Prakash Chandran (Host): There's a reason why we call major inconveniences a pain in the neck. Tension migraines, loss of sleep, and reduced mobility can make living with neck pain downright miserable. But what causes neck pain and how do we get rid of it? Joining me to discuss are Kyle Pearce and Evelyn Meisner, both physical therapists for Orthopedic Associates of Central Maryland, division of CAO coming to you from Westminster. Hello, I'm Prakash Chandran and I've got a Bone to Fix with you. Kyle and Evelyn, thank you so much for joining us today. I really appreciate your time. We're talking about neck pain today, a topic I'm very familiar with through experience. Evelyn, I am curious how common is neck pain in the patients that you see?

Evelyn Misener, DPT: We do see a lot of patients with neck pain. I would say it's not the most common issue that I see people for, but every single day I see someone with neck pain. My caseload's always, I've got a few people with neck pain, it's pretty common.

Host: Yeah. And Kyle, is that the same for you? Same patient load, just coming in with a hurt neck?

Kyle Pearce, DPT: Yes. I always feel like I have at least one or two people a day on my schedule, and it's a staple of what we treat here. Our Westminster office is no different than the rest of our offices at Orthopedic Associates of Central Maryland. We treat the whole body, but the neck is always going to be one of those main things. It's every day you're going to have at least one or two.

Host: Yeah. Well that makes a lot of sense. You know, we live in a society now where there's just a lot of work at a desk. Maybe posture issues are just more common than they used to be. But Kyle, I'm curious, like what are the most common causes of neck pain?

Kyle Pearce, DPT: Just like you said, one of the most common things is neck pain from sitting at a desk. We have many people in our practice who come in that have been working a desk job for the last 20 or 30 years and that wears on you. Without sitting in proper posture and doing some strengthening and stretching that are going to be good for you; it's going to lead to some neck pain at some point down the road.

Host: Yeah. And Evelyn, I am curious, just from sitting in a chair or you're being in a chair for a long time, I'm curious as to how that contributes to neck pain for, cause I think for the most part your neck is just pretty still. How would you explain that to someone that is curious about it?

Evelyn Misener, DPT: So, I mean, I'm a little self-conscious now cause I'm sitting here seeing my shoulders raise up a little bit. And even when we're not moving, sometimes we get ourselves in a position where we just have this low tone. Your upper traps are just on, you know, like they're never like fully relaxed.

So one, that's one of the things that we see is people have these trigger points from just constantly having these muscles that are overactivated. Another thing that we see is this forward head posture. So if you're sitting at your desk, you're looking at your computer, and you slowly bring your head a little bit closer, that can be problematic too, because you end up lengthening the muscles in the front of your neck and then they get really tight in the back.

So that can cause headaches and pain. So one of the things we do in physical therapy, is work to retrain that posture when you're sitting. We also help with setting yourself up ergonomically to the best of your advantage. And we teach people how to stretch the muscles that are tight and how to strengthen the muscles that are weak.

Host: Now Kyle, Evelyn started to get into this already. She was starting to talk about retraining the posture, and I'm curious as to what that means. You know, if someone's been at a desk for a long time, they come in and perhaps their head is a little bit more forward and they have this pain, where do you start them?

Kyle Pearce, DPT: So I'm sitting over here listening to Evelyn and we're our constant reminders as we work so closely together. If she sees me, at the end of my day with my head forward and a little bit too close to that computer, we can remind each other. In a setting where you might work by yourself at home or in an office where you're not in office full of physical therapists, you might have to set yourself a reminder on your phone and that can be a really easy tool. Check your posture. Once you learn where a good posture should be, with that head drawn back and the shoulders back a little bit, arms supported, do a 30 to 60 minute check, throughout your day. If you set a reminder on your phone and you say, Hey, I need to reset my posture; that's a good place to start. With a lot of people, once they learn where good posture is. One of the other tools we can do is really, like Evelyn said, strengthen those muscles that might be weak so it's easier throughout the day. That kind of thing is going to require more of a strengthening course of either physical therapy or home exercises where you're getting better muscle control and it's going to be easier to adjust when you do reach that eighth hour of your day and you set that reminder on your phone and it's like, I got to bring that head back. And over time it becomes a little easier to just do it automatically.

Evelyn Misener, DPT: Yeah. And I also, like to tell people that I see, you don't have to have a hundred percent perfect posture all the time. I like to say, think about your best posture, and then relax like 20%, because it's just not realistic to be sitting like this all day long, all the time. That, that's probably going to hurt too. So you just have to find that kind of happy medium.

Host: Now, Evelyn, we're talking about training the posture and obviously that first starts with like understanding what good posture is. But let's say you're in pain and you come to physical therapy. I am curious as to how physical therapists can actually help correct that posture so you can then start training the habit.

Evelyn Misener, DPT: Yeah. So if you're coming to physical therapy and you're already in a lot of pain, our first priority is to get that pain under control. So that might look like very gentle stretching to begin with. Some hands-on treatment where we'll do some massage, look at your mobility and make sure that everything gets calmed down.

And then, just like we're talking about now, we'll give you advice on ergonomically how to set yourself up for success. So make sure that your eyes are even with the top of your screen so you're not having to look up or look down. You want to have a nice neutral position. You want to have your shoulders relaxed, your elbows at 90 degrees, your feet touching the floor, and your hips and your knees at 90 degrees too.

And then aside from those, the basics, we're going to teach you exercises that are pretty simple that you can do throughout your day that do help strengthen those postural stabilizing muscles. Maybe some shoulder blade squeezes. We do a lot of working on strengthening the upper back and the arms because that also plays a role in neck pain.

Host: Yeah. Now I've been told once that your body needs to work with gravity. And your body is a stack. And that is why it's so important to keep those shoulders back, that neck back because the gravity forces pushing downwards, and even as you said, Evelyn, the feet need to be on the floor. Kyle, is that how you like to tell your patients how they should be thinking about it and why enforcing posture while they're sitting down is so important.

Kyle Pearce, DPT: Yeah, definitely. So when once we get out of that stacked position and our head is positioned in front of the rest of our body, we're holding up a 10 pound bowling ball in front of our body and these upper trap muscles that lead up to the sides of our neck and our head that help control side to side motion, then become muscles that help hold up something. They really then get overworked.

And that's where a lot of our hands-on techniques will come into play to at least loosen those to start out. Evelyn, myself and Alyssa Cleary are three physical therapists at our Westminster office, are all trained in trigger point dry needling. And sometimes that is an excellent tool to help loosen some of those muscles that have really gone to the point where they won't just release from a deep tissue massage.

But once we loosen those muscles, it's then going to be their job to keep that head stacked on top of their body, like you mentioned, so that they don't flare up in the future. Cause patients are always asking, am I going to need this forever? Once you are in the routine and in the habit of keeping yourself with that head stacked on top of the shoulders as you put it.

Host: Yeah. And Kyle mentioned a couple things, Evelyn. But it seems like there are some immediate things that you're able to do that you're trained for to help relieve some of that stress. Some things might be pressure points, some things might be traction. Can you speak to some of the immediate things that you're trained to do to help correct posture and to alleviate pain?

Evelyn Misener, DPT: I mean, like I was saying before, the first things we're going to do are going to teach you ergonomics. We're going to teach you stretching and then the hands-on treatment. So the soft tissue mobilization that Kyle touched on a little bit too. So we're trying to decrease some of the tone and the tightness in these muscles.

And then sometimes we'll do traction. We also have electrical stimulation. There are a lot of things that we can do to just calm the system down. And then Kyle also talked about the trigger point, dry needling, sometimes that's a thing that we need to offer to people to really get things to finally get better. But oftentimes we don't need to go that far.

Host: Yeah. It's interesting, there's a toolbox of techniques I'm hearing that you have, but every person has a unique set of circumstances, right? And maybe even like a unique work environment that they're working in that is contributing to this. So, Kyle, I'd love for you to maybe talk about, as people are in their offices all day or in their work environment, how can they start to think about proactively avoiding pain?

Kyle Pearce, DPT: So sometimes proactively avoiding pain is doing the preparation. Making sure you're getting good night's, rest and hydration level; all of that's important for daily living. But when you are thinking about keeping yourself in good mechanics throughout your day and not impacting your level of pain, you want to be strong first.

Doing regular exercise, cardiovascular exercise is going to be very helpful. I like to recommend yoga as a form of exercise. If you've ever been in a yoga class where they talk about drawing the crown of your head towards the ceiling, it's automatically putting yourself in better posture.

So actively being in a exercise program is one of those preemptive things. We need to keep our body tuned up so it can tolerate daily living. But other things I've thought about as we're walking through this is, making sure that ergonomic setup that Evelyn has mentioned a couple times.

Maybe our chair's not right. Maybe that preemptive, let me avoid neck pain, is talking to your boss and getting a different setup for you, whether you're working at home or in the office. Many employers would prefer for you to be out of pain, than missing some work to go into physical therapy visits.

Host: Yeah, that totally makes sense. And Evelyn, I guess same question to you. When you think about helping people proactively avoid pain in the workplace and maybe even while they're at the workplace, things they can do there, how do you think about it?

Evelyn Misener, DPT: Well, I love what Kyle said. I think that it can be really helpful to set a timer or something if you don't have the option of having a standing desk, so that you can change from a standing to a sitting position throughout your day. It can help to set a reminder for yourself on your phone. Just, get up every 30 minutes, walk around, even if it's just for 30 seconds, it'll make a difference. And then not even just in the workplace, but sometimes it's something as simple as just changing your pillow. Sometimes people are sleeping on a pillow that isn't helping them.

You want to try to keep your head in a neutral alignment so you don't want to be tilting forward backwards. Be side bent to either direction too much, you want to keep a neutral position. So your pillow can really make a difference for that too. And then, yeah, eating a healthy diet, just staying active so that you're not sitting on your butt all day at work and then also sitting on your butt all day at home.

Host: Yeah. It's so funny that you mentioned the pillow, Evelyn, because I didn't even think about this. But obviously where we spend half our time, is sleeping. And I, when I look at my wife's pillow, for example, it's like a massive lump and her head is tilted forward. And if she's sleeping, with her back to the mattress, well then her head is like pushed and trained to be forward, which I didn't even realize is a strong contributor to probably getting neck pain.

Evelyn Misener, DPT: Yeah. I mean, it's the same thing. Sometimes we go home and we sit down on our couch and it's like really soft and cushy, and you think you're so comfortable, but you might only actually be comfortable for 10 minutes because it's doing nothing to support you. And then you get yourself in this position where your head's just forward bent like that, it causes problems.

Kyle Pearce, DPT: Let alone our teenagers who spend most of their time on their phone, or even all of us now at this point in time, our phone is attached to our hip literally and figuratively in some cases. But having that head down, that's another activity that's going to encourage us to have that kind of bent forward posture and putting a lot of pressure and stress at the base of that neck at what we call, CT junction, the spot between your cervical spine and your thoracic spine.

Host: Yeah, it's crazy. Like the society we live in today is just, it trains us so much to just like lean forward, tilt our head down, we're looking at a laptop, we're looking at our phone, and over time your body just gets trained and then that stack is misaligned. And I'd never thought about the bowling ball analogy, but you have this now your head is like weighted forward and pulling your whole body down so it does have this chain reaction. As we start to wrap up, I'd like to ask this of both of you, but Kyle, let's start with you. You've seen lots of people with neck pain. You probably have noticed some patterns. What's one thing that you want to leave with our audience that might help them or you might want them to take away from this conversation?

Kyle Pearce, DPT: So one thing I would love to leave people with is that sometimes you need help. Just doing all the things you can do of doing a little bit of self massage, self stretching, it can get you only so far. Sometimes you need a helping hand to get you to the point where it's going to be manageable long term.

And then it's going to require maintenance. Not necessarily coming into physical therapy once a year for maintenance, but reminding yourself what those things that Kyle and Evelyn told you, you should be doing regularly. Don't be afraid to ask for help from your primary care doctor, your orthopedist. Come out and see us and we'll help you get there.

Host: Awesome. And Evelyn, I'll let you have the last word.

Evelyn Misener, DPT: Yeah, and I, would also say one of the things that's great about the Centers for Advanced Orthopedics is that we also have doctors that we're attached to, that we can communicate with very easily. So you can go see one of our orthopedic docs and see what they say, and they might send you to physical therapy.

So we really work together as a team. And like Kyle was saying, if you try some of these things you look up on the internet, you try to fix your posture, you get a standing desk, you're using a good ergonomic setup, and you're still not feeling good, don't hesitate to come see us because sometimes it just takes a session or two to get you back on your feet or sitting comfortably.

Host: Well, I think that is amazing advice. Thank you both so much for your time.

Evelyn Misener, DPT: You're welcome.

Kyle Pearce, DPT: Thanks for having us.

Host: That was Kyle Pearce and Evelyn Meisner, both physical therapists for Orthopedic Associates of Central Maryland, division of CAO, coming to you from Westminster. For more information about OACM physical therapy for conservative care, or to make an appointment at one of our eight convenient locations, you can visit MDBoneDocs.com.

If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. That's all for today. I'm Prakash Chandran and that was a Bone That's Fixed.