Physical Therapy: Don’t paint the ceiling

For all of you over 40 or with a history of neck problems, I have one piece of important advice: Don’t paint the ceiling.

As we start to get teased by the increasingly warm days, I know for myself, the project juices start flowing.  For all of you over 40 or with a history of neck problems, I have one piece of important advice: Don’t paint the ceiling, literally.

I’m not picking on this middle to older age group on purpose but I see too many people in the clinic that have developed neck strain with associated nerve impingement from this exact activity. The reason why it hits the older population more has a lot to do with the aging spine.

In between each of the vertebrae on both sides of your neck, there is a small exit hole (foramen) for the nerve to leave through and proceed down into the arm.  When the size of this exit hole gets compromised in any way, the nerve traveling through it will get compressed and produce nerve impingement or what we medically term as foramenal compression.

So how does painting the ceiling and aging relate to this you may ask? Well, compression on the nerve is generated by both predisposing and precipitating factors.

Degeneration would be one of those predisposing factors. As we age, through a degenerating process, the vertebrae get closer together thus decreasing the size of the foramen where the nerve exits. Second, the degenerative process also tends to include a deposit of bony spurs around the vertebrae and possibly around the edges of the foramen.

The general degenerative picture produces a scenario where there is very little room for error around the nerve as it travels its course through the spinal canal and foramen.

Precipitating factors such as painting a ceiling, working underneath a car, watching an air show, talking on the phone too long, or reading on your side produce one common denominator, and that is sustained bending of the neck backward or sideways. This also physically closes down the foramen on one side of the vertebrae or both.

When there is little room for error in a degenerating neck, it doesn’t take long for these neck kinking positions to start irritating the nerve, especially if you are not conditioned for the activity. Once the nerve is irritated, swelling sets in compressing the nerve further and producing symptoms of referred pain into the shoulder or shoulder blade. If compression persists, pain can refer down as far as your finger tips and even include numbness and tingling.

How do we first prevent this?I think you are really setting yourself up for problems when you take on activities that put an older neck in awkward positions. First, try to maintain a relatively chin tucked posture during activities, that is keeping your chin towards your Adam’s apple. If you must reach up high with that paint brush, use a stool to get yourself to eye level with the task, or use an extended handle on the roller so you can stand back from the target area keeping your chin from lifting too high.

More obviously, take regular breaks. A good stretch during your break time would be to tuck your chin a few times to your Adam’s apple, holding for 10 seconds each time. This will help take your neck regularly out of the bad zone to reduce the potential for swelling build up in and around the nerve.

When on the phone, use a cradle or head-set, or simply hold the phone up with your hand not your shoulder. Try not to read on your side unless your pillow is supporting your head in a neutral position.

Lastly, if you are watching an event in the sky, or working under a car, sit back and relax a little, use a recliner or creeper.

What if prevention fails?

The first thing you can do is to try your best efforts with rest, ice and maybe even anti-inflammatories (with your doctor’s recommendation).

If the problem is still at large, there are some very beneficial things your physiotherapist can do to help. Through a combination of manual joint mobilization and soft tissue manipulation, some of the secondary joint and muscle stiffness can be relieved.

Often traction, either manual or mechanical, is an asset in readily improving the problem. Traction is a technique that ever so slightly pulls the vertebrae apart with a goal of taking pressure off the nerve. More importantly, the process of the foramen being slightly stretched open and relaxed creates a circulatory effect to help move swelling out of the region.

And lastly, if the pain and stiffness has been going on longer than eight weeks, IMS can be a very effective form of treatment in releasing neck compression caused by neuropathically tightened muscles.

The prognosis of this type of injury will largely depend on how much bone growth exists around the foramen. In a largely degenerative case, surgical removal of the bone may be an eventual result.

So if you think you might be at risk, avoid the potential headache and hire out the arduous task.