Editor’s Note: Please note that unexplained neck and back pain should first be checked with your neurologist or neurosurgeon, to determine that there is no tumor that could be causing the pain, and that might be worsened with manipulation. Always check with a neurologist before undertaking any chiropractic treatment or physical therapy on the neck or spine.

Eight out of ten people suffer from neck and back pain. It is the second highest reason for a doctor's visit, behind respiratory infections, and the leading cause of worker absenteeism. I am a Physical Therapist (P.T.) specializing in the care of neck and back injuries and I also have VHL. Having worked as a P.T. for over 10 years and having just been diagnosed with VHL, I laugh at the irony of now suffering from neck and low back pain! I certainly have empathy for my patients!

Neck and Low Back Pain (LBP) is common among patients with VHL because of the central nervous system (CNS) tumors, scar tissue from spinal surgeries and the stress that comes with a chronic illness. I remember as a child, watching my mother apply BenGay¹ to her aching back. She wore a brace with metal stays for years. She would awaken early in the morning, take her pain medicine, and then go back to bed to wait for its effects. This is the way she managed her pain so that she could support me, as she was a single parent.

How do you manage your pain? Do you use heat or ice? Is stretching helpful? How about sleeping? Is your pillow a problem?

As a Physical Therapist and as one who suffers from VHL, I would like to provide some helpful hints for managing neck and LBP.

1. Once your pain becomes chronic, using heat or ice is a matter of personal preference. I use a hot water bottle 1-2 times per day at the base of my neck. Heat relaxes tissues and increases blood flow. Ice, on the other hand, is a fantastic analgesic, if you can tolerate the cold!! Ice decreases circulation and keeps swelling down. Try heat or ice instead of pain medicine to manage your pain.

2. I teach all of my patients proper posture and body mechanics. Your head position is very important. Your head weighs 10-12 lbs. If your head is in front of your shoulders, during computer work for instance, the weight of your head increases 3-5 times (as far as your muscles are concerned). So the muscles that support your head are supporting the weight of a 3 year old child instead of supporting an infant. This will cause fatigue and pain. Keep your head back so that the hole in your ear is over your shoulder. Practice an exercise called a "chin tuck". Think of the chickens in the farmyard, clucking and moving their heads back and forth. They are doing chin tucks ... tucking the chin backward (not looking up). This is a helpful exercise to alleviate neck pain and normalize posture.

3. Over half of my patients complain of pain in the morning. Some of this is related to sleeping posture -- sleeping on the stomach or sleeping in a 3/4 turn that twists the low back all night. How does this cause low back pain? Try putting your leg up on a chair to stretch the back of your thigh. Stay that way for several minutes and then try to move your leg! This pain is similar to the pain we experience from poor sleeping positions held over many hours. Lying on your side with a pillow between the knees, or on your back with a pillow under your lower legs, are two great sleeping postures. Avoid reading in bed or using too many pillows to sleep. Try rolling up a towel lengthwise and placing it inside your pillow case. This adds extra support for your neck.

4. A stretching program is important, as is regular exercise. This program should be given to you after a thorough evaluation to see what muscles are weak and where you are lacking in Range of Motion.

Those of us with VHL have chronic issues that have no easy answers. I find that as I take my mind off myself and focus on others, I am helped; As I keep a positive attitude, I am better able to cope. Prayer and meditation help me relieve stress. Pain does not have to keep you from living and contributing.

The choice is yours. Just remember that you are not alone.

1. A U.S. brand of mentholated cream for muscle aches

As printed in the VHL Family Forum 7:4, December 1999. For permission to reprint, please contact VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.