Neck and Back Pain

A Chat with Deborah Hogan, registered physical therapist, Massachusetts, Sunday, February 20, 2000

Moderator: We have Deb Hogan with us today. Deb is a registered physical therapist who has VHL. Professionally she specializes in chronic neck and back pain, and with her own involvement she has a special empathy for those issues. We are delighted to have Deb with us today.

Chatter: What is your opinion of using massage therapy and acupuncture for chronic back pain? My husband has had success with it.

Ms. Hogan: I don’t have experience with acupuncture. I use massage in my own treatment, especially for neck pain, and it’s very effective. I also give people hand-held massage gadgets, such as a theracane, so that people can use some deep pressure and manage their pain independently.

Chatter: My husband had gone to physical therapy and it seemed to make the pain worse. They had him doing stretching exercises to increase flexibility. They sent him home with a flexible hose and a large ball. The kids enjoyed it and recommended that he use them.

Ms. Hogan: He did some strengthening and a physio ball. Stretching can sometimes make things worse, especially if someone over-does. People should maintain their full neck and back range of motion, but you have to be careful not to over-stretch and over-do, especially when there is pain involved. What are the issues that caused the pain?

Chatter: The physician thought the back pain was caused by weak stomach muscles following abdominal surgery. Since then the spinal MRI discovered a herniated disc.

Ms. Hogan: For herniated discs some specific back extension exercises are helpful, to put the disk back in place, if the herniation is caught early enough. If there is leg involvement (numbness, tingling), pelvic traction can be used as long as there is no hemangioblastoma or syrinx involved. In that case you should not allow any physical therapist to touch you with the traction. Pulling and stretching on the machine should not be done with a spinal tumor.

Chatter: Massage therapy and acupuncture did more for pain relief. His massage therapist has also recommended the theracane and he has used it.

Another Chatter: What about neck exercises and massage for stress? My husband has VHL, and I have the stresses that come with standing by. I store stress in my shoulders. During one VHL episode my shoulders were literally as stiff as a board. What do you do for that?

Ms. Hogan: I think sometimes shoulder rolls, circles with the shoulder, shrugging, can increase the blood flow. When they are really hard like that it is sometimes that there are chemicals caught there, like lactic acid from exercise, and blood flow needs to be increased to those areas. Theracane, tennis ball, and massage are all helpful.

Prepare two tennis balls.  Put each one in a sock and use the sock to control the position of the ball. Holding the end of the sock, put one tennis ball on the right shoulder and one tennis ball on the left shoulder. With your hand, push the tennis ball into the shoulder. If the pain is in the mid-back, push your back against a tennis ball on the wall. Use the sock to control the ball. Do knee bends, moving against the ball on the wall. Or lay down on the tennis ball for mid or lower back pain.

Another Chatter: Which is best: electric heat, massager, or vibration "thumpers"?

Ms. Hogan: A heating pad is fine. Some of the massagers are actually a combination of heat and massage, which is great. Using heat or ice will be according to the patient’s preference, whichever reduces the pain better. Both massagers are heat are fine, whatever works. Moist heat is better than a dry heating pad.

Chatter: What do you suggest for neck pain?

Ms. Hogan: Usually a hot water bottle with boiling water and a towel wrapped around it. That’s great for neck pain. Also be careful of reading in bed or using too many pillows, and watch the tension level in your shoulders.

Chatter: Sometimes I feel like my neck is too weak to hold up my head.

Ms. Hogan: Have you had any laminectomies or surgery in this area? Or do you currently have a hemangioma there?

Chatter: I currently have a tumor there, and I have had surgery there also.

Ms. Hogan: In that case you do not want to do exercises involving motion, but you do want to strengthen those muscles. You can do some isometric exercises to strengthen the neck. Those are exercises where you create resistance – a force moving in direction and a force moving in the other direction – to make your muscles work without actually moving them. The idea is to keep the head in alignment, but use the resistance to strengthen the muscles. This is the most painless way to strengthen the neck.

Put two fingers on your right temple. Try to push into those fingers gently for 3-5 seconds. Keep pushing with your fingers too, so that your head does not actually move, but the muscles are working. Do that five times. Repeat on the other side, with your fingers on the left temple.

Then put your hand on the back of the head. Try to push your head back, and resist that pressure with your hand, and hold that for 3-5 seconds. Repeat five times. Similarly, with your hand against your forehead, try to press your head forward.

Then put your two fingers on the right temple. This time try to turn into those fingers. Hold this tension for 3-5 seconds, five times. Repeat on the left side.

Chatter: Do you believe that by strengthening the back and neck it would relieve some of the pain?

Ms. Hogan: Yes, I do believe that strengthening will help. The head weighs 10-12 pounds. Muscles that are weak cannot support the head in everyday activities. They become fatigued, and pain results.

Chatter: I tend to use more than one pillow because I’m unable to lie flat without experiencing vertigo since my last surgery.

Ms. Hogan: If you have to use more than one pillow, be sure to elevate the shoulders too, not just the head. Or put the head of the bed up (put some bricks under the legs at the top of the bed, or use a wedge pillow to support the entire upper body. Get more of the body up, not just the head.

Another Chatter: My husband has found that taking glucosamine sulfate has helped his neck pain. His neurosurgeon actually supported his taking the glucosamine.

Ms. Hogan: No comment on glucosamine. That’s outside my area of expertise. Perhaps Gale can comment?

Gale Lugo, Natural Health Consultant, Florida: Glucosamine has often been used for arthritis, but I don’t know about its use with other kinds of pain. Success is what matters!

Chatter: He has noticed a positive difference. It is possible that his pain could be arthritic.

Ms. Hogan: It is good that he is experiencing some relief. There are so many reasons for pain that it would be hard to predict who else might benefit.

Another Chatter: I often have neck pain. What kind of exercises do you recommend for someone who gets dizzy and has neck pain?

Ms. Hogan: Tell me first what hemangiomas you have now or have had in the neck? What prior brain or spinal surgeries have you had?

Chatter: I have had hemangiomas on the brain stem and in the right hemisphere of the cerebellum. The major symptom had been severe neck pain. I’ve been trying to figure out what I can do to stay fit. Any upper body movement causes soreness and dizziness.

Ms. Hogan: Was the pain relieved after surgery? Or is this the same pain? When was the surgery done and how long did it take?

Chatter: The pain was relieved but the dizziness grew worse. I get neck pain from typing, painting, and driving.

Ms. Hogan: You should first get a checkup and get clearance from your neurosurgeon before doing any exercises. Ask for a referral to a physical therapist.

Chatter: My HMO has not been good about paying for physical therapy. They think there is no use since I have brain damage.

Ms. Hogan: Even one or two sessions will get you on the right track. You need guidance designed for your specific issues, and with the agreement of your neurosurgeon. You would probably be safe doing the isometrics we discussed here. Be careful to continue breathing! Holding your breath will increase the dizziness. Shallow breathing will make you feel light-headed.

Chatter: Since my brain surgery I find that my stamina is no longer as good. Do you find this to be true with others?

Ms. Hogan: You should be okay with doing something for your lower body but be sure to check that with your neurosurgeon. Examples would be stationary bicycle, walking or calisthenics, marching in place, something to raise the heart rate, even using an ankle weight in a sitting position. Support your head against the wall if needed, and strengthen the lower body without moving your head.

Chatter: Can this kind of dizziness improve with time? It’s been 28 months.

Ms. Hogan: I have no experience with brain injury.

Joyce Graff: We had a conversation some weeks ago with Diane Roberts Stoler, author of Coping with Mild Traumatic Brain Injury. She has some very good recommendations for working with this kind of left-over symptoms of the brain injury. It generally will improve, but it could take a long time. 28 months is not abnormal.

Gale Lugo: Ginger tea is also good for dizziness.

Chatter: My father had the same problem and he told me it takes years for the dizziness to get better.

Another Chatter: Is there any difference in your advice for a degenerative condition in the cervical spine, as opposed to hemangiomas?

Ms. Hogan: You can be more aggressive with a degenerative condition, because everyone begins to degenerate after age 20! So more strengthening can be done, and less restriction on range of motion.

Another Chatter: Deb, the other day I was sitting at the computer, stretched, and my neck/upper back went into a spasm. I applied ice immediately, and since then I have been using a heating pad and slowly moving my head, so that I don’t become stiff. Do you recommend anything else at this time?

Ms. Hogan: Just continue to move gently through your range of motion until the soreness goes away. You probably over-stretched a muscle and it has a stretch reflex that causes it to contract when it’s over-stretched. This causes residual muscle soreness that can last for days. Increasing the blood flow to the area with hot showers and heat and gentle range of motion – that should take care of it.

Another Chatter: Are there muscles that can cramp where your ribs are?

Ms. Hogan: Yes, your abdominal muscles are there as well as your intercostal muscles. Do you have trouble taking a deep breath when this happens?

Chatter: Yes, and I also have trouble just moving. It feels like a charley-horse but in my right side muscles. I get it every time I have a hearty laugh.

Ms. Hogan: Well don’t let that stop you from laughing! Have you had abdominal surgery? Do you have an incision there?

Chatter: I had scoliosis surgery with instrumentation. I don’t have an incision there, but I went from 80 degrees to 40 after 15 hours of surgery. I have rods in my spine to keep it from bending.

Ms. Hogan: With the scoliosis you have one side of your waist that’s tight and one side that’s over-stretched and weak. The side that’s tight may cramp when you laugh or move in that direction. This will be made more marked because you can’t move to the side. Even so you could do some isometrics to strengthen those muscles. Tighten and release, pull your belly button in, push your right shoulder into the door without bending, then turn around and push the other shoulder into the door.

Another Chatter: I found out recently that I also store tension in the second most popular stress storage place in the body – the gluteus maximus!

Ms. Hogan: Yes, your bottom is a popular spot, especially if you tend to stand on one leg. If there’s one side that’s worse than the other, maybe you’re standing too often on that leg. Use that tennis ball to massage the buttocks. It works great!

Moderator: Deb, thank you so much for joining us this evening. It’s been a very informative discussion!