Can choosing the right pillow help many individuals with neck pain get a full night’s sleep and reduce pain-like symptoms?
The Effects Of Neck Pain
How often do you feel stiffness in your neck and shoulders after being hunched for an extended period? Does it hurt when turning your neck from side to side? Or have you been suffering from constant headaches or migraines that are making you have a hard time falling asleep? As the second most common musculoskeletal condition, neck pain is a multifactorial disease developed through various risk factors that can impact a person. (Kazeminasab et al., 2022) The multiple muscles surrounding the neck are constantly overstretched and tight, which can cause pain and discomfort to the upper extremities due to environmental factors. Some environmental factors can range from improper posture to injuries that can affect the neck. When many people are experiencing neck pain associated with environmental factors, it can cause considerable personal pain and discomfort, disability, impaired quality of life, and, for adults, loss of time from work. (Ben Ayed et al., 2019) At the same time, when people experience neck pain, they can develop disruptive sleeping habits. We associate with certified medical providers who inform our patients of the effects of neck pain and how it can disrupt their sleeping habits. While asking important questions to our associated medical providers, we advise patients to incorporate various techniques to reduce neck pain and find ways to stay asleep longer. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
How Neck Pain Disrupts Sleep
Now, many people wonder how neck pain is associated with sleep. Environmental stressors like chronic stress from the workplace or natural disasters can cause a person to have tense neck muscles and can increase sleep disturbances. (Yabe et al., 2022) When environmental stressors impact the body, the musculoskeletal system becomes tight and tense in different body areas. In the neck, the muscles that surround the cervical can become tense and develop trigger points in muscle tissue, causing referred pain and discomfort. When neck pain causes disruptive sleep problems, it can cause impairment to the multifunctional protective role of sleep via physiological homeostasis and restoration. (Van Looveren et al., 2021) At the same time, some of the pain-like symptoms that can be increased with neck pain associated with disruptive sleep include: (Chin et al., 2021)
Soreness
Pain
Numbness
Difficulty in movement
However, there are ways to reduce the effects of neck pain and get a full night’s sleep, starting with the bedroom.
Low Back & Neck Pain Rehabilitation-Video
Choosing The Right Pillow For Neck Pain
Now, when it comes to getting a full night’s sleep, it is important to find the right mattress to stay asleep as well as feel refreshed. However, as important as it is to sleep in the right mattress when dealing with neck pain, finding the right pillow can do wonders for the neck and help people get enough sleep. When it comes to finding the right pillow, the individual needs to find a pillow with an appropriate height that can provide adequate support for the head and neck to reduce cervical spinal stress and relax the surrounding neck and shoulder muscles. (Lei et al., 2021) This is because when it comes to quality sleep, many people prefer sleeping positions, pillows, and mattresses aimed at comfort. Many pillows have a variety of materials that can help aid in comfort and help reduce neck pain. Some of the types of pillows include:
Memory foam
Polyfilled pillows
Down Pillow
Latex
Combo style
Finding the right pillow for neck pain allows the individual to have their neck fully supported while having the pillow in a lateral position to reduce neck fatigue and improve sleep quality (Son et al., 2020). By doing so, many people can finally get a good night’s sleep and wake up feeling better. By choosing the right pillow, many people will begin to be more mindful of their bodies and make small changes to their routine while getting the sleep they deserve.
References
Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629
Chin, W. S., Chen, Y. C., Lin, T. T., Guo, Y. L., & Shiao, J. S. C. (2021). Short sleep and chronic neck and shoulder discomfort in nurses. J Occup Health, 63(1), e12236. doi.org/10.1002/1348-9585.12236
Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4
Lei, J. X., Yang, P. F., Yang, A. L., Gong, Y. F., Shang, P., & Yuan, X. C. (2021). Ergonomic Consideration in Pillow Height Determinants and Evaluation. Healthcare (Basel), 9(10). doi.org/10.3390/healthcare9101333
Son, J., Jung, S., Song, H., Kim, J., Bang, S., & Bahn, S. (2020). A Survey of Koreans on Sleep Habits and Sleeping Symptoms Relating to Pillow Comfort and Support. Int J Environ Res Public Health, 17(1). doi.org/10.3390/ijerph17010302
Van Looveren, E., Bilterys, T., Munneke, W., Cagnie, B., Ickmans, K., Mairesse, O., Malfliet, A., De Baets, L., Nijs, J., Goubert, D., Danneels, L., Moens, M., & Meeus, M. (2021). The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade. J Clin Med, 10(17). doi.org/10.3390/jcm10173836
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Yoshida, S., & Tsuji, I. (2022). Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake. BMC Musculoskelet Disord, 23(1), 459. doi.org/10.1186/s12891-022-05410-w
What is the recommended way to choose a mattress for individuals with back pain?
Back Pain Mattress
When choosing a back pain mattress, one size does not fit all in selecting one for those with spine pain. Several other factors play a role, as well. However, whether a firm or soft mattress is the best option for individuals whose back pain keeps them up at night, most health experts say the choice is yours and that the mattress that makes you feel most comfortable is likely the best option. The research says that medium firmness seems to provide the most painless sleep. A review gathered information from 24 controlled trials where participants used soft, medium-firm, firm, or custom-inflated mattresses. The results showed that medium-firm and self-adjusted mattresses were best for sleep comfort, quality, and spinal alignment. (Radwan A. et al., 2015)
Medical Status
Selecting the back pain mattress best suited to your spinal condition is more than just how hard or soft the mattress is. Individuals and their healthcare providers should thoroughly review their medical history to tailor the mattress to their needs. Before purchasing a mattress, check the following:
Age
Medical history
Injuries current and past
Current diagnosis or diagnoses
Disease and/or Conditions
Sleeping preferences
For example, symptoms of spinal stenosis tend to present themselves when one is standing and walking but not when lying down. For this reason, mattress firmness is not a big issue only for people with spinal stenosis. However, it must be taken into consideration for those who have degeneration along with spinal stenosis.
Individuals with spinal arthritis without stenosis, disc problems, or non-specific back pain need to consider the relative firmness or softness of the back pain mattress. People with these conditions do better with more support, i.e., a firmer mattress. While everyone needs some back support when they sleep, those who have undergone multiple back surgeries often need less. The tissues have been altered and may be stiffer after several surgeries. In this case, a softer mattress may be more suitable and comfortable.
Mattress Age
Mattress springs break down over time, which makes the bed softer. This can aggravate the spine and back muscles. Based on this, investing in a new mattress makes sense, or pain and stiffness can worsen with the current one. While this will vary among individuals, medical research may help shed some light: A study measured the comfort and quality of sleep for 27 participants with low back pain and stiffness. The participants recorded their sleep comfort and quality in their beds for 21 days and then with a new prescribed mattress and bedding system, which they used for 12 weeks. The study found that the participants showed significant and progressive improvement in back pain and stiffness on the new mattresses and improved sleep quality significantly. (Jacobson B. H. et al., 2010)
Sleeping Position
The position usually slept in makes a difference in the support needed for the back pain mattress. Some recommendations for back sleepers, side and fetal position sleepers, and stomach sleepers:
Side Sleepers
Most people are side sleepers.
They sleep in the fetal position with their knees drawn up toward their chest.
This position tends to place pressure on the hips and shoulders.
For side and fetal sleepers, a slightly softer mattress is recommended.
The foam the mattress is made of conforms to the body, especially in the thoracic and lumbar regions of the spine.
Stomach Sleepers
For the stomach sleeper, soft mattresses can irritate the back.
A soft mattress encourages the abdomen to sink into the bed.
The resulting position is known to increase the arch in the lower back and cause pain.
A medium-firm surface is good for stomach sleepers.
The idea is to derive support from the chosen mattress without the abdominal sinking.
The sinking effect is amplified if you have a large abdomen.
For thin individuals, sinking may not be as much of an issue.
Back Sleepers
For support, place a thin, rolled towel or pillow under the knees and lower back of those who sleep on their backs.
A pillow/s under these areas will help support them and provide more comfort.
Researchers divided the participants according to their usual sleep position. They were assigned to a medium-firm mattress with foam and latex layering based on their preferred sleep position. The participants rated their sleep comfort and quality daily for three months. The researchers found that the new mattresses improved back pain and stiffness. For this reason, they concluded that sleep surfaces relate to sleep discomfort and that replacing a mattress with one uniquely suitable to your spinal condition can reduce and relieve pain. (Jacobson B. H. et al., 2010)
Injury Medical Chiropractic and Functional Medicine Clinic
Choosing the right back pain mattress ultimately comes down to personal preference. Individuals should try various mattresses and see which one they like best. Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. We build optimal health and wellness solutions with primary healthcare providers and specialists. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Chiropractic Care Can Transform Pain Into Relief
References
Radwan, A., Fess, P., James, D., Murphy, J., Myers, J., Rooney, M., Taylor, J., & Torii, A. (2015). Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep health, 1(4), 257–267. doi.org/10.1016/j.sleh.2015.08.001
Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. doi.org/10.1016/j.apergo.2010.05.004
Can non-surgical treatments help individuals with piriformis syndrome reduce referred sciatica pain and help restore hip mobility?
Piriformis Muscle & Piriformis Syndrome
Within the lower extremities, various muscles, ligaments, tendons, and nerve roots allow the legs, hips, and thighs, enabling individuals to be mobile and help with good posture. One of the muscles, known as the piriformis muscle, is located in the gluteal region of the lower body, which helps the major muscles with every movement and allows the individual to walk, run, and rotate at the hips. (Chang et al., 2024) At the same time, the piriformis muscle is over the sciatic nerve, the longest and largest nerve that travels through the lower limbs down to the heel and provides motor-sensory function to the lower limbs. (Giuffre et al., 2024) Environmental factors like physical inactivity, excessive sitting or standing, lifting heavy objects, or improper posture can affect the piriformis muscle and develop musculoskeletal issues in the lower extremities. We associate with certified medical providers who inform our patients of the effects of piriformis syndrome, which affects their lower body extremities and causes pain and discomfort. While asking important questions to our associated medical providers, we advise patients to incorporate various non-surgical therapies to reduce the pain-like symptoms associated with piriformis syndrome. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
Have you experienced a pins and needles sensation in your hips and thighs that make it unbearable to walk? Do you feel radiating pain that travels down to your feet? Or have you noticed tightness in your hips and glutes region when stretching? When environmental factors impact the body, especially in the upper and lower extremities, they can cause overlapping risk profiles that can develop into chronic conditions. So, environmental factors affecting the piriformis muscle can lead to a musculoskeletal condition called piriformis syndrome. Piriformis syndrome is a somatic and neuropathic musculoskeletal condition caused by excessive or prolonged contraction of the piriformis muscle. (Jankovic et al., 2013) Many individuals who have dealt with piriformis syndrome will begin to report pain in the gluteal region that is causing sensations down the leg that can compress the sciatic nerve. (Hicks et al., 2024)
What Triggers Piriformis Syndrome?
Three causing factors can trigger piriformis syndrome in the lower extremities. Environmental factors like excessive movement, physical inactivity, or musculoskeletal conditions can compress the sciatic nerve over time, entrapping it and causing gradual pain. Additionally, trigger points in the muscles caused by repetitive strain can lead to muscle spasms or inflammation to irritate the sciatic nerve, which may present with a different musculoskeletal condition. (Pfeifer & Fitz, 1989) Finally, many people will begin to think that the pain they are experiencing is sciatica pain instead of piriformis syndrome.
Sciatica-Like Symptoms
Now, sciatica and piriformis syndrome are completely different but have similar symptoms that cause them to correlate. Sciatica is caused by spinal issues affecting the lower back that causes radiating pain down the leg. Piriformis syndrome only involves the piriformis muscle pressing one sciatic nerve area, causing overlapping risk profiles. Some of the common symptoms both sciatica and piriformis are associated with include:
Numbness
Tingling & burning sensations
Inflammation
Muscle spasms & tenderness
Pain & discomfort when sitting or standing
Sciatica: Causes, Symptoms, & Tips- Video
Non-Surgical Treatments For Piriformis
Luckily, numerous treatments are non-surgical and can help many individuals with piriformis syndrome find relief. Non-surgical treatments are affordable and non-invasive, customized to the person’s pain. With piriformis syndrome, non-surgical treatments can help improve pain and functionality back to the lower extremities and provide symptomatic relief from the piriformis muscle. (Vij et al., 2021) Some of the non-surgical treatments that are excellent for reducing pain-like symptoms associated with piriformis include:
Physical Therapy: Physical therapies allow the muscles to be mobilized and stretched and decompress the musculoskeletal structures. (Gandolfi et al., 2023)
Acupuncture: A trained acupuncturist incorporates small needles into the acupoints around the piriformis and provides anti-inflammatory effects. (He et al., 2023)
Chiropractic Adjustments: Chiropractors utilize mechanical and manual spinal manipulation to realign the body, stretch and strengthen the affected muscles, and alleviate pain.
Rest: Avoiding strenuous activities and sleeping on the right mattress can help reduce spinal pain associated with piriformis syndrome and improve sleep quality.
Incorporating these non-surgical treatments to reduce piriformis syndrome can help many individuals be more mindful of their bodies daily. They can be part of a daily routine in a person’s health and wellness journey in managing piriformis syndrome and reducing its pain-like symptoms. Doing so allows the lower extremities to be mobile again and the individual to be pain-free.
References
Chang, C., Jeno, S. H., & Varacallo, M. (2024). Anatomy, Bony Pelvis and Lower Limb: Piriformis Muscle. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30137781
Gandolfi, M. G., Zamparini, F., Spinelli, A., & Prati, C. (2023). Asana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yoga Protocol. J Funct Morphol Kinesiol, 9(1). doi.org/10.3390/jfmk9010006
Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Can J Anaesth, 60(10), 1003-1012. doi.org/10.1007/s12630-013-0009-5
Pfeifer, T., & Fitz, W. F. (1989). [The piriformis syndrome]. Z Orthop Ihre Grenzgeb, 127(6), 691-694. doi.org/10.1055/s-2008-1040313 (Das Piriformis-Syndrom.)
Vij, N., Kiernan, H., Bisht, R., Singleton, I., Cornett, E. M., Kaye, A. D., Imani, F., Varrassi, G., Pourbahri, M., Viswanath, O., & Urits, I. (2021). Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med, 11(1), e112825. doi.org/10.5812/aapm.112825
Can listening to sleep sounds help achieve and maintain healthy sleep patterns for individuals having trouble sleeping?
Sleep Sounds
Sleep sounds include white, pink, green, or brown noise, binaural beats, ASMR, nature, and ambient sounds. Each has different benefits and can potentially improve sleep. (Ebben M. R., Yan P., & Krieger A. C. 2021) Sound has no color, but it follows a spectrum. The color of a sound refers to the power spectrum of a particular noise signal. Each color has different qualities.
White noise, such as an untuned radio or television, is the most well-known background noise and is often used as a sleep aid.
Green noise features more powerful mid-range frequencies.
Brown noise is a more low-frequency rumble deeper than green and white noise.
Pink noise combines white noise softened by brown and could be the most effective option for improving sleep.
White noise is a sound that includes all the audible frequencies at equal volume, like a continuous hiss. One study found that adults fell asleep faster while listening to white noise. (Messineo L. et al., 2017)
Green noise, which features more powerful mid-range frequencies, is similar to natural sounds like ocean waves, rainfall, and rustling leaves. It’s more soothing than white noise and can help individuals with anxiety sleep better.
Brown noise, also known as red noise, has a deeper tone than white noise and is similar to the hum of an airplane. It can help mask lower-pitched sounds and may be especially helpful for individuals with ADHD, as it aids in productivity and concentration. Brown noise mimics sounds found in nature but with a low-frequency rumble. Examples include heavy rainfall, thunder, or loud waves.
Pink Noise
While further scientific research on sleep noise is needed, evidence has begun to suggest that pink noise may be the most effective option for improving sleep. (Ong J. L. et al., 2016) Pink noise is softer and more soothing than the other colored sleep sounds. It combines white noise softened by brown noise and is considered more relaxing because of its lower pitch. It has a pleasant-sounding, balanced volume across frequencies, making it calming to the human ear. Pink noise includes digital recreations of natural sounds such as a gently flowing stream, soft rain falling, wind rustling through trees, or calm waves lapping at the shore.
In a study, adults over 60 were given intermittent bursts of pink noise while sleeping, similar to rushing water. (Papalambros N. A. et al., 2017) The following morning, participants were given memory tests, which indicated that retention levels were approximately three times greater than those of the control group not exposed to the pink noise. Another study found that steady pink noise significantly reduced brain wave complexity during sleep while improving stable sleep time with less fragmentation and fewer wake periods. (Zhou, J. et al., 2012)
Injury Medical Chiropractic and Functional Medicine Clinic
Choosing the right sound for you ultimately comes down to personal preference. Individuals can try each color and see which one they like best. Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to restore health. Individuals can recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Beyond Medicine: The Power of Chiropractic Care
References
Ebben, M. R., Yan, P., & Krieger, A. C. (2021). The effects of white noise on sleep and duration in individuals living in a high noise environment in New York City. Sleep medicine, 83, 256–259. doi.org/10.1016/j.sleep.2021.03.031
Messineo, L., Taranto-Montemurro, L., Sands, S. A., Oliveira Marques, M. D., Azabarzin, A., & Wellman, D. A. (2017). Broadband Sound Administration Improves Sleep Onset Latency in Healthy Subjects in a Model of Transient Insomnia. Frontiers in neurology, 8, 718. doi.org/10.3389/fneur.2017.00718
Ong, J. L., Lo, J. C., Chee, N. I., Santostasi, G., Paller, K. A., Zee, P. C., & Chee, M. W. (2016). Effects of phase-locked acoustic stimulation during a nap on EEG spectra and declarative memory consolidation. Sleep medicine, 20, 88–97. doi.org/10.1016/j.sleep.2015.10.016
Papalambros, N. A., Santostasi, G., Malkani, R. G., Braun, R., Weintraub, S., Paller, K. A., & Zee, P. C. (2017). Acoustic Enhancement of Sleep Slow Oscillations and Concomitant Memory Improvement in Older Adults. Frontiers in human neuroscience, 11, 109. doi.org/10.3389/fnhum.2017.00109
Zhou, J., Liu, D., Li, X., Ma, J., Zhang, J., & Fang, J. (2012). Pink noise: effect on complexity synchronization of brain activity and sleep consolidation. Journal of theoretical biology, 306, 68–72. doi.org/10.1016/j.jtbi.2012.04.006
Insomnia is a condition with causes that vary from person to person and can be a result of stress, caffeine, and excessive screen time. Can modifying eating habits help reduce episodes and improve sleep patterns?
Eating Habits and Insomnia
Insomnia is a common sleep disorder characterized by persistent difficulty falling asleep, staying asleep, and/or both. Individuals often experience daytime sleepiness, mood disturbances, or cognitive impairments. There are two types:
Primary insomnia, which is not linked to other health conditions.
While there are various causes of insomnia, researchers have recently learned more about its impact on eating habits. New data has found that an individual’s dietary pattern may impact sleep habits. (Gan Z. H. et al., 2024)
Risk Factors
Chronic insomnia is linked to negative health outcomes, including an increased risk of high blood pressure, diabetes, obesity, depression, heart attack, and stroke. (Chalet F. X. et al., 2023) (Marie-Pierre St-Onge et al., 2016) Researchers recruited over five thousand participants who did not have insomnia and evaluated their eating habits and insomnia incidence. (Gan Z. H. et al., 2024) Results showed that 464 of the participants developed insomnia, and of those, the risk was lower in vegetarians than those who ate more meat. Males who followed a more plant-based diet had a reduced incidence of insomnia; however, this relationship was not seen among females. The research suggests that a diet with more vegetables may positively affect sleep. Many plant-based foods are rich sources of sleep-supporting compounds, such as melatonin. Treating and preventing insomnia is important for restoring health and daily functioning.
Past nutritional data highlights the relationship between healthy sleep and a diet rich in fruits, vegetables, legumes, and other sources of tryptophan and melatonin. (Zuraikat F. M. et al., 2021) Prior research also shows how vegetarian diets can help reduce chronic inflammation, positively impacting sleep. (Dzierzewski J. M. et al., 2020) Specifically, the Mediterranean diet, known for its anti-inflammatory effects, is linked to improved sleep and reduced insomnia. (Zaidalkilani A. T. et al., 2021) Also, data links a vegetarian diet to improved mood, which might enhance the quality of sleep by moderating mental health, including depression condition. (Wang X. et al., 2023)
Support Quality Sleep
According to dieticians, looking at an individual’s eating habits during the day is crucial in determining why they can’t sleep at night. Often, making a few small dietary adjustments is enough to help with better sleep. Some steps to try include:
Increase magnesium by adding more leafy greens, nuts, and seeds.
Incorporating melatonin-rich foods like walnuts rather than relying on melatonin supplements.
Easing off caffeine, alcohol, and refined carbohydrates can help improve sleep quality.
Dietary changes should not be the only way to combat insomnia. Cognitive behavioral therapy (CBT-I) is a recommended first-line treatment rather than sleeping medications, along with learning healthy sleep habits and using the right mattress. This therapy can help improve sleep habits and behaviors by rethinking sleep and current practices that could affect an individual’s ability to sleep well. Combining CBT-I with a healthy diet and regular physical activity can significantly impact overall health and sleep patterns.
Injury Medical Chiropractic and Functional Medicine Clinic
Individuals who struggle with insomnia or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to avoid deprivation side effects and restore health. A chiropractic therapy team can assess your condition and develop a customized treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body heal.
Gan, Z. H., Chiu, T. H. T., Lin, C. L., Lin, M. N., & Kuo, P. H. (2024). Plant-based dietary patterns and risk of insomnia: a prospective study. European journal of clinical nutrition, 78(3), 228–235. doi.org/10.1038/s41430-023-01380-x
Chalet, F. X., Saskin, P., Ahuja, A., Thompson, J., Olopoenia, A., Modi, K., Morin, C. M., & Wickwire, E. M. (2023). The Associations between Insomnia Severity and Health Outcomes in the United States. Journal of clinical medicine, 12(6), 2438. doi.org/10.3390/jcm12062438
St-Onge, M. P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., Bhatt, D. L., & American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council (2016). Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation, 134(18), e367–e386. doi.org/10.1161/CIR.0000000000000444
Zuraikat, F. M., Wood, R. A., Barragán, R., & St-Onge, M. P. (2021). Sleep and Diet: Mounting Evidence of a Cyclical Relationship. Annual review of nutrition, 41, 309–332. doi.org/10.1146/annurev-nutr-120420-021719
Dzierzewski, J. M., Donovan, E. K., Kay, D. B., Sannes, T. S., & Bradbrook, K. E. (2020). Sleep Inconsistency and Markers of Inflammation. Frontiers in neurology, 11, 1042. doi.org/10.3389/fneur.2020.01042
Zaidalkilani, A. T., Alhaj, O. A., Serag El-Dine, M. F., Fekih-Romdhane, F., AlRasheed, M. M., Jahrami, H. A., & Bragazzi, N. L. (2021). Arab Women Adherence to the Mediterranean Diet and Insomnia. Medicina (Kaunas, Lithuania), 58(1), 17. doi.org/10.3390/medicina58010017
Wang, X., Song, F., Wang, B., Qu, L., Yu, Z., & Shen, X. (2023). Vegetarians have an indirect positive effect on sleep quality through depression condition. Scientific reports, 13(1), 7210. doi.org/10.1038/s41598-023-33912-7
Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?
Long Thoracic Nerve
Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.
Anatomy
The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.
Function
The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)
Susceptibility to Injury
The LTN is relatively unprotected and can be damaged by several things, including:
Heavy backpacks
Sports
Activities the body is not used to, like digging
Using crutches
Conditions
Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)
Axillary lymph node dissection
Improperly placed intercostal drains
Chest tube placements
Mastectomy
Thoracotomy
The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.
The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.
Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:
Stand about two feet from a wall, facing it.
Place both hands on the wall and gently push against it.
If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
Have a family member or friend stand behind you and check the shoulder blade position.
If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.
Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.
Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.
Treatment and Rehabilitation
Treatment for LTN pain and reduced movement may include:
Rest
Heat or ice
Anti-inflammatory pain medication
Neck support or a pillow
Avoiding strenuous activity and driving
If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)
One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
Full shoulder motion and strength recovery are expected six to 12 months after surgery.
Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. doi.org/10.7759/cureus.1923
Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. doi.org/10.7556/jaoa.2017.025
Can individuals with insomnia find various ways to reduce its effects, such as a full night’s rest and promoting healthy sleep habits?
Insomnia
Many people have often struggled to get a full night’s sleep occasionally, as environmental factors can keep them from falling asleep, making them tired throughout the day. In most cases, many individuals sometimes suffer from a chronic condition known as insomnia. Insomnia is a common sleep disorder, whether short-term or chronic, and it can negatively impact a person’s ability to sleep and stay asleep. (Dopheide, 2020) Insomnia can be in two forms: primary and secondary. Primary insomnia is a fairly common condition that can be resolved without treatment, while secondary insomnia is due to medication side effects or neurological issues that are causing sleep issues. Additionally, insomnia can be developed through various environmental factors like genetic variants, early life stress, major life events, and brain functions and structures that can cause individuals to be vulnerable and have insomnia. (Van Someren, 2021) We associate with certified medical providers who inform our patients of the effects of insomnia that can affect the body when they are not getting enough sleep. While asking important questions to our associated medical providers, we advise patients to incorporate healthy sleeping habits into their treatment plan to reduce insomnia and get proper sleep. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
How It Affects The Body
So, how does insomnia affect the body and a person’s daily routine? Well, when environmental factors start to impact a person, it can cause overlapping risk profiles in the body that can develop into mental disorders like depression. There is a bi-directional relationship between insomnia and depression, as it can cause sleep alterations that can affect the nervous system and develop into chronic conditions. (Riemann et al., 2020) Some of the symptoms that insomnia can affect the body include: (Naha et al., 2024)
Fatigue
Memory impairment
Cardiovascular disorders
Gastrointestinal disorders
PTSD
Daytime napping
However, there are ways to manage insomnia and reduce the co-morbidities.
Exploring Integrative Medicine-Video
Ways To Manage Insomnia
When managing and treating insomnia, many people must recognize the many environmental factors that can lead to its development. Since insomnia is linked with environmental factors, many people start making small routine changes to mitigate its effects. Many people can start by identifying the disorder and other co-morbidities contributing to its development. (Waterman & Selsick, 2023) This, in turn, helps doctors develop a customized treatment plan to manage their insomnia.
Sleep Habits
One of the ways many people deal with insomnia can begin with changing their sleep habits to help reduce the environmental factors affecting their sleep quality. Some of the changes include:
Make sure the bedroom is dark, cool, and has minimal noise
Incorporating these small changes in sleeping habits can help reduce the stressors contributing to insomnia.
Non-Surgical Treatments
Another way for individuals to manage their insomnia is by incorporating non-surgical treatments. Non-surgical treatments like mindfulness meditation, chiropractic care, and acupuncture can help many individuals calm the mind and body by combining deep breathing exercises. (Chan et al., 2021) At the same time, the body and muscles can begin to relax and even help stretch out tense muscles that are affected by insomnia. Many people can utilize non-surgical treatments as part of their routine to live healthy lives and have the best quality of sleep they deserve.
References
Chan, N. Y., Chan, J. W. Y., Li, S. X., & Wing, Y. K. (2021). Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics, 18(1), 32-43. doi.org/10.1007/s13311-021-01029-2
Dopheide, J. A. (2020). Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. Am J Manag Care, 26(4 Suppl), S76-S84. doi.org/10.37765/ajmc.2020.42769
Riemann, D., Krone, L. B., Wulff, K., & Nissen, C. (2020). Sleep, insomnia, and depression. Neuropsychopharmacology, 45(1), 74-89. doi.org/10.1038/s41386-019-0411-y
Van Someren, E. J. W. (2021). Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev, 101(3), 995-1046. doi.org/10.1152/physrev.00046.2019
Waterman, L., & Selsick, H. (2023). Insomnia and its treatment should be given more importance. Br J Gen Pract, 73(733), 344-345. doi.org/10.3399/bjgp23X734421
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