What to do if you awaken with a stiff neck

The common problem of awakening with a stiff neck is a topic that is addressed poorly, if at all, during medical training. In fact, it doesn't even have a consistent name in the medical literature. It is sometimes referred to as "torticollis” or "wry neck", but these terms also apply to more serious neurological or congential conditions.

What causes a stiff neck? The exact cause of a stiff or wry neck is sometimes never determined. It may be the result of a minor injury, a sudden jerk, or simply sleeping with the head in an awkward position. Some people believe that sleeping in a cold draft can cause this problem, although this has never been proven. The most likely source for the pain is a small swivel joint in the neck called a facet. These facet joints allow for great neck flexibility, but are also vulnerable to injury. With injury to a facet, muscle spasm develops that causes the neck to twist away from the painful side as a protective mechanism.

What can be done at home for a stiff neck? In most cases, the problem will resolve on its own in a few days to a week. There are, however, a number of measures that can help make you more comfortable or help speed up its resolution. These measures include:

1. Taking an OTC pain medication, such as Tylenol or ibuprofen.
   
   
2. Applying ice packs intermittently to the painful area during the first 24 to 48 hours of its onset. An ice massage combines the benefits of the application of cold along with massage and can help even more. This is done by freezing ice in a paper cup and massaging the painful area with the exposed ice for 10 minutes.
   
   
3. Applying heat following the use of ice can help even further. This can be done using a warm, moist towel or heating pad, or by taking a shower and directing hot water to the neck. Some experts recommend alternating between heat and cold treatments for the first few days after the onset of neck pain.
   
   
4. Gently massaging the neck muscles will help to relieve pain and encourage blood flow to the area. A topical muscle cream, such a Bengay or Icy-Hot, can be used along with massage.
   
   
5. The neck should be kept mobile by performing gentle range of motion exercises. These are done by slowly moving the chin to the chest and then the ears to each shoulder. It is best to avoid the use of a cervical collar (neck brace) and to try to return to normal activities as soon as possible.
   
   
6. Sleeping with your head on a low, firm pillow will help avoid the increased stress on the muscles and facet joints that sleeping on too many pillows can cause.
   
   
7. Activities that require a full range of motion of the neck, such as driving, should be avoided until improved.

How might you suspect a more serious problem? Rarely, awakening with stiff neck can be due to a more serious problem than the self-limited problem described above. Neck pain associated with weakness or tingling in the arm or hand could be due to a herniated (ruptured) cervical disc. Forceful trauma preceding the onset of neck stiffness may
have caused serious injury to bones, ligaments, or muscles in the neck. The presence of fever along with neck stiffness is suggestive of an infection, such as meningitis, and warrants prompt medical attention.

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Flu Vaccination Update for 2011-2012

Recently, officials from the Centers for Disease Control (CDC) released guidance regarding influenza vaccination for the upcoming 2011-2012 influenza season. This included information about the anticipated strains of influenza virus during this year's season, recommendations for special groups of individuals, and announced the release of a flu vaccine delivery method. Here are the highlights from that update:

1. Predicted strains: Most seasons, the antigens that provide protection in flu vaccine are changed to keep up with the influenza viruses as they evolve. This year, however, the predicted strains of influenza virus likely to affect Americans are as they were for last year (A/California/7/2009 (H1N1)-like virus; A/Perth/16/2009 (H3N2)-like virus; and B/Brisbane/60/2008-like virus).
   Accordingly, the vaccine is unchanged from last year. This does not mean, however, that people who received flu immunization last year are adequately protected this year. The levels of protective antibody against influenza viruses can decline over the course of a year, so even people who got a flu vaccine last year should be vaccinated again this year to make sure that they are optimally protected.
   
   
2. Children: The CDC recommends that annual flu immunization should begin at 6 months of age. Children aged 6 months through 8 years need 2 doses of influenza vaccine, administered a minimum of 4 weeks apart, during their first season of vaccination to optimize immune response. Because the 2011-2012 vaccine strains are unchanged from the 2010-2011 vaccine strains, children in this age group who received at least one dose of the 2010-2011 seasonal vaccine will require only one dose of the 2011-2012 vaccine.
   
   
3. Pregnant women: The CDC is making a special effort to see that pregnant women receive flu vaccine. Pregnant women and children younger than 6 months of age are at higher risk for severe illness from influenza. Vaccination during pregnancy has the double benefit of decreasing the risk for illness in the mother as well as the risk of influenza and its complications in infants during the first 6 months of life.
   
   
4. Egg Allergy: Two types of vaccine are used for influenza immunization. The injectable form ("flu shot") uses an inactivated vaccine that contains viruses that have been killed. A second type, given as a nasal spray, is made with live, butweakened flu viruses. Both vaccines are produced using eggs and can cause allergic reactions in someone with an egg allergy. For those individuals who have had only a mild reaction to eggs, such as hives, the CDC advises that they receive the flu shot rather than the intranasal form. A healthcare provider familiar with the manifestations of egg allergy should administer the injection and the recipient should be observed for at least 30 minutes afterward. People who have had a previous severe allergic reaction to eggs or from influenza vaccine should not receive flu vaccine. Severe reactions include swelling of the face or throat, respiratory distress, lightheadedness and recurrent vomiting. These individuals are at greater risk for severe reactions, including anaphylaxis, with re-exposure to egg proteins contained in the flu vaccine
   
   
5. New preparation: In addition to the traditional flu shot and the intranasal preparation, there is a new type of flu shot that is delivered just beneath the skin (Fluzone Intradermal, Sanofi Pasteur). This intradermal flu vaccine uses an ultra-thin needle and may be preferable for people who don't like shots. This type of vaccine has been approved for adults 18 through 64 years of age and is equally effective as the regular flu shot.
   

Last year, the CDC made the recommendation that everyone 6 months and older should receive the flu vaccine annually. The influenza vaccine will keep you from getting sick from the virus strains contained in the vaccine and it can make your illness milder if you get a related but different strain of the influenza virus. Since it takes about two weeks following vaccination for antibodies to develop in the body and provide protection against influenza virus infection, it's a good idea to be vaccinated as soon as the vaccine becomes available, rather than waiting for flu season's first outbreak.

Suffering for Fashion, Part 2 - Faux Pas

Many women, as well as men, take the position of Billy Crystal's alter ego, Fernando, that "it is better to look good than to feel good". Unfortunately, following the latest fashion trends can also have adverse health consequences. In the name of fashion, women can risk injury and illness, as well as having to endure discomfort. Let's look at some of these health-related fashion faux pas and simple remedies for women to "feel good as well as look good".

Tight clothing: This fashion trend, aimed at creating a slender appearance, seems to come and go through the decades. Wearing clothes that are too tight, however, can set the stage for several health problems. It is one of the most common causes for a nerve injury known as meralgia paresthetica, which produces tingling, numbness and burning pain on the outside of the thigh. Additionally, constrictive clothing has been implicated in causing urinary tract infections, vaginal yeast infections, and even blood clots in the legs.

• Recommendations: New clothing should be purchased to fit the "now" you, not the you that you hope to become after losing weight. If you do succeed in losing that extra five pounds, reward yourself with a new outfit. If you do wear tight jeans, make sure that they are made from a fabric with elasticity and breathability. For persistent problems, such as meralgia paresthetica or urinary tract infections, it is best to avoid tight clothing altogether.

Heavy handbags: For some time now, there has been a fashion trend toward carrying larger handbags. Like having additional storage space in your home, a larger bag can lead to - guess what - carrying more stuff. The extra weight from bulky purses, particularly when worn over the same shoulder has the potential to cause a stiff neck, headache, and shoulder pain. They can also contribute to accidents and falls as they can throw you off balance and cause you to bump into things.

• Recommendations: Remove all non-essential items from the purse to minimize its weight. Use a wider shoulder strap and periodically switch the bag from side to side to avoid strain to just one side. A "backpack-type" bag or handbag worn diagonally across the chest may help to distribute the load better.

High heels: High heels may be uncomfortable, but more importantly, may change the alignment of the spine leading to low back pain as well as foot-related problems like bunions, corns, and blisters. So why do women keep wearing them? From a fashion standpoint, they make women appear taller and generally accentuate the female form. Prolonged wearing of high heels, combined with a pointed toe, can lead to a deformity called "hammer toes" in which the toes are permanently forced into a "clawed" position. The relatively unstable heel can also result in "turning an ankle" leading to sprains or fractures.

• Recommendations: Limit the amount of time spent in high heels and stick with a two-or three-inch heel and a rounded or open toe. Instead of a stiletto heel, opt for high heels that use wedges or platforms instead. Whenever possible, wear shoes with a wider toe box and firm arch support. They may not be as fashionable, but they can help to avoid injuries and deformities.

Cosmetics and hair dyes: For the most part, cosmetics and hair dyes are tested and found to be safe. Inappropriate use, as well as certain ingredients, however, can cause health problems. Cosmetic products that come in aerosol containers represent a fire hazard and can cause lung damage if they are inhaled deeply into the lungs. The use of mascara is a common cause of corneal abrasion, which is a scratch on the surface of the eye. Alpha hydroxy acids (AHAs) are a common ingredient in many creams and lotions used to reduce wrinkles, spots, and sun-damaged skin. They have been implicated in causing a number of problems including facial swelling, blistering of the skin, itching and skin discoloration. Certain preservatives (paraben, quaternium-15, DMDM hydantoin, others) used in cosmetics can also cause the skin to become irritated. Problems that are even more serious have been connected with the use of now banned or regulated ingredients in cosmetics, such as mercury compounds, vinyl chloride, and hexachlorophene.

• Recommendations: The Office of Women's Health of the Department of Health and Human Services has provided a number of recommendations for safer cosmetic use:
  
  
  • Never drive and put on make-up. Not only does this make driving a danger, hitting a bump in the road and scratching your eyeball can cause serious eye injury.
    
    
  • Never share make-up. Always use a new sponge when trying products at a store. Insist that salespersons clean container openings with alcohol before applying to your skin.
    
    
  • Keep make-up containers closed tight when not in use.
    
    
  • Keep make-up out of the sun and heat. Light and heat can kill the preservatives that help to fight bacteria. Don't keep cosmetics in a hot car for a long time.
    
    
  • Don't use cosmetics if you have an eye infection, such as pinkeye. Throw away any make-up you were using when you first found the problem.
    
    
  • Never add liquid to a product unless the label tells you to do so.
    
    
  • Throw away any make-up if the color changes, or it starts to smell.
    
    
  • Never use aerosol sprays near heat or while smoking, because they can catch on fire.
    
    
  • Don't deeply inhale hairsprays or powders. This can cause lung damage.
    
    
  • Avoid color additives that are not approved for use in the eye area, such as "permanent" eyelash tints and kohl (color additive that contains lead salts and is still used in eye cosmetics in other countries). Be sure to keep kohl away from children. It may cause lead poisoning.

Suffering for Fashion, Part 1 - Men are not immune!

What can cause your center of gravity to be thrown off, constrict blood flow in the neck, put pressure on your back, and predispose you to accidents or cancer? Sounds like something that should be avoided at all costs, right? In fact, these all can be consequences of following the latest styles. Clothing, footwear, and lifestyle trends that many people voluntarily embrace in the name of fashion can all be hazardous to your health.

Fashion is generally considered to be the domain of women. It is true that men don't seem to have to adjust to changes in fashion as often as women do. However, men are not immune to fashion-related health consequences. This week's Health Tip explores some of the health consequences that men experience from following the latest styles. Next week, we'll look at how women too "suffer for fashion".

Neckties: In addition to being uncomfortable, neckties may contribute to other health issues, such as eye problems and accidents. A study published in the British Journal of Ophthalmology found that tight neckties, pressing on the jugular veins, increases pressure within the eye. Over time, this increased pressure can lead to the development of glaucoma, a major cause of retinal degeneration and blindness. Neckties can also be involved in accidents should they become entangled in machinery or in an elevator door.

• Recommendation: Many men now opt for a looser tie (a healthier fashion trend) with the top button unfastened, or no necktie at all. When dress codes dictate wearing a tie, the wearer should be able to slip a finger easily between the neck and the collar.
  

Tight underwear: In some instances, elevation of testicular temperature causes a reduction in the quality and quantity of sperm, leading to infertility. Wearing tight underwear, which is thought to increase scrotal temperature, has been proposed as one mechanism for this. At least one study, however, comparing scrotal temperatures of groups of men wearing boxers vs. "tighty whities" did not demonstrate a significant temperature difference between the two.

• Recommendation: Many infertility specialists continue to advise men who are found to have a low sperm count to wear boxer shorts, avoid saunas, and hot tubs. These simple measures, if effective, may circumvent a costly infertility evaluation and treatment.
  

Tanning: The "healthy glow" from a tanning bed or sun exposure is anything but. Darkening of the skin cells from tanning is a defense mechanism against further damage brought about from UV radiation in the first place. A report by the International Agency for Research on Cancer concludes that exposure to UV radiation from any source can lead to skin cancer, including melanoma, premature skin aging, and eye damage, such as cataracts.

• Recommendation: Advocates of tanning devices sometimes argue that using these devices is less dangerous than sun tanning because the intensity of UV radiation and the time spent tanning can be controlled. However, there is no evidence to support these claims. The American Academy of Dermatology and other health organizations advise limiting exposure to natural UV radiation from the sun and avoiding artificial UV sources such as tanning beds entirely.