Neck Pain and Falls

It is our privilege to shed some light upon poorly appreciated implications of common neck pain. We hope some of this information can help you, the reader, and/or your loved ones.

Cervical (neck) pain can be caused by many different things, including disc disease, “pulled muscles,” tension, and more. One common cause of neck pain is spinal stenosis, which is the technical term for the narrowing of the spinal canal, formed by the bones of the spine. Spinal stenosis can be caused by age-related degenerative changes. Occasionally, it may cause compression of the spinal cord, causing neurological changes, referred to as myelopathy. If left untreated, myelopathy can lead to gait deficits, hand clumsiness, muscle weakness, spasticity (muscle tightness), sensory impairment, and more, including severe complications like paralysis, though this is not common.

Cervical myelopathy not only causes falls, but can also progress and worsen from even minor trauma due to falls. One study reports that the medical conditions of 9.6 percent of patients with degenerative cervical myelopathy worsened as a result of even minor external injuries. For this reason, preventing falls in these patients is crucial.

Treating patients with balance deficits and falls is a medically complex undertaking. This is why at Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute we pioneered a nationally unique one-stop shop multidisciplinary comprehensive fall prevention program, stemming from Dr. Atanelov’s work at Johns Hopkins. During a routine intake, we perform a thorough and comprehensive medical evaluation: Is the balance impaired due to diabetic neuropathy, spinal stenosis, Parkinson’s, stroke, knee or hip pain, leg weakness, spasticity, vestibular deficits, poor vision, or cognitive deficits, etc…? Our medical examination includes comprehensive neurological, cardio-pulmonary, vestibular, and musculoskeletal assessment. , based on Dr. Atanelov’s uses his background in physiatry, a medical field utilizing human biomechanics specialty training in physiatry (a medical field focusing on how to manage various conditions affecting ambulation gait and daily activities, such as getting dressed, showering, gardening, etc...) to diagnose and treat risk of falls, balance deficits, pain and manage stroke rehabilitation.

Next, a management plan is put together. This may include nerve studies; medication changes; ordering MRI’s, X-rays, or blood work; giving steroid and Botox injections as needed; and providing tailor-made on-site physical and occupational interventions. Our therapy and physician team discuss patient progress and adjust the treatment approach and goals as necessary.

A patient with suspected cervical spinal stenosis, for instance, may need electrodiagnostic evaluation, MRI, pain management interventions such as medication adjustment, physical modalities, trigger point injections, Kinesio-taping, manual therapies, and spasticity management. Our physical therapist, Shannon Sheckels, may focus on controlling pain, regaining muscle strength, and joint range of motion for a patient with spastic hamstrings, poor balance, knee pain, and weakness. Our occupational therapist, Aidel Cooperman, will consider the patient’s cognitive function, vision deficits, and home environment and design real-life daily function exercises to ensure safe and effective cooking, dressing, and washing, etc... In this example, the physical therapist would work on a more local anatomical problem (e.g., poor knee range of motion), while the occupational therapist works on a more global daily life problem (e.g., cooking). The physician and the therapists coordinate their care and work together to trouble-shoot any barriers to patient goals.

At Steady Strides, our goal is to “graduate” our patients after the intervention is completed. The length of the process varies, but our aim is to complete the workup and intervention within six to ten weeks. Success of our outcome-centered, evidence-based approach has been recognized both at Baltimore City and Maryland state level since our inception just under two years ago, and Steady Strides is a key consultant and participant in both the city and state fall prevention public health initiatives.

As a medical institute, we also offer educational and research opportunities for both healthcare providers and lay public. For more information, please refer to www.steadystridesmd.com, email hello@steadystridesmd.com, or call 443-898-8160.