With advances in technology and the development of knowledge and skills of treating practitioners, it has become apparent that this problem is much more common than originally thought. A great excuse for a blog topic!
The neck is made up of a stack of seven bones known as vertebrae. These are numbered C1-7, where ‘C’ stands for cervical (i.e. the neck region of the spine). The vertebrae are numbered from top (near the skull) to bottom (where the neck meets the back). Between the vertebrae are little holes where nerves run through on their way to provide electrical signals to our muscles and other body parts. Between the 4th and 5th vertebrae, the C5 nerve root lives. The DSN is a little off-shoot of the C5 nerve root which runs from the neck to the back of the shoulder and mid-back.
The DSN provides electrical stimulation to three muscles in the neck/shoulder region, all of which attach to the shoulder blade (or ‘scapula’) at one end, and the spine at the other. On its way to these muscles, the nerve pierces through another muscle in the neck (one of the three scalene muscles if you’re really interested!).
Two of the three muscles that the DSN supplies help to move the shoulder blade inwards from its resting position, towards the spine. These are the Rhomboid Major and Rhomboid Minor muscles. The other muscle, the Levator Scapulae, as its name suggests, helps to elevate or lift the shoulder blade. The proper functioning of these muscles is important for us to be able to move our shoulder through its full range of motion. Injury or entrapment of the nerve can lead to poor muscle function and subsequently, poor shoulder movement.
Signs and symptoms
As previously mentioned, the nerve pierces through one of the neck muscles on its way to innervating the other three muscles. This creates a potential point of entrapment of the nerve and this can lead to signs and symptoms commonly experienced with DSN injury. People with DSN injury may present to the clinic with any or all of the following signs and symptoms:
Who does it affect?
DSN injuries are common throughout the general population. People whose occupation puts their posture in a compromising position every day and leaves them open to issues around the neck joints and muscles are particularly susceptible to this issue. It has also been seen in people who lift weights and after car accidents.
Great news! We may be able to help you get over this issue. Once we’ve been through our assessment and are happy with our diagnosis, we can get to work on you. Yes, this is a problem which primarily affects muscles that drive shoulder movement, but the root of the problem is usually down to poor function of the joints and muscles around the lower neck and upper back. Don’t be surprised if we direct quite a bit of our treatment at the spine.
Poor movement patterns in the spine and shoulder have to be corrected and re-trained over a period of weeks to months. This is to ensure we get to the root cause of the problem and don’t just bandage over the top of it. Strength and stability exercises of the trunk and shoulder will be on your to-do list.
As previously mentioned, your occupation may be driving a lot of these issues. We may suggest changes to your work (i.e. a desk set-up assessment) and other aspects of your lifestyle to ensure you’re hitting this issue from all angles. That way we have more chance that the problem will be resolved permanently.
First and foremost, if you think you have a problem, please get in touch today on 039499 9456 so we can start your journey to recovery.
Let us take you on a scan of the body, focus on some potentially problematic areas, and give you some advice to avoid any long-term issues.
Head and neck
First stop is the very top! For all of you that normally head out to the office every day, the pandemic might mean you’ve had to start working from home. Not having your usual desk set up can place a great deal of stress on the neck region. Are you now working on a laptop instead of a desktop computer? Are you sitting on the sofa instead of an adjustable chair? Close your eyes for 30 seconds and hone your thoughts in to your neck. Move it around… How does it feel? Is it tight, restricted or does your head feel heavier than usual? It could be that your new ‘desk’ set up’ is causing some strain in places it doesn’t usually. Think about the effect of having your head looking down at a laptop for 8 hours a day compared to straight up at a monitor set to the ideal height... Your poor muscles must be feeling the strain too.
We recommend trying to recreate your office space as close as possible to the real thing. If you don’t have a desk at home, a dining table may be more suitable than sitting on a sofa or armchair. You also need to ensure you are moving your neck and shoulders more regularly to avoid them being in a strained position for too long. Take a break every 30 minutes and move into a different position.
Our spine sits at the core of the body, and we need good function throughout to ensure our limbs can also function with minimal effort and maximum efficiency. Are you used to an active job and now you find yourself homeschooling the children, or trying to break the day up with a bit of reading, gaming, TV or doing a crossword? Life is suddenly much more sedentary for most of us, so it’s important to avoid getting stiff. Sitting with poor spinal posture for extended periods, day after day can wreak havoc. Our spines curve ‘out in the mid-back and ‘in ’ in the lower back. If we don’t look after those curves carefully by protecting our posture from excessive strains, then we leave ourselves open to sore backs and poor functioning limbs as a result.
We recommend avoiding long periods of sitting or lying down. Save it for bedtime! Try some standing spinal twists or bends (gently, of course), go for a walk around the garden, or do a session of yoga, Pilates or simple stretching through the day to mobilise your spine. If you have kids, get them to do it with you. They will enjoy a break from their school work, no doubt.
Anyone who works in a seated position knows what effect this can have on the hips. Having your hips in a ‘flexed’ or in a seated position for long periods of time can leave your hip flexor muscles tight and short. This decreases your ability to open the body out into a fully straight position, reducing flow of fluids through the central part of your body and leaving the back chain of muscles in a lengthened state, which can eventually result in the weakening of the chain.
We recommend lots of upright exercises for this one. Counteract the time spent seated working or binge watching a TV series with some standing-based exercise. Jumps, skipping, walking, running or bridging is a nice way to open those hips and get the blood flowing.
Our underlying message through all of this is to move, move, move! You are a movement machine, so regularly start the ignition and go for a spin. Look after yourselves and please get in touch today on 03 9499 9456 if you need help keeping your pandemic posture in check or book online today.
Why does it occur?
There are two main reasons a person may develop flat feet. They are:
Most babies will have a flat foot at birth, but usually by the age of 10, a strong and supportive arch has developed. For some people, the arch simply does not develop, and this may or may not lead to problems down the line.
Signs and symptoms
The obvious sign to look for is a flattened arch of the foot. If you look at someone from the front or slightly to the side, you may notice that the majority or whole of the inside border of the foot is touching the ground, as opposed to there being a clear space between the heel and ball of the foot.
What effect can this have on the body? It is quite possible and very common, for someone to have flat feet and have no symptoms at all. This is known as being ‘asymptomatic’. It may surprise you to know that only 10% of people with flat feet experience symptoms. These people are known as ‘symptomatic’.
People who do experience pain as a result of this condition do so because the lack of arch supporting the inside region of the foot has a knock-on effect to the mechanics of the rest of the limb. This then affects how the pelvis and spine function too. Pain in the middle part of the foot, heel, knee, hip and lower back are all common complaints. It is also not uncommon for someone with flat feet to experience recurrent ankle sprains, where they regularly ‘roll the ankle.
“Do I need treatment if I have flat feet?” If you have no symptoms and having flat feet does not affect your life in any way, the answer is simply ‘no’.
If you have pain caused by this problem, then this is where we (and other professionals) come in. Pes planus is a great example of how a problem in one part of the body may lead to pain and dysfunction in a completely different part of the body. It’s an osteo’s dream! Not your pain, of course… However, we are experts at recognising the root cause of a problem and putting a plan in place to get it resolved fast.
Techniques we use may include soft tissue massage, joint mobilisation of the foot, ankle, knee, hip or spine and strengthening exercises. Exercises will aim to strengthen the arch itself, but may focus up the chain to the thigh, glutes and trunk as well. A large part of our job here is to also educate a patient on which footwear to use and whether or not they require the help of orthotics (these are special insoles for your footwear). Some children and adults may need some extra support inside their shoes to help reduce the effect of mechanical change up the limb. We may decide that you will benefit from seeing a podiatrist or other foot specialist who is able to design and supply you with insoles that are unique to you and the shape of your foot. Being obese can also increase the load on the lower limbs, therefore increasing the effects of pes planus in the process. In these cases, we can help to advise on how you go about losing weight through changes to your diet and exercise regimes.
For the majority of cases, a combination of these treatments above will result in improved mechanics and reduced pain, allowing the patient to continue doing the things they love. For the very few people who do not respond to treatment, an orthopaedic specialist's opinion may be required for long term management. This is always a last resort.
Check out your feet. Do you have a flattened arch when you stand up and weight bear? Is there any associated pain? If so, call us today on 03 9499 9456 and we’ll tell you what needs to be done to beat the pain! Arch you glad you read this now?! 😉