The jaw is an area that doesn’t generally get much attention as some other parts of the body, but jaw problems are more common than you probably think. A class of jaw‐related issues called temporomandibular disorders affect millions of Americans each year, and the bothersome symptoms that result often require treatment.

The temporomandibular joint (TMJ) is a hinge joint that connects the part of the skull directly in front of the ears (temporal bone) to the lower jaw (mandible). It allows you move to your jaw up and down and from one side to the other, which is necessary for talking and chewing. The term “temporomandibular disorder,” or TMD, is used to describe a variety of conditions that cause pain and dysfunction in this joint and the facial muscles that surround it.

TMDs affect over 10 million Americans, with a much higher prevalence in women than men. The definite cause of TMDs is still unclear, but some theories suggest that they are caused by injury in that region, grinding or clenching teeth, osteoarthritis, or stress. TMD symptoms vary from patient to patient, but most report one or more of the following:

• Jaw pain or tenderness on one or both sides of the jaw
• Difficulty opening and closing the mouth
• Popping, clicking, or locking of the jaw
• Earaches or ringing in the ear

TMDs often occur with neck pain and headaches or vertigo

Another notable characteristic of TMDs is that many patients experience neck issues in addition to painful jaw symptoms. In some cases, neck‐related problems can manifest as headaches, and research has shown that up to 56% of patients who are treated for headaches also have a TMD. Experts believe that this relationship works in both directions, meaning that TMDs can contribute to the development of headaches, and vice versa. Neck issues and headaches can also mimic muscle pain in the jaw muscles, and it may therefore be difficult to distinguish the two conditions. Therefore, it’s often best to treat TMDs, neck pain, and headaches together.

TMDs have also been associated with vertigo, which is feeling a sense of rotation or movement when the body is stationary. Although the relationship between these disorders has been debated, some research has shown that those with a TMD have a stronger chance of experiencing vertigo than those without a TMD. This may be due to the proximity of the middle ear (which is likely involved in TMDs) and the inner ear (which is involved in vertigo). Common symptoms of vertigo include dizziness, nausea/vomiting, balance issues, headache, and fatigue.

Red flags for jaw pain, headaches, or vertigo

As movement experts trained to identify connections between various complications, physical therapists can effectively treat any of these potentially related issues. However, in some cases, care from another medical professional may be required if a more serious condition is present. Below are some important red flags related to jaw pain, headaches, and vertigo to be aware of:

• New onset hearing loss in only one ear
• Seeing double
• Facial or limb weakness
• New onset headache
• Abnormal eye movements
• Bowel or bladder dysfunction
• Extreme bruising, swelling, or throbbing pain
• Unexplained weight loss
• Symptoms arising after recent head or neck trauma

If any of these are present, it may be necessary to see your primary care physician or go to an urgent care center or the emergency department for a comprehensive evaluation. In most other cases, we encourage you to visit us to get started on a treatment program right away.

In our next post, we’ll explain how physical therapy can effectively treat TMDs.

October is National Physical Therapy Month, which is recognized and celebrated by physical therapists throughout the country every year. The goal of the campaign is to increase awareness of the important role physical therapists play in reducing pain, improving mobility, and encouraging a healthy lifestyle in patients. In honor of this important month, we’d like to educate our readers on some of the most important characteristics of our practice.

Physical therapists are experts in the way the body moves. When patients come to us with an injury or painful condition, we carefully identify the source of the problem and then create an individualized program that targets the patient’s impairments and limitations. Through this process, we help patients experience reductions in pain and gradually regain their ability to move and function similarly to original levels.

Although more people are now becoming aware of the numerous benefits afforded by physical therapy, several mistaken beliefs about the practice persist. Therefore, in honor of National Physical Therapy Month, here are seven common myths and misconceptions about physical therapy and the truths behind them.

7 common myths about physical therapy

1. You need a referral to see a physical therapist: A recent survey found that 70% of people think a referral or prescription is required to be evaluated by a physical therapist. In fact, all 50 states and Washington, D.C. allow an evaluation without a referral under what’s called direct access to physical therapy.
2. Physical therapy is painful: Physical therapists try to minimize your pain and discomfort—including chronic or long–term pain. They work within your pain threshold to help you heal, restoring your movement and function in the process. Although some pain will be part of the process, therapists will always work to keep this to a minimum.
3. Physical therapy is only for injuries and accidents: Physical therapy can effectively treat a wide range of conditions, many of which may not be due to a specific incident. It is also strongly recommended to condition the body and prevent future injuries.
4. Any healthcare professional can perform physical therapy: Physical therapy can only be performed by a licensed physical therapist. Current physical therapists complete a three–year post–graduate degree program in which they earn a doctorate in physical therapy.
5. Physical therapy isn't covered by insurance: Most insurance policies cover some amount of physical therapy, but beyond insurance coverage, physical therapy has proven to reduce costs by helping people avoid unnecessary imaging scans, surgery, and/or prescription drugs like opioids.
6. Surgery is my only option: Numerous studies have shown that physical therapy can be just as effective as surgery, and that it may therefore serve as an alternative for many conditions, including degenerative disc disease and meniscus tears.
7. I can do physical therapy myself: Although participation is key to a successful treatment plan, all patients need the expert care of a licensed physical therapist to guide them towards appropriate exercise and actions to address their problem.

The value of physical therapy over surgery and opioids

Physical therapy is not a magical cure–all that will immediately fix any physical problem, but it does have a vast range of applications and is appropriate for most painful conditions. Other popular treatment options for pain like surgery, injections, and pain medications (like opioids) may be tempting due to the prospect of immediate relief; however, research frequently shows that physical therapy often leads to similar—or better—outcomes while also saving patients money and time.

For example, one study showed that physical therapy was just as effective as surgery in the midterm and long term for reducing pain and improving function and flexibility in patients with various tendon disorders. Similarly, another study found only minimal differences after five years between patients treated surgically compared to those who had physical therapy for ACL tears. Surgery has great value that can often lead to positive outcomes, and it may be necessary in certain situations, but it does come with some potential downsides that should be acknowledged. These include high costs, long recovery times, and risks associated with the procedure. Physical therapy, on the other hand, is universally regarded as an affordable, safe intervention with minimal to no affiliated risks.

Physical therapy can also help patients avoid taking pain medications like opioids, which are a significant problem in the country today due to alarmingly high rates of addiction, overdose, and death. One study of 454 patients with low back pain found that those who participated in physical therapy had a lower chance of being prescribed opioids in the following year, while another found that those who saw a physical therapist early were 33% less likely to use narcotic analgesics like opioids and 50% less likely to receive non–surgical invasive procedures than patients who did not.

The earlier a patient sees a physical therapist, the more likely they are to experience positive outcomes with lower overall healthcare costs. This is exemplified in another study in which 308 patients with neck pain were divided into different groups depending on when they consulted a physical therapist: early (within 14 days), delayed (15–90 days), or late (91–364 days). Results showed that early physical therapy was associated with an average savings of $2,172 on healthcare costs over one year compared to late physical therapy, as well as a lower risk for patients being prescribed opioids, having a spinal injection, or undergoing an imaging test.

In our next three posts this month, we’ll continue to honor National Physical Therapy Month by showing you how physical therapy can serve as an important treatment tool for jaw pain, headaches, and vertigo, some less commonly reported conditions.

As we’ve shown over the last few posts, falls are one of the greatest dangers to the over–65 population, and suffering from just one fall can lead to an unfortunate cascade of consequences that will significantly impact one’s health status. But we’ve also explained that falling is far from inevitable in older age, because you have the power to reduce your personal risk by making lifestyle changes in and out of your home, learning safe walking and transferring techniques, and seeing a physical therapist for a personalized fall–prevention program.

Physical therapy prevention programs are typically designed to improve strength, flexibility, mobility, balance, and proprioception (how you sense the position and location of your body in space), all of which are inherently associated with staying steady on your feet. Many of these programs have been implemented for older adults in long–term care facilities, and they are generally classified into one of these groups:

• Single interventions: consists only of various exercises
• Multifactorial interventions: consists of a customized combination of various exercises and other interventions, such as reducing medication use, modifying one’s home environment, and managing low blood pressure
• Multiple component interventions: consists of a fixed combination of exercises and other interventions that are intended to promote mobility, prevent muscle loss, and improve muscle coordination during physical tasks

Research on the effectiveness of these types of programs for preventing falls in older adults is mixed, with some identifying benefits and others failing to do so. Therefore, a powerful study called a systematic review was conducted to evaluate the current evidence on various exercise–based programs for reducing falls in community–dwelling older adults.

Most studies support the use of exercise–based prevention programs

Researchers performed a comprehensive search of four major medical databases for high–quality studies that assessed the impact of exercise–based programs (single interventions, multifactorial interventions, or multiple component interventions) for preventing falls and fall risk in older adults. This search led to 34 studies fitting the necessary criteria for inclusion in the systematic review.

Twelve of the included studies were themselves systematic reviews that reported outcomes on the reduction of falls, and of these, 11 reviews concluded that exercise–based interventions significantly reduced the incidence of falls. In addition, 10 systematic reviews discussed fall risk factors as outcomes, and eight of these reviews concluded that there was a significant improvement in various risk factors, including balance, muscle strength, functional mobility, heart and lung health, gait speed, or fear of falling. Only six papers evaluated negative outcomes among patients, and most of these cases were minor, suggesting that these programs were generally safe. Further analysis revealed that the most effective exercise programs were those that accounted for the specific needs and risks of each participant with a personalized rather than a one–size–fits–all approach.

Based on these findings, it appears that various types of programs with single interventions, multifactorial interventions, or multiple component interventions that include light to moderate exercise training can reduce fall risk factors and the incidence of falls in older adults living in long–term care facilities. We therefore encourage you to contact us if you’re interested in learning more about our fall–prevention services for you or a loved one.

Falls are scary, and they can be disabling in a variety of ways. Directly, they often result in injuries that can make it difficult to move and function normally. Indirectly, they can create a significant fear of falling in many individuals, which in turn leads to less movement and activity that can further increase the risk for another fall. Whichever way you look at it, falls can truly interfere with the lives and independence of older adults.

That’s why if you or someone close to you is considered at–risk for falling, you may be interested in learning how to lower this risk. As we explained in our last post, there are several steps you can take independently that will help to reduce your fall risk, such as exercising regularly and ensuring that you’re using the correct technique when transferring from sitting to standing or walking with an assistive device. But if you want to take fall prevention to the next level or if more hands–on help is needed, the most direct and effective solution is for you to see a physical therapist.

Physical therapists are human movement experts who specialize in finding ways to help patients move more effectively and confidently. As such, they are perfectly equipped to identify which older adults are at risk for falls and then guide them through personalized interventions and help them make lifestyle changes that will improve their health and reduce their risk for falls.

From screening, to assessment, to prevention

The first step of this process is for physical therapists to determine whether an individual is at risk for falling. This is done by an initial screening, which can be given to anyone aged 65 years or older or with a balance disorder. One component of this screening will be to answer the following three questions:

1. Have you had 2 or more falls in the last 12 months?
2. Have you fallen recently?
3. Do you have any difficulty with walking or balance (the therapist will also perform an examination to determine if these deficits are present)?

If the answer to any of these questions is “yes,” then the patient is considered to be at a “high risk for falls.” From there, a much more thorough assessment will be performed, which will include a detailed interview about what medications the patient is taking, their fall history, and a physical examination to evaluate balance, strength, mobility, and other factors. This assessment allows the physical therapist to more accurately understand the true risk for falls and the impairments that need to be targeted in each patient.

Based on these findings, the therapist will then create a personalized fall–prevention program that the patient will begin immediately. Every program is therefore unique according to the patient’s specific impairments and abilities, but research has shown that the best prevention strategies include a variety of different exercises, particularly those that aim to improve balance and strength. As patients repeatedly perform these types of exercises, their reaction times will become more automatic, which will consequently reduce their risk for falls. Part of the program will also involve recommendations to regularly engage in physical activity, which—as we’ve explained—will boost fitness levels and further reduce one’s risk for falls.

Lastly, the physical therapist will educate patients and provide specific instructions on how to reduce or eliminate hazards in the home environment and elsewhere. Below are some of the most effective tips:

• Conduct a walkthrough of your home—or have a friend/family member do it—to identify possible hazards that may lead to a fall, then make necessary changes
• Install handrails on both sides of all stairways, avoid clutter and putting any items on the floor, remove throw rugs and make sure your home is well–lit
• In bathroom, use nonskid mats, a raised toilet seat and grab bars as needed
• Get your eyes checked once a year, and get adequate calcium and vitamin D
• If you’re taking numerous medications, learn the side effects and if there are any interactions that can increase your risk of falling
• Wear shoes with nonskid soles and consider using Velcro or Spyrolaces
• Take your time, be patient and ask others for help with difficult or risky tasks

While the power to prevent falls is ultimately in your hands, seeing a physical therapist will be extremely helpful for guiding you on the most important changes to make in your life and to identify the safest approach to keep you on your feet. In our next post, we review a study that shows how effective an exercise–based prevention program can be for older adults at risk for falls.

Although falls in the elderly result in nearly one million hospitalizations and tens of billions in healthcare spending each year, many people are still not properly informed about the scope of the problem or what they can do to address it. This gap in knowledge has been the motivation behind Fall Prevention Month, which is put forth every year during the month of September. The primary goal of the campaign is to boost awareness about the many dangers of falling with educational resources and guidance on what can be done to manage this risk. To do our part in helping these efforts, the focus of this month’s posts will be on why falls occur and what you can do to reduce your risk.

Getting the facts about falls in older adults

If you’re wondering just how common falls are and their associated costs, the statistics below should help to put matters in perspective:

• Falls are the leading cause of non–fatal injuries responsible for hospital admissions and death in older adults
• One out of every three adults over the age of 65 and one of every two adults over 85 will fall at least once each year
• Every 11 seconds, an older adult is treated in the ER for a fall, and every 19 minutes, an older adult dies due to a fall
  • This equates to approximately 2.8 million visits to the ER, more than 800,000 hospitalizations, and 27,000 deaths each year
• Falls are among the 20 most expensive medical conditions in the U.S., with the yearly costs of fall–related injuries estimated to be about $50 billion
• About 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence
• The death rate associated with falls for seniors increased by 30% from 2007 to 2016
• Less than half of those who experience a fall tell their doctor about it

Common consequences of falls

Fractures are by far the most serious consequence of falls, with hip fractures occurring most frequently and posing the biggest threat to older adults. In the senior community, an astonishing 95% of hip fractures are caused by falls, and more than 300,000 adults over the age of 65 are hospitalized for this type of injury every year. Other common fractures include the spine, arm, forearm, leg and ankle, and the risk for these increases even more when osteoporosis—also common in older adults—is present.

Hip fractures are particularly devastating because of their impact on mobility, as many older adults struggle to recover or regain their prior level of function afterwards. Surgery is also needed for many patients, which is associated with additional risks. Sadly, older adults have a 27% risk of dying within one year if they fracture their hip.

If a fall does occur, many individuals go on to develop an even greater fear of falling, even if they’re not injured. This can cause them to limit their activities, which leads to reduced mobility and loss of physical fitness. Worst of all, this process can develop into a vicious cycle that further raises the risk for falling due to these changes.

Red flags that suggest an increased risk for falling

Falls occur due to a combination of individual and environmental risk factors, many of which become increasingly common in older age. These risk factors can be seen as red flags, and the greater the number of red flags present, the higher that individual’s risk for falling. Here are some of the most important red flags to be aware of:

• Having had a fall in the last six months
• Taking four or more prescription or over–the–counter medications daily
• Having trouble walking or standing
• Using a cane, walker, or crutches, or needing to hold onto things when you walk
• Needing to use your arms to help you stand up from a chair
• Periodically feeling unsteady, weak, or dizzy when standing
• Not having had an eye exam in more than two years
• Having a hearing problem or progressively worse hearing
• Exercising less than two days—for at least 30 minutes—per week
• Drinking any amount of alcohol every day
• Having more than three chronic health conditions (like heart or lung problems, diabetes, high blood pressure, or arthritis)

If two or more of these red flags applies, you or a loved one may be at an increased risk for falling. But the good news is that there are several changes you can take to mitigate this risk and keep you or your loved one safe. We’ll explore some of these in our next few posts.

Most people who develop neck pain will improve without any interventions, usually within a few days or weeks. But for some, the problem continues or may even worsen. Between 50–85% of patients report symptoms that don’t completely resolve, and almost half of these individuals will go on to develop chronic neck pain. This term is used to describe pain that lasts for more than three months, which can lead to additional issues like stress, anxiety, a reduced quality of life, and a tendency to avoid certain behaviors that could aggravate the pain.

It is therefore important to develop strategies to treat patients with chronic neck pain early to help them avoid further complications. Physical therapy is among the most reliable and effective treatments for neck pain in general, but research suggests that it may need to be supplemented by additional interventions for those with chronic neck pain to produce the best possible outcomes.

Study conducted to gauge the value of self–management for chronic neck pain

Self–management programs provide patients with the education and skills that are necessary to effectively manage their condition and improve their wellbeing in the long term. These types of programs have been used and researched in other populations with musculoskeletal pain, but not to a significant extent in those with chronic neck pain. Therefore, a study was conducted to determine if adding self–management treatment to a physical therapy program was more effective than physical therapy treatment alone for chronic neck pain patients.

For the study, patients with chronic neck pain for at least 6 months were recruited and screened for inclusion. This process led to 53 patients being accepted, who were randomly assigned to either the control group or the experimental group. Patients in the control group underwent a physical therapy program designed to improve the joint and soft tissue function, posture, coordination, and movement patterns. The sessions included manual therapy techniques, stretching exercises, and coordination and stabilization techniques.

Patients in the experimental group underwent the same physical therapy program as the control group plus a self–management program. This program was based on social learning theory and emphasized the importance of patients partnering with physical therapists to manage their own health. It was structured around giving patients more control of their treatments and included educational information, symptom management, problem–solving, and relaxation techniques. The program lasted 30 minutes and took place twice per week for four weeks. All patients were assessed before the interventions began, immediately afterwards, and three months later for several outcome measures, including neck disability, fear–avoidance beliefs, pain, and health–related quality of life.

Immediately after the interventions, patients in both groups experienced improvements in all variables, but the improvements in fear–avoidance beliefs, pain, and health–related quality of life were significantly greater in the experimental group than the control group. Similar results were identified at the three–month follow–up, as patients in the experimental group reported significantly greater improvements in all four outcomes—neck disability, fear–avoidance beliefs, pain, and health–related quality of life—than the control group.

These findings highlight the importance physical therapy for chronic neck pain, but also show that empowering patients with self–management strategies can help them experience even greater benefits. Therefore, patients with chronic neck pain are strongly encouraged to see a physical therapist for a comprehensive assessment and an individualized treatment program that will likely lead them to less pain, greater functionality, and a better overall quality of life.

The spine is made up of 24 bones called vertebrae that are stacked on top of one another. Together, these bones connect to create a canal that protects the spinal cord from damage. The uppermost portion of the spine that begins at the base of the skull is called the cervical spine. It contains nerves that carry messages between the brain and muscles in the shoulders, arms, and hands. This is achieved through nerve roots that travel through the spinal canal and branch out through openings in the vertebrae called foramen.

Cervical radiculopathy, which is also referred to as a pinched nerve, occurs when one of these nerve roots is compressed or pinched when it branches away from the spinal cord. This is caused by any condition that injures or irritates one or more nerves in the cervical region of the spine, including a herniated disc, spinal stenosis, or degenerative disc disease. In most cases, patients with cervical radiculopathy experience a burning pain that starts in the neck and travels down the arm. This pain can get worse from turning or straining the neck. Other symptoms include tingling, as well as weakness or loss of sensation in the shoulders, arms, or hands.

Some patients with cervical radiculopathy will get better on their own over time, while others will continue to experience symptoms for extended periods. For patients that fail to improve, conservative treatments—particularly physical therapy—are typically recommended as the first step. A standard physical therapy program for cervical radiculopathy will include a variety of stretching and strengthening exercises, as well as a manual therapy component.

Study was conducted to investigate the effectiveness of manual therapy on sensory features for patients with cervical radiculopathy

Manual therapy involves numerous hands–on mobilization and manipulation techniques that are intended to alleviate pain and improve mobility and function. Although studies have shown that manipulation and mobilization of the cervical spine is effective for improving pain and function in cervical radiculopathy, research is lacking on the effects of these interventions on sensory features. Therefore, a study was conducted to evaluate the effectiveness cervical mobilization for patients with cervical radiculopathy.

The type of study performed was called a randomized–controlled trial, in which 28 patients with a history of cervical radiculopathy for at least 3 months were randomly assigned to either the experimental group or the comparison group. Patients in the experimental group underwent an individualized cervical mobilization technique that consisted of posterior–anterior or lateral vertebral glides. Both techniques involved a physical therapist applying pressure at grade 3 to different areas of the cervical spine for 3 sets of 1 or 2 minutes. For patients in the comparison group, the therapist applied a minimal amount of pressure to the most pain region of the cervical spine for 3 sets of 2 minutes.

All patients were also instructed to perform strengthening exercises for the deep flexor muscles and participated in an educational session about pain and the safety of manual therapy and exercises. Patients were assessed before treatment began, 5 minutes after the first session, and then 5 minutes after the sixth session for several outcome measures, including the hypersensitivity for pressure and thresholds thermal—or heat/cold–related—pain.

Results showed that patients in the experimental group experienced greater improvements than the comparison group in mechanical pain hypersensitivity, which was demonstrated by an increased threshold to mechanical pain after the sixth session. These patients also self–reported greater improvements in the intensity of pain, neck function, and active cervical range of motion, which corroborates the improvements in mechanical pain thresholds.

These findings suggest that cervical mobilization techniques can lead to various benefits for patients with cervical radiculopathy, which could translate to better functionality and quality of life. Additional research is needed to confirm these findings, but patients with cervical radiculopathy should strongly consider seeing a physical therapist for a personalized program that will likely include some manual therapy component.

In our next and final post, we review another study on the benefits of physical therapy for chronic neck pain.

The neck has an incredibly important job to do. It supports the head and allows us to move it in a wide range of directions so that we can better navigate the world around us. But because of how frequently it’s used and its position in the body, as we’ve already seen, the neck is also a very common location for pain. And as anyone that’s been there before can attest to, sometimes all it takes is one bad night’s sleep to ruin your day.

For each person, there are a variety of factors that may contribute to the development of neck pain. What’s most important to understand is that some of these factors are out of your control, while others can be addressed to reduce your chances of experiencing neck pain.

For example, age–related changes to the structures of the upper spine are inevitable in all individuals, and these changes may be a cause of neck pain for some. While nothing can be done to slow down or stop the aging process, there are several steps you can take right now to help prevent neck pain from developing. One of the most impactful things you can do is to keep your upper spine strong and flexible through regular physical activity and targeted exercises for the muscles of the neck. Therefore, to help you in the process, here are our top 3 exercises for reducing your risk for neck pain:

Our top 3 neck pain prevention exercises

To see videos of each exercise, go to www.MyRTR.net and enter prescription code RJWH77HK1

1. Upper cervical flexion in supine
   • Lie on your back with your head supported on a rolled towel or ball
   • Slowly bring your chin toward chest
   • Return to the starting position
   • Repeat for one set of 5 repetitions, twice per day
2. Active cervical rotation
   • Lie on your back on a flat surface
   • Slowly rotate your head to one side until a comfortable stretch is felt
   • Hold for 20 seconds
   • Slowly rotate your head to the opposite side until a comfortable stretch is felt
   • Repeat for one set of 5 repetitions, twice per day
3. Active cervical side bending
   • Lie on your back on a flat surface
   • Slowly bring your ear toward your shoulder; if necessary, use your hand to gently pull your ear toward your shoulder Hold for 20 seconds
   • Return to the midline
   • Repeat for one set of 5 repetitions, twice per day

Regularly performing these exercises will bolster the strength of neck muscles and increase the flexibility of supporting joints, which will lower your chances for developing neck pain in the process. However, even when preventive measures such as these are taken, pain may still develop due to the multifactorial nature of neck pain. When this occurs, physical therapy is your best option available, and in our next two posts, we summarize some research that shows why.

Most of us can recall one or more occasions when the day got off to a rough start because of a stiff neck. This can be explained by the fact that neck pain ranks among the most common types of pain you can get. Statistics vary on just how many people encounter neck pain, but recent evidence suggests that its lifetime prevalence is between 20–70% and that 10–20% of individuals are affected by it at any given time.

Dealing with neck pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick an item off the ground or twisting your torso when looking to the side might suddenly take more time and make you less mobile in the process. Being regularly bothered by pain and movement limitations will often lead one to wonder what’s causing the pain and what steps can be taken to address it.

The truth is that the specific cause of neck pain is usually difficult to pinpoint, and regardless of its cause, the most effective treatment is usually a comprehensive, individualized course of physical therapy. Nonetheless, there are a few signs that could be a “red flag” that warrants further investigation. To help you better understand what could be causing your neck pain and what to do next, here are the 7 most common causes of neck pain seen by physical therapists and some red flags to be aware of:

The 7 most common neck pain conditions treated by physical therapists

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can damage or tear it; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck strains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Sprains and strains are responsible for most cases of neck pain, particularly in younger patients; these injuries can occur either from a single incident or result from repetitive stress over time
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; herniated discs are more common in the lower back, but also occur in the neck; typical symptoms include a sharp or burning pain in the shoulder or arm, as well as numbness or tingling and weakness
• Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is typically only seen in older adults
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of neck pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; patients typically experience pain and stiffness, and possibly weakness or numbness in the neck as well
• Cervical radiculopathy: occurs when one of the nerve roots in the neck is compressed or pinched when it branches away from the spinal cord, which is caused by any condition that injures or irritates these nerves; symptoms include a burning pain that starts in the neck and travels down the arm, chest, upper back, and/or shoulders, and weakness, numbness, and/or tingling in the fingers

Red flags

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of neck pain in patients under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

In our next post, we describe our top exercises to reduce your risk for neck pain.

Tennis is a great form of physical activity that works out many parts of the body due to its demanding dynamics, but just like every other sport, it also comes with a risk for injury. The most common injury in the sport is called lateral epicondylitis, which is often referred to as tennis elbow.

The lateral epicondyle is a bony bump on the outside of the elbow that serves as an attachment point for several muscles, tendons, and ligaments of the elbow and forearm. When the arm is overworked, a muscle in this region called the extensor carpi radialis brevis (ECRB) gets weakened, which eventually leads to microscopic tears in its tendon, which attaches to the lateral epicondyle. This results in inflammation of the ECRB tendon, which is called lateral epicondylitis, or tennis elbow.

As we explained in our first post, tennis elbow is a repetitive strain injury that’s caused by repeatedly performing certain movements over a long period. Athletes who play tennis and other racquet sports have an elevated risk for developing tennis elbow, particularly due to the groundstroke in these sports, which directly puts a strain on the ECRB. But tennis elbow can occur in anyone who performs repeated movements that involve the elbow, such as painters, plumbers, and carpenters. When tennis elbow occurs, the most common symptoms are pain and a burning sensation in the outer part of the forearm and elbow that gets worse with activity, as well as weakened grip strength.

Fortunately, 90% of patients with tennis elbow will significantly improve with nonsurgical treatment alone, such as physical therapy. Physical therapists are movement experts who will first perform a thorough evaluation to identify the source of your pain and determine if any of your movements or activities may be contributing factors. From there, the therapist will design a personalized, evidence‐based treatment program designed to alleviate your symptoms and restore your physical function with a variety of interventions.

19 studies are accepted into comprehensive review

A recently published study called a systematic review highlights just how effective physical therapy can be for this condition. For the study, researchers performed a comprehensive search for published literature that evaluated various physical therapy interventions for tennis elbow. This search led to 19 studies being accepted into the review, all of which were published in the last five years. Each study assessed the effectiveness of one or more physical therapy interventions, including therapeutic exercises, manual (hands‐on) therapy, taping, orthotic devices, and pain‐relieving modalities like ultrasound, ice, and heat.

Results showed that the physical therapy techniques analyzed generally had a positive effect on patients’ symptoms and helped to resolve the clinical signs of tennis elbow. The two interventions found to produce the most benefits were strength training exercises and manual therapy—including massage and stretching exercises—both of which also had a very favorable cost‐benefit ratio. Most of the other techniques analyzed were also found to have positive effects on patients with tennis elbow.

These findings provide further evidence that many of the interventions frequently used in physical therapy are beneficial for tennis elbow by helping to alleviate painful symptoms. Therefore, patients who are bothered by symptoms that may suggest tennis elbow should strongly consider consulting a physical therapist for an evaluation that will likely lead to a comprehensive treatment program and an eventual path to recovery.