## Tuesday, February 28, 2012

### It's a Pain in the Neck

Have you ever had one of those aggravating cricks in your neck that just won't go away? Neck pain can make it difficult and even downright painful to turn your head, comb your hair, get dressed, and complete everyday tasks.

Excel Math is designed to help students learn skills they can apply to their lives so they can grow into adults who are not pains in the neck (but who have higher-level thinking skills and are proficient in elementary math concepts).

Here's a Student Lesson Sheet from the Fifth Grade Excel Math Lessons. You can try a few problems and confirm your work by adding the the answers for the problems in each box. If the sum of those answers matches the Checkanswer in the corner, you are correct. For the first box you would add the three answers together (one word problem and two division problems) to get \$28.60 (shown in box A). This page is designed as Guided Practice—problems the students can do in class, guided by the teacher, after the lesson is presented:
 Fifth Grade Excel Math Student Sheet

These Guided Practice sheets give the teacher a chance to move around the room and give students individual help, as needed. While the other students work through the problems on their own, the teacher can see at a glance which students are having trouble getting the correct Checkanswer (in the lettered sections) and can be available to instruct those students one on one.

Some students (and teachers and office workers) may get occasional neck pain from poor posture, sitting slumped over their desks or computers. In fact, neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Studies estimate that 10.4% to 21.3% of people will develop neck pain in a one-year period, with a higher incidence noted in office and computer workers. (No surprise there.)

The prevalence of neck pain is generally higher in women than in men, higher in high-income countries than in low- or middle-income countries, and higher in urban areas than in rural areas. Many factors influence the onset and course of neck pain, including risk factors outside our control such as age, sex, and genetics.

If you have neck pain (or any other kind of pain), your doctor may ask you to rate the pain on a scale of one to ten. This is the Wong-Baker Facial Grimace scale:

 Click this image for a more elaborate version.

Clinicians offer various therapies to patients who are looking for relief from neck pain:
• medication
• manipulation and mobilization
• massage
• acupuncture
• electrotherapy
• exercises
• traction
• patient education
• biopsychosocial rehabilitation
The first federally-funded studies on neck pain examined which treatments of three treatments were most effective. As reported in the Annals of Internal Medicine, researchers in Minnesota tested 272 people between the ages of 18 and 65 who had nonspecific neck pain for 2 to 12 weeks. They wanted to determine whether spinal manipulation therapy, medication, or home exercise with advice  worked best for acute and subacute neck pain in both the short and long term.

The studies found that for participants with neck pain, spinal manipulation by chiropractors was more effective than medication in both the short and long term. However, a few instructional sessions of home exercise (such as gentle stretching) resulted in similar outcomes at most points in time. One measure showed about 80% of patients in the spinal-manipulation group and the home exercise groups reported a reduction of at least 50% in pain levels after 12 weeks compared with about 70% of people in the medication group.

About 30% of patients in the exercise and manipulation groups reported a 100% reduction in pain levels during the same time period compared with about 13% of patients in the medication group. "It's good news for patients that there's something they can do themselves," says Gert Bronfort, vice president of research at Northwestern Health Sciences University in Bloomington, Minnesota, and the study's lead author.

 Source: Annals of Internal Medicine

On the other hand, according to the authors of the editorial, Pain in the Neck: Many (Marginally Different Treatment Choices) from the Annals of Internal Medicine, the findings of available studies do not give us one single, optimally effective treatment for neck pain. Overall, most therapies had low to moderate effectiveness. And even the Minnesota study mentioned above did not include a placebo group and did not track whether patients actually adhered to home exercise or medication. They were free to add additional therapies to their treatments as they wished. In other words, everyone's situation has to be evaluated on a case by case basis, in consultation with a professional, to determine the best treatment or treatments for their particular needs.

To prevent neck pain, try doing moderate exercise on a regular basis. Swimming, walking, stretching, and biking can all help strengthen your body and keep you in shape. (Consult your doctor before beginning any exercise program.) When seated in front of a computer, take frequent breaks. Get up, walk around the room, stretch, and change your position. Once you begin to feel discomfort in your neck, check with your healthcare provider, and then ease some of the pain with this simple exercise: Gently retract your neck, pulling your head back like a chicken, and then tilt your chin slightly downward. Do you think a relaxed version of the chicken dance would work just as well?