Upper back/neck pain?

November 3, 2012 7:06 AM

Any ideas on how to treat this upper back/neck pain?

I'm a 34 year old female, a nurse, fit and healthy. I am on the floor doing long-term-care after working in a clinic for the last five years.

My job is very physical, not only speed-walking but turning people, lifting people, and standing in very awkward positions for prolonged periods of time. I am aware of safe lifting but I think the issue comes from the little tasks. I am constantly interacting with people in wheelchairs. When stopping to have a conversation in the hall it is awkward to squat so I bend over for a minute. Then I do it again 10 minutes later when someone has a question. Also, bending over to open the bottom two drawers of my med cart which I probably do ten times an hour. Repeat for 12 hours.

I've been at this job for two months and I'm getting increasingly worse mid to upper back/neck pain. It seems to originate below my left scapula and radiates to my left neck and bilateral mid back. My lower back is ok. I'm thinking this is related to bending over too much. However, how the heck am I supposed to get into the bottom of my cart without bending over? Should I really go into a deep squat each time I talk to someone who is hard of hearing in a wheelchair or open up my cart?

I don't want to turn into the older nurses I work with who start each shift by popping 8 ibuprofen. I want to avoid daily pain medication but it is becoming increasingly difficult. I have had a professional massage which felt great but was pricey and the effects were only temporary. Might regular massage help? I have always been skeptical of chiropractors but am warming up to the idea of seeing one if it might help. Moist heat helps, but temporarily.

I know I should ask my doctor, but (very ironically) I don't have health insurance. It will kick in the first of January and I have already made an appointment with my doctor. FWIW I am sheepish because I have prided myself on being a "good nurse" for the last ten years - being mindful of safe lifting, taking care of myself. And I still wound up with back pain! Any advice is greatly appreciated.

posted by anonymous to Health & Fitness (16 answers total)

Massage couldn't hurt.
posted by Thorzdad at 7:08 AM on November 3, 2012

Yup, embrace the squat.
posted by lulu68 at 7:22 AM on November 3, 2012 [3 favorites]

I find that upper back pain and neck pain for me isn't caused by bending over as much as it is by poor shoulder posture. It goes away when I lift weights, particularly shoulder and upper back exercises which seems to pull my arms back during the rest of the day.
posted by srboisvert at 7:27 AM on November 3, 2012 [5 favorites]

I get similar problems from looking at a computer screen all day - Clearly a different cause, but similar symptoms. And FWIW, massage relieves the symptoms temporarily, but doesn't change the cause (or significantly reduce the long-term damage you do to yourself).

So, I found that all the advice on posture in the world didn't help, if I couldn't recognize my body letting me know the good-vs-bad (and although a lot of the generic tips help - a LOT - not everyone has exactly the same internal arrangements). So, personally, I found that Yoga taught me to recognize when I have my head sitting properly on my spine, rather than at a slight offset that will make me hurt later. I don't tend to recommend flaky new-agey crap for medical care (and I say that as a certified herbalist), but yoga doesn't depend on any external unknowns to help us - It teaches us to recognize our own body's condition, undoing years of having society teach us to ignore things like minor discomforts that lead to real long-term damage.

From the situation you describe, though, you already know what to do - squat rather than bending down when talking to people physically below you - Not only does this let you position your head, neck, and shoulders in a "better" arrangement, it also changes the social dynamics of the situation when you can talk to people eye-to-eye on the level, rather than literally talking "down" to them.
posted by pla at 7:30 AM on November 3, 2012 [2 favorites]

I have back pain too, and it turns out I have a slipped disc- you might want to get it checked out.

As for what helps, yoga has been amazing. There are several shoulder and back stretches from yoga you can do throughout the day that help to compensate for bending over and yoga class is great for stretching out and aligning your spine. It has greatly reduced my pain.
posted by bearette at 7:36 AM on November 3, 2012

Squat, possibly a lifting (lumbar support) brace at least for a while, and you might look into something like Pilates for strengthening your core - which should in turn help you squat and rise more easily and efficiently.
posted by Lyn Never at 7:38 AM on November 3, 2012

Could be the shoes. Kind of surprising how many back problems have their source in your feet.
posted by Apoch at 8:02 AM on November 3, 2012 [2 favorites]

Definitely squat for your med cart. I'm a doctor and I am often talking to patients sitting in stretchers or wheelchairs, or they are children. I make sure there are a lot of rolling stools around and whenever I need to stop and talk to someone, I say "give me a moment to pull up a chair" and I do so. Not only does it help me not be on my feet all the time, it makes the patient feel that I am taking the time to listen to them. When I want to get down on their level I usually get on my knees rather than bending over. A bit hard on the knees but... easy on the back. If the conversation is going to be brief, I think you should make a conscious effort not to bend over or change your position while talking to them. I don't think it is necessary to be on their level every time they ask you a simple question.

side note I hope the nurses aren't really popping 8 ibuprofen at a time - they should know better, that's well above the maximum dose.
posted by treehorn+bunny at 8:04 AM on November 3, 2012

I'm coming off a 3 month bout of neck/shoulder/upper back pain. I was prescribed all sorts of things but two made the most dramatic improvement: 1)Manual physical therapy (sort of specialized massage) from a great physical therapist. 2) Re-teaching by my PT about how I hold my head and neck. According to her, many people stand/walk/sit with their chin up a bit which leads to lengthening of the muscles in the front of the neck with tightening of the muscles in the back of the neck. I found that was absolutely the case with me, I was subtly leading with my chin when I walked and stood. Once I became conscious of lowering my shoulders, lowering my chin a bit and lengthening the muscles in the back of my neck, I had a dramatic improvement.
posted by SweetTeaAndABiscuit at 8:16 AM on November 3, 2012

Try more support for shoes, be aware of your posture, do stretches throughout the day.
posted by KogeLiz at 8:23 AM on November 3, 2012

The Trigger Point Therapy Workbook is my go to bible when having myofascial pain. It has diagrams of the body where referred pain shows up relative to trigger points. I have loaned this book to many people over the years. They usually purchase their own copy, as I will only loan it out for one week.

The excruciating pain in my back originated in the mid deep gluteus maximus. I was rubbing and massaging the wrong muscle! The authors, (Clair Davis, NCTMB; Amber Davis, NCTMB) recommend using a tennis ball in a knee high for areas you can't reach. As per the author's instruction, I would drape the knee high/tennis ball over my shoulder and line up the tennis ball on the trigger point area for my pain. Lean hard against a wall with the tennis ball between your body trigger point and the wall. Move your body slightly from side to side. It hurts so good! I did this several times a day for several days. The pain has been gone for years.

I also have the companion book Fibromyalgia & Chronic Myofascial Pain It addresses the theory of myofacial pain and ways to prevent it.
posted by JujuB at 8:48 AM on November 3, 2012 [2 favorites]

I just took a peek in my book. The diagram for your upper back pain pattern appears to be caused by the rhomboid muscles.

The function of the rhomboids is to move the shoulder blade toward the spine, to help raise the shoulder blade, and to hold the shoulder blade still when needed, as a solid support for the operations of the arm and hand.

A significant amount of pain at this site may also be coming from the serratus posterior superior muscle, which lies beneath the rhomboids, and from the middle trapezius covering them. There may be trigger points in all three layers. Other muscles that send pain to the inner edge of the shoulder blade include the scalenes, infraspinatus, latissimus dorsi, serratus anterior, and levator scapulae. The spinal muscles cause pain at this same level but nearer the spine.
posted by JujuB at 9:10 AM on November 3, 2012

I carry tension in my neck and shoulders and it is the first place I clench when I get stressed or when I prepare to do a lifting job. It also gradually gets more and more tense as I sit at my desk all day. The result has been muscle spasms moving through the exact areas that you describe.

I have been getting these for years so I've had lots of time to experiment with what works and what doesn't. Being aware of the problem helps because I can remind myself to unclench the muscles whenever I think about it.

The most helpful thing I have done is to build up my shoulder and core muscles so that my whole back area is more balanced. I had a couple of over-tensed and thus overbuilt-up muscles and some that were never used and super weak. Working them all to become more even has caused me to find it much easier to spread out the load and sit and move more properly and as a result the spasms are much fewer and far between. I use yoga and other similar bodyweight exercises to accomplish this but any exercise that is meant to balance you out would work.

Another thing that I've discovered lately that you might try: When the pain starts to build but before it's a full fledged spasm that lasts for days, I find that if I take a couple of teaspoons of cod liver oil I can calm down the eruption before it cascades into pain. I sometimes also do some massaging of the area with one of those little trigger point massage tools. I'm trying to cut down on the ibuprofen that I take for this and I've found that replacing it with the cod liver oil is nearly as good for mild pain. And as a bonus, it's full of nutrients so even if it doesn't help with your pain as much as it has helped me, it is still quite good for you.

You should also do a search for shoulder pain here on ask mefi. I have seen several posts about similar pain caused by desk sitting and some of the suggestions for relief might end up being helpful to you as well even though your cause is different.
posted by tinamonster at 9:44 AM on November 3, 2012

I was in physical therapy for back pain and one thing they told me is that if you stretch your calf muscles and hamstrings, you are less likely to hunch over and your back doesn't have to do as much work. It really made a difference.
posted by desjardins at 9:59 AM on November 3, 2012

As a prevention of future problems, I HIGHLY recommend Alexander technique:
http://en.wikipedia.org/wiki/Alexander_technique

The Alexander technique aims to teach people how to stand, hold themselves and move differently in order to eliminate unnecessary tension in their bodies. It is an educational process, not a relaxation technique or form of exercise. The Alexander technique has been shown to be helpful for people suffering from tension headaches, back pain, frozen shoulders, housemaid's knee, flat feet, tennis elbow, minor digestive problems, asthma, difficulties sleeping, clumsiness, irritability and lethargy.[1][2] Practictioners say such problems are often caused by people repeatedly mis-using their bodies over a long period of time, for example by standing or sitting with their weight unevenly distributed, holding their heads incorrectly, or walking or running inefficiently. The purpose of the Alexander technique is to help people unlearn bad physical habits and return to a balanced state of rest and poise in which the body is well-aligned.

It will help you learn how to use your body better, especially your neck and back, improve your habits of body usage, to minimise risk of future problems.

Short term, It will not be cheap, you will have to do 10-12 individual classes over 2-3 months.
Long term: You can have back and knees that work without pain for the next few decades.

IMO the long term preventative methods are key to a healthy back.

(I have no personal or business involvement in Alexander Technique, only as a student, and having seen the positive effect it had for my family, including as part of rehab after major spine operation.)
posted by Dr Ew at 1:34 AM on November 4, 2012

From an answer to another person with a similar question:

1. Check out the book Back Care Basics by Mary Schatz. Also good are DIY traction exercises you can do in your home, as seen here: http://www.bulgingdiscfixed.com/Bulging-Disc-Back-Pain-Relief.pdf

2. Chairs in our society are actually ergonomically bad for the back and should have been innovated hundreds or thousands of years ago. Try sitting on an exercise ball, if your office will allow it. This actually strengthens the back and ab muscles and burns calories while you sit on it, and actually improves concentration (I'm sitting on one as I write). Some school systems in other countries have swapped out all their chairs for these balls. GAIAM makes a ball chair-- a ball inside a chair on wheels-- for about $90 which fits people 5'11 and under.

3. This article provides some more info:
http://www.huffingtonpost.com/2012/07/24/sitting-at-work-why-its-dangerous-alternatives_n_1695618.html?ref=topbar#slide=1265222

4. If you can't sit on a ball, you could look into back friendly eco furniture. Here is one site:
http://www.zafu.net/index.html
I believe you can find it for cheaper, or even make your own.

5. Oh-- and also Qi Gong done regularly can work wonders. Check out Lee Holden's series of videos. Particularly Qi Gong for Lower Back and Upper Back.
posted by cotesdurhone at 8:19 PM on November 28, 2012