Today’s episode is about Cervicalgia, also known as non-specific neck pain. It is a Q&A session and that we have collected many questions from the general public and have organized them into a discussion that should help anyone listening better manage their neck pain.

Matt: Welcome to Honest Talks, a video podcast dedicated to helping you make your neck feel better.

Matt: Here, we answer your questions as they relate to physical therapy and offer actionable advice. Today’s episode is about Cervicalgia, also known as non-specific neck pain. It is a Q&A session and that we have collected many questions from the general public and have organized them into a discussion that should help anyone listening better manage their neck pain, because that’s essentially what this whole video podcast is about. Also, if you’re interested in the sources behind a specific answer, please visit our website honest.physios/honest-talks, and you’ll find the sources, the transcription for the episode. But before we get started, I have to issue the disclaimer that the information presented in this podcast is for informational purposes only. It should not be interpreted as medical advice because we don’t know you or your case. So you should always consult with your doctor or other qualified health professional before starting any new program, particularly if you have any pre-existing conditions. Please don’t disregard professional medical advice either or delay seeking treatment because of something you heard on this podcast. It’s important to remember that everybody’s body is different. So what works for one person may not be safe or effective for another. So listen to your body and stop anything that seems to be causing you discomfort. Anyway, we hope you enjoy the podcast and find it helpful on your journey to be better in health and wellness. My name is Matt Esrick. I’ll be your host. I’ve been a physical therapist for eight years in Long Island, New York. Six of those years, I’ve been in private practice. I own the only truly one-on-one clinic on Long Island where we specialize in conditions of the spine, balance and fall prevention, and then treating the physical manifestations of anxiety. We use a cute little puppy in our office for that too. With me is my co-host, Chris Ott. He’s been in the game about 12 years now. He owns three orthopedic practices on the east end of Long Island. Yes, we are talking about the Hamptons. They are three mid-sized clinics with a number of different specialists there. So if you have any orthopedic problem, they’re good practice to go see. If you want to know more about myself or my co-host, Chris, feel free to go to our website. You can learn about some of our education research we’ve done, our sporting backgrounds. Right now, I just want to take a moment and thank the sponsor for our episode, Made by Physios, CBD. They are the only CBD brand that is owned, managed and developed by actual clinicians. I can’t say enough good things about the product. We use it every day in clinic. It is safe, effective, and they hold themselves accountable. Made by Physios is made in the USA, GMO-free, full spectrum, vegan, gluten-free, cruelty-free, and it’s made in a CGMP facility that’s inspected by the FDA. You really can’t ask for more at a CBD company. I highly recommend you check them out, madebyphysios.org. Let’s kick it off with what actually is Cervicalgia, Chris? How would you define this?

Chris: Great intro. Thank you, Matt. Cervicalgia is typically described as a nonspecific neck pain, meaning you don’t have a more defined diagnosis yet. It’s a variety of different causes or it could be from a variety of different things, like a muscle strain, could be a degenerative type of a situation, or maybe just from an injury. Based on what the cause is, it’s going to vary a little bit and it’s going to dictate what your treatment is. Physical therapy is typically a really good fit for Cervicalgia, but in more severe cases, sometimes someone is going to have to get other forms of medical treatment.

Matt: That seems to speak to treatment effectiveness, which is one of the questions we actually got from Mike L, who asks, “What types of physical therapy interventions have proven effective for nonspecific pain in the research?” You want to take this one, Chris, or you want me to take it?

Chris: Why don’t you take this one, Matt?

Matt: Look at what’s in the research. You’ll find that two of the main components of PT are quite effective, particularly if they’re used in combination with each other. The first one being exercise. We’re PT, we’re all about exercise. That’s obviously graduated. It’s a stepwise progression over time, where you might try something challenging, you might be on that step for a bit, it levels out, you start to do better, and we go up a step. The second half of that is what is known as manual therapy, which is hands-on techniques that can feel like a combination of massage, something we call joint mobilization, where someone’s generally trying to help you move your joints for you in a specific way. It could be manipulation, which is the classic bone cracking, but that’s got to be warranted, just like any of the other stuff that’s done. That is generally what works the best for this condition. There are alternatives, they are short-lived. You could do something like heat, ice, stim. Some people like ultrasound, although that’s not really proven all that effective. And laser, but again, if you’re asking me about research, the research on laser is pretty weak. Similarly, there’s a question from Dana W. that asks me to compare alternative treatments for long-term outcomes, because that’s what everyone’s after, is a long-term outcome. Dana, that’s a fair question. The reality of it is that there are strengths and weaknesses to each approach. PT is evidence-based, there’s extensive research supporting its effectiveness, particularly for cervical or nonspecific neck pain. We’re almost the first line of defense that we have long-term benefits because we’re addressing the underlying causes, there’s minimal side effects. And believe it or not, PT is actually very cost-effective. It’s often cheaper than the other options in the long run. But it does come with its weaknesses. So for example, there are some slower results, it requires commitment, which is often a problem for a lot of people. That’s where your relationship with your therapist can come in. And you need to be an active participant and then actually adhere to the program that’s developed. Now, when we look at the alternatives, like medication, so medication could be rapid relief, there’s a variety of options too. However, the side effects, there’s a lot of them. I mean, you don’t know what’s going to happen until you actually take it, whereas if you did an exercise, your response is pretty immediate. It doesn’t actually address the underlying cause, it essentially masks them, which is something I often say in the clinic. And there is the risk of long-term use or even addiction in certain cases. When you look at injections, you’re getting targeted pain relief, which is great. I have nothing against injections. I think it has a place in the rehab spectrum, just like medication does. But again, it’s passive. So you’re addressing a systemic problem with it. Sorry, you’re avoiding having a systemic problem by having a localized injection, which is good. But the pain relief is short term, it’s technically invasive, because you are taking a needle. And it can be costly. Not all injections are covered by your insurance or however else you plan on paying. And then we look at good old surgery. So first caveat to this is for servicounsel, you shouldn’t be getting surgery. It warrants further investigation. You should be going through what we call conservative care first, which would basically be everything I already named in this response. But you could get a lasting solution. Surgery is permanent, and it can offer significant pain relief if it’s done right and you’re a good fit for it. I think the weaknesses there are pretty obvious. Potential complications, risk of infection. And then there’s the last part of success rates. How do you define success in surgery? I tell all my patients, don’t let your surgeon define it for you, because his definition of success may differ from yours. And more importantly, when you do look into the research across almost all spinal conditions, if you are getting surgery, the success rate is about 30%, which, as I like to say, if you were at a racetrack betting on a horse, and I told you that horse at 30% odds, you’re not betting on that horse. So hopefully that answers your question, Dana. It was a bit lengthy, but I had a lot to say on that one. So moving on, we have a question on treatment philosophy, asking essentially about traditional methods as alternative approaches. I know, Chris, you wanted to take this, and the question is from Jen Elp. Are acupuncture, massage, or yoga as effective as conventional physical therapy techniques?

Chris: Well, thanks for your question, Jen. Those are really common things that we get asked really almost every single day in the clinic, too. So we’ll get my opinion on this one. I’m really a big fan of acupuncture. Out east where my clinics are, we happen to have a great relationship with some different local acupuncturists, and we see really good results with it. It can be really complimentary if you are going to physical therapy already, and we will often have patients that we will both treat at the same time. The other thing I really like about acupuncture is it’s pretty low risk. I really only can’t think of any negative occurrences, aside from maybe it didn’t help as much as you were hoping or something. So definitely a thumbs up for acupuncture. As far as massage goes well, we’re a hands-on clinic, and we’re going to be using massage techniques during our treatments. So I’m definitely a big advocate of massage therapy as well. Or in addition, sometimes a person just wants to have a more thorough massage or they want to have maybe their whole body massaged because if you have a neck issue, a lot of times there’s going to be tension and other problems elsewhere in your body that a massage therapist could help you out with. So certainly a thumbs up there. And then lastly, yoga. I’d say you have to be a little bit careful with yoga because it is a pretty broad practice. There’s a wide variety of techniques from basic to much more advanced. However, a lot of the more basic stuff can be very beneficial, and we’ll even utilize many of their exercises in RPT sessions too. So with the yoga, I’d say mostly a positive there, but just be careful, use some common sense. And if you’re unsure, maybe don’t do it or ask a professional or someone who’s more knowledgeable with that particular topic.

Matt: I completely agree with you there, Chris. I just wanted to add a couple of things. One of which is definitely talk to your therapist first if you’re planning on integrating these things because therapists might also offer them. I think both of us know PTs who are also Pilates instructors, which is very complimentary. Some offices have massage therapists that come in. And yoga, there is that overlap. So you might want to just know, are you going to be incorporating yoga exercises so you’re not wasting time and money or creating unnecessary hurdles for yourself? And then the last bit is more of just a clarification because I get asked this all the time. I’m not going to speak on it more than just this, which is acupuncture and dry needling are not the same thing. So if you want to get acupuncture, you’re going for an Eastern medicine approach. If you want to go dry needling, you are going for more of a Western medicine approach. We are not discussing the differences right now or the benefits of one or the other. Just know that they are, in fact, not the same thing. So don’t be sold on the fact that they are. Next question comes from Karen L. She’s asking, why does my therapist keep getting on my case about setting goals to treat my neck pain? I feel like I might know Karen L. on this one because this is the type of question where I have an answer where it’s a hill I’m willing to die on, which is you absolutely need to set goals. Otherwise, you have no active participation in your therapy, which is not a good thing. You will not have the outcome you want. You should definitely be setting goals with your therapist. Chris and I can both tell you that we will set goals for you, but that’s more of a paperwork thing. We want to know your actual goals, though. What are you working on? You’re trying to get on the floor with your grandkids. Are you trying to lift boxes to get back to work? Do you just want to get rid of the pain in your neck? What is it? And if you don’t set them yourself, then you’re not doing your part. And that kind of speaks to a similar question from Dave F about resuming activities. So you might be limited in your activities. More likely, we’re going to ask you to modify them based on your goals. And that should be just part of the discussion. So if you’re like, I want to play pickleball because that’s the latest craze, apparently, and you can’t because your neck is bothering you, then one of your goals should be to slowly reintegrate back into those activities you enjoy. I often tell people I’d rather see them in the grocery store than in PT because it means they’re out living their lives. But if you’re not ready to go shopping for yourself because of whatever’s going on with you, then that’s something we should be addressing. Would you say that’s pretty fair, Chris? Is there anything you want to add to that?

Chris: I think that’s pretty well said on both. On the goal topic, I do maybe differ slightly. I do understand and ask my patients, of course, on what their goals are. But sometimes it is a little bit obvious. And occasionally, I get a chuckle back from the patient of, I want my neck not to hurt anymore, is my goal.

Matt: So next question is a pretty good one. It’s about short-term versus long-term approaches to treating neck pain. This one comes from Jen Kay. She says, my doctor told me to come to PT two to three times a week. Is a concentrated burst of therapy better than a steady but less frequent program?

Chris: That’s a great question. I think I’ll take that one if that’s OK with you.

Chris: All yours.

Chris: Where my clinic is, we actually get, I guess not by choice, but we get to see both of these scenarios pretty regularly. It’s a seasonal area. So we’ll often have patients that are there for maybe a short term. So they may only get to see us for a short burst. But we also have a lot of people who travel. They might snowboard a bird down in Florida or somewhere else. So we do get to see both of these situations pretty regularly. I do like to see the person two, three times a week, because I do feel you get a lot of benefit and a lot of gain. You really get to accelerate their education and really improve the situation rapidly. But that’s not always the case. And in some circumstances is actually I feel better to space it out. Maybe it depends more on if it’s like a very acute topic. Maybe you need that more accelerated burst versus a management topic. If this person has maybe like arthritis in their neck, I do have many patients like that. And we’ll treat them once a week or every other week, give them some good education, work on their home exercise program, and build that up so that they can maintain it as much as possible. But in today’s day and age, a lot of times insurance companies are very restrictive with how many visits the patients get. And we try to work the best with what we have.

Matt: I think that’s pretty related to Jim A’s question about should I prioritize daily home exercises or maintain a frequent in-person session? And I don’t know if you want to add to your answer for that or if you feel like you answered it already, Chris.

Chris: Yeah, it was pretty similar. I would say both. You’re going to get benefits from both of those things. Something I’ll often say in my clinic is if this is your health we’re talking about, let’s get greedy. You want to do everything that you can to build your situation, fortify your body, protect yourself so that you can continue to live an awesome life. If you leave something on the table, that’s fine, but that’s on you. And that’s something you’re going to be able to benefit from in the future. You only get one body, so you want to take care of it as best you can. And there’s so much research about staying strong and maintaining activity levels. So we’re going to use that knowledge and try to create a better future for us and our patients.

Matt: No, it’s absolutely true. It segues into Joe S’s question regarding exercise intensity and managing daily activities. Joe S is asking, “Is pushing through pain with challenging exercises beneficial or could worse with my symptoms? And should I keep doing my exercises if I am in pain?” Joe, it’s a good question. I get asked that daily. Challenging exercises are very beneficial because we’re ultimately trying to build your resiliency. So, I mean, if your threshold is here, but what’s going on with you is making your starting line be here, you don’t have a lot of room before you’re set off in pain or whatever else is going on. So those exercises are designed to increase this space by increasing your resiliency, but also reducing your pain, in fact, so that your starting level is back, calm down where it should be. Could it worsen your symptoms? Yes, it absolutely could. That’s kind of part of the process of providing feedback to your therapist, checking on your techniques in clinic with them, but that’s what you’re supposed to be working on, making sure you’re doing it right. I mean, I can tell you countless stories of people, “Well, we’re doing squats. We send them home with squats because they did it good in clinic. Maybe they didn’t practice enough or maybe they’re just kind of going through the motions at home where it’s like, “Oh, I got to do 30 of these,” and then they don’t have the proper technique and the next time I see them, the squats were bothering me. Then we go over it and you see, “Yeah, if I did them the way you’re doing them, I’d be hurting too. So let’s tweak this or let’s maybe back off a bit and change the exercise routine,” which speaks to your last part of the question, “Should I keep doing my exercises?” You should, but listen to your body. I mean, some of your programs should be geared towards pain relief and some of it should be geared towards progressing you towards those goals we were talking about earlier. Next question is about pain management strategies and I think a lot of people will get some benefit out of this. This is a great question for Maria P. Can you talk about two exercises? You know what, Chris, can you talk about two exercises that you like to use to help with cervicalalgia?

Chris: Oh, absolutely, Maria. I’ll give two of my common favorite ones that I’m utilizing for cervicalalgia patients. The first one, I’ll just give a good description of these two and we’ll probably post a link to a video on how to do them so you can see it and maybe give it a try. But the first one is called the supine chin tuck. The patient’s going to be lying on their back. I’m usually going to be instructing them to close their teeth lightly, place their tongue on the roof of the mouth and then retract their chin a little bit and then raise their head off the pillow. I like this exercise a lot because it helps to strengthen the front muscles of the neck. They’re weak in almost everybody, even if you don’t have a neck issue. There’s not a lot of exercises out there to strengthen this group of muscles. The second one that I would probably say I use almost every day and even for things outside of cervicalalgia is another sitting exercise actually where we’re going to focus maybe not on the neck, but the next segment of the spine down, which is our thoracic spine. That’s going to be either a seated rotation or a seated side bend. I like those because they help to mobilize or loosen up our thoracic spine, which in many cases de-stresses our neck and other surrounding joints. I find them to be very safe, effective and something that pretty much anyone can benefit from.

Matt: There you have it, Maria P. Chris gave you some really solid starting points and we will be posting the videos and links on the site for those so you can check them out, practice them, provide some feedback. Next question is from Mike S. “I know my posture at work sucks. Are there any simple hacks or fixes to improve it that won’t cost me a lot of money or interfere with the workplace?” All right, posture is definitely a very common topic as it relates to non-specific neck pain or really any neck pain condition. We’re concerned about your posture. When I talk about posture, I mean mostly your habits, how you are in that moment, whether it’s sitting like I am right now or if you’re back or if your head’s on a phone, that would be your posture at that time. As a habit is what you’ll find so you might hold your phone in one hand or you tend to sit at a laptop when you’re doing specific work as opposed to a desktop. When it comes to simple hacks or fixes, the first line of defense is really what is known as ergonomics which is tailoring your work environment to your body rather than the reverse of that. So increase your screen height to about eye level, mid screen should be eye level, but arm length away. Bluetooth keyboard is usually a really good pick so you can sit back. I would say the simplest hack that I see particularly for neck is make sure you have an office chair with a headrest. It is amazing how much little change like that just knowing that your head is back there, your spine is dealing with less force at less torsion angles will feel better. In terms of interfering with work, there are other options but honestly I would have to know more about what you actually do at your job because if you’re a coder we’re going to have a different conversation than someone who’s just answering emails. So that would be my first recommendation and if you want to email in I could give you more or maybe we can have a follow up discussion in another episode about more of this. Next question is from Jane Kay. Should I be side sleeping with neck pain and if so how many pillows should I use? Or maybe she’s just asking how many pillows should I use? What do you think Chris?

Chris: Oh I love this question especially because I’m also a side sleeper so I feel you Jane. I get asked this question a lot and I feel like I talk about sleeping posture every single day at work. One clue often that you should think about if you’re waking up in the morning and you’re not feeling well, you’re stiff, you’re achy, look at your sleeping posture. It might be your mattress but it might just be your pillow setup. If you’re a side sleeper I really like to endorse you need to find enough pillows that make up the amount of space between your shoulder and your head. For most people that’s going to be two pillows of a medium density and a medium thickness. I tell people to try different ones, see what works best for you but we really want to make sure that your neck is in good alignment when you’re sleeping. When you’re sleeping your body is at rest, it’s healing, it’s calming down, it’s doing all the repair work and fixing what you just did through that previous day. But if you don’t want that head, there’s too much pillow on this side, it’s going to jam your neck way up to this direction or if there’s too little it’s going to really compress your neck, your shoulder and eventually it’s going to cause some kind of topic in my opinion. So definitely well worth it to spend a little bit of time and to figure out what’s going to work best for you maybe buy some different pillows or just go around your house and try all the pillows and see what one is the one for you.

Matt: Next up is, this will be another one you’ll like Chris, Ryan B. Is cracking the neck okay to do for neck pain and how often should I do it?

Chris: That’s a really good question and one that I used to think about a lot. I’m in that category of people that’s often getting a little pop or a crack multiple times in my neck per day and I’ve often thought like, “Is that good? Is it bad? Should I be doing that? Should I be leaving it alone? Should I be asking a doctor?” I guess my opinion and my answer to that now is it depends. If it’s just like a light little motion or you can tilt your head and get that alleviating click, I think that’s probably fine. If it’s a little more than that and you need to be very forceful, especially if that’s a daily occurrence, then I’m less interested in doing that and that’s usually when I recommend you should probably see like a professional, whether it’s a physical therapist, a chiropractor, maybe even going to your primary care or a physiatrist would be beneficial to help guide you into seeing the most suited professional for you. I guess that’s my opinion. If it’s nice and light, that’s fine, but if you need to put some significant force or something through that, you should really get it checked out because you don’t want to have an issue in the future.

Matt: Yeah, I mean it can definitely have benefit, but I think what Chris is stressing more than anything which I just wanted to reiterate is you have to be safe. Know what’s going on. Don’t just base it off of does it feel good. Base it off of what it’s taking to feel good. Don’t hold back on reaching out to a professional if that’s a route you want to pursue. Similarly when we talk about exercise safety, we have another question from Ann T. Can vigorous exercises or heavyweights be safely incorporated for a woman in her 50s with osteoporosis?

Chris: Ooh, excellent question. I really like this one and I get the privilege of working with a lot of people who are on Medicare and in that second part of life and many of who experience osteoporosis or osteopenia, both of which are a reduction of bone density. I guess to answer the question, my answer is yes. I think weight training is so beneficial for everyone to work on. I think it brings so much positive to the table. With that being said, if you do have some sort of reduced bone density, you have to be careful depending on how severe the issue is, which usually you can go to your doctor and get a DEXA scan. It sounds like this person has already gotten that diagnosis, but there’s usually some sort of a severity level associated with this, whether it’s very minimal or very severe. Adding weight training in is likely going to be beneficial, but you have to go really slowly and if you’re not sure, you need to find those answers first and do this with a skilled professional. I treat patients who have the gamut of bone density, some who have like a minimal issue and they want to get on it right away and make sure that they can do everything they possibly can to prevent further degradation. But I also have had several patients who have such severe bone density that they’ll fracture a rib or a vertebrae in their back from sneezing or coughing if it’s too vigorous. It’s a completely different treatment approach with that person. I actually have one woman who I work with who has very severe osteoporosis from being on lupus medications for a lifetime. She doesn’t even know how many fractures. She breaks multiple things per year and I actually don’t even touch her. I just give her skilled guidance through all of her exercises and she loves it and I love it and I don’t have to worry about overstretching or damaging her body in any way because that would be terrible for everyone.

Matt: Hannah Age has a question.

Matt: Fair question. I get this question a lot in particular, not just directly, but I’m probably about 60 pounds overweight. How much does my weight influence my neck pain? Well Hannah, first is yes, your weight will influence your neck pain because across almost all medical conditions, obesity which 60 pounds extra weight is considered to be a part of that category will have a negative impact on virtually all conditions. That being said, is it directly impacting your neck? Not exactly. It’s going to be indirect in the sense that your body is doing more work to achieve the same day-to-day routines and there’s more force on it because weight is technically a measure of force. So, if you lose weight, will your neck feel better? It’s hard to say. The likely answer is yes because overall you will feel better and your body is doing less work to achieve the same results and you’ll be more proactive in your health if you did lose weight. But if there is an underlying condition, like let’s say this is more than just normal cervical to like it’s a disc issue or something degenerative which is pretty common for people who’ve been carrying extra weight for a long time, then it might help but it’s not going to get rid of it. No, you will need further interventions and that would be a scenario I would suggest you go seek out a PT or a nutritionist or some of the alternative medicine approaches to help with that pain. But the fact that you’re acknowledging it and you want to get started with it is a good step in the right direction so I applaud you for that. The next question is kind of a special interest of mine. It speaks to the psychological impact of pain. It’s from Michelle G. She says, “I’ve had neck pain for over a decade. I’ve tried everything. What do you suggest now because I don’t want surgery?” If you’ve had neck pain for over a decade, one, I’m sorry to hear that. Two, I’m glad you have tried a variety of approaches but it definitely warrants further investigation because there’s going to be an approach for you that works. Sometimes it might be a hard look in the mirror of, “Did I really hold myself accountable? Was I putting in the effort needed?” Other things might be, “Did I have the right team?” I mean, maybe you didn’t have the right people to help you. And then there is the psychological impact of pain piece which is if you’ve had this for over a decade, there are going to be other considerations. I mean, literally, if you look at the studies that will change the morphology of your brain, it will change how your brain maps out different body regions and different responses. So something like a light touch in your neck might set off a massive chain reaction. And that might warrant some extra services such as mental health counseling to help better manage situations related to it because pain is definitely an experience. But I would definitely, if you’re going to start over, I would start with conservative care again because surgery should be your last line of defense if you need it. So I mean, you might need some new imaging studies or something like that. But definitely find a PT who’s willing to work with you that you have a good rapport with or feel like you could build a good rapport with and go from there. Now we have a question from Taris C, a pretty good one, at least I think so. Can apps, trackers, or virtual reality tools enhance or speed up my recovery? I’m a little bit of a tech nerd, admittedly. Yes, there is a saying in business that I think applies here, which is, if it’s not measured, it’s not minded. So if you have your data, you can analyze it, you can hold yourself accountable because that’s a big deal. And it will give you an extra piece, which is, you know, there’s going to be times where you plateau in your progress. It doesn’t mean you’re not making progress, but it’s usually those times where you might, you know, fall off your program or other things get in the way and you can look at your data and look at a reminder, but like, listen, I used to be here and I climbed the mountain to here and, you know, you’re still here even if you fall off a little bit. So it suggests that, you know, you have something to look back on and be proud of and keep you motivated. That being said, there are a variety of apps and trackers. I mean, I have tons of patients that use the step counters. I’ll be honest, I’m not a huge fan of that, not because it doesn’t do a good job, but because I think you should look beyond your steps. If that’s your starting point, that’s fine. But once you are out walking like a mile or two, you don’t really need to count your steps anymore. You need to challenge yourself a little bit, maybe speed up your time walking or, you know, use a different metric. That’s also where the apps come in because they’ll give you different metrics. In terms of trackers, I think I kind of just spoke to that. They’re one in the same. VR tools are interesting. If it’s a way to keep you active, like gaming, I mean, I have a 12 year old nephew who loves to do all these interactive games and stuff. It’s hard to get him to go running, but he will zoom around in a game all day long. So, you know, whatever works for you, by all means, use it. Will it speed up your recovery? If you do more and you’re adherent, yes, it will speed up your recovery. That’s what the research suggests. Next question is on remote consultations in telehealth. And I think this is a very, very good question to have Chris answer because if you don’t know, Chris has three children, whereas I only have one. And he’s got three practices, whereas I only have one. So he’s a very busy guy, and this is very related to something he experiences himself. From Mel P. She is saying, I am really busy. I barely have enough time to do anything, let alone make it to an office appointment. Our online sessions with therapists as effective as in-person consults for managing my neck pain.

Chris: Great question. It’s a hard one to answer. I personally much prefer in-person consults and that kind of care. I think there’s a lot of value that’s hard to gain from online. With that being said, though, I think an online consult or telehealth visit is, if that’s the only option, by far it’s worth it. Absolutely. There’s still going to be a lot of valuable feedback. It’s going to be very good communication, education that can occur on that, even just checking in and seeing where you are in our clinic. We don’t do a ton of it, but we do do some. We also have a lot of patients that travel. So when they’re away, it’s a way to check in with them and see how things are going, see how their progression has gone, backing up a few questions. Matt had mentioned giving a patient squats for homework and sometimes the technique and the mechanics maybe vary a little bit or they forget some of the details. This is now a situation where you can view their form, their technique, correct it right away and get them right back on a positive track.

Matt: Yeah, it’s a game changer in certain respects. If you’re using it for the right reasons, I find if you’re just using it as a convenience feature, you might quickly realize that there’s a lot of setup and prep that requires you to, sorry, that you’re required to do before going into your session. Because, I mean, you might be exercising, but you need to get on the floor for it while simultaneously holding your phone so your therapist can see you. I mean, just to give you an idea, I mean, we’ve gone through this podcast several times for different episodes and I can’t tell you how many times I was adjusting the screen just to make sure the lighting looked good. Now imagine doing an exercise and trying to do that. Make sure it’s a good fit for you, but don’t dismiss it because as Chris was saying, something is always better than nothing. Then our last question is from Andy A. Can mindfulness techniques such as meditation or other methods complement PT for pain relief and stress management? I think we both should probably answer this one. Andy, I love mindfulness techniques. I have learned through trying and guiding people that I am not a good person to lead a meditation at all. I think it’s just not in my forte. That doesn’t mean I dismiss it because there are different types of meditation. I mean, technically there are types of meditation where just walking through the woods and enjoying nature is a form of meditation and that’s great for stress relief being out in nature. In terms of mindfulness techniques, that’s very important. Checking in or taking inventory on yourself will help a lot. I often recommend people try humming, like a closed mouth deep hum. It’s your vagus nerve in your neck which is responsible for a good amount of calming your body down. If you’re more interested in that, you can file me in Google the pathways because it’s quite extensive. Chris, I know you have some opinions on this as well, so let Andy A. have it.

Chris: Mindfulness. I would definitely say that mindfulness, meditation, those type of techniques are super beneficial not only for just serve a couch but really all types of wellness. I’m a very big advocate of overall health. I’m very much about going outside, spending time in the outdoors in nature. There’s a lot of research that supports that, how it helps your mind and your body which is super valuable. As far as do I do a lot of instruction, I’ll admit like Matt, I’m not the best at guiding meditation or breathing techniques. I usually refer out. There’s a lot of yoga studios and other places that are specializing in that kind of a thing. Everyone needs to also find what works for them. Although I like to go for a walk in the woods, that might not be a lot of other people’s cup of tea and they’re going to do a lot better in doing maybe like an ice bath or meditation in a sauna or something like that. There’s nothing wrong with that. There’s all kinds of great resources out there today. Even if you go down a techie route, you could even go on YouTube or download different apps that will guide you through something that will often benefit your situation, calm your body’s tensions and stresses and in many cases help your cervicalgia.

Matt: To close out the show, we have a segment we like to call true tips is one of those kind of difficult questions for Chris or I that we get. Today’s is if a patient really wants to buy something as a quick fix to help them with their neck pain, what do you tell them to purchase?

Chris: All right. Well, there’s a million things out there. I like to keep things simple if possible. So I’m going to go with a super basic and commonly found foam roll. I think there’s a lot of different easy, simple things that one can do to help de-stress their neck and often get a lot of gain for usually something very inexpensive cost.

Matt: I’m not sure if it’s the inner torturer that I get called all the time or not, but I often recommend cervical traction devices. They are expensive, fair warning, so definitely try before you buy. But you’re essentially laying on advice that cranks your neck at a certain amount of force to create space. Usually feels pretty good, works in both scenarios, is safe. Not a long-term success, but definitely a quick fix if that’s what you’re looking for.

Matt: All right. So that concludes this episode of Honest Talks. We thank you for listening. Like, subscribe, comment. If there’s anything you’d like to hear more about, feel free to check out our videos on Instagram and our YouTube channel. Tune in next time for another Q&A session. This time it’ll be on cervical disc issues. And you can also go to our site for more articles or other questions and info that can help you. Thanks for listening.