Occupational Therapy for Neck and shoulder pain

The neck and shoulder are one of the most used parts of our body, after the brain of course! The neck and shoulder share a lot of muscles that are common to both the joints.  That is these muscles support the neck as well as the shoulder.

The trapezius is one large muscle that attaches on the vertebral column near the neck and the shoulder.

The shoulder muscles in comparison are very small and help the shoulder in all its movement. These muscles also get less nutrition when compared to the large trapezius muscle. The trapezius supports the shoulder and the neck whereas the shoulder muscles only support the shoulder.

Due to small size and less nutrition the shoulder muscles tend to weaken before the trapezius. The weakened shoulder muscles stop supporting the shoulder and the trapezius is now overloaded. As a

result after few days the trapezius starts hurting and is wrongly diagnosed as neck pain or cervical spondylosis. This is a common phenomenon, which is followed by a visit to the family doctor/orthopaedic surgeon and intake of painkillers.

The human body adapts to this pain and the pain subsides for some time. This cycle is repeated a few times before the trapezius and other neck muscles just give up and the patient is in tremendous pain.

This is followed by some more painkillers, X-ray and MRI and sometimes surgery for cervical spondylosis.

If you have been reading so far, even though you may not be a doctor you know that this is not cervical spondylosis, but incorrectly diagnosed shoulder weakness.

One may argue at this point that the x-ray and MRI show changes and prolapsed disc that indicates cervical spondylosis. Also the patient suffers from tingling numbness in his/her hands and arms. These are secondary changes due to weak muscles at the neck and shoulder.

If the initial shoulder weakness, which was incorrectly diagnosed as cervical spondylosis was treated for shoulder weakness this whole scenario would never had taken place.

Some medical practioners may diagnose the problem correctly and advise SHORT WAVE DIATHERMY, ULTRASOUND OR PULLEY AND SHOULDER WHEEL exercises. These methods prevent excellent short-term relief but never treat the root cause, which is weakness, the heat delivered via short wave diathermy or ultrasound DOES NOT strengthen the muscles.

Pulley and other generic shoulder exercises do more harm than good as straining the shoulder muscles in presence of weakness invariably leads to further damage than good.

The evidence based and right way to manage neck or shoulder pain is to consult a specialist Shoulder surgeon or shoulder therapist. A shoulder surgeon is an orthopaedic surgeon who SPECIALISES in shoulder problems. These are different from a regular Orthopaedic surgeon who practises general orthopaedics. A shoulder therapist could be an Occupational Therapist who has specialised in treatment of SHOULDER.

 (In no way is it suggested that a general orthopaedic or a general therapist cannot diagnose or treat shoulder problems, but it merely states the fact that a specialist is better versed with these issues.)

Once your problem of neck or shoulder pain has been correctly diagnosed by a battery of clinical tests the treatment plan is chalked out.

This typically involves band exercises for shoulder/neck, exercises for movement of the shoulder and neck and a physician referral to evaluate certain vitamin levels.

Note- A True shoulder and neck therapy program rarely involves any heating, painkillers or painful movements. Patients usually report 50% improvement in the 1^st 5-10 days. They are usually pain free by 3^rd or 4^th day.

For any further questions or suggestions - contact the author.

Article provided by:

RehabCare

Neck and Shoulder Pain Clinic-Mumbai

Dr.Amol Sangekar

Shoulder and hand Therapist

BOT (Mumbai). OTR/L (USA).

Fellowship in Shoulder rehabilitation.

912265047363

9821294029

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Occupational Therapy for Tuberculosis of Spine

A CASE THAT REDEFINED MY CAREER AS AN OCCUPATIONAL THERAPIST...

XYZ was a 57year old male, suffering from upper back tuberculosis. Before he underwent the surgery, he complained of sudden development of weakness of both his lower limbs, which further resulted in complete loss of strength within a week’ time. The investigation report showed that he was suffering from tuberculosis of dorsal spine with significant neural compression. His life underwent a dramatic change, and he became completely dependent for all his daily living tasks, and to add to the problems further he even lost control over his urine and motions. 

I remember, when I evaluated him the first time, he barely had movements in his lower extremity, left slightly better than the right.  I started with occupational therapy intervention from 5th post – operative day when he was medically stable and discharged. We started with static exercises of all the affected muscles with varying intensity, frequency, and duration of exercise and each time any progress was noted it was a matter of success for both me and the patient. It was with the help of active assistive exercise and activities, that gradually over a period of three weeks we started to appreciate some improvement in the muscle strength in his legs. 

The gradual improvements were a great source of strength, inspiration and motivation for him and me as well. It was evident from his diligently following the exercise regime. It was evident from his body language that there was a sense of purpose in his participation. He appreciated the changes, he was able to sit and move in and out of the bed. His improvements in sitting balance enabled him to self feed, watch TV for longer period of time and maintain reasonably well posture. He started to inch towards pursuing his favorite pastime of sitting and reading and even work on his laptop. Been a senior engineer, his ability to lay his hand once again on his laptop was a milestone of sort.

One very challenging part of managing him was encountered when I attempted to make him stand, weighing 110 kg and a  stature of 6.3 feet tall, and the kind of weakness that he had, it really was a daunting task to facilitate him for attempted standing. I am immensely thankful to the physical assistance being provided by the building watchman. His insurmountable mental strength prevailed, he started using walker after about a month’s period, he couldn’t believe, he and his wife were in tears when he managed to stand on his own with a walker; they had almost given up all hopes. The whole experience inspired me like never before; I should say that it was a defining moment for me as a professional. It gave me immense confidence in dealing with my patients. 

The regular therapy sessions went on, the gradual improvement was mutually motivating, as time passed by the initial therapeutic interventions gave way to next set of interventions and then to next, the therapeutic sessions continued and continued for next 8 month, regularly and religiously. 

As our therapeutic journey was coming to an end, more and more emphasis was been given on his performance in activities of daily living, he was trained to walk independently on streets, in his garden, unleveled streets, and staircase. These valiant efforts were punctuated with painful trips and falls, but he always held on to his grit and determination and that became the cornerstone for his successful rehabilitation. 

 

After about a year, he is currently working with the same company that he used to, and he now travels extensively across the globe. I will always consider this opportunity as a perfect kick-start to my aspiring professional career. It was also a high point in understanding the true essence of patient-therapist relationship, which till now was just an academic jargon. 

(The Author wishes to acknowledge with gratitude, the intellectual contribution of 
Dr. Shovan Saha - Occupational Therapist, in editing & re-formatting of this article)

Article By:

Dr. Dr. Yogita Chhawchhria

B.O.TH, M.O.TH.

Occupational Therapist & 

Rehabilitation Consultant.

Proprietor: Yashasvi Rehab Center,

Shop No. 3, Building 10,

Durga Sadan Society,

Tilak Nagar, Chembur - 400089.

Email: yashasvirehab@yahoo.co.in

Contact No: 9820794435 / 9821557137

Services available: Occupational Therapy, Speech Therapy, Special Education, Clinical Psychology, & Physical Exercise Therapy.