Anthony L. Komaroff, M.D.
---- — DEAR DOCTOR K: I'm still recovering from a neck injury, but I'm scheduled to begin rehabilitation exercises with a physical therapist next week. How can I start rehab when I'm in so much pain?
DEAR READER: Your question reminds me of the time I recommended rehabilitation exercises to a patient with knee pain. The patient responded: "So you're prescribing a little pain to get rid of my pain? Don't get mad at me, Doc, but I don't feel so good that I can afford to feel bad."
After a little explanation and persuasion, the patient agreed to the exercise program. Ultimately, he was glad he had done so.
Although it may be hard to believe, without active exercises it is hard to relieve pain, restore function and reduce the risk of reinjury in your neck.
If you're still in too much pain to perform rehab exercises, your physical therapist can do some "passive pain-relieving interventions" to ease your pain and get you ready for active rehab. These techniques are not a substitute for necessary exercises. Instead, they make it easier for you to do them.
-- THERAPEUTIC ULTRASOUND. Also called ultrasound diathermy, this treatment converts sound waves into heat that penetrates into deep tissues. The ultrasound is delivered through a wand rubbed gently over the affected area.
-- TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS). In this therapy, small adhesive electrodes are placed on your skin at or near the sites of your pain. The electrodes transmit a very low electrical current to underlying tissues. This current "distracts" your brain from paying attention to the pain messages coming from that part of your body.
TENS does not have a direct impact on the underlying cause of pain. But by relieving your symptoms, it may help you participate in your rehab program.
LOW-LEVEL LASER THERAPY (LLLT). Also called phototherapy or biostimulation, it is a noninvasive therapy in which a single wavelength of light delivers energy to the site of treatment. No one is quite certain how it works. It's possible that wavelengths of light, delivered at certain intensities, reduce inflammation and speed up tissue repair.
TRACTION. To apply traction, a physical therapist uses hands, weights or special equipment to create a sustained pull on the neck. Traction may be used to reduce spasms or to relieve pinched nerves. Although traction has been used for many years, its value is still unclear.
We have more information on neck pain in our Special Health Report, "Neck and Shoulder Pain." Learn more about it at AskDoctorK.com, or call 877-649-9457 toll-free to order it.
If your neck pain is caused by strained muscles in the neck, here's a remedy you can do at home. Take a small towel or large washcloth and soak it in fairly hot water. Wring it out and drape it on the sore area. When it starts to cool off, heat it up again and repeat the process. This can loosen tense muscles.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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