Advice For Patients With Back, Neck And Shoulder Disorders

Advice For Patients With Back, Neck And Shoulder Disorders

Advice For Patients With Back, Neck And Shoulder Disorders

The new approach to back, neck and shoulder pain

We have learned a lot about musculoskeletal pain in recent years and there has been a revolution in its treatment. Health care providers now approach these problems in a di erent, more active way.

Many people have learned to cope with their musculoskeletal problems them- selves, but occasionally, one may need professional help. This booklet gives you the most up-to-date, research-based advice on how to deal with the pain, avoid disability, and recover quickly. It also gives advice on when to seek help.

Some facts about musculoskeletal pain

• Musculoskeletal pain is very common. Four out of ve people su er from back or neck pain at some point during their lives. At this very moment, seven out of every one hundred people experience pain in the shoulder regions.

• Musculoskeletal pain is usually not caused by any serious illness or damage.

• Often a person has simultaneous pain in more than one region: back, neck and shoulder.

• Most of back and neck pains resolve quickly, at least
enough to continue normal activity. 3

• Half of the people who get back or neck pain experience recurrent pain within two years. Still, this does not necessarily mean that it is a serious condition.

• Back and neck pains typically follow a cyclical pattern – the pain occasionally goes away but it can return later. Shoulder pain is often steadier. After successful treatment, the shoulder may almost be free of pain. However, sometimes restricted shoulder mobility may be the main problem.

• If the pain is intense, you may need to reduce your activity. However, rest for more than a day or two usually does more harm than good. Stay active.

• People who recover fastest and cope the best are those who stay active and get on with life. The human body is designed for movement.

• If the pain is prolonged or recurs often, active rehabilitation through exercise is highly recommended to improve lost function and relieve the pain.

The structure of the musculoskeletal system

The spine is made of solid, bony blocks joined by discs to make it strong and exible. Ligaments and powerful muscles surround the spine for protection. It is actually di cult to damage the spine.

The pelvis is a mediating structure between the spine and the lower extremities. In the musculoskeletal system, joints are a chain in which the lower a ect those that are higher up. That is why, for instance, the correct position of the spine is important when rehabilitation exercises of the shoulders are carried out. Age-related, natural weakening is typical for the musculoskeletal system as a whole.


Reasons for pain: Separating fact from ction

Most people with back or neck pain do not have major spine damage.

Very few people with back or neck pains have a slipped disc or pinched nerves. Even a slipped disc usually heals by itself.

Most changes in x-ray or MRI images are normal changes related to age, like when hair turns grey.

Even with today’s technology, doctors often cannot determine an overriding cause for back or neck pain, which may sound disappointing. Serious disease or damage to the spine is rare, and very few patients need surgery for back or neck pain.

Accidental shoulder injuries often require surgical treatment. The decision has to be made by an orthopedic doctor.

Sometimes anatomic abnormalities of the shoulder may need surgical treatment.

Most b a c k pain arises from the discs, muscles, ligaments and joints. They are simply not working as they should, especially when lifting heavy loads or when put under pressure. You can think of the back, neck or shoulder as “out of order”; so the goal is to get proper function restored.

Emotional stress can increase the amount of pain you feel. Tension can cause painful muscle spasms.

People who are physically t generally experience less musculoskeletal pain. If they do experience pain, they recover faster.

The answer to musculoskeletal pain is to get the a ected areas into condition and physically t, and to learn how to live with the residual problems.

Exercise and take care of your physical condition!


Rest or activity for pain?

Rest is an old-fashioned choice for back pain treatment. We now know that bed rest for more than a day or two harms the spine. This is due to many reasons: • Your bones, muscles and ligaments soon weaken.

• Your spine sti ens and loses control and coordination. You lose general physical tness.

• You may get depressed, causing the pain to feel worse.

• You will nd it increasingly harder to get back to an active and normal life style.

You may need to restrict heavy physical loading and activity when the pain is bad, but the message is clear – bed rest is a poor solution. The most important thing is to get moving as soon as possible and remain active.

Why is exercise good?

Regular exercise:
• Makes you feel good


Muscular spasm, r
fear of pain.


Impairment in endurance, mobility, str ength and coordination.



• Releases natural chemicals known to reduce pain Improves coordination and control of movement, builds muscles, stronger bones and ligaments

• Makes you generally t

Even when your back, neck or shoulders are sore, there are a number of activities you can gradually start without putting too much stress on the spine and joints:
• Walking, cycling or swimming

• Obtaining guided physical training, if you feel unable to exercise on your own

Keep in mind that what does not hurt, probably doesn’t cause any harm. Listen to your body.

Diminished use of the spine;
less oppor tunity to calibrate the pain sensation against the pain experience.

Staying active

Youmayhavegooddays and bad days, which is normal. On a bad day, you can usually do something to control the pain and reduce your most strenuous activities, while staying active and working.


Relief of spasm and decreased fear of pain


Increased use of the spine
leads to muscle activation
and improved coordination; greater opportunity to calibrate the pain sensation against the pain experience.


What if the pain gets worse?

If you haven’t been involved in an accident, it is unlikely that your spine or shoulders are damaged. What action you take depends on how bad your pain feels at the moment.

Controlling pain

There are many things you can do to help lessen your pain. They may not eliminate the pain completely or cure your spine, but you can control pain enough to actively enjoy life. If these methods are not su cient, you may bene t from guided active treatment, which helps you take better care of yourself.

Improved endurance, mobility, coordination, strength and postural control.



Anti-in ammatory drugs are often simple and safe painkillers. All drugs should be taken according to the directions for use.

Heat and Cold

During the rst two days, it is recommended that a cold pack be applied to the painful area for 5 to 10 minutes at a time. Some patients prefer heat, such as a hot water bottle, bath or shower.


Most doctors now agree that manipulation can help with pain control, but it does not prevent the recurrence of pain.

Manipulation is safe if done by quali ed professionals such as osteopaths, chiropractors and specially trained physical therapists and doctors.

Pendulum exercises in shoulder disorders

These exercises are useful in relaxing muscles, controlling pain and maintaining mobility:

• Take a light weight in your hand.
• Support yourself with other hand by leaning on a table.

• Relax the upper arm muscles in the hand holding the weight. Using small, movements; sway the weight back and forth.

• Try moving the weight into a circular motion, as if you were drawing a circle on the oor. You will feel a slight pull in the shoulder. This relaxes the muscles in the shoulder region.

• Use small, cautious movements of the body to sway the weight back and forth.


Other treatments

Other treatments are used to reduce symptoms due to back, neck or shoulder problems. While these may o er some relief for a limited period, they may be expensive in relation to their long-term results.

Relieving Stress and Tension

It is not always possible to eliminate the cause of stress, but it is possible to learn to reduce its e ects with breathing control, muscle relaxation and mental calming techniques.

How to stay active?

Musculoskeletal pain is usually not a serious disease. It should not cripple you unless you let it. How the pain a ects you depends largely on how you react to the pain and what you do about it. If you nd it di cult to start an activity, seek professional help. You will be able to get on with your normal life after a short, guided active treatment period.

Two strategies for dealing with pain

Some people avoid activity while others use it to bring pain under control.

The avoider fears the pain, worries about the future, rests a lot, and hopes the pain to goes away.

The coper knows the pain can be reduced. The coper does not worry about the future and deals with the pain by staying positive and active.

Avoiders su er the most. They have pain longer, are out of work longer and can become disabled.

How to become a coper?

• Live life as normally as possible – keep up daily activities. • Avoid only exceptionally heavy tasks.
• Stay t – start gradually and have patience.
• Take control over your pain