Strength and flexibility for older patients, part 2.(EXERCISE RX)

The neck and shoulders are made up of versatile, but vulnerable, muscles. Patients may present with a variety of complaints related to the neck and shoulders, including headaches, numbness, radiating pain, stabbing pain, dull aching pain, and loss of sensation. Tight muscles in these areas may also cause numbness or weakness in the arms.

Diagnosis of the cause of neck and shoulder pain remains a challenge but is very often due to extreme nuscle tightness rather than a neurologic problem. This tightness may stem from many things, including tension caused by pain or nervousness, poor posture, or some extreme exercise position achieved during a yoga class. Radiating pain is more likely to be a nerve pressure problem, compared with aching or numbness, and nerve pressure pain may be relieved with a combination of traction and therapeutic exercises.

Most people who don't do exercises for their shoulders as they age become weak and stiff in this area. In addition, poor posture and overweight increase the likelihood of developing neck and shoulder pain with age. Often, people with stiff shoulders engage the neck muscles to compensate for the lack of movement in the shoulders, which results in soreness and may speed the development of osteoarthritis in the neck.

Most osteoarthritic changes occur between C5 and C6 and between C6 and C7. Almost everyone eventually develops osteoarthritis in the neck. On average, 45% of adults aged 40-49 years, 72% of adults aged 50-59 years, and 83% of adults aged 60-75 years have some osteoarthritic changes, but those who keep the neck and shoulders loose with stretching and strengthening exercises don't notice it. Full rotation of the neck does not cause osteoarthritis, and proper stretching can relieve some of the discomfort associated with it.

In this month's column, we'll look at several exercises that can help older patients relieve stiffness in the neck and shoulders. (See illustrations and instructions for patients below.)

These exercises are appropriate for older patients, but remind them to ease their heads back gradually when rotating the neck, since putting the neck back too suddenly can press on the spinal cord, and, in rare cases, older patients could occlude a blood vessel if the neck motion is too dramatic.

It's important to try to relax the shoulders during the exercises--tell patients to concentrate on keeping ...