The neck and shoulders are often the site for tension pains; try shrugging your shoulders up to your ears several times, this often helps.

Remember exercise in a warm environment.

1. Lie on back with head on 2 pillows and hips and knees bent; raise head smoothly and press

chin on to chest; feel the stretch in the back of the neck; lower gently and repeat 4 times.

2. Remove one pillow, still keep hips and knees bent, gently turn head to one side, feel the

stretch, hold and then turn to the other side. Repeat 4 times.

3. Sit on a chair; bend head forwards and gently turn it from side to side: be careful not to

arch your head backwards.

4. Stand with head in a good position; take arms in large vigorous circles backwards 10 times

and forwards 10 times.

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Standing-For a correct stance, lift the top of your head keeping your chin tucked in. As well as standing tall, you should stand relaxed. Standing still for a long period can be uncomfortable for someone not used to it, and it is then easy to sag, so increasing the fatiguing effect by straining the muscles. However, except for soldiers on parade, standing still is rarely necessary. Mostly, we are free to look about, move our hands and shift from one foot to another, and so any given stance is seldom maintained for long. Consciously pulling in your abdomen is helpful.

One remedy for postural stress is to change position. If you cannot, and the job calls for work with one hand only, use the other hand to lean on. When you use both hands and are standing at a work bench, table or sink, ideally you should be able to rest your pelvis or stomach against it, with one foot forward in line with your hands, so that you have a balanced posture.

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Ultrasound-This is used in treating injury to muscles, tendons and ligaments, but not bones. Ultrasonic therapy uses the energy of sound waves at very high frequencies, inaudible to human beings. The waves are applied to the affected area through a special apparatus. They penetrate the skin painlessly, and help to relax muscular spasm, and reduce swelling and relieve pain; they also promote healing in the tissues.

Short-wave and microwave diathermy-This is a method of relieving pain and stiffness in the deep tissues by applying high-frequency electromagnetic waves which cause heat in the tissues. Short-wave treatment affects deeper tissues than microwave. It is claimed to increase blood flow and to promote the body’s repairing processes. Breakdown products are more quickly removed and healing substances more rapidly delivered.

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• about the nature of the pain – you should say whether it is a sharp or stabbing or burning pain, or a dull ache; whether you feel it at one side or radiating to other places, the arms or legs, for instance; whether you are having tingling sensations there, or a feeling of numbness;

• about the origin of the pain – tell your doctor when and where you first felt it; whether any particular activity had brought it on; whether it started suddenly or developed gradually; whether there are any postures or movements which make it worse – or better;

• about the duration of the pain – tell your doctor how long it is since it started; whether you have it all the time; whether it has got worse since the onset, or stayed the same; whether there are times during the day or night when you feel it more.

• if it is a new pain.

The doctor may not follow this pattern; listen carefully to the questions and be as precise as you can in your answers. The doctor may also ask you about the kind of work you do – active or sedentary, domestic or outdoor – in order to assess the stresses that it may exert on your spine. Your past history of ‘injury’ is important.

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Anything that alters the shape or position of the vertebrae causes additional stress on the facet joints which help to keep the vertebrae in place, and they, in turn, then exert more stress on the muscles and ligaments.

When all the joints of the spine are fully mobile, the sum of all the little movements that they are able to perform amounts to a wide range of activity – all that anyone should ever need. But if some of these joints should become stiff – something that one might be unaware of at the time – the other joints find it more difficult to carry out their normal range of movements. This, in turn, places the adjoining muscles at a disadvantage, causing them to go into spasm, which then puts stress on the work of the other muscle groups in the region.

Moreover, many people go in for daily activities which require the spine to move in ways which are anatomically unwise. Many so-called keep-fit exercises also demand movements which the spine is not constructed to perform, and which are stressful to the joints.

A frequent injury is ‘whiplash’ (which may be caused in a car accident) when, as the result of impact, the head is violently jerked forwards or backwards and the neck ligaments severely strained or even torn.

At the lower end of the spine, the pelvis is joined to the sacrum by the sacroiliac joints, reinforced by strong ligaments, which may, however, be damaged by a sudden jolt: by sitting down very hard, or by violent exercise that involves a twisting motion. A commoner reason for trouble there is reserved for mothers. Towards the end of pregnancy, hormonal action softens these ligaments, in order to allow easier passage to the baby’s head through the pelvic ring, and this makes the sacroiliac joints prone to injury. Once the baby is born, the ligaments tighten again over a period of several months.

However, if there is additional strain when the joint is loosened, or if there are frequent pregnancies, the ligaments joining the two bones may never quite recover their original immobility.

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