Frequently asked questions about three of the most common knee conditions

The knee is the largest and one of the most complex joints in the body. It primarily joins the thighbone (femur) to the shinbone (tibia), but also includes the kneecap (patella) and fibula in the lower leg. These bones and the muscles that surround them are connected through a series of ligaments, tendons, and cartilage (menisci) which collectively stabilize the knee and allow it to bend, twist, and rotate.

The knee also acts as a shock absorber that takes on many of the forces from the upper body to the lower body, while allowing the leg to bend back and forth with minimal side–to–side motion.

The knee's design makes it extremely durable and capable of withstanding significant loads during everyday activities and physical performance, but like every other body part, it has limits. When the knee is pushed too far–either through a traumatic injury or from gradual, sustained damage over time–it can result in a number of painful conditions.

Knee pain ranks behind just back pain as the second most common condition affecting the muscles and bones, and it's the single greatest cause of disability in individuals who are 65 and older.

There are numerous conditions that can cause knee pain, and below, we answer some frequently asked questions about three of the most common knee–related conditions:

Patellofemoral Pain Q: What causes patellofemoral pain?

A: Patellofemoral pain syndrome, or runner's knee, is an umbrella term for any type of pain involving the patellofemoral joint (which is the joint between the kneecap [the patella] and the femur) or the area directly surrounding it. It accounts for about 20–25% of all reported knee pain and most commonly affects adolescents and young adults.

Runner's knee is an overuse injury that typically develops when the knee is overworked from excessive or repetitive movements, especially when athletes suddenly increase their activity levels. Excessive friction and stress on the patellofemoral joint and surrounding soft tissues can lead to irritation and inflammation within the joint. Poor joint alignment and weak thigh muscles may also contribute.

Q: Where does it usually hurt?

A: The most common symptom of runner's knee is pain around the front of the knee or along the edges of the patella, which frequently occurs when walking up or down stairs or hills, after long periods of activity or sitting, or after standing or walking on uneven surfaces.

Q: How can a physical therapist help?

A: Patients with patellofemoral pain may benefit from physical therapy, which is a natural, noninvasive intervention derived from a thorough evaluation of the knee and the joints above and below. Physical therapists treating runner's knee will design a program that typically includes education about the condition, stretching and strengthening exercises–with a strong focus on the hip muscles, the quadriceps, and the hamstring muscles of the thigh–sport–specific training for athletes, and possibly the use of taping or bracing and/or a foot orthotic device to help maintain the knee in an ideal position during movement.

Meniscus Tears Q: What causes a meniscus tear?

A: The meniscus is a tough, rubbery, C–shaped piece of cartilage that rests between the tibia and femur in the knee. Each knee has two menisci (plural of meniscus), with one on the inner and one on the outer side of the knee, and both absorb shock and stabilize the knee. Meniscus tears most commonly occur from twisting or turning too quickly on a bent knee, often when the foot is planted on the ground. But older adults can experience degenerative meniscus tears, in which the meniscus has weakened and worn thin over time, and can then tear from minor trauma.

Q: How can a physical therapist help?

A: Many patients with meniscus tears can be effectively treated without surgery through a physical therapy treatment program, which will typically include manual (hands–on) therapy, strengthening exercises, icing and other pain–relieving modalities, and possibly the use of an assistive device like a cane or crutches. If you decide to have surgery–which may be recommended for severe tears in athletes and active individuals–physical therapy can help you prepare for the procedure and recover afterwards.

Q: Do I need an MRI?

A: This depends on several factors, including the severity and duration of your symptoms. Before an MRI is performed, it makes good sense to seek out the care of a physical therapist. Quite often physical therapy is all you need. While MRIs are not needed for the vast majority of mild cases, doctors may recommend having an MRI if your symptoms are moderate or severe; however, it's important to understand that this is not always necessary, and the choice is ultimately up to you. Conservative, cost–effective, natural care is what should be done first. Scientific research suggests that you should try physical therapy before having any expensive tests. If physical therapy is unsuccessful, you'll be stronger, more flexible, and better prepared for an MRI and surgery if need be. Do know that having an MRI generally increases the chances of undergoing surgery, which has been found to raise the risk for osteoarthritis in the future.

Knee Osteoarthritis Q: What causes knee osteoarthritis?

A: Knee osteoarthritis is a disorder that involves the cartilage in a knee joint. In a normal knee, the ends of each bone are covered by cartilage, a smooth, very slippery substance that protects the bones from one another and absorbs shock during impact. In knee osteoarthritis, this cartilage becomes stiff and loses its elasticity, which makes it more vulnerable to damage. Cartilage may begin to wear away over time, which greatly reduces its ability to absorb shock and increases the chances that bones will touch one another.

Q: Where does it usually hurt?

A: Knee osteoarthritis typically leads to pain within and around the knee that tends to get worse with activities like walking, ascending/descending stairs, or prolonged sitting/standing. Other symptoms include swelling, tenderness, stiffness, and a popping, cracking, crunching sensation.

Q: Do I need an X–ray or MRI?

A: An X–ray of a knee with osteoarthritis can show a narrowing of the space between bones due to the loss of cartilage. MRIs provide much greater detail of the knee and will reveal specific changes in bones and soft tissue that may be related to knee osteoarthritis. However, these imaging tests are not often needed, and could lead to unnecessary interventions like surgery that may not alleviate the pain. This is due in part to the fact that although most individuals over 50 will have signs of knee osteoarthritis on imaging, many will not experience any symptoms. Even though an x–ray may show severe signs of cartilage loss, these findings do not mean you won't be successful with physical therapy and therapeutic exercise. Scientists have concluded that it's important for patients to try physical therapy/therapeutic exercise, rather than simply looking at an image and deciding against physical therapy treatment. In other words, no matter how bad the x–ray or MRI may look, physical therapy often helps.

Q: How can a physical therapist help?

Physical therapy is strongly recommended as an initial intervention for all cases of knee osteoarthritis. Although no treatment can slow or stop the loss of cartilage, a physical therapist can help to reduce your pain levels and preserve your knee function through movement–based strategies like stretching and strengthening exercises, hands–on therapy, bracing, and recommendations for activity modifications.

Skiing is a great form of exercise that works out many parts of the body while allowing you to experience the outdoors during the colder parts of the year. There are many steps to ensuring a successful day—and season—on the slopes, including the use of appropriate clothing, proper protective gear, and planning ahead. But another crucial component to this process that should never be overlooked is good hydration and nutrition.

What you eat and drink before, during, and after a day of skiing can have a major impact on your performance on the mountain. Sticking with a smart nutritional plan over time can also lead to better overall fitness and help you work towards optimal levels of strength, flexibility, balance, and endurance. This is particularly important for skiers, since the sport is associated a fairly high injury risk, with injuries to the knee—especially sprains and tears of the medical collateral ligament (MCL) and anterior cruciate ligament (ACL)—being most common. Therefore, focusing on proper hydration and nutrition could help you take your skiing skills to the next level while also reducing your risk for injuries to the knee.

Why is hydration important and how much do you need to drink?

Water is vital to our health and ability to function. Every cell, tissue, and organ relies on water, and it makes up about 60% of our body weight. Water is essential for many of the body’s most important biological tasks, and keeping the body hydrated helps the heart more easily pump blood to the muscles, which makes them work more efficiently.

On the other hand, when muscles are dehydrated, they are deprived of electrolytes that are necessary to proper functioning. This can impair both muscle strength and control, which can negatively affect your performance on the slopes. In one study, underhydrated individuals were significantly less capable of performing a resistance exercise compared to those who were adequately hydrated. Being dehydrated may also play a role in developing muscle cramps, but evidence is conflicting, and other factors are likely also at work.

It’s also important to realize how hydration needs are different when skiing. In cold weather, the body doesn’t get as hot, sweat evaporates more rapidly, and the body’s thirst response is diminished by up to 40%, even when you’re dehydrated. As a result, you may be fooled into thinking that you’re properly hydrated, even when your body requires more water to function properly. This is why you should never wait until you’re thirsty or notice symptoms of dehydration—such as little or no urine, dry mouth, confusion, nausea, headaches, fatigue—to start drinking water. Instead, aim to stay well hydrated (meaning your urine is pale yellow) before, during, and after skiing. Exactly how much water you’ll need varies from person to person depending on body weight, exercise intensity, and other factors, but the following ranges are a good starting point:

• Before skiing: 17-20 oz. of water at least 2 hours before getting on the mountain
• While skiing: 7-10 oz. of water for every 10-20 minutes on the slopes; try carrying a plastic, reusable water bottle with you and/or take frequent water breaks
• After skiing: 16-24 oz. of water for each pound lost due to sweating; it is particularly important to rehydrate if you’re skiing again the next day

What comprises a strong nutritional plan for skiing?

Making smart dietary choices while skiing may take some additional effort on your part, but doing so could make a real difference in your energy levels and how well you’re able to carve as a result. This means planning ahead and not relying only on the food offered at lodges, which don’t always provide the best possible options.

Before skiing

• Having a quality, nutritious breakfast is essential for starting your day off on the right foot; an ideal breakfast before skiing should include a slow-burning carbohydrate source combined with a protein source
• Consuming the right amount of carbohydrates will ensure that you have sufficient energy levels to get through an entire day of skiing
• Protein can help to improve physical performance in several ways, particularly by increasing the amount of muscle mass you’re able to gain while skiing
• Some of the best breakfast options that contain both carbs and protein include a smoothie made with bananas, nut or oat milk, and protein powder, yogurt with fruit, oatmeal with chia seeds, flax seeds, and/or nuts, and avocado toast with egg
• Try to avoid eating just protein or just carbs for your entire breakfast (like a piece of fruit), as it will fail to keep you full for an extended period of time

While skiing

• While a well-balanced breakfast is key for the day, aim to keep it relatively small, as eating too much can overburden your digestive system and lead to fatigue
• Instead, keep yourself sustained with easy on-the-go snacks throughout the day; pack a few low-sugar bars (especially whole foods-based nutrition bars with minimal ingredients), peanut butter packets, pieces of fruit, or a bag of nuts or raisins; these will keep your energy levels high and blood sugar stabilized as you burn calories while skiing
• Be sure to also eat a lunch that fills you up without overdoing it, with protein and carbs again being the main macronutrients to focus on; try to limit your intake of fats, as it can take more energy to digest high-fat foods
• Smart lunch options include a chicken or ham sandwich, fish tacos, a burger with a side salad (skip the fries), and soup/chili; if you’re able to cook on your own, here’s a great recipe for turkey chili
• We realize that cafeteria options are not always great on the mountain, so if your lunch is subpar, you can always make up for it with a healthy recovery dinner

After skiing

• Ideally, you should try to have another small snack within two hours of getting off the mountain—aprés ski usually fits the bill here—and then a fairly large meal for dinner; if you haven’t noticed, there’s a general trend here: you should be eating most of the day when skiing
• Consuming a meal loaded with a good balance of carbs and protein is also important after you’re done for the day and the recovery process begins
• These macronutrients are important for different reasons during your recovery, as protein will help with the repair and growth of muscle, while carbs will replenish your stocks of glycogen (energy storage for muscles) for the next day
• While fats should generally be avoided during the day, feel free to eat some fats with dinner (preferably healthy ones), which you can do by topping your food with avocado, using olive oil in meals, or fatty fishes like trout and salmon
• Great recovery dinners include meatballs with veggies and a small serving of pasta, herbed chicken with roasted broccoli and potatoes, miso ginger tofu bowl, and salmon with veggies

In our last three newsletters this month, we’ve shown you how prevalent temporomandibular disorders (TMDs) are in the general population, offered several suggestions to help you reduce your risk of experiencing these issues, and provided our top tips for at-home remedies for alleviating your symptoms independently. While these remedies are beneficial for many patients, they can only go so far, and may fail to completely eradicate symptoms in some cases.

 

For persistent or severe TMD symptoms, a more systematic intervention will likely be needed. Numerous treatment options are available for TMDs that range widely in terms of cost and intensity, but there is a general principle that should be applied when deciding how to proceed: less is often best. This means avoiding expensive and irreversible interventions that are not often necessary and instead choosing minimally invasive, safe, low-risk treatment options that have been proven to work.

 

Physical therapy is a conservative (non-surgical) intervention that fits these criteria to a T. When treating patients with TMDs, physical therapists employ a variety of movement-based strategies that are designed to reduce pain levels, restore normal jaw movement, and lessen stress on the jaw. The techniques utilized are gentle and involve a combination of patients’ own movements and the therapist moving specific structures in a particular manner to increase range of motion. Physical therapy is also supported by evidence, as research has shown that it can produce improvements in both primary TMD symptoms and the headaches that often occur simultaneously.

 

Each physical therapy treatment program for a TMD will vary depending on the severity of symptoms and the findings of the initial evaluation, but some of the most commonly-used interventions that are likely to be employed include the following:

• Posture education: there are several postures that can contribute to or worsen a TMD, such as sitting with your head positioned too far forward, which stresses the muscles of the TMJ; therefore, if posture is identified as a possible cause, your therapist will teach you to become more aware of your posture and try changing the position of your jaw, head, neck, breastbone, and shoulder blades when you’re sitting and walking

• Manual therapy: another common intervention is manual therapy, in which various hands-on techniques are applied to increase movement and relieve pain in tissues and joints; your therapist may use manual therapy such as massage or soft-tissue mobilization to stretch the jaw to restore normal flexibility or break up scar tissues that may have developed

• Stretching and strengthening exercises: your therapist will also teach you to perform a specific set of exercises that won’t exert a lot of pressure on your TMJ, but can strengthen the muscles of the jaw and restore a more natural, pain-free motion

• Pain-relieving modalities: for severe pain, your physical therapist may administer additional interventions to alleviate it, such as electrical stimulation or ultrasound 

 

If your therapist suspects that your TMD is caused by teeth alignment problems, jaw clenching, or teeth grinding, he or she may refer you to a dentist who specializes in TMDs for additional care. Dentists can correct these issues with devices like bite guards, which create a natural resting position that will relax the TMJ, relieve pain, and improve jaw function. Surprisingly, it appears that many dentists are unaware that physical therapy is a safe and effective option for TMDs, as a survey-based study found that only 41% of dentists knew that physical therapists were capable of treating these patients. However, participating in the study led to 81% of the dentists involved being more likely to refer their TMD patients to a physical therapist, and 80% wanted to learn more about collaborating with physical therapists in their practice.

 

We hope that after reading these newsletters, you have also become more likely to consult a physical therapist if you encounter a TMD that’s interfering with your enjoyment of life. Physical therapy is an extremely safe, relatively inexpensive intervention that can lead to significant improvements when patients commit to treatment, and we invite you to see what it can do for you.

 

There are 22 bones in the face and head, but the lower jawbone—or mandible—is the only one of these that can move. The mandible connects to the temporal bone of the skull at two points just in front of each ear through the temporomandibular joint (TMJ). And as we discussed in our last newsletter, the TMJ is of interest not only because it allows us to move our jaw in multiple directions so we can talk, yawn, and chew, but also because it’s a common location of pain.

Temporomandibular disorders (TMDs) affect over 10 million Americans, with a much higher prevalence in women than men. While TMD symptoms – like jaw pain and fatigue, dizziness, difficulty opening or closing the mouth, headaches, and pain around the ear—may not severely impair an individual’s ability to navigate the world, symptoms can certainly become a bothersome distraction and reduce your quality of life.

Another frustrating feature of TMDs we’ve already touched on is how experts are not entirely certain what mechanisms are responsible for their origin. While previous trauma to the jaw could play a part in some TMDs, in most cases there is no clear-cut cause. Repeated clenching or grinding of the teeth, bad posture, high stress levels, muscle spasms, and arthritis could all contribute, but it is often difficult to identify a single factor responsible. Although this uncertainty might lead you to believe that there’s not much you can do to avoid a TMD, this is not in fact the case. Based on what is known about TMDs, healthcare professionals believe that several strategies may be effective for reducing your risk. With this in mind, here are our 6 best tips for preventing TMDs:

6 Tips to Reduce Your Risk for TMDs

1) Be more careful with what and how you chew

• Avoid chewing gum
• Chew with both sides of your mouth
• Avoid eating too many hard or crunchy foods
  
• Take smaller bites of food
  
• Don’t bite on hard objects like pens or pencils
  
• Avoid biting your nails

2) Practice good posture

• Keep your head balanced and not hunched forwards, your shoulders straight, and torso aligned with your head and shoulders (with good posture, a straight line can be drawn from your ears to your shoulders)
  
• Avoid cradling your phone between your neck and shoulders
  
• Try not to regularly carry a heavy purse or backpack on one shoulder
  
• Consider using ergonomically designed products for your office setup

3) Avoid clenching and grinding: if you grind or clench your teeth on a regular basis, focus on reducing or eliminating this habit; becoming more conscious of your clenching, relaxing before bed, and using mouth guards and night splints could all help you work towards this goal.

4) Be aware of the position of your teeth: try to keep your tongue at the roof of your mouth and avoid letting your teeth touch; your teeth should be kept at least a few millimeters apart unless you’re chewing, and even then they should not be making much contact with one another.

5) Improve your sleeping habits: sleep on your back or side and avoid sleeping on your stomach, which can strain your jaw; make sure your pillow provides enough support for your head and neck.

6) Alleviate stress: if your stress levels are high, explore options to reduce your stress, including meditation, yoga, mindfulness practices, and cognitive behavioral therapy.

Read our next post to learn about some simple remedies and treatments to try out if you’re dealing with any TDM-related symptoms.

Although you’re more likely to hear about pain occurring in certain parts of the body—like the knees, shoulders, and spine—the reality is that it can strike just about anywhere. The jaw is one region that doesn’t generally get much attention, but jaw problems are actually more common than you might think. A class of jaw-related issues called temporomandibular disorders affect millions of Americans each year, and the nagging symptoms that they create often need to be addressed.

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. Temporomandibular disorder, or TMD, is a general term used to describe a variety of conditions that cause pain and dysfunction in this joint and the facial muscles that surround it.

The definite cause of TMDs is still unclear, but some theories suggest that they may be due to injury in that region, grinding, or clenching teeth, osteoarthritis, or stress. Regardless of their cause, TMDs are generally classified as either muscle-related or joint-related depending on which part of the jaw is affected. Symptoms vary widely from patient to patient, with some of the most common signs of TMDs including:

• Jaw pain or tenderness, which can be on one or both sides of the jaw
• Aching pain in/around your ear or in your face
• Difficulty opening/closing the mouth or chewing
• Popping, clicking, or locking of the jaw
• Earaches or ringing in the ear

TMDs often occur with neck pain and headaches

Another notable characteristic of TMDs is that many patients will experience neck issues at the same time as their jaw symptoms. In some cases, neck-related problems can manifest as a headache, and research has shown that as many as 56 percent 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. As a result of this connection, neck issues and headaches can mimic muscle pain in the jaw muscles, and it may therefore be difficult to distinguish the two conditions. This is also why it’s often best to treat TMDs and neck problems simultaneously, which we will discuss in one of our next posts.

The risk of developing TMDs is fairly low throughout childhood but rises slightly in adolescence around the teenage years, with girls being more likely to experience a problem than boys. In these younger ages, overexerting the jaw is believed to be the main culprit, which can occur from high levels of stress or anxiety, repeatedly clenching the jaw or grinding teeth, or from a traumatic injury. High stress levels can actually make kids more likely to tighten their jaws, and over time, these behaviors will change the alignment of one’s bite and affect the muscles used for chewing.

The risk for TMDs continues to increase into middle age, and the majority of cases are seen between 20–40 years. Approximately 10 percent of adults are currently affected by a TMD, and up to 7 percent will eventually seek out treatment because their symptoms are severe. Women are at least twice as likely to develop a TMD than men, and stress, jaw injuries, and jaw clenching are once again risk factors that could contribute. Unregulated stress and a long-term habit of jaw clenching will likely increase this risk even more on account of the repeated stress placed on the jaw over time.

Read our next post for a list of our top prevention strategies that will help to reduce your risk of developing a TMD.

Some of the most common causes of neck pain include sleeping on your neck wrong, sitting or standing for prolonged periods with bad posture—especially from leaning over too much, performing repetitive movements, and carrying a heavy backpack, purse, or briefcase. Neck pain can also develop from conditions like osteoarthritis, a herniated disc, spinal stenosis, or from sudden injuries that may cause whiplash or other problems in the neck.

These conditions variably lead to pain, muscle tightness and spasms, a decreased ability to move your head, and headaches. Some individuals may experience complete or partial relief after performing simple home remedies and avoiding further aggravation of the spine, but for many others, they continue to be affected by painful symptoms that usually hinder their enjoyment of life.

For patients that fail to improve on their own, the next step is usually to consult with a healthcare professional, and many will go to their primary care doctor first. Doctors may recommend medication, additional testing, a referral to a specialist, or some combination of these interventions. Many of these options are costly, may have side effects, and often have limited scientific proof of effectiveness.

Physical therapy, on the other hand, has been supported by an abundance of research that has found it to be effective for reducing patients’ costs and their use of healthcare. It is also generally recommended that these patients see a physical therapist sooner rather than later, but there is a lack of research on the direct relationship between these variables. Therefore, a recent study was conducted to investigate how seeing a physical therapist at different points in time affected patient costs and healthcare use. The conclusion states:

This study has found an association with the timing of physical therapy consultation on healthcare utilization and costs, where delayed and late physical therapy consultation is associated with increased costs and overall healthcare utilization, particularly of healthcare services with conflicting evidence for effectiveness.

Based on these findings, patients with neck pain should strongly consider seeing a physical therapist, and preferably sooner rather than later. Thus, if you’re currently dealing with neck pain, we recommend consulting your local physical therapy first before your primary care provider. Taking this approach will allow you to get started on a personalized path to recovery right away while avoiding additional referrals, diagnostic tests, and other interventions that are usually expensive and unnecessary.

About 10—20% of Americans are affected by neck pain at any given time. If you happen to be part of this population and are dealing with neck pain right now, you may be wondering what you can do to alleviate it.

Poor posture and bad positioning of the neck is a major reason that pain develops over time. With this in mind, you can consider how you move your neck in your daily activities the biggest contributing factor in whether you’ll develop neck pain and how severe it will be.

For this reason, if you are currently impaired by neck pain, one of the best things you can do is look at how you use your neck throughout the day and identify any postures that might be contributing to your pain. For example, if you take public transportation to work, observe your neck is position throughout your commute. If you notice that you tilt your head down when reading or to the side when taking a nap, you should try to change your habits to avoid these movements, and consider using a neck pillow for the short naps to keep your neck properly aligned. Following the same recommendations provided in our last newsletter on your bed and workstation setup will also help to relieve your neck pain over time.

Some other effective steps you can take to alleviate your neck pain right now include the following:

Disclaimer: before you try these or any other exercises, ask your doctor or physical therapist.

• Apply ice or heat: for mild neck pain that you have just started to notice, apply an icepack to the neck for 20 to 30–minute intervals every few hours for 2–3 days; after this period, apply heat to the area with a hot compress, heating pad, or hot shower
• Perform some each neck movements
• It’s important to keep the joints in your neck mobile even when you’re in pain, but to avoid any jerking movements that can put strain on the neck
• Try to also perform these movements regularly:
• Roll your shoulders backwards in a circle for 10 repetitions
• Squeeze your shoulder blades together for 10 repetitions
• Bring your ear to your shoulder 10 times on each side
• Exercise in a pool: many individuals find pools—especially those kept at a warm temperature—to be soothing for neck pain; aquatic exercise, gentle swimming strokes, or simply moving around the water with the neck submerged may all help
• Reduce stress: high levels of stress can cause you to tense the muscles in your neck and may make pain worse; this is why it’s important to try to find ways to reduce your stress in order to prevent further neck pain and stiffness
• Other
• Stay hydrated at all times
• Have a partner gently massage the sore or painful area
• Limit the amount of time you spend looking at your phone
• Try to avoid driving for long periods of time

If your neck pain persists after trying out these home remedies, it’s best to see a physical therapist next for a complete evaluation and personalized treatment program. We’ll look into the crucial role that physical therapy can play in correcting neck pain in our next newsletter

Although you may not pay it all that much attention, the neck has a pretty crucial job to perform. It provides support for the head and allows movement in a variety of directions so you can better see and navigate the world around you. But as we discussed in our last newsletter, the neck is also an extremely common site of pain on account of how frequently it’s used, and this pain can stand in the way of a satisfactory quality of life.

A wide array of factors can contribute to the development of neck pain in any given individual. Unfortunately, some of these factors are completely out of your control, like the age-related changes to the cervical spine that make certain neck conditions more likely to occur. These are considered non-modifiable risk factors and simply have to be accepted since nothing can be done to alter them. On the other hand, modifiable risk factors are those that each individual has the capacity to change. And in doing so, you have the power to reduce your risk for encountering neck pain.

Two modifiable risk factors that can strongly influence your chances of getting neck pain relate to where you sleep and work. These are the two places that many of us spend the majority of our time on any given day, which means that how you position your body—particularly your neck—in each of them warrants your attention. Below are some of the best tips to improve your posture and positioning at your bed and at your work desk to lower your risk for neck pain.

Tips for better posture while sleeping

We spend roughly one-third of our lives sleeping, so the habits we develop in both our sleeping patterns and in how our beds are set up can have a major impact on the rest of the day. Sleeping in the wrong position or on a pillow that’s not supportive enough can lead to neck pain immediately or may contribute to it gradually over time. Try the following to optimize the setup of your bed:

• Avoid stomach sleeping: the best sleeping position is on the back, followed by the side, while stomach sleeping turns the neck to the side and can lead to neck pain; sleeping positions are often established earlier in life and can be difficult to change, but trying to start a night’s sleep on the back will increase your chances of remaining in that position
• Use the right pillow: make sure your pillow is of the appropriate firmness for your neck; different types of pillows are better for different individuals, but a good rule of thumb is to try to use a pillow that keeps your upper spine in neutral alignment, which means the natural curve of the neck is supported and maintained; feather and memory foam pillows may be helpful, while pillows that are too high or too stiff should be avoided
• Maintain healthy sleeping habits: getting the recommended 7–9 hours of sleep each night is associated with a host of health benefits, one of which is a reduced risk for neck pain

Tips for better posture at your work desk

For the many individuals that work in an office of any sort, another significant chunk of each day is spent sitting at a desk. As with bed setups, the way in which a workstation is arranged affects the neck and can play a part in the development of pain. To ensure that your workstation is not adding any strain to your neck, we recommend the following:

• Make sure your computer is at eye level and not too close or far away from you; you shouldn’t have to crane your neck down or strain your eyes to look at it
• When seated, the feet should be flat on the floor and the back of the chair should be in an upright position
• Keep the keyboard directly in front of you, close by, and at a height so your shoulders are relaxed, elbows slightly bent, and wrist and hands straight
• Consider using a document holder placed next to your computer to avoid constant neck movement when switching between the two

Other

• Avoid neck strain when using your phone by raising it to eye level, taking frequent breaks, and minimizing phone time
• Use a headset or headphones if you are on the phone frequently
• Use a neck pillow for flights and long car rides
• Regularly perform stretching and strengthening exercises for the neck to keep it flexible and strong

In our next newsletter, we’ll look into some of the ways you can alleviate neck pain on your own if it’s bothering you right now.

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. As we’ll show you, the likelihood of having neck pain also increases as you get older, and different conditions are more common at certain ages.

There are seven bones (vertebrae) in your neck, which are collectively referred to as the cervical spine. These vertebrae are called C1—C7, with C1 being the first vertebra at the base of the skull and C7 being the lowest vertebra around the chest area. Providing further support for these vertebrae are intervertebral discs, which sit between each bone to cushion them and absorb shock during impact. The cervical spine also consists of numerous joints that allow for an impressive range of motion that you can notice any time you nod, turn, or rotate the head in any direction. Unfortunately, this wide range of motion is one of the main reasons neck pain is so prevalent.

Sprains and sprains are most likely to occur in children and young adults

Throughout childhood and adolescence, the chances of experiencing neck pain are fairly low, but this is not to say that this age group is immune. If neck pain does occur in children, it is most likely due to strains or sprain of the muscles or ligaments in the neck. The reason is that although neck muscles and ligaments are flexible at these ages, they can still get pushed beyond their limits. When this does happen, it is typically the result of maintaining bad postures for extended periods of time or sleeping on the neck wrong. Patients with neck strains and sprains will probably complain of pain and discomfort in the back, side, or front of the neck that limits their movement and activity.

Age—related changes begin playing a role in middle age

Neck strains and sprains remain fairly common later in life, but several other neck conditions also enter the fold. The primary reason is that certain unavoidable, age—related changes begin to occur in the cervical spine. For example, the structures that make up the neck become weaker, the intervertebral discs lose some of their height, and the joints in the neck adapt to other changes in the body. Eventually, these changes make the structures of the neck slightly less effective, and this can often lead to the development of other neck conditions. Some of the most common disorders include:

• Osteoarthritis: this condition results from the ends of bones in the neck losing protective cartilage
• Spondylosis: a general term used to describe any pain related to age—related changes in the spine
• Herniated disc: this occurs when some of the jelly—like substance in an intervertebral disc protrudes out, which may cause pain and other symptoms that radiate from the neck

These types of issues typically develop between the ages of 40–60 but can be seen even earlier in certain individuals. Symptoms also range significantly, as some people experience regular pain and physical limitations, while others may have signs of age—related changes but fail to notice any impairments.

Similar issues plus additional complications may await in older age

For adults over the age of 65, age—related changes continue to occur and may begin to become more advanced in some cases. This means that conditions like osteoarthritis and spondylosis are even more likely and may be more severe for some individuals. Other conditions like spinal stenosis and osteoporosis are also more common in older age and can therefore be added to the list of possible neck problems. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the structures within it, while osteoporosis is a condition that causes bones to become weak and brittle. Other mobility limitations could make neck—related issues even more of an impairment for the elderly, but all of these problems are still treatable.

What’s important to understand is that while there is nothing that can be done to stop the aging process, there are a number of changes you can make to your everyday life that can significantly reduce your chances of experiencing neck pain. We will discuss these tips in our next newsletter.

October is National Physical Therapy Month, which is an annual opportunity for physical therapists nationwide to campaign and speak out about their profession. The goal of the campaign is to increase public awareness of the important role that physical therapy plays in reducing pain, improving mobility, and encouraging a healthy lifestyle for patients. In honor of this important profession, we’d like to walk you through a brief summary of how physical therapy has evolved over the years and some of the many conditions it is used for in treatment.

The roots of physical therapy can be traced back to approximately 435 BC, when Hippocrates—typically referred to as the “Father of Medicine”—utilized techniques like hydrotherapy (water–based treatments), massage, and manual (hands–on) therapy on patients. But it wasn’t until the early 20th century that the modern physical therapy practices we know today began to take form.

Two major historical events played a significant role in the development of physical therapy: the devastating polio epidemic and the impact of several major wars throughout the 20th century.

Call to action from the polio epidemic

The first major outbreak of polio hit the U.S. in 1916 when over 9,000 cases occurred in New York State alone. At the time, polio was treated with long–term splinting and bed rest, but this approach caused most patients to experience severe weakness and decreased flexibility that was impairing their mobility. As public and private experts recognized that these current methods were grossly insufficient, they called for a more effective strategy through a national program that would train individuals to administer better interventions to polio patients.

This resulted in several schools of physical training and allied therapies to implement programs that would produce “physical reconstruction aides,” which were later renamed physical and occupational therapists. These aides would prescribe various treatments—like massage and hydrotherapy—as prescribed by surgeons and other doctors, and numerous strides in the profession were made during this time. Among these was the development of manual muscle testing to assess muscle strength, which also helped to create techniques designed to reeducate weaker muscle.

Response to World War I through the Vietnam War further molds the profession

World War I was raging around the same time, with the U.S. entering in the spring of 1917. Consequently, over 200,000 wounded troops returned home and in need of structured treatment to rehabilitate them. In response, a plan was formulated that led to the creation of a group comprised of reconstruction aides/physical therapists who would provide exercise programs, hydrotherapy, and other modalities, and massage for these patients to help them regain their lost abilities. A partnership between physical therapists and the medical and surgical community was also forged in the 1920s, which further increased recognition and support of the profession.

Physical therapists’ services were also required during World War II, which sent home a multitude of soldiers with amputations, burns, fractures, and nerve and spinal cord injuries. The U.S. Army once again met this need by implementing plans to recondition these wounded soldiers through physical retraining, vocational rehabilitation, and psychological support. Research into the use of electrical stimulation during this time also helped physical therapists learn that their efforts should focus not only on preventing muscle atrophy but also in building back muscle mass and strength.

The 1950s saw physical therapists progress from technicians to professional practitioners, primarily through the American Physical Therapy Association establishing a professional competency examination in 1954. In the '50's with the Korean war, and then thru the 60's and 70's with the Vietnam war there again was a large number of wounded soldiers requiring structured treatment. This further advanced the profession with new interventions intended to rehabilitate surgical wounds, increase range of motion, and restore strength and flexibility, particularly after serious burns. In addition, the Vietnam War was the first time physical therapists were allowed to treat patients with neurologic injuries without a doctor’s referral due to a shortage of surgeons.

Additional progress into the present

The reach of physical therapy has continued to expand in the years that followed and into the 21st century, it is now recognized as an integral part of healthcare for patients with a wide variety of injuries and painful conditions. Physical therapists are movement experts whose efforts remain focused on improving the quality of life of their patients through education, hands–on care, and prescribed exercises. They are capable of effectively managing practically any condition associated with pain or impaired mobility, and they do so with personalized treatment programs that are unique to each patient. The list of the conditions they treat includes, but is not limited to, the following:

• Arthritis
• Back and neck pain
• Foot and ankle injuries
• Hand and wrist injuries
• Knee pain
• Shoulder injuries
• Sprains, strains, and fractures
• Work–related injuries
• Osteoporosis
• Headaches
• Surgery rehabilitation
• Balance and vestibular conditions
• Stroke rehabilitation
• Cancer rehabilitation
• Fall–prevention programs
• Sports injuries

We hope you enjoyed learning about the origins of physical therapy in this abridged history of the practice.