Neck stiffness from podiatry work

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I have been practicing for 17 years. Have had a "stiff" neck for quite a few years. In the last 2 weeks I have been more aware of the neck stiffness (it's not painful) & also some lightheadedness. Also some right trapezius/shoulder tenderness with some "radiating" type sensation down my right arm. I have been seeing a Physio the last couple of weeks (2 treatments)& she says some of my cervical joints are "very" stiff & she has been mobilising them toegther with some exercises (chin tuck with shoulder stretches to armpit) - it loosens things up but not making much of a difference.

I'm trying to think about my posture, how I sit, where my arms are when assessing/treating. Does anyone have any suggestions about better ways to sit when say doing routine footcare? How to hold my arms? Different chairs etc. It's much more a frustration than being painful but I'm more worried long term.

 

Re: Neck stiffness

How high do you have the patient when you are treating them? We had some physio guy come in when I was back at uni and give us a talk on positioning of the chair, ergonomics etc.

I found that if I lower the patient and bend at the elbows rather than having the patient higher and raising my arms at the shoulder I got less back pain.

Just a thought

 

Re: Neck stiffness

Thanks Sam. I possibly have had the chair lower in the past but now I am raising it up more. Most of the issues are neck related hence I'm trying to reduce neck flexion so I have the patient couch higher & I'm trying to sit closer so my arms are not as extended. You never really give much thought to these things until you have a problem. I wonder what the incidence of neck/upper back problems there are in Podiatrists?

 

Re: Neck stiffness

Hi Mark,

As well as correcting your working position you should look at the fact that you have had the problem for years, not months or weeks.

Not wanting to point out the obvious, but two weeks of physio treatment and exercises are hardly likely to cure a chronic problem.

Talk to your physio and obtain a realistic expectation of permanent improvement.
He/she may also be able to provide some advice on your working ergonomics.
Be prepared to spend some cash on a decent operators chair.

 

Re: Neck stiffness

Thanks for your reply David. I've had a stiff neck for some time but never really symptoms. The stiff neck is just "stiff" not painful. It's only the last 2 weeks where I experienced this very lightheaded feeling & then these weird arm sensations. I am one to want rapid results I'll grant you that

 

Re: Neck stiffness

Any recommendations of decent operators chair?

 

Re: Neck stiffness

Hi Mark,

You might consider a plinth that has a motorised 'Trendelenburg Tilt' facilility. This will allow better positioning of the patient. The ideal working position is head up, back straight, no need to raise the shoulders. This will also allow you to work standing up to give the neck and back some occasional relief. Use cantilever nippers and hold the scalpel in a finger-driven pen hold rather than in a palm grip that causes it to have to be driven by the shoulder muscles.

What you are describing is cervical spondylitis. Taken on a year or two, the condition could lead to vertebral trapping and stiffening (sclerosis) of the carotid arteries with intermittent occlusion of bloodflow to the head (lightheadedness/blackouts.

Treatment is all about prevention and holding off the condition. Activity is the key. Exercise neck and shoulder regions on regular (daily) basis. Sport can be helpful in this respect.

Hit me after 20 years - hope some of this helps

 

Re: Neck stiffness

I've been having a similar problem recently. I have been visiting an osteopath who has been quite brutal but appears to be making a difference. The osteopath quizzed me at length about my working day and my posture and recommended that I try a 'Saddle Stool'. As I work primarily in the NHS there is zilch chance of having one provided but I thought I'd like to try one out and see just how comfy / practical / beneficial they might be before I funded one myself. I contacted some of the companies that sell these and asked if it would be possible to trial one before buying. The result - I now have 3 different styles of saddle chair cluttering up my dining room for the next month!! It could well be worth your while doing a similar thing - I was suprised at how keen the companies were to help. I haven't actually tried any of them yet so can't give a verdict but they look intersting!

 

Re: Neck stiffness

I find a saddle chair very comfortable, but they are expensive.

Get hold of a dental supplies catalogue. They generally offer more choice in operator chairs.

 

Re: Neck stiffness

I too have suffered from periodic cervical neck pain and radiating paraesthesia's.

Hence I ask, why sit?

I stand for almost all consultations, with the chair elevated to an appropriate position.

Arguably a more professional position to consult and perform examinations, great for my periodic neck pain, most helpful when someone has a vaso-vagal (quick freedom of movement), and avoids the embarrassment of looking up skirts and feeling like I am a pedicurist...

LL

 

Re: Neck stiffness

The saddle seats are good but make sure you get the appropriate size - I trialed them a few years ago and didn't really like them but now use one everyday as the size is a much better fit to my body.

If you want quick results it may be worth seeing an Emmett therapist - problems can often be solved within one visit with their muscles techniques. I did some training in this recently and was quite suprised at the effects it can have - PM me if you want anymore details about it or who to see etc

Chloe

 

Re: Neck stiffness

Had plain x-rays taken which said the following "loss of cervical lordosis otherwise unremarkable with no evidence of any bony foraminal narrowing which may explain radicular symptoms in arms". The Physio often highlights my kyphosis/Dowager's Hump. I have been standing treating patients for most of the day which maybe has helped a little (hard to say).

 

Re: Neck stiffness

JohnPod you seem to have some knowledge about the problem. Ive been given the basic exercise of chin tucks with hold rolls to the shoulder & arm pit. Any other suggestions?

 

Re: Neck stiffness

Hello Mark,

Yes - trained as a physio before turning to feet.

The exercise that did me most good and I recommend most highly is low-impact neck stretches:

Turn the head as far as you can to the left. Hold it there for several seconds. The muscles will accommodate and then you can turn jthe head just that bit further, stretching all the soft tissue structures. Repeat to the right.

Repeat, but up and down (chin tuck/star gaze).

Repeat, but tilt head (ear to shoulder). This is perhaps the most difficult as it stretches the sternocleidomastoids.

Finish with gentle head-roll. You will probably hear graunching noises!

 

Re: Neck stiffness

JohnPod I guess I should ask my physio/GP but being a Pod & Physio you perhaps have a unique perspective. The x-ray said no degenerative changes therefore can it still be cervical spondylosis?

 

i also had this problem, except my neck was also painful!
I also had pain running down my arms, it was awful.

i tried many different things, some worked some did not.

what worked

1. physio, neck tucks and strength exercise
2. the saddle chairs worked a little, but sitting on the all day is hell
3. standing up while working, hard on the back tho
4. nightly massage from spouse
5. the best advice is to keep moving, make sure your chair has all the tilts going, my best "neck" chair was an old castellini dental which had a fantastic range, if i cut nails i would tilt it down, heels i would tilt the trendel way up, and so on

i have quit the profession for now, and my neck is totally better!

 

Hi Mark,

It is my understanding that cervical spondylytis is visible in the cervical vertebrae of most people over 23-25 years of age. The most obvious sign is outgrowths/spicules on the spinous processes. It is these that pinch/tweak/compress blood vessels and other soft tissues as the head turns.

Foraminal narrowing would restrict the free pull-through of the spinal cord within the cord canal and rotational movements of the vertebrae would threaten abrasion of the cord, rather as tarsal tunnel or carpal tunnel tightness.

Although many of us suffer there is very little published evidence (chose the subject of back pain for a degree topic some time back). The main difficulty is to know whether it is truly occupation related or due to other history. Seems this occupation certainly aggravates the condition.

Think of it as an RSI. The trick is to do nothing habitually. Ring the changes - spread the load.

 

JohnPod I've greatly appreciated your comments. As I said, my x-rays were NAD (I sympathise when patients come back with nothing on scans -"but I really am feeling something"). Saw my GP & he wanted me to get back into regular exercise (I had been running regulalry until an achilles tendon strain developed after running 2 half marathons 3 months ago) & keep seeing Physio. He thought some of the sensations were stress related.

 

Mark after reading this I would recommend that other causes be ruled out, this is not cervical spondylitis. Spondylitis refers to an inflammatory process which is routinely observable on plain film, as is spondylosis which is a degenerative process (and non inflammatory).

You describe some radiating type sensation down your right arm and lightheadedness. This sounds more vascular in nature and if it is positional or postural I would rule out Thoracic Outlet Syndrome vs. vascular compression of the neck or upper extremity vasculature. Hautant's and Roo's tests are fairly reliable orthopedic maneuvers of TOS and I have seen positives in numerous patients over the years who describe symptoms such as yours where no known cause was found prior. A decreased neck lordosis in and of itself should not cause the symptoms that you describe, although it typically causes muscular pain for obvious reasons.

I would add that again spondylitis is an inflammatory process and your films were essentially 'clean'. Spondylosis is not common in young patients but does occur and in later stages may cause not only stenosis of the canal itself but foraminal narrowing which would affect the nerve root or sheath and pain is pathognomonic for osteoarthritis but not vascular symptoms.

Stress and posture are causative in many types of myofascial pain syndromes and often manipulation affords great relief of symptoms. I perform this service for patients every day Mark with a very good rate of success, especially when a direct and more emergent cause is ruled out.

 

My advise is (KISS).

After 18 years as a pod i too have had problems for the last few years.

I was advised by a physio to give up the job!!

I now send my patients to the gods ie as high as the chair goes, I bought a saddle seat (£450) and worth every penny, I also now work from the left hand side, bit awkward to start with but soon got used to it.

i go to a massage person every 3 weeks, no not the lovely gentle type but the real hard pumellng, every time she works on the rt side as thats obviously where i get all the use.

with all the above I am not "cured" but am able to continue to work and am almost painfree.

just one word about N.H.S and saddle seats.

they are obliged re health & safety to alter your work and equipment for you so you dont get R.S.J. so i cant see why you cant argue for a saddle seat ( on them).

you will find plenty of research on dentist arenas as they have more of a problem than we do.

in the end there is nothing to stop a NHS employee buying thier own saddle seat as after all its your health at stake.?? Claim it on tax

 

Hi I think it is inevitable that in our profession we will inevitably encounter "upper neck pain".

And I think it has a lot to do with the Levator Scapulae (LS) and Trapezius muscles. Often the former one is the culprit! Part of its function is to support he head and helps make the shoulder shrug possible-sound familiar? Its the one that is also involved with post whiplash pain in the neck. I've had a few of experiences... It wasn't entirely my fault..

When there are trigger points in these muscles and the Rhomboids, referred parasthesias can occur. just like in the foot. I used to be a massage therapist while doing Podiatry and most of the patients I saw had tightness associated with these three muscles! Fellas, if you want to get someone moaning, work on the LS muscle- its a guaranteed success.

I often massage myself with a corner of a wall. I use my bodyweight and control the pressure at "that point". It's not as good as a professional working on me but its something that I can do Whenever i want and don't have to make an appointment. my friends think I'm weird as it is. until one of them tried it!

Deep tissue massage is the way to go after light to medium efflurage is done and/or a heat pack is applied to loosen the muscles first - so either visit an osteopath, physio or a good massage therapist. You will need more then one visit to get the problem under control and it seems you might need a visit once every so often. in a perfect world I'd recommend at least once a month!
and if your working too much well thats not going to help.

hope this helps

Steve

 

These have been all good replies. My Physio (who I think is a good Physio with post grad. qualifications in manipulative Physio) still thinks it's cervial spondylosis & believes it's common for x-rays to not show subtle changes (CT would be much better). She has me doing general stretches plus strengthening of my lower trapezius (now that's a tricky stretch).

 

Hi Mark,
Ive also suffered from back pain and suggest that you get your physio to come to your office to check out your working area.

Where is the equipement in relation to the patient ? Do you twist and extend your neck to look for equipment because its too far away. I also invested in a saddle chair fantastic !

Also look outside work how old is your bed etc. You might spend the same time sleeping as at work so it could be a combination.

Defenitly get hold of a saddle set ask to try it out for a week it has helped me greatly.

Michael Weber

 

I've had a saddle chair for the last 12 months which did help with lower back pain. I think the issue is predominantly related to my general posture plus constantly working with my arms too far extended. My Physio has asked me to try & work with my elbows flexed to 90 degrees i.e. to try & sit/stand closer to the feet. That together with regular stretching I'm hoping will settle the problem. I've also bought a new contoured pillow to improve my neck position while sleeping. I will also add that my GP recommended I try a low dose anti-anxiety medication (as well as suggestions of yoga & more exercise) just as a temporary measure. Some might think that extreme but he felt getting me to relax would be a big help. Sorry this has been a bit of a drawn out post but I sincerely thank everyone for the thoughts & I guess I hope it might at least help others if they come here with similar problems.

 

Mark
I would like to thank you for bringing this topic up for discussion. Posture whilst working is something we tend to forget unless we have a problem also although I have not been in practice for many years my neck does get a little 'tight' so I have now started using the stretches that were advised and not only has it helped with my posture at work it has helped my neck when shooting arrows.
Thanks again
Wendy