Caitlin Whyte (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.

Today, we are joined by Wendy Towers, a Nurse Practitioner at University of Maryland Shore Medical Group Neurosurgery in Easton, Maryland to talk about managing your neck pain. Now Wendy, what are some common causes of neck pain to start us off here?

Wendy Towers, MSN, AGACNP-BC (Guest): Well, what we find when people come to the office complaining of neck pain, it's usually things that are chronic in nature, such as patient's age, they complain of loss of mobility in their neck. They may develop headaches. They'll hear cracking and popping sounds that are being troublesome to them and causes a lot of times are just the wear and tear of our daily lives. Having our computer screens at an incorrect level, looking down at our phones constantly sometimes we'll just wake up with a stiff neck.

I think everybody's kind of had that problem where they wake up and they're like, oh, I can't really turn my head a certain way. And then it eases over time. When patients eventually come to see us, it's usually because just the normal types of things like Advil and heat and cold and stretching hasn't helped. And then they see their primary and then they end up coming to see us at some point. But usually it's just more chronic repetitive complaints every once in a while, we don't tend to see it because in our practice, we don't see a lot of trauma patients, but of course, any kind of trauma will also cause significant neck pain and muscle strain.

Host: You know, in our very digital society where we are using computers and mobile phones, we tend to look down a lot, which puts stress on the neck. What are some ways we can adapt the way we handle our devices to prevent neck pain?

Wendy: One of the things that I find to be very important is having our computer screens and being aware of having good body mechanics. It seems that a lot of people are constantly looking down or they have their computer screens up too high. And they're, like I'm constantly having to tilt my head or patients wear glasses. And there's new prescriptions now where you can see a computer screen easier than if you, instead of for distance, you just have like computer glasses that kind of regulate for your distance. So, a lot of times neck pain is okay also associated just with tension. We are a society, especially in the United States where we're always on the go. We always need to be in the know. So, we just build up a lot of tension too, that causes a lot of neck pain. And like you said, with the mobile devices we're lost without them.

So we tend to keep ourselves stiff too. You know, we're looking down, we're not really being very mobile with our necks and that really causes our muscles to not like us too much. And then we get the significant neck pain with that too.

Host: Are there ways to prevent damage to your neck that causes neck pain like exercises for instance?

Wendy: I think one of the things that's really important, that seems sometimes counterintuitive. And I really talk to our patients about this, especially one who don't need to have surgical intervention, but they have significant neck pain is that they tend to want to not really mobilize their neck. They are fearful of because they hear the cracking and the snapping and the popping kind of sounds. They become very fearful of that. And therefore they become more stiff and more stiff over time. So, I really encourage them to do a lot of neck rolls and think about like moving their head back and forth, side to side and really rolling the neck, doing things with yoga, acupuncture and acupressure, heat and cold. Those kinds of things can really help. But exercises, for example, I went to recently to the physical therapy for some neck pain that I was having, and they gave me exercises that I did daily and it wasn't just, you know, moving my neck side to side, it was doing small weightlifting and doing a lot of stretching in ways that I hadn't thought about before.

So, seeking out physical therapy can really help with exercises for each individual patient. There are some things that some people can't do, but then there's other things that people can do. And if you individualize it through your PT program or looking online for different things can really help. It seems counterintuitive sometimes, but actually moving your neck is an important piece of good neck health.

Host: How can advanced practice providers help with managing neck pain?

Wendy: Nurse practitioners at the University of Maryland System have multiple roles. My role in particular, as a Neurosurgery Nurse Practitioner at Shore Regional Health is one that sees patients in clinic preoperatively, or if they don't need surgery, for assessments and diagnosis and treatment plans.

I also work alongside the surgeon, assisting them in surgery. And then I see patients in the post-operative floor, the hospital and patients post-operatively in the clinic. So, I have a well-rounded neurosurgical experience that's similar to the neurosurgeons experience. There are neurosurgery nurse practitioners who focus mainly in the clinic and they see all of the preoperative patients, get them ready for surgery. They can see patients, do assessments, diagnose, make treatment plans for patients who aren't going to be going to surgery and then refer them to the surgeon when it's time for a surgical consultation. And then there's a vast majority of neurosurgery nurse practitioners who work within and PAs, too, who work within the hospital setting in the post-operative floor setting; they work on postoperative neurosurgical units, seeing patients, not just for spine pain, but it could be they could see them after a patient has a brain tumor. They really take care of the gamut of postoperative care for neurosurgery patients in general. And then there's variations on the theme, but we're all trained to assess patients, order tests and develop treatment plans.

So, there's no one area that we are absolutely specialized to. I'm just very fortunate that I have the depth and breadth of experience to be able to see patients throughout their whole surgical experience and see patients who don't require surgery, which is also something that's wonderful to see patients who don't need to have surgery.

And that's a lot of times that we see with patients with neck pain, they come in and frequently they don't need to have surgery, but they need a treatment plan. And it's great to be part of the team that helps get them feeling better.

Host: Can you talk about the complimentary or natural therapies that can help manage neck pain, like acupuncture, massage, things like that?

Wendy: Oh absolutely. And I'm a big fan of all of the complimentary therapies. I actually, love massage. I get it every two weeks, if I can. I definitely invest in acupuncture. And one of the things I don't think people know is some of these things can be paid for through insurance, depending on your insurance carriers. Acupuncture, you can have a copay. So, there are definitely things that I think sometimes people don't look into that can be really helpful. The different kinds of gels, and there's a big push throughout the country for looking at CBD oil and so forth to help with that. There's different applications. My feeling is with that is that you go to see somebody who's reputable in the community, like your local pharmacist sometimes has an herbalist on staff that can really educate patients on the different types of modalities and what may work best for them. I've used all of these different kinds of things for different aches and pains and, you know, working in the surgical field, we spend a lot of time looking down at patients, you know, we get stressed and our muscles tighten up.

So there's a lot of things that I can really relate to having neck pain, because it's a chronic condition that I've had for over 30 years. And how do you deal with that, is using multiple modalities to really help and one thing may work great one time and something else works better the next time. So, really listening to your pain, thinking about, you know, not just like the Advils or even though they're are wonderful, anti-inflammatories can really help, but looking outside the box, especially if you keep trying the same thing over and over again, and it doesn't work, then trying something new can really be beneficial.

Host: And at what point would someone need surgery for their neck pain?

Wendy: I would say for the most part, neck pain in general, doesn't relate to needing surgery intervention. Usually what happens is that patients who have neck pain start to develop other neurological complaints, such as radiating pain down an arm, numbness, tingling in their hands, feet, having difficulty walking, picking up something, they start losing muscle strength. Those are all the things that you start saying, okay, something else is going on and we can help with relieving the neurological pressure of, you know, anything that's been compressed, whether it's just the spinal cord in general or a specific nerve root, like from a herniated disc or a severe degenerative disc disease.

But in general, neck pain alone, doesn't lend itself to surgical intervention. So, when we see patients that come in that are really just describing neck pain and we do an examination and we just don't see any neurological deficit, it's sometimes hard for patients to understand that surgery is not going to necessarily help neck pain. Now, if they have a deformity, where they might not have so much neural compression, but they have kyphosis where they're their whole neck is going forward; you know, there may be some thought of if we get you realigned and that might help, but for the most part, it would have to be very significant and more than likely you'd have neural compromise somewhere that would dictate needing surgery.

So I would say for most patients listening to this, if you have neck pain only, and you really don't have other neurological complaints that working with massage, acupuncture, different kinds of CBD applications, Advils, the Motrins, the heat and cold, regular exercise looking to see at your basic body mechanics, all of those things are the things that are really going to help you and then seek neurosurgery help when you start to develop weakness, numbness, shooting pain, having difficulty walking or urinary dysfunction, there's something that's going to be triggering the real need to have surgical intervention.

Host: Well, thank you, Wendy for joining us today. You can find more shows just like this one umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.