientswithposturalneckpainorneckinjurysuchaswhiplashcanshowimprovementinpainandfunctionifthesedeepneckflexormusclesarestrengthened.Asaforementionedthatthehumanmovementsystemisanintegratedsystem,asaresultofunderactivityandinabilityofthedeepneckflexorsand
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cervicalerectorspinaetomaintainanuprightcervicalspineposition,thesuperficialcervicalmusclesincludingtheuppertrapezius,levatorscapula,sternocleidomastoid,andpectoralisbecomesynergisticallydominanttoprovidestabilitythroughthecoreandshouldergirdlecomplex.Thisisbecausemovementoccursthroughthecoordinatedcontractionofanumberofmusclesaroundajointandifthesedeepcervicalflexorsdonotcontractproperly,thenthebrainwilllookforalternativesolutionstocreatethesamemovement,resultinginthesynergists/helpermuscles(thoseglobalmusclesclosertothesurfacesuchasuppertrapezius,sterncleidomastoidetc)takingovertheroleoftheprimemovers(i.e.synergisticdominance).Thesesynergistsarenotdesignedtobetheagonistandtheyarelessefficient(superficialmusclescomposemainlyofType2fibres,theyarestrongbutarequicktofatigueandtheyarenotsuitableforprolongedposturalactivities).Overtime,thiscanleadtodysfunctionalmovementpatternswhichcanresultinneckpainthroughdevelopmentoftriggerpoints.
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Practicaladvicesonhowtoreducetherisksofneckpain
Ifitisnotpossibleforyoutoprovidedentalcareinabalancedposture,whatcanyoudotominimizethedamagingeffectsofprolongedtorqueresistance?
Improvementofyourworkpostures
Firstly,itisimportanttogettoknowyourhabitualheadposture(startbywatchingyourselfinfrontofamirrororevenvideoingyourself)atworkinparticularandprobablyoutsidework.Correctitconsciouslyinyoureverydayroutineuntiltheproperposturefeels‘normal’bylearningtotransformyourharmfulhabitualposturalpatternsintohealthyones.Youcandothisbyconsciouslythinkingaboutyourpostureandbyapplyingyournewknowledgeuntilthenewpostureandmovementpatternsbecomeestablishedasanorm.
Improvementofworkergonomics
Furthermore,regardingworkergonomics,selectionofagoodoperator’schaircanhelpyoutomaintainaneutralspinewhilstyousit.Butitisstilladvisabletoavoidprolongedsittingwhichcanleadtotighteningofyourhipflexorgroupofmusclesandweakeningofyourglutesduetoreciprocalinhibition.Theglutealmusclesareimportantforpelvicstabilisationandtheirweaknesscanleadtosynergeticdominanceofthesynergistmusclesofthebackpredisposingtolowerbackpain.
Itisalsoadvisabletoadjusttheoperativepositiontoacomfortablelevelbecauseifyourchairistoolowandthepatient’schairistoohigh,thiscausesyoutoelevateyourshoulders.Alternately,ifyourchairistoohighandthepatient’schairistoolow,you’llhavetoflexyourneckexcessively,bothscenarioscouldleadtoneckpain.
Alwaystrytomaintainanuprightposture,maintainingthenaturethoracickyphoticandlumbarlordodiccurves.Forinstance,bypositioningyourchairclosertothepatient,youcanminimizeforwardbendingoverthepatient’shead.Yourheadcanbeasheavyasabowlingball,andwhenyouleanandflexyourheadforward,youforceyourneckextensormusclestoworkexcessivelytoholduptheweightofyourhead.Itisalsoimportanttopositionthelightbeamsoyoudon’thavetostrainyourneckexcessivelywhenyoulookintothepatient’smouth.Positionyourinstrumenttrayclosetoyousothatyoudonot
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havetooverextendyourselftoreachforyourhandpiecesorinstruments,thusputtingexcessivestressonyourback,shoulders,andarms.
Alternateworkpositionsbetweensitting,standing,andsideofpatient.Switchingpositionsallowscertainmusclestorelaxwhileshiftingthestressontoothermuscles.Furthermore,itisadvisabletotakefrequentbreaks,especiallyifyouhavetositforaprolongedperiodoftime,evenifitisonlyforshortperiodoftime,togetupandmovearoundorevendosimpleexercisessuchasretractingyourscapulaeasyouawaitanaesthesia,settingofmaterials,etc.
Lifestylechanges
Choosingsupportivecervicalpillowsisveryimportantsincewespendaboutathirdofthetimeofthedaysleeping.Thistimecanbeusedtohelpyourneckposturewiththeproperneckpillowsupport.Pillowsthataretoosoftandtoolargecancauseproblems.Tosupportyourneck,yourheadshouldrestonasmall,hardpillow.Furthermore,toavoidneckandbackpain,itisimportanttoselectagoodmattressthatsupportsyourbody,iselasticateverypointanddoesnotsinkinunderthepelvis,shoulderorhead.
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Practicaladvicesfordentistswithneckpainandforwardheadposture
Introduction
Exercisesareimportantbecauseinter-vertebraldiscscontainnobloodsuppliesandtheyderivetheirnutritionbydiffusioncausedbycompressionanddecompression.Thelongeryousitorstandwithoutmovingorchangingyourposture,theworsethisisforthedisks.
Atthispoint,itisimportanttoemphasisethatyoushouldproperlywarmupyourentirebodypriortoanyexerciseandstretches–thisensuresthatallyourmuscles,joints,tendonsandligamentsyouwanttotrainarewell-suppliedwithbloodandadequatelyprepared.Awarm-upmuscleismore‘elastic’andaloosenedjoint(onethatisadequatelylubricatedwithsynovialfluids)areabletohandlemorestressandlesssusceptibletoinjuries.Itcannotbeoveremphasizedthatcorrectiveexercisesshouldbeperformedinapain-freerangeofmotion.Ifyouexperiencepainwhenperformingtheseexercisesyoumustconsultyourexerciseprofessional,doctororphysiotherapist.
Strengtheningexerciseforthedeepneckflexors:
Sinceweaknessesofthedeepneckflexorsiscommonlyassociatedwithneckpain(similartoweaknessofthetransversusabdominisiscommonlyassociatedwithlowerbackpain),thereareanumberexercisesthatcanbedonetore-activethesetinymuscles.Itisimportanttobeawarethatitistheforwardheadposturethatcontributestodeepneckflexorweakness.Forthisreason,apartfromdoingstrengtheningexercisesforthedeepneckflexors,itisimperativetodevelopgoodposturalhabitsforthenormalfunctionoftheneckandshouldergirdles.
Neckflexorscanbeactivatedbysimpleheadnoddingmotions(chin-tucks),i.e.bymovingthechinclosertothethyroidcartilage(‘Adam’sapple’).Thiscanimproveboththestrengthandenduranceofthesedeepmuscleswhichcanimproveyourposture,thebiomechanicsofyourneck,shouldersandupperlimbs.
Teachingpointsofchintuck:Standagainstawallsotheretractionoftheheadisjustuntilittouchesthewall.Holdthiswhilebreathingnormallyfor10secondsandrepeatthis12-15times.Progression-hold
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forlongerasyoubecomestronger.Youshouldalsofeelsomestretchinginthemusclesatthebackofyourneckatthesametime.
Correctiveexercisesforhyperkyphosis
Dentalprofessionalswithhyperkyphoticpostureshouldavoiddoingexercisesthatcausefurthertighteningofyourpectorals,suchaschestpresses,pressupsandbiking.Pleaseberemindedthathyperkyphosisisduetomuscleimbalances–tightnessofthepectoralsothesemusclesneedtobestretched.Theweakenedbackmuscles(middletrapeziusandrhomboids)needtobestrengthened.
Examplesofstrengtheningexercisesforthemiddletrapeziusandrhomboids:
• Seatedrow
• Single-armdumbbellrows-Holdingadumbbellinyourrighthand,placeyourlefthandandleftkneeonabench.Holdtheweightwithyourarmstraight.Useyourupper-backmusclestopullthedumbbellupandbacktowardyourhip.Pause,andthenslowlylowertheweight.Pulltheweightupsoyourelbowpassesyourtorso.
• Reversefly-usingasetoflightweightdumbbells.Sitontheendofaweightbenchwithyourbackstraightandyourcoremusclesengaged.Leanforward,bringingyourchestoveryourknees.Liftbotharmstoshoulderlevel,squeezingtheshoulderbladestogether.Loweryourarmsdownoneithersideofyourbody.Whenperformingthisexercisemakesurethatyourelbowsareslightlybentandyoudonotraiseyourarmshigherthanshoulderlevel.
Anexampleofpectoralstretch:
• Standinadoorwayornexttoawall.• Bendthearmbeingstretchedat90degreesandplacetheforearm
flatagainstthewallordoorframe.• Stepforwardsandrotateyourbodyawayfromyouroutstretched
arm
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• Holdforbetween10and30seconds.
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Conclusions
Itisadvisablethatifyouareconcernedwithyourneckpain,orifyouarenotsurehowtogetstartedwithaneckexerciseprogram,consultwithyourdoctor,exerciseprofessionalorphysiotherapist.Theywillcarryoutafullposturalassessmentforyouanddeviseabespokerectificationprogrammeforyouaswellasgivingyouguidanceintheexecutionoftheselectedcorrectiveexercises.Theauthorisnotmedicallyqualifiedandisnotattemptingtoofferyouanydiagnosisortreatment;heisprovidingyouwithasimplisticoverviewofmusculoskeletalneckpainpurelyfromtheperspectiveofanexerciseprofessionalandtheviewsexpressedinthisarticleshouldnotbeconsideredasorsubstitutemedicalopinions.
Onlyalimitedvarietyofcorrectiveactivitiesforposturaldysfunctionsthatpredisposetotheneckpain(strengtheningexercisesandstretches)havebeenmentionedandthereareplentyofalternativesavailable.Itisclearlybeyondthescopeofthisarticletodescribethefulllistofactivitiesandthedetailexecutionofeachoftheseexercises.Theobjectiveofthispieceofworkistosimplyhighlighttheharmfulconsequencesofpoorposturetotheneckandthelowerbackduetothepractiseofdentistryandsomeofthewaystocounteracttheseadverseeffects.Itisimperativethatyouengagethecorrectprofessionaltogiveyouadviceandguidancetoensurethatthecorrectactivatesarebeingchosenforyourparticularsituation.Itmustbeemphasisedthatexcisesalonearenotadequate,wemustalsotrainourbodiessothatwecanrecognisewhenweadoptpoorordangerousposture.Ifyourequireanyfurtherinformation,pleasegetintouch–[email protected]
