The best pillow for neck and shoulder pain is firm enough to hold the head at a healthy angle but soft enough to alleviate pressure points. Most sleepers find success with either memory foam, latex, buckwheat, or feather pillow, as these materials offer the best balance of support and pressure relief. An example of such pillow is available on the following link: Memory Foam Pillow for Sleeping – Ergonomic Design with Dual-Sided Firmness for Side, Back, and Stomach Sleepers – Cervical Support Pillows for Neck & Shoulder Pain, Charcoal & Gel-Infused: Amazon.co.uk: Kitchen & Home
Upper cross syndrome and lower cross syndrome are terms referring to muscle weakness and tightness in certain areas of the body that may be contributing to pain and/or reduced functional level. Each “syndrome” entails two predominant areas of muscle tightness and two predominant areas of muscle weakness. Oftentimes, these limitations occur as a result of impaired posture and can lead to pain. Once identified, both upper cross and lower cross syndromes can be effectively treated and managed with physical therapy care.
UPPER CROSS SYNDROME
The upper cross syndrome refers to the “upper half” of the body; the waist up. The two zones of muscle tightness are the pectoralis (pec) muscles and the upper trapezius/levator scapulae muscles. The pec muscles (pec major and minor) are located on the anterior (front) aspect of the chest. The upper trapezius and levator scapulae muscles are both located on the lateral (side) aspect of the neck and connect into the back. At the end of a long workday at a desk, posture can become less than ideal which includes forward head posture and slouching of the shoulders. With poor posture, these muscles become stretched and are unable to perform their jobs as effectively as needed and can lead to pain.
LOWER CROSS SYNDROME
The lower cross syndrome refers to the “lower half” of the body; the waist down. The two zones of muscle tightness are the lumbar (low back) paraspinal and the hip flexor muscles. The lumbar paraspinal is located in the lower back on either side of the spine. The hip flexor muscles are located on the front of each hip. Standing posture contributes to the prominence of the lower cross syndrome and includes increased curvature through the lower back and positioning of the abdomen in a more anterior (forward) position. Over time, standing with increased curvature through the lower back and can lead to increased tightness through the lumbar paraspinal and hip flexor muscles. These limitations form half of the “cross” of the lower cross syndrome. The second portion of the cross of lower cross syndrome involves weakness through the gluteal and abdominal muscles. With poor standing posture, these muscles become stretched and are unable to perform their jobs as effectively as needed and can lead to pain. https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/
(1) LOFT. The loft determines the angle of your head in relation to your spine. A pillow that’s too high or too low can force your neck to bend at an unnatural angle, causing strain and discomfort over time. That’s why sleep experts recommend choosing a pillow loft that keeps your head and neck aligned with your spine.
(2) SUPPORT. In addition to being the right height under your head, a pillow should also adequately support your neck.
(3) FIRMNESS LEVEL. The pillow firmness will determine where your head comes to rest, so it’s important to give this aspect careful consideration. Pillows that are too firm may cause pressure points, for example in the ears when side sleeping. On the other hand, pillows that are too soft may sag under your head and fail to provide proper support.
(4) PRESSURE RELIEF. A good pillow provides pressure relief by taking the strain off the neck and contouring to reduce pressure points. For the best pressure relief, choose a pillow that’s the appropriate shape and size for your sleeping position, and the appropriate firmness to alleviate pressure at contact points.
(5) PRICE. When shopping for a pillow, keep in in mind that certain types of pillows will last you for years, while others may need to be replaced after a year or two as their materials wear out and lose their loft or conforming abilities.
(6) QUALITY MATERIAL. Within broad categories such as memory foam or feather pillows, the quality of the individual pillow plays a significant role in determining its longevity and comfort. https://www.nhs.uk/conditions/neck-pain-and-stiff-neck/
The spine is a column of bones arranged one on top of the other. The bones are linked at the back by joints called facet joints, one on each side. The facet joints hold the bones together and stabilise the spine, while also allowing movement.
The facet joints may become painful either due to wear and tear (also called degenerative change), stress or injury, although the reason is not always clear. Pain is felt around the facet joints and in the surrounding area. For example, pain starting from the joints of the lower back will often be felt in the buttocks and upper legs.
WHEN IS DENERVATION USED?
The denervation procedure is usually considered after trying less invasive treatments, such as medication, physiotherapy, transcutaneous nerve stimulation (TENS).
Exercise, acupuncture, yoga/pilates and relaxation therapy may also help ease back pain. Spine surgery could be also considered in selected cases.
Denervation is usually only considered if you have responded well to local anaesthetic injections near the affected areas, and these have helped to reduce pain.
WHAT IS THE FACET JOINT RADIOFREQUENCY DENERVATION
Facet joint radiofrequency denervation is a procedure in which nerve fibres supplying the painful facet joints are selectively destroyed by heat produced by radio waves and delivered through a needle.
The treatment is usually performed after an injection of a local anaesthetic close to the affected joints has helped to reduce feeling and pain.
The denervation treatment involves placing a special needle (radiofrequency probe) near the nerve of the joint; when a radiofrequency current is passed down the probe, a very small area of heat is created that causes a break in the nerve. This procedure does not affect any other part of the body. https://www.nice.org.uk/researchrecommendation/radiofrequency-denervation-what-is-the-clinical-and-cost-effectiveness-of-radiofrequency-denervation-for-chronic-low-back-pain-in-the-long-term
(1) Muscle spasms
Muscle spasms or cramps are quite common. They can happen at any time of the day, but especially during exercise or in the days following a workout. They are commonly caused by muscle overuse, nerve compression, lack of blood flow, dehydration.
Muscle spasms in the lower back often occur when you are bent over and lifting something, but they can happen during any movement involving your lower body.
(2) Strained muscle
A strained or pulled muscle occurs when a muscle is overstretched or torn. It’s commonly caused by overuse, physical activity, lack of flexibility.
(3) Herniated disc
The spine is made up of many parts including spinal discs and vertebrae. If a disc slips, it means that the soft center of the disc has bulged out, which can irritate the nearby spinal nerves. A slipped disc may be accompanied by severe shooting pain.
Spondylolisthesis is caused by an injured vertebra shifting or slipping forward on the vertebra directly below it. More likely in younger people who participate in sports like gymnastics and weightlifting, spondylolisthesis is often the result of untreated spondylolysis. Spondylolysis is a stress fracture or crack in the small, thin portion of the vertebra that connects the upper and lower facet joints.
Lower back pain may be the result of arthritis. Your joints are protected by cartilage, and when your cartilage deteriorates, it can cause pain and stiffness. There are many different types of arthritis, including osteoarthritis, psoriatic arthritis, rheumatoid arthritis.
The back pain you are feeling when you bend over is likely due to a muscle pull or strain. It could, however, be something more serious such as a herniated disc. If you are experiencing severe back pain, blood in urine, changes in bowel or bladder habits, pain when you lie down, or fever, you should get medical help right away.
If your back pain does not go away or improve over time, schedule an appointment with your doctor for a full diagnosis. https://www.nhs.uk/conditions/back-pain/
The spinal column on the back is made up of vertebrae. Vertebrae are the 33 individual bones that interlock with each other. The vertebrae are numbered and divided into regions: cervical (there are 7 vertebrae in this region), thoracic (there are 12 vertebrae in this region), lumbar (there are 5 vertebrae in this region), sacrum (there are 5 fused vertebrae in this region), and coccyx (there are 4 fused vertebrae in this region). Only the top 24 vertebrae are moveable; the vertebrae of the sacrum and coccyx are fused.
L5-S1 helps transfer loads from the spine into the pelvis and legs. The L5-S1 motion segment has distinctive anatomy and receives a higher degree of mechanical stress and loads compared to the segments above. These characteristics may make L5-S1 susceptible to traumatic injuries, disc herniation, degeneration, and/or nerve pain.
Conditions affecting the L5-S1 spinal motion segment are usually treated with non-surgical methods. If the lower back and/or leg symptoms worsen or do not improve despite non-surgical treatments, or in case of certain medical emergencies, such as tumors or cauda equina, surgery may be recommended.
NON-SURGICAL & SURGICAL TREATMENTS FOR L5-S1
NON-SURGICAL TREATMENTS FOR L5-S1
- Medication. Over-the-counter (OTC) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first for pain stemming from L5-S1. For more severe pain, prescription medication, such as opioids, and/or corticosteroids may be used.
- Physical therapy. Specific exercises and physical therapies can be designed to target pain stemming from L5-S1. These therapies help stabilize the back and keep the muscles and joints well-conditioned for long-term relief, while also providing a healing environment for the tissues in the lower back.
- Chiropractic manipulation. Manipulation of the lumbar spine through chiropractic adjustment may help relieve pain stemming from L5-S1.
- Self-care. Mild to moderate pain may be treated with heat and ice at home. For sciatica pain, it is usually advised to stay active and continue daily activities as tolerated. While bed rest may provide temporary relief from symptoms, it usually does not aid in faster or long-term recovery for sciatica.
- Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals. These injections are more effective in treating the inflammatory causes of pain, such as pain from herniated disc fragments.
SURGICAL TREATMENTS FOR L5-S1
- Microdiscectomy: A small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
- Laminectomy: A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
- Foraminotomy: The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
- Facetectomy: The facet joints are trimmed to relieve compression of nerve roots.
- Lumbar interbody fusion: A degenerated disc is removed and L5-S1 vertebrae are fused with implants or bone grafts. https://www.nhs.uk/conditions/lumbar-decompression-surgery/
PAIN MANAGEMENT SPECIALIST
A pain management specialist is a doctor who evaluates your pain and treats a wide range of pain problems. A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain.
FIRST VISIT TO A PAIN MANAGEMENT DOCTOR
On the first visit, a pain management doctor will ask you questions about your pain symptoms. He or she may also look at your records, your medication list, and prior diagnostic studies (X-ray, MRI, CT). The doctor will perform a thorough physical exam. At the first visit, It helps to have a pain journal or at least, to be aware of your pain patterns.
Common things your doctor may ask on the first visit:
- Where is your pain? (what body part)
- What does your pain feel like? (dull, aching, tingling)
- How often do you feel pain? (how often during the day or night)
- When do you feel the pain? (with exercise or at rest)
- Setting for the pain? (is it worse standing, sitting, laying down)
- What makes your pain better? (does a certain medication help)
- Have you noticed any other symptom when you have your pain? (like loss of bowel or bladder control)
If you find you’re having difficulty managing your pain, ask the GP for a referral to a specialist pain clinic. Pain clinics offer a wide range of treatments and support. They aim to support you in developing self-help skills to control and relieve your pain. https://www.nhs.uk/live-well/healthy-body/how-to-get-nhs-help-for-your-pain/
(1) SUPPORT YOUR BACK
If your office chair doesn’t have lumbar support, grab a small towel and roll it up. A small pillow will also work. When you slide back in your chair after finding your proper posture, place the towel or pillow between the chair and your lower back. This support device should help you maintain good posture. If the towel or pillow is too large, you could be forcing your spine into an awkward position that will be painful quickly.
(2) ADJUST YOUR CHAIR
Move your seat up or down until your legs are parallel with the ground and your knees are even with your hips. Your arms should be parallel to the ground, too.
Your feet should be resting on the floor. If they aren’t, use a stool or footrest to elevate your feet until you are in this position.
(3) PUT YOUR FEET ON THE FLOOR
Your feet should be flat on the floor. If you’re wearing shoes with heels, removing them may be most comfortable.
Don’t sit with your legs crossed. This can reduce blood flow and cause muscle strain.
(4) KEEP YOUR COMPUTER SCREEN AT EYE LEVEL
Adjust the monitor until it’s about an arm’s length away.
The top of your computer’s screen should be no more than 2 inches above your eye level. Computer monitors that are too low or too high can strain your neck and eyes.
(5) USE A HEADSET IF YOU SPEND A LOT OF TIME ON THE PHONE
If you spend a lot of time on a phone and typing or writing at the same time, use a speakerphone. Bending your neck to cradle the phone can cause stiff muscles, pain, and even ligament damage over time.
(6) TAKE REGULAR BREAKS
Sitting for long periods can reduce blood flow and cause muscle fatigue. To prevent that, take frequent breaks.
When you take a break, stand up and walk away from your desk if you can. Get your blood flowing by doing some calf raises and shoulder shrugs. https://www.nhs.uk/live-well/healthy-body/how-to-sit-correctly/
(1) FIND THE RIGHT POSITION
If you sleep on your side, put the pillow between your knees and draw them up slightly toward your chest. If you like to sleep on your back, try the pillow under your knees, or roll up a small towel and place it under the small of your back.
Avoid sleeping on your stomach because it puts a lot of strain on your back. If it’s the only position you can fall asleep in, put a pillow under your stomach to take some of the pressure off your back.
(2) GET A GOOD MATTRESS
The type of mattress you need depends on your body type. A soft mattress can be good if your hips are wider than your waist because it will let your spine stay straight while you sleep. If your hips and waist already line up straight, a harder mattress might feel better because it will give you more support.
(3) GET IN AND OUT OF BED CAREFULLY
Be extra careful when you get in and out of bed. Bending forward at your waist or making quick and jerking motions can cause you more back pain.
Take your time and roll over onto one side and use your arms to push your way up. You can then swing your legs out of bed to stand up slowly. Reverse the movements when it’s time to lie down at night.
(4) EXERCISE YOUR CORE
Getting regular physical activity is a great way to improve the quality of your sleep. But doing targeted exercises to strengthen your core, the muscles in your abdomen, hips, lower back, and pelvis can also help ease back pain.
(5) TRY GENTLE YOGA STRETCHES BEFORE BED
Talk to your doctor about which poses are safe for you to practice and which ones won’t make your pain worse. It might be helpful to start off using yoga props like blocks and bolsters for added support so that you can hold poses comfortably. https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/tips-to-reduce-stress/
Uneven shoulders can be the result of an imbalance somewhere else in the body. Playing sports and certain injuries can cause muscular imbalances especially in the upper body. Asymmetrical sports such as tennis, golf, and baseball are especially likely to cause uneven shoulders and postural imbalances.
Other common causes of uneven shoulders include:
- poor posture
- pinched nerve
- uneven hips
- flat feet
- shoulder injuries
- weak or tight muscles
- overuse or misuse of the shoulders
- incorrect sleeping position or only sleeping on one side
- using one side of the body to hold objects
HOW TO TREAT UNEVEN SHOULDERS
- Regular therapeutic massages help to relieve muscle tension and increase flexibility.
- It’s a good idea to engage in regular exercise and participate in sports as much as possible. Yoga, swimming, and rowing can help to strengthen and realign your body.
- Make it a practice to check in with your posture continually throughout the day. It may be helpful to use a mirror. Become aware of your posture not only while you’re standing or sitting, but as you’re completing your usual activities. Start using your non-dominant arm as much as you can to balance out the workload.
- Incorporating relaxation techniques into your routine can help you to relieve stress, tension, and tightness in the body. This may include meditation, breathing techniques, or anything else that helps you to relax. https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/