TRACY S. HORTER, BS
This paper was written in order to share the comprehensive guidelines I use as handout material when teaching daily living activities to patients with cervical pain. I have found the information to be helpful to patients in their understanding of their disability and in their learning to protect themselves.
Whatever the cause for your painful neck (and possibly, pain in your arms and shoulders), mainte nance of good posture is very important. This refers not only to "standing tall," but to proper use of your head, neck, and arms as you move about throughout the day. By learning to use proper body mechanics in all positions you can reduce strain on muscles, joints, bones, and ligaments as well as help prevent aggravation of pain and fatigue. With the help of the following suggestions you can begin to correct positions and motions which bring on or aggravate your neck and arm pain. When your doctor believes you are ready to exer cise, you will receive an exercise instruction sheet which includes the details of what to do daily to maintain or develop strength and motion in your affected joints. Remember three important items with regard to your neck and arms: 1) Everything you do with your arms affects your neck muscles; 2) As soon as your head leaves the vertical position it is in when you are upright, the forces of gravity make it more difficult for your neck and back muscles to hold your head and body up. The result is increased strain and fatigue, and 3) you must learn to break up your activities into short periods of work (about 15 minutes), then rest. This prevents strain and fatigue which lead to increased pain. There are four ways to protect yourself: 1) pace yourself, 2) plan your day (and your week), 3) Set priorities — decide what must be done first and do it, and 4) position yourself properly whether work ing or resting.
Mrs. Horter is a physical therapist and was on the staff of the Bryn Mawr Hospital, Bryn Mawr, PA, when this paper was written. She is currently affiliated with Sidney Hillman Medical Center, 2116 Chestnut St, Philadelphia, PA 19103.
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POSTURE Stand tall with knees slightly bent, buttocks tucked under, stomach pulled in, shoulders comfort ably back, and head tall and straight. Assume this position whenever standing. Sit tall in a good sturdy chair which affords good support to your arms and which extends as high up your back as possible. You may find it more comfortable to place your feet on a footstool so your knees are higher than your hips while sitting. This takes the strain off your low back by flattening it. Do not sit in bed to read or watch television as this places a strain on your neck and back.
MOVEMENT 1. Learn to move your body in one plane. Your head, body, and feet should always be facing the same direction so you are not twisting. 2. Avoid leaning over to do something, particularly for a prolonged period of time. For your neck —try to elevate whatever you are working on to a level that does not require you to be hanging your head down; ie, place your book on an angle against a pile of books on a table in front of you. For your back —never bend at the waist, always bend at the knees and hips. If you have to pick up something low, place one foot a little ahead of you and then squat down keeping your buttocks tucked under you. 3. Avoid maintaining a constant position especially when using your arms in activities such as holding up a book, needlepoint, or the newspaper. This not only makes you use the same shoulder mus cles for a prolonged period but probably places you in a position with your head down, too. PHYSICAL THERAPY
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How to Care for Your Neck
DRIVING Driving is probably a painful activity for you
Vjjfeir'
• '•>' •
Volume 58 / Number 2, February 1978
when your neck hurts. Try to stay out of the car whenever possible either as a driver or a passenger. If you must drive get as close to the steering wheel as is safe and comfortable. Gripping the bottom of the steering wheel should not bother your arms as much as gripping the top of the wheel. Learn to use your rearview and sideview mirrors instead of turn ing your head. Avoid quick starts and stops. Do not wear your hard collar when driving unless your doctor so specifies. If you are the passenger you should wear your collar. Rest your head back against the headrest, if available, to relax your neck muscles. If taking a long trip, get out of the car every hour or two to change your position and relax your muscles.
REST You will need short periods of rest during the day to unwind and give those neck and shoulder muscles a rest. Use a hard bed if possible and when lying down on your bed use a fairly flat pillow under your head to avoid your head being pushed forward uncomfortably. Use a small bolster pillow, firmer on the ends and softer in the middle which fits in behind your neck and allows your head to maintain proper alignment with your body. These are available at surgical supply houses. Avoid lying on your stomach. Necks take time to feel better —Be Patient!
Our newest anthology consists of articles published in the Journal on Research, Statistics, and Communications. One source for the best in reference material to assist researchers and writers in pre paring for publication. This anthology was introduced at the Combined Sec tions Meeting in Phoenix and sales were brisk! Paper, 138 pp, $5.00 ppd. Make check payable to APTA, 1156 15th Street NW, Washington, DC 20005.
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4. Do not lift anything heavy. If you must lift, never do so at arm's length. Split up into smaller lots whatever is to be lifted (a pile of books or groceries), get as close to the load as possible, bend your knees, keep your elbows bent, and keep the object close to your body as you lift. 5. Do not reach. Walk over to what you want to pick up or if the object is over your head use a stepstool. 6. Exceptions — "If you must." There may be things you must do out of necessity or for special per sonal reasons. If the activities are not good for your neck or back but you must carry them out, do them for 10 to 15 minutes at a time and then rest. Do not wait until you hurt because your pain and fatigue will only get worse from that point on. Special precautions should be taken when performing the following activities: 1) Cer tain housecleaning tasks like vacuuming, washing the floor or windows, cleaning the bathtub, or sweeping; 2) Outside activities such as raking, trimming the yard or shrubbery, heavy shoveling or hoeing, or washing the car. Gardening can be done for short periods of time preferably from a seated position on a low stool or in an "all-fours" position.
This paper was written in order to share the comprehensive guidelines I use as handout material when teaching daily living activities to patients with cervical pain. I have found the information to be helpful to patients in their understanding of their disability and in their learning to protect themselves.
Whatever the cause for your painful neck (and possibly, pain in your arms and shoulders), mainte nance of good posture is very important. This refers not only to "standing tall," but to proper use of your head, neck, and arms as you move about throughout the day. By learning to use proper body mechanics in all positions you can reduce strain on muscles, joints, bones, and ligaments as well as help prevent aggravation of pain and fatigue. With the help of the following suggestions you can begin to correct positions and motions which bring on or aggravate your neck and arm pain. When your doctor believes you are ready to exer cise, you will receive an exercise instruction sheet which includes the details of what to do daily to maintain or develop strength and motion in your affected joints. Remember three important items with regard to your neck and arms: 1) Everything you do with your arms affects your neck muscles; 2) As soon as your head leaves the vertical position it is in when you are upright, the forces of gravity make it more difficult for your neck and back muscles to hold your head and body up. The result is increased strain and fatigue, and 3) you must learn to break up your activities into short periods of work (about 15 minutes), then rest. This prevents strain and fatigue which lead to increased pain. There are four ways to protect yourself: 1) pace yourself, 2) plan your day (and your week), 3) Set priorities — decide what must be done first and do it, and 4) position yourself properly whether work ing or resting.
Mrs. Horter is a physical therapist and was on the staff of the Bryn Mawr Hospital, Bryn Mawr, PA, when this paper was written. She is currently affiliated with Sidney Hillman Medical Center, 2116 Chestnut St, Philadelphia, PA 19103.
184
POSTURE Stand tall with knees slightly bent, buttocks tucked under, stomach pulled in, shoulders comfort ably back, and head tall and straight. Assume this position whenever standing. Sit tall in a good sturdy chair which affords good support to your arms and which extends as high up your back as possible. You may find it more comfortable to place your feet on a footstool so your knees are higher than your hips while sitting. This takes the strain off your low back by flattening it. Do not sit in bed to read or watch television as this places a strain on your neck and back.
MOVEMENT 1. Learn to move your body in one plane. Your head, body, and feet should always be facing the same direction so you are not twisting. 2. Avoid leaning over to do something, particularly for a prolonged period of time. For your neck —try to elevate whatever you are working on to a level that does not require you to be hanging your head down; ie, place your book on an angle against a pile of books on a table in front of you. For your back —never bend at the waist, always bend at the knees and hips. If you have to pick up something low, place one foot a little ahead of you and then squat down keeping your buttocks tucked under you. 3. Avoid maintaining a constant position especially when using your arms in activities such as holding up a book, needlepoint, or the newspaper. This not only makes you use the same shoulder mus cles for a prolonged period but probably places you in a position with your head down, too. PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/58/2/184/4559704 by Washington University in St. Louis user on 19 February 2019
How to Care for Your Neck
DRIVING Driving is probably a painful activity for you
Vjjfeir'
• '•>' •
Volume 58 / Number 2, February 1978
when your neck hurts. Try to stay out of the car whenever possible either as a driver or a passenger. If you must drive get as close to the steering wheel as is safe and comfortable. Gripping the bottom of the steering wheel should not bother your arms as much as gripping the top of the wheel. Learn to use your rearview and sideview mirrors instead of turn ing your head. Avoid quick starts and stops. Do not wear your hard collar when driving unless your doctor so specifies. If you are the passenger you should wear your collar. Rest your head back against the headrest, if available, to relax your neck muscles. If taking a long trip, get out of the car every hour or two to change your position and relax your muscles.
REST You will need short periods of rest during the day to unwind and give those neck and shoulder muscles a rest. Use a hard bed if possible and when lying down on your bed use a fairly flat pillow under your head to avoid your head being pushed forward uncomfortably. Use a small bolster pillow, firmer on the ends and softer in the middle which fits in behind your neck and allows your head to maintain proper alignment with your body. These are available at surgical supply houses. Avoid lying on your stomach. Necks take time to feel better —Be Patient!
Our newest anthology consists of articles published in the Journal on Research, Statistics, and Communications. One source for the best in reference material to assist researchers and writers in pre paring for publication. This anthology was introduced at the Combined Sec tions Meeting in Phoenix and sales were brisk! Paper, 138 pp, $5.00 ppd. Make check payable to APTA, 1156 15th Street NW, Washington, DC 20005.
185
Downloaded from https://academic.oup.com/ptj/article-abstract/58/2/184/4559704 by Washington University in St. Louis user on 19 February 2019
4. Do not lift anything heavy. If you must lift, never do so at arm's length. Split up into smaller lots whatever is to be lifted (a pile of books or groceries), get as close to the load as possible, bend your knees, keep your elbows bent, and keep the object close to your body as you lift. 5. Do not reach. Walk over to what you want to pick up or if the object is over your head use a stepstool. 6. Exceptions — "If you must." There may be things you must do out of necessity or for special per sonal reasons. If the activities are not good for your neck or back but you must carry them out, do them for 10 to 15 minutes at a time and then rest. Do not wait until you hurt because your pain and fatigue will only get worse from that point on. Special precautions should be taken when performing the following activities: 1) Cer tain housecleaning tasks like vacuuming, washing the floor or windows, cleaning the bathtub, or sweeping; 2) Outside activities such as raking, trimming the yard or shrubbery, heavy shoveling or hoeing, or washing the car. Gardening can be done for short periods of time preferably from a seated position on a low stool or in an "all-fours" position.
