Physical Rehabilitation Medicine/neck muscles


Dr. Tetlow,

I am hoping you can recommend exercises for my neck and upper back.

I do laboratory bench work (always looking down) and over the years I have developed a condition in which my neck and shoulder muscles tighten and remain tightened.  They feel almost like a rock.  It seems to cause a nerve problem because my lower jaw will go numb at times.

Currently I take muscle relaxers and they keep my neck muscles *halfway* soft and my migraines at bay.  My jaw has not gone numb since I started taking them.

Recently I have started pilates and my neck and shoulders are cramping through my muscle relaxers!  I really like pilates and am doing the modified exercises and not using my neck.

The only thing I can think to do is ask you what exercises will counteract the action of me looking down doing benchwork.  I can't exactly reverse the movement... unless I do a back-bend.  If that will work believe me I will try it.  I'm afraid to know how hunchbacked I will be after 30 more years in the lab ha ha ha!

Massage doesn't work (several therapists have tried to unlock my muscles with no success).

The only manual relief I've gotten is from a particular physical therapist who would apply pressure to certain points... I'd feel the muscle spasm and then relax.  I asked him to tell me what he was doing (it wasn't massage) but he wouldn't.  He gave me one back/neck exercise that I can do on my own and that's it.

Please don't put my question in the question pool - it's like the Bermuda Triangle of Allexperts :)

Thanks so much please help me...


Dear Amanda,
I have a few thoughts, and keep in mind this response is for informational purposes only, and does not substitute for medical advice or treatment.

For individuals with tight muscles and muscle spasms, low magnesium can be the culprit. Magnesium relaxes smooth muscle an skeletal muscle. For these individuals, I would recommend magnesium glycinate, the best absorbed form, at night...dosage can start as low at 200mg or 400mg and you go up each night until one has a bowel movement the next morning or the next day. Smooth muscle relaxation can cause loose stools, so don't over dose! One can end up with a dose like 600mg or 800mg or more each night...there is no toxicity!...and it can take more than 1-2 months to replete your levels. Low magnesium can be associated with anxiety, trouble sleeping...and this mineral is involved in over 300 chemical reactions in the body. Low magnesium can also cause migraines. (I'd suggest magnesium and B complex for that...and acupuncture is wonderful).

There is a blood test called a Red Blood Cell Magnesium that looks at a 3 month average, rather than the serum magnesium test that is just a spot check--someone with your symptoms might be deficient or low normal. An opportunity to raise your levels! It is reasonable to start taking magnesium without a test, but either option works.

In terms of exercises, I recommend "reverse translation", which means you tuck your chin moderately and then move your whole head backward while continuing to tuck your chin. You can feel a stretch in just the right spot if you do this right. You should stretch your neck and do reverse translation 5 times x 5 long seconds every hour when you are working...and also become aware of when you hold your breath. Keep breathing!

Massage can be very helpful--and neck tightness is never just about the neck, but also potentially about other areas like your back, shoulders, jaw...and you did mention those. Self massage is also wonderful.

None of this advice is meant as a substitute for an in-person history and exam from a qualified practitioner. You deserve that personalized, one-on-one care.

I hope this information has been helpful.

Dr. Georgia

Physical Rehabilitation Medicine

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Dr. Georgia Tetlow, MD, FAAPMR


I can answer all questions related to integrative, alternative and holistic approaches to physical rehabilitation medicine and wellness.


I am a practicing physician with expertise in all areas of integrative, alternative, holistic and physical rehabilitative medicine.

PROFESSIONAL SOCIETY MEMBERSHIPS American Academy of Physical Medicine and Rehabilitation, 2003-present Pennsylvania Medical Society, 2005-present Association of Academic Physiatrists, 2006-present

PUBLICATIONS Tetlow, G.K., Kamen, L.B. Step-Down Treatment of Opioid Dependent Chronic Pain Syndromes Incorporating Cognitive Behavioral Strategies with Buprenorphine. Archives of Physical Medicine and Rehabilitation 2007;88(9),E74. Kamen, L., Tetlow, G. Step-down treatment of opioid dependent chronic pain syndromes incorporating cognitive behavioral strategies with buprenorphine. The Journal of Pain 2007;8(4):S42. Kucer, B., Tetlow, G.K., Heckert, K., Ankam, N., Miller, A., Thomas, J., Sharma, S. Evolving an Effective Teaching Model to Introduce Physical Medicine and Rehabilitation to Medical Students: A Novel Approach. American Journal of Physical Medicine and Rehabilitation 2007;86(4):S133. Tetlow, G.K., Zysk, K.G.: Traditional Ayurveda (Chapter 19). In: Micozzi, M, ed. Fundamentals of Complementary and Alternative Medicine. New York: Churchill Livingstone; 2001:345-357.

EDUCATION 2000-2004 M.D. University of North Carolina at Chapel Hill School of Medicine ~ Chapel Hill, NC 1996-1999 B.S. Antioch College Biomedical and Premedical Sciences ~Yellow Springs, OH 1992-1993 Haverford College ~ Haverford, PA POST-GRADUATE TRAINING 2009-2010 Bravewell Fellowship, Jefferson-Myrna Brind Center of Integrative Medicine University of Arizona Center for Integrative Medicine, Tucson, AZ 2005-2008 Residency in Physical Medicine and Rehabilitation Thomas Jefferson University Hospital, Philadelphia, PA 2004-2005 Internship in Internal Medicine Albert Einstein Medical Center, Philadelphia, PA TRAINING EXPERIENCE Bravewell Integrative Medicine Fellowship Sponsored part-time 2 year clinical fellowship to augment conventional medicine with evidence-based practices from a wide variety of traditions to address health Thomas Jefferson University Hospital Musculoskeletal Medicine, Inpatient, Outpatient and Consultative Rehabilitation; Diagnostic and Interventional Ultrasound; Research Mentorship; Yoga on Unit for Acute Rehabilitation Patients (instructor) Magee Rehabilitation Hospital Musculoskeletal Medicine, Inpatient Acute Rehabilitation; Research Mentorship; Senior Advisory Moss Rehabilitation Hospital Musculoskeletal Medicine; Inpatient and Outpatient Amputee Medicine; Outpatient Pain Medicine; Spasticity Clinic (utilizing botulinum toxin injections); Electromyography Albert H. duPont Hospital for Children Inpatient and Consultative Pediatric Rehabilitation, Musculoskeletal Medicine CERTIFICATIONS Advanced Cardiac Life Support, valid through 2012 Mindfulness Based Stress Reduction Practicum, 2007 Institutional Review Board Training Certificate, Thomas Jefferson University Hospital, 2007 Certificate in Ayurvedic Studies, 1995 Phoenix Rising Yoga Therapist, 1993 Certified Hatha Yoga Instructor, 1992

Awards and Honors
AWARDS Resident Award for Exemplary Scholarly Activity Senior resident award for unusual productivity of peer reviewed scholarly activities as determined by the faculty Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 2008 Rex Newton Research Presentation Award In recognition of research presentation “Inter Rater Reliability of Photo Documentation for Scoring the Walking Index for Spinal Cord Injury (WISCI),” judged competition Pennsylvania Academy of PM&R Annual Meeting Philadelphia, PA, 2007 Rehabilitation Medicine Certificate of Achievement Awards In special recognition of contribution to the department, scholarly activity, medical student teaching Thomas Jefferson University Hospital Philadelphia, PA, 2006, 2007 Arnold P. Gold Foundation Leonard Tow 2004 Humanism in Medicine Award In recognition of exemplary compassion, competence and respect in the delivery of care University of North Carolina at Chapel Hill, 2004 Brody Award in Medical History For essay entitled “Music and ECG Interpretation: Factors in Common, Purposes Unshared” Duke University Durham, NC, 2002 Howard Hughes Medical Grant To study the etiology and management of bone complications following pediatric bone marrow transplant University of Utah/Primary Children’s Medical Center Salt Lake City, UT, 1998- 1999 Horace Mann Presidential, J. D. Dawson, Mari Michener Science, and Austin Patterson Chemistry Scholarships In recognition of academic excellence Antioch College Yellow Springs, OH, 1996-1999 Heller Foundation Grant To study the role of neurological factors in the disease process at the Ayurvedic Institute, Albuquerque, NM, Haverford College Haverford, PA, 1994 Dana Scholarship In recognition of academic excellence, leadership and commitment to social change Haverford College Haverford, PA, 1993-1994

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