Easing Upper Back and Neck Pain with Dr. Fredrick Wilson

Podcast Transcript

Intro:

There's so much health advice out there. Lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health questions so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:

Hi, and thank you for joining us for this episode of the Health Essentials Podcast. My name is Kate Kaput, and I'll be your host. Today, we're talking to osteopathic medical specialist, Frederick P. Wilson, about neck pain and upper back pain. From working sedentary desk jobs to looking down at our phones all the time to feeling the impacts of aging, neck pain and upper back pain are unsurprisingly common. In fact, studies show that a whopping 80 percent of people experience back pain at some point in their lives. Dr. Wilson, who is the director of the Cleveland Clinic Solon Center for spine health is here to talk to us today about different types of neck and upper back pain and how to both prevent them and manage them. Dr. Wilson, thanks so much for joining us today.

Dr. Frederick P. Wilson:

My pleasure.

Kate Kaput:

So I'd like to start by having you tell us a little bit about your work here at Cleveland Clinic. What kind of work do you do and what kind of patients do you typically see?

Dr. Frederick P. Wilson:

Well, I am an Osteopathic Physician. So, I am also certified in osteopathic manipulation. So, though I see pretty much the same kind of patients that everyone else sees in the medical spine center, I do tend to see some of the patients that have what we would call mechanical back or neck pain, and the minor imbalances that can cause pain, nothing you can see on an x-ray, nothing that needs any surgery, but it's its pain that can kind of come and go and not be horrific and not cause any nerve pain, but just cause pain and with manipulation, I can balance those out and make the pain go away. But I see a lot of the other are kind of patients as well, anyone with back and neck pain.

Kate Kaput:

Got it. So it sounds like a kind of back and neck pain that a lot of us can relate to, and it sounds like you're just the guy to talk to us today about it. So, give us a bit of a general introduction to upper back and neck pain. How do time and age in particular impact those parts of our body? Are these some issues that come standard with aging? What amount of pain is standard with aging?

Dr. Frederick P. Wilson:

Well, hopefully, there isn't any increase in back and neck pain with aging, but one of the major issues that can develop is that people, as they get older can get weaker in their upper back muscles, which can lead to kind of forward bending. And every time we bend our head a little bit more forward, we're taking it out of balance. Normally, the head sits balanced over the spine. And the head is approximately 10 to 12 pounds and so there's not too much force but every few degrees that we lean forward, it's as if our head is heavier and heavier and it means that the back and neck muscles are forced to do more work than they're supposed to do, so we can get strain, mechanical pain, even some of these minor imbalance that can be fixed by someone like myself.

Kate Kaput:

So if not aging, in terms of demographics, are there some people who are more likely to experience this type of pain than others, or is it really the type of thing that can impact anyone?

Dr. Frederick P. Wilson:

Well, certainly, I see it a lot now with people who work at home. Especially with the COVID issues, everyone's working from home virtually, a lot of them have lap computers that they've been given by their work and so they're not desktop computers, so they're smaller so they're leaning forward looking at their computer, which again, takes their head out of balance and can lead to next strain and upper back strain. And then of course, I can always remember one day I was leaving the main campus at five o'clock in the evening and all the residents were leaving as well and every one of them had their phone out and every one of them had their head pointed down at their phone. And again, same thing, this is called tech neck. T E C H tech neck. So they can get a lot of neck strain and upper back pain as well. So yes, it's becoming more common because of all the computer work and phone work that we're doing.

Kate Kaput:

I would imagine that you kind of see patients everywhere you go, you see somebody with their head down on their phone, future patient, right there.

Dr. Frederick P. Wilson:

You'll notice some later today.

Kate Kaput:

Yeah. So let's talk a little bit about some more causes and impact. A common cause of upper back pain and neck pain is arthritis. What can you tell us about how arthritis develops and how it can impact that part of the body? What exactly does it mean to have arthritis in your neck or upper back?

Dr. Frederick P. Wilson:

Well, the joints in our neck are made of smooth cartilage and we have the discs between each vertebra and the neck, and they act as cushions and they take some of the weight out of those joints. But as we get older, we lose some of the water that's in the jelly of the discs and so that makes the discs smaller. And so as we get older, there's more and more weight that's put on these joints and they react by developing arthritis because they're forced to do more work with more weight than they were when we were younger.

So we do tend to see it more in the 55 plus group. And also again, as they're leaning forward because of losing the strength in their upper back then they are forced to kind of pull their head up this way which puts not only strain in the muscles, but it's putting more weight on the joints as well. So there's a lot of strain that could lead to arthritis. Vibration can accelerate issues with that as well. So we can see it in people who are trucker or bus drivers where there's a lot of vibration involved they can develop lower back and neck issues as well.

Kate Kaput:

That's really interesting I didn't realize that. You talked a little bit about some of the habits and activities that can contribute to this kind of pain, including sedentary jobs and looking down your phone all the time, can you tell us anything else about some of the daily things that we do or I guess don't do that can also contribute to this kind of pain?

Dr. Frederick P. Wilson:

Well, mechanical pain which I was talking about a little bit earlier, usually involves a joint that's not sitting quite right on another one. And again, kind of depends on your work. Let's say you're working on telephone wires or telephone poles, so a lot of your day is spent with your head back and maybe turned and you're looking at the problem that they have to fix or climbing, they're always with their head back. So depending on your job, your head may be held in a position that's not normal. So it puts a lot of strain on certain muscles and it can cause some of these imbalances, again, that someone like myself can do a little tweaking with an adjusting just so that those joints are sitting in a more balanced position. It's a lot on what they do, if it's abnormal kind of jobs.

Kate Kaput:

Got it. That's interesting that you can sort of tell where someone's back and neck pain is coming from based on the position of their head and their specific job they do, and the positions they're in a lot. That makes sense.

Dr. Frederick P. Wilson:

That's very important also in diagnosing pain because the first thing we try to figure out is what kind of pain is this? So we'll say, "When did the pain start? What kind of work do you do?" Just to get a better feeling for, are they working on a computer? Are they tipping their head back? Are they lifting heavy things? And usually, 80 percent of the time you'll know what the problem is before you even touch it.

Kate Kaput:

Are there other common kinds of upper back and neck pain that you see a lot or other common causes? Anything that we haven't talked about yet that is common in your line of work?

Dr. Frederick P. Wilson:

Well, I see a lot of patients with fibromyalgia as well. Fibromyalgia is a condition where you have kind of chronic musculoskeletal tightness kind of pain. And I generally see that if I'm looking at my schedule and I see a 22, 23 year old patient with neck pain, it's the first thing I think of as a possibility. These patients also have tend to be more anxiety or obsessive-compulsive personality as well, and so I think they hold their shoulders up a lot and they cause chronic neck pain. And just when I touch their upper back and neck, the muscles are really, really tight.

So for the younger people, I see more of this myofascial or mechanical pain, and then probably I'll see people from the ages of 40 to 50, 55 who get herniated discs or discogenic pain. And then again, once we get past about the age of 55, I'll start seeing the older people that have what we call cervical spondylosis, which is a combination of disc degeneration, the joint arthritis, maybe some stenosis, narrowing of the holes the nerves run through, which can cause pain that radiates down either or both arms so the age group is always a hint as well.

Kate Kaput:

So you're a little bit of an investigator kind of figuring it all?

Dr. Frederick P. Wilson:

Absolutely. This is what I like about it so much is that it's really trying to ask the right question so that you can determine what it's. You want to basically just to confirm in your mind that you're on the right track.

Kate Kaput:

Yeah. Seems like there are quite a lot of options under the umbrella of neck pain and upper back pain. I know that sometimes this type of pain can also cause issues in other parts of the body like tingling and weakness or numbness in your arms and legs. Can you talk to us a little bit about what's going on when that starts to happen and what kind of back issues you might be facing there?

Dr. Frederick P. Wilson:

Most of the time when patients are complaining of tingling, I think they may have an issue that we were just speak of where they may have some arthritis, some disc bulging, which has caused some narrowing of the holes that the nerves run through and once they reach a critical size, so that they're starting to pinch on those nerves, sometimes people will complain more of tingling rather than of shooting pain down their arms. Sometimes it's a prelude to the actual pain. So I'm thinking of that. And being an osteopathic physician, our ribs lift up as we take a deep breath, and that includes the first rib. And the first rib is actually the bottom of the triangle that consists of two muscles in our neck and the first rib. And sometimes if that rib is elevated choking off that triangle, it can also cause some numbness, tingling, heaviness of the arms, that kind of thing. And being an osteopathic physician, I can actually balance that rib kind drop that rib allowing more room in that triangle so lower our symptoms can go away.

Kate Kaput:

Got it. So, you spoke about this a bit at the beginning of our conversation, but we hear a lot from people who say that they just thought pain was a standard part of aging and that there's nothing they can really do about it or that can be done about it. Can you speak a little bit to that mindset and maybe dispel that myth, should we just expect to live with pain as we get older, or is there help for people who are experiencing chronic upper back and neck pain?

Dr. Frederick P. Wilson:

Well, like we had mentioned earlier, as people get older and they start losing their strength and their thoracic extensors, they tend to start leading that head forward, which puts more strain on the upper back and in the neck. So if they strengthen those muscles and are able to pull those shoulders back, as you pull your shoulders back, you see my head rising back up kind of over my spine in a more balanced position. So if these older people can at least do some of these exercises, which don't have to be hard, then they can have less of that forward drop of the head which can reduce their strain and reduce their pain.

Three quick ones that I give them are called scapular squeezes, where they just pinch their shoulder blades together, count to four, kind of relax them maybe 10 of those, and then I tell them to do pushups in the corner of a room hands against the wall lean forward so that you're past your hands on the wall and come back or through a door frame, hands on a door frame, again, push your shoulders past your hands and come back, strengthening those upper muscles. You can also do Superman, laying on your belly, raise one arm and an opposite leg like you're a Superman flying and then you use the other arm, but you're laying on your stomach. So that extends that upper back and then helps to strengthen that upper back, pulling their shoulders back, pulling the head back, improving that angle of the head over the spine.

Kate Kaput:

Okay. That makes a lot of sense. So some things that you can do on your own to kind of prevent and manage. But say that you're experiencing back or neck pain, and you really want to see a doctor to get to the root cause of the issue. What's the process there? What sort of questions is the doctor going to ask? What sort of tests might they run to figure out what's going on? Walk us through that process a little bit.

Dr. Frederick P. Wilson:

Well, like I was saying earlier, I think the history is very important in the diagnosis. So if you can pin down what the problem is, or maybe a couple of problems you might take the next step from me, which would be getting an x-ray of their neck. I had someone just the other day, who I was trying to decide, is this disc pain or is this muscle myofascial pain? On an x-ray if you're trying to differentiate discogenic pain from myofascial or muscle pain, on the x-ray, the disc spaces will be narrowed if a disc has lost some of its water or jelly, giving you an indication there may be some disc changes going on, but in a normal neck, there's Alor dotted curve, a backward curve which is normal. And in people who have very tight muscles, it'll be straight not bent back. So the person that I was looking at had a very straight neck, all the discs were perfect so that told me that this is not discogenic pain, but rather it's more chronic myofascial muscle pain. So we treated them that way for that.

Kate Kaput:

Got it. So again, it's sort of that investigation and using different tools, questioning history as well as the testing and all of that to diagnose from the many options.

Dr. Frederick P. Wilson:

Exactly.

Kate Kaput:

Okay. So, you've, again, spoken a little bit about some of the treatment options, including exercise, physical therapy, some of that manipulation. Speak to us a little bit more about common treatments for upper back and neck pain. Well, some of the options, pain medication, physical therapy, chiropractic care, et cetera, what can you tell us about what's available to people?

Dr. Frederick P. Wilson:

Well, we use a lot of physical therapy. So for this particular person who did have issues, she was working on her computer at home. So I sent her to physical therapy for some postural training so they can teach her the corrector way of sitting in a computer all day because she works eight hours a day. So I wanted her to learn that they can also teach her other exercises, and I can add maybe some manipulation for a little bit of tweaking, but physical therapy is always helpful or more often than not.

Sometimes we use anti-inflammatories. I don't like to use them on a daily basis because they can certainly affect kidneys and irritate stomachs. So I'm not one to have them take anti-inflammatories every day. We really stay away from opioids anymore, after the opioid crisis a few years back. Another medicine we use a lot is probably what I prescribe the most is some of the membrane stabilizers. There's a couple that are very good at nerve pain. All of our nerves have a coating or sheath and it makes that sheath somewhat tougher so that nerve is not usually irritated. So it'll help radiating arm pain or leg pain if there's a lower back problem. So yes, physical therapy is big and again, strengthening exercises, medications if needed. And sometimes if they're not better then you have to start thinking MRI, if you're considering some epidural injections in the neck for a disc or nerve impingement or something like that.

Kate Kaput:

And so how common is it to need surgery for this kind of pain?

Dr. Frederick P. Wilson:

We try very hard not to do surgery. Surgery should be your last resort. Anytime you do a surgery inside a spinal canal there's a risk of some scarring inside, and if that scarring should encase a nerve roots against the wall of the spine, our nervous system is very fluid and reaching out with one arm can pull all the nerves in one direction. So if you've got one nerve anchored and with any pulling motions, it gets pulled on and it's going to cause pain down that nerve. And once that scarring is there, there's no getting rid of it. You cut scars with surgery and you get worse scars. So we try to make that the very last resort. At first, we try physical therapy and medications then we might try the steroid injections, but if they're getting severe pain that won't get better or if they're starting to get weakness from that nerve being pinched, then you have no choice, but to go in and free it up.

Kate Kaput:

Got it. So we've spoken a little bit about some of the things that you can do at home including those exercise and kind of working on your posture, the way that you sit, if you work at a desk a lot, anything else that you can do at home on your own to help with back and neck pain? What about ice packs, heating pads, do those do anything for kind of minor pain?

Dr. Frederick P. Wilson:

For acute pain or acute muscle spasms, ice generally is better than heat. The first 5-10 days, I tell people to apply ice 20 minutes, every two hours. Ice is also good for nerve pain. If people are telling me they're having pain shooting down an arm, it can be an additional treatment for their nerve pain. Heat is better for some chronic problems like we mention fibromyalgia. That's one of those problems where they have muscle tightness for years so this is a very chronic problem. So they like to take a nice hot shower or a hot bath, first thing in the day just to kind of get them going so that will certainly help.

And of course, it doesn't cause so much in the way of neck pain, but aerobic exercise is always good for our bone strength. And of course we can get compression factors, typically not in the neck, more in the lower back, but it's important to have strong bones as well. And that also means taking the right amount of vitamin D and calcium. And an average person about a thousand milligrams of calcium and 600 milligrams of vitamin D a day, especially in Cleveland, because we can't make any during our winter times because we don't see the sun very much. So, it's important to take those supplements as well.

Kate Kaput:

What about massage therapy, acupuncture, or even those sort of percussive technology? Those sort of massage guns that you by at home, can things like that help?

Dr. Frederick P. Wilson:

Well, acutherapy or acupuncture, I should say, it's been around since it's 3,000 years give or take. So obviously, it's been around that long it's got to work and it does work. But it works by inhibiting the pain message from reaching the brain. And so it's not that it's taken the cause of pain away, it just takes the pain away and that's not long lasting. It might last a week or two. So when people of chronic pain, it's a great adjunct to do maybe once or twice a month, but it's not going to fix the pain.

As far as the vibration, I'm not a huge fan of vibration. We used to recommend 10s units as well. Tens units used introduce an electric stimulation of the nerves and that can kind of confuse the body or not allow that message to reach the brain kind of like acupuncture so they'd have less pain, but a lot of people feel irritated just by the electric stimulation so it's not effective for them. Vibration can help, but I'm not a big fan. I haven't used that a lot but I'd say to people, if you want to try it and go ahead and try it, if it helps great, if it doesn't well don't buy it.

Kate Kaput:

My husband just bought me one of those massage guns for our anniversary. So, for people who are fortunate enough to not yet be dealing with upper back or pain, you've spoken a bit about prevention, anything else that they can do to ensure that they stay that way, that they don't start to experience this kind of pain? Anything else about working on our posture at home or just anything in general that you can tell us about kind of keeping it from happening in the first place?

Dr. Frederick P. Wilson:

Well, the physical therapist will say, "Posture means everything." I've never seen a physical therapist who wasn't standing with excellent posture. So it's standing with good posture, but especially these days for the neck, it's going to be working on their computer. Again, so many people will be leaning forward on a computer and they're not supposed to, they're supposed to have you back against the back of the chair, maybe even a little pillow behind your back, elbows at 90 degrees, knee at 90 degrees planted firmly, and your computer screen is supposed to be even with your eyes. But again with laptops, they can't be that way so that's almost impossible to do that. So the laptops probably aren't the best method of doing homework on a computer.

Kate Kaput:

Because I'm trying to adjust my posture as we're talking, it's tough. It's kind of tough.

Dr. Frederick P. Wilson:

It's very important, yes.

Kate Kaput:

So what about standing desks? Can those help kind of varying the way that you...

Dr. Frederick P. Wilson:

They're more meant for lower back than neck pain. I imagine they could help neck pain as well, but they're more meant for lower backs because a lot of people with disc problems have pain even just sitting. Even if you're sitting in a proper alignment, they still have pain so they have to stand, put their back in extension and they can do better. So it's really more meant for back pain.

Kate Kaput:

Got it. Dr. Wilson, is there anything that we haven't discussed today on this topic that you think is important for our listeners to hear?

Dr. Frederick P. Wilson:

Well, I think what it comes down to is we have to eat right. You have to get our calcium and our vitamin D. We have to keep our core strong, and maybe some aerobic exercises for bone strength as well. And we need to try to live a healthier life. Smoking, absolutely horrible because it's also bad for discs in the neck and in the lower back. So yes, it's also important to get your exercise for bone health and to try to keep their core strength because with a good core strength and good posture, we put less of that forward bend into our upper body and necks, which is going to take the stress off that area, better for your discs, better for everything in your upper back and neck. And of course, get your calcium and vitamin D for bone strength.

Kate Kaput:

So it sounds like as with so many other topics related to our health, an ounce of prevention can really go a long way.

Dr. Frederick P. Wilson:

Absolutely. I don't know where I heard this, but it was, "We stay healthy until we're about 20, but after age 20, we have to work for our health." And I really think that's true.

Kate Kaput:

All right. Thank you so much, Dr. Wilson for being here with us today and for speaking with us on this important topic.

Dr. Frederick P. Wilson:

It was my pleasure. Thank you for having me.

Kate Kaput:

To all of our listeners, to learn more about back and neck pain care from Cleveland Clinic, please visit clevelandclinic.org/spine. Thank you for joining us today.

Outro:

Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow on Facebook, Twitter, and Instagram for the latest health tips, news, and information.