Sleep Tips for Arthritis in the Neck

If you have arthritis and find it difficult to sleep, you are not alone. Sleep disturbance affects up to 10.2 million U.S. adults with arthritis, according to a 2011 study by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The study estimated that people with arthritis (or any chronic disease) are almost three times as likely to have insomnia as their healthy counterparts.*

I spoke with two New York City physical therapists to find usable tips on sleeping with neck arthritis. I was pleasantly surprised to find that at least one of these tips may even save you money.

Sleep in Spinal Alignment

Hagit Rajter, physical therapist at the Joint Mobility Center at New York's Hospital for Special Surgery, says that when you sleep, your head should be in line with your spine. She advises you to think of your head as an extension of your spine. This means you should neither excessively bend your head forward, nor extend it back. Tilting to either side is out, too.

Rajter cautions against these movements because she says they may lead to cervical radiculopathyand/or a pinched nerve. Symptoms may include pain down one or both arms, weakness, numbness or tingling. (Cervical radiculopathy could be understood as sciatica of the neck and arm area.)

Debbie Turczan, a physical therapist and yoga instructor, agrees. "When sleeping on your side, it is important to support the neck and head so that the spine remains straight," she says.

Flat pillows are less than ideal, Turczan says. (This includes feather pillows that flatten too easily.) The reason is that a pillow that is too flat will position your head lower than your spine. Remember Rajter’s suggestion (above) of keeping your head as an extension of the spine? With a flat pillow, it’s just not obtainable.

Turczan suggests rolling up a thin towel and placing it under your neck when sleeping on your side. This will help support your neck, as well as keep it in good alignment. When sleeping on your back, Turczan suggests using a smaller towel roll under your neck, for the same reasons.

Avoid Sleeping On Your Stomach

Have you ever noticed that when you lie or sleep on your stomach you have to turn your head? This is why Rajter recommends against the prone position during the night. "Imagine what it would feel like if, during the course of your work day, you were required to maintain a position in which your neck was twisted," Rajter says. "Would you be able to hold your neck like that for a full six full hours? How would it feel? That’s what sleeping in a prone position does to your neck."

Again, Turczan agrees, adding, "Stomach sleeping is not ideal because one will need to keep their neck rotated all the way to one side or the other in order to breathe. Sleeping with your neck rotated for many hours can exacerbate neck pain."

Choose the Right Pillow

When it comes to pillows, there’s no proven benefit to spending a lot of money. Although some people are convinced they need to spend upwards of $150 on a therapeutic pillow, Rajter rejects this idea as unnecessary. Instead, stick with the goal of comfort and the ability to conform the pillow to your neck space, she advises.

The main points about selecting a good pillow for neck arthritis pain are:

• It should be wide enough to support the distance between your shoulders and your neck.
• You should be able to shape and reshape the pillow. This is to fit it to your form in a supportive way. Rajter suggests down feather pillows.
• For side sleepers, the pillow should be tall enough to fill in the space between your mattress and your ear.

Avoid Neck Collapse with a Collar

One way to keep your neck in a good alignment during the night (i.e., keeping your head as an extension of your spine and avoiding excessive tilting, bending or extending as discussed above) is to wear a soft collar. "Soft collars worn at night may prevent your neck from collapsing," Rajter says. This may help decrease morning pain or stiffness. “The collar is particularly good if you have chronic neck pain." Speak with your doctor if you think this might make a good option for you.

*This number was the estimate before any statistical adjustment to account for socioeconomic and other variables in the subject population was made.

Back Series Exercises

Yoga for Back Pain Series 1: Yoga for Back Health

http://yoga.about.com/od/yogaandbackpain/ss/backpain01_4.htm

Pelvic Tilts

This series of four poses is designed to support back health and relieve back pain through yoga. On each page, you will find links to full instructions for each pose and an explanation on how the pose addresses back pain from Anne Asher, About.com's Guide to Back Pain.

1. Come to lie in your back with the knees bent and the soles of your feet on the floor.

2. Do 5-10 Pelvic Tilts to warm up the spine.

Supported Bridge Pose

1. Have a yoga block nearby.

2. Press into the soles of the feet to lift the hips. Slide a yoga block under your sacrum, coming into Supported Bridge.

3. This should be a comfortable resting position that you may want to hold for several minutes.

4. To come out, press into the feet the lift the sacrum off the block, slide the block out, and slowly lower your back on to the floor.

Reclined Big Toe Pose - Supta Padangusthasana

1. Have a yoga strap nearby.

2. Release your left leg flat on the floor (you may keep it bent with the sole on the floor if this is more comfortable) as you draw the right knee in to your chest.

3. Loop the strap over your right foot and straighten the leg coming in to Reclined Big Toe Pose - Supta Padangusthasana.

4. Repeat on the other leg.

Supine Spinal Twist - Supta Matsyendrasana

1. Lift your hips slightly off the floor and shift them about an inch to your right.

2. Bring your right knee into your chest and extend the left leg on the floor.

3. Drop your right knee over to the left side of your body, coming in to Supine Spinal Twist - Supta Matsyendrasana.

Yoga for Back Pain Series 2: Basic Flexibility for Pain Prevention

Basic Flexibility for Pain Prevention

This series of four poses is designed to prevent back pain through improving basic spinal flexibility, strengthening the core and the spinal support muscles, and becoming comfortable with the movements that control flexion and extention of the spine. On each page, you will find links to full instructions for each pose.

Begin the series by coming on to all fours with the wrists underneath the shoulders and the knees underneath the hips.

Cat-Cow Stretch

Do 5-10 Cat-Cow Stretches to warm up the spine.

Downward Facing Dog - Adho Mukha Svanasana

1. Come back to a neutral spine.

2. Exhale, curl your toes under, and straighten your legs, coming back to Downward Facing Dog.

3. Bend your knees, coming up onto the balls of your feet and bring the belly to rest on the thighs and the sit bones up high. Then sink your heels, straightening the legs and keeping the high upward rotation of the sit bones.

4. Hold the pose for five breaths.

Cobra Pose - Bhujangasana

1. Inhale, come forward to a Plank position.

2. Exhale, lower down onto your belly.

3. Place your forehead on the floor and your palms flat directly under your shoulders.

4. Inhale, engage the muscles of your lower back, press the tops of the feet into the floor, and lift the upper chest off the floor while keeping your gaze on the floor.

5. Exhale, lower your forehead back to the floor.

6. Repeat this motion three to five times.

Child's Pose - Balasana

1. Push back to Child's Pose.

2. Separate the knees as wide as your mat and let the belly sink down between the knees.

3. Rest here 5-10 breaths before coming back on to all fours and repeating the entire sequence.

Plank Pose

Type of pose: Arm Balance

Benefits: Strengthens the arms and spine. Preparation for more challenging arm balances.

Instructions:

1. From Downward Facing Dog, draw the torso forward until the shoulders are over the wrists and the whole body is in one straight line. This is very similar to the position you would take if you were about to do a push up.

2. Press the forearms and hands firmly down, do not let your chest sink, press back through the heels.

3. Keep the neck in line with the spine and broaden the shoulder blades.

Beginners: Move back and forth between Down Dog and Plank making sure the distance between your hands and feet does not change.

Advanced: Try lifting one leg at a time.

 

Yoga for Back Pain Series 3 - Hip Work For a Balanced Back

 

Mountain Pose - Tadasana

This series of standing yoga poses addresses several of the causes of back pain - tight hamstrings and weak hips. The series starts with Mountain Pose which helps establish a postural baseline. You will then move into three poses that stretch the hamstrings and strengthen and align the hips.

Begin the series by coming to stand in Mountain Pose - Tadasana.

Take 5-10 breaths here.

Triangle Pose - Trikonasana

Step the left foot to the back of your mat. Turn the left foot open to a ninety degree angle. Align the hips to face the left wall. Begin to draw the right arm forward as you draw the right leg up and into the hip socket. Come into Triangle Pose, bringing the right hand down to the right shin, ankle, the floor, or onto a block. Bring the left arm up toward the ceiling. Work on stacking the left hip over the right and opening the chest by turning the ribs toward the ceiling.

Hold 5 breaths.

Extended Side Angle Pose - Parsvakonasana

From Triangle Pose, bend the right knee so that it come directly over the right ankle, coming into Extended Side Angle Pose. Bring the right hand to the inside or outside of the right foot. You may also use a block or bring the right forearm to rest across the right thigh. Keep stacking the hips and opening the chest.

Hold 5 breaths and then step to the front of your mat.

Standing Forward Bend - Uttanasana

Stretch the arms up towards the ceiling before folding over the legs coming into a Standing Forward Bend. Hinge at the hip so that the spine cascades down over the legs.

Hold 5 breaths.

Back and Postures

http://backandneck.about.com/od/ergonomics/ht/goodsittingposture.htm

How to Sit with Good Posture

Regardless of what your mother may have said, sitting up straight requires a stable, balanced position of the pelvis. Along with this, you need to develop awareness of ideal body alignment and tostrengthen core muscles. (Core muscles hold you upright.) Your mother may also have told you that good things are worth working for. On this point, she is standing on solid ground. Good posture is a habit, and it requires consistent practice.

Difficulty: Easy

Time Required: 5 minutes

Here's How:

1.        Position your hip and knee joints. Sit on your chair. Begin your quest for good sitting posture by establishing the position of your lower body. Your knee and hip joints should make a 90 degree angle. If your chair allows, and if you need to, adjust the height of the seat until these joints are at right angles. Your feet should be flat on the floor. If your feet don't reach the floor, try using a footrest or place a book under them.

2.        Get on top of your sitting bones. During sitting, body weight is transferred from the pelvis onto the chair. On the bottom of the pelvis are two knobby bones called sitting bones. Notice if your weight is transferring onto your chair in front of the sitting bones, in back of them, or if you are right on top. If your weight is forward, your low back may be arched, which can tighten up muscles. If it's back, you are probably slumping. Slumping can cause pain, strain or disc injury. To get on top of the sitting bones, gently rock back and forth on them. Pause in the center, between the two end positions.

3.        Preserve your curves. Most of us have a slight curve in the low back. Spinal curves (in several areas) help maintain upright posture. You should be able to slip your hand in the space between your low back and the back of the chair. Problems arise when we over arch the low back. It can cause muscle strain or spasm. If you over arch, try to let the pelvis drop into a neutral position so that you are right on top of the sitting bones. If you slump, you may benefit from a lumbar cushion. A lumbar roll placed between your low back and the back of the chair can support your natural curve if your muscles are weak or tired.

4.        Take a deep breath. The primary breathing muscle is the diaphram. When you inhale, it moves down the trunk to make room for the lungs to expand with air. Because the diaphram moves vertically and helps increase intra-abdominal pressure, it also plays a role in upright posture. A breathing technique known as diaphramatic (or belly) breathingcan help you use this muscle to your best advantage. It involves bringing the air all the way down the trunk, rather than letting it get stuck in the chest area (which is very common).

5.        Check your shoulders. Okay, time for a quick shoulder check. Are they up by your ears? Is yourtrapezius muscle sore? Learning posture techniques such as this one can get technical, and cause a little stress. Most people respond by automatically tightening up their shoulders. Let them relax and drop now. Positioning the shoulder blades (flat bones on your upper back) lower can help support your head and neck, and maybe even prevent acrick. If your shoulder girdle is forward of your hips, move your trunk backwards. Shoulders and hips should have an imaginary vertical line between them.

6.        Bring your head back. Many of us forget that our head is connected to the spine. You can see this in someone with a kyphosis, where their upper body and head are far forward of the rest of their trunk. Now that you have a supportive sitting position, and the tension is out of your shoulders, try bringing your head back. Ideally, your ears should be in alignment with your shoulders. Based on your condition, this may not be fully possible. That's okay. Don't force it. The idea here is to do what you can within the limits of your pain or condition, and to make incremental changes toward an aligned sitting posture.

7.        Practice good sitting posture often. Congratulations! You are aligned and sitting with good posture. Remember, good posture is a habit. Habits take time to develop, so be sure to practice this technique for good sitting posture often.

How To Establish Core Support

True core support cannot happen in the body if the neck and shoulder muscles are holding tension. When there is upper body tension, the whole body is off-center, however slightly. From an off-center position, the deep abdominal muscles cannot be accessed.

This simple session uses specific breathing techniques and your imagination to effect changes in posture. These techniques release unnecessary muscle tension and activate the deep muscles of core support.

Difficulty: Easy

Time Required: 20 minutes

Here's How:

1.        Lay on your back on the floor. Bend your knees, place your feet flat on the floor. Your heels should be directly in line with your sitting bones, located at the base of your pelvis. Tie a scarf or belt around your thighs just above your knees. 

2.        Place your hands between the sides and back of your ribcage for feedback. Imagine that your ribcage is a balloon. As you inhale, inflate the balloon. Use your mental intention to inflate right where your hands are. Try to make this image come alive for you. Try also to inflate the balloon in the back of your ribs.

3.        On the exhale, make a long, slow hissing sound, as though you were letting air out of a tire. During each exhale, imagine that your neck and shoulders are made of melted candle material. Your neck and shoulders are soft, yet malleable. 

4.        Let your imagination begin at your neck. As the wax flows down, in your mind's eye, see your neck softly lengthening toward your feet. Remember, you are still exhaling. 

5.        Still exhaling, as your melted candle drip reaches your shoulders, it is as if a pair of hands smooths the wax out wide (the same direction your shoulders go), very gently. Work from the center outward. Allow yourself to relax. 

6.        Next, the melted candle material flows down the center of your chest, from the breastbone to the pelvis, always lengthening toward your feet. Let the melted candle soften your chest and ribs as it moves. 

7.        During the exhale, feel front of your body naturally falling against the back. 

8.        After you have melted your upper body, but before all of your air has been expelled, pull in slightly at the front of your pelvis. The place to pull in is just below your belly button. Try to use more intention than force, but do exert a muscular effort. In Pilates, this would be the "scooping", or "navel to spine". Substitute force with muscular intention when scooping.

9.        I thank the teachers who contributed to my understanding of this work: Elizabeth Larkham of Polestar Education, Jean-Claude West and Anna Schmitz, Andre Bernard of Creative Body Alignment, Marie Jose Blom from Long Beach Dance Conditioning. The material in this article is a synthesis of the work of these people, along with the work of Lulu Sweigard, Mabel Elsworth Todd, Joseph Pilates, Rudolph Laban, Irmgard Bartinieff, and many others in this tradition.

Tips:

1.        For maximum relaxation and concentration, read the instructions into a tape, and play the tape back while you experience the session.

2.        Don't force anything. It is all in the breathing and imagination.

3.        Tie a scarf around your ribs. This will provide resistance to your breathing, which will build posture muscles in the upper body.

4.        If you cannot keep your exhale going long enough to complete all the instructions in one cycle, that's okay. Just breathe in and continue from where you were. With practice, your breathing capacity will develop.

5.        You can also use these techniques to release stress and upper body tension.

What You Need

·         A belt

·         A scarf

·         A piece of floor

·         20 minutes of uninterrupted time

·         Your imagination

How To Do a Pelvic Tilt

Pelvic tilts are often recommended for developing support for the low back, abdominals, sacroiliac joint and adjacent structures. They are great for low back problems due to poor posture and muscle atrophy, and provide a starting point for spinal stabilization exercise programs. Pelvic tilts can be done in several different positions. Beginners can try the exercise laying on their back. Pelvic tilts against a wall are more challenging. Pregnant women can do them on all fours.

Difficulty: Easy

Time Required: 10 minutes

Here's How:

1.        Starting position-- Beginners, lay on the floor with your knees up/feet flat. In the advanced version stand against a wall. The following body parts should be touching the floor or wall:

·         soles of feet (beginners) or heels (advanced)

·         backside

·         mid/upper back and shoulders

·         head

There should be a space between the floor or wall and your low back, as well as your neck. Can you slide your hand between your low back and the floor or wall? Great, then you are ready to go!

2.        Inhale first, then initiate the pelvic tilt movement as you exhale. When you let your breath out, your abdomen should come toward your back. (This happens naturally during exhale.) An effective pelvic tilt will utilize this leverage begun when the abdomen pulls in during exhale. Just continue the pulling and see how far you can tilt the bottom of your pelvis up. This will result in your low back gently stretching and reaching in the direction of the floor or wall.

3.        Inhale to come back to start -- Allow the spine and pelvis to return to their original position. This movement takes less muscle work than the previous movement of bringing the low back to the floor or wall. Most of the effort needed to return to the starting position comes from breathing in. Just allow the body to come back to where it began.

4.        Be aware of how forcefully you do this movement -- After you perform one or two pelvic tilts, and you understand what to do, perform one just to check your tension level. If you find the work to be tiring, go easier. Be gentle with yourself, this is not a race. It's an opportunity for healing and strengthening. You don't have to reach the floor/wall the first time. Success is measured by the progress you make each time you perform the pelvic tilt.

5.        Specifically, check the tension in your hip joints -- The hip joints are located at the place where the legs connects deep into the pelvis at the hip sockets. Because we want to work the abdominals in this exercise, lighten up on the tension at the front tops of the thighs (the quadriceps). When performing the pelvic tilt, try to pull the pelvis from the abdominals, rather than pushing the from the butt.

Supported Bridge Pose for Back Pain

Warm Up with the Pelvic Tilt

Warm up with the pelvic tilt to gently stretch the muscles of the low back and pelvis. Unless the area around the injury is inflamed, the pelvic tilt and other stretches may help you accomplish more of an extended back position. 1 Just remember to go gently and respect the limits of your pain. If the area is inflammed then it is best to stop the exercise session and take care of it.

Then, with the block centered and the sacrum fully supported, the supported bridge pose may help to reduce symptoms associated with low back disk problems. This is because the supported bridge pose places the low back in extension, which has been shown to relieve symptoms associated with intervertebral disk problems. 1 Warming up with the pelvic tilt will prepare the muscles, allowing an approximation of the position of extension in the low back when in the supported bridge pose.

Supported Bridge Pose

Type of pose: Restorative, backbend

Benefits: Allows the spine to open while being gently supported.Can help relieve back pain.

Instructions:

1. Lie on your back with the knees bent and the soles of your feet flat on the floor. Have a yoga block handy.

2. You should be able to barely touch the backs of your heels with your fingertips when the arms are lying on the floor.

3. The feet should be parallel and stay that way through the duration of the pose.

4. Press down into the soles of the feet as you lift the hips off the floor.

5. Slide your yoga block under your back directly under the sacrum. Let your sacrum rest on the block. Let the arms rest alongside the body.

6. This should be a comfortable resting position. You may wish to stay here several minutes.

7. To come out, press down into your feet and lift the hips again. Remove the block and gently lower your back to the floor.

Beginners:

It is a good idea to start with the block on the lowest level (see photo number 1). If this feels comfortable, you can try turning it to a higher level (as in photo number 1). Since this is a restorative pose, choose the level that gives you the most ease. If you feel any pain, come out.

Advanced:

Try lifting one leg at at time off the floor, keeping the block in place. You may also lift both legs at the same time in a supported version of Shoulderstand.

Supine Spinal Twist - Supta Matsyendrasana

 

Type of Pose: Supine

Benefits: Stretches the glutes. Stretches and relaxes the spine.Can help relieve back pain, though should be approached with caution by those with degenerative disk disease.

Instructions:

1. Come to lie on your back.

2. Bend your knees and put the soles of your feet on the floor.

3. Lift your hips slightly off the floor and shift them about an inch to your right.

4. Draw your right knee into your chest and extend the left leg on the floor.

5. Drop your right knee over to the left side of your body.

6. Open your right arm to the right side in line with your shoulder. Rest your left hand on your right knee.

7. Turn your head to the right, bringing your gaze over the right shoulder.

7. Work on releasing your left knee and your right shoulder to the floor.

8. Hold 5 to 10 breaths before drawing your right knee back into your chest and doing the other side.

Variations: Before twisting, take your legs into the air and wrap your right leg around your left, coming into Eagle legs. Then twist, bringing the right knee over to the left side of the body.