Insight by Dr. Nicole Mastando

A good nights sleep begins with the right pillow

Posted: October 6, 2015
By: Dr Nicole Mastando

Do you wake up most days with neck pain that seems to get better throughout the day only to return the next morning? If you said yes there's a good chance that you're one of millions of people who are using the wrong pillow, sleeping in the wrong position or both. Forutnately, in many cases making a couple of simple changes is all you need to feel great again.

When it comes to pillows there is no such thing as "one size fits all." As a matter of fact, pillows that are "designed" to relieve neck pain are often gimmicks; very expensive gimmicks I might add. It doesn't matter what your pillow is made of or what it costs. If you are using a pillow that doesn't suit you, you are wasting your money. The good news is that once you learn what to look for, you'll never fall for the marketing tricks again.

We've all seen advertising claims that "designate" a particular pillow for a specific sleeping position. In most cases, these are marketing ploys that stuff the pockets of the retailer.

The one exception is the contoured pillow, which 99 percent of the time, is for back sleeping only. The very petite may get away with sleeping on their side on a contoured pillow, but it is not common.

Before I move on, I'd like to address stomach sleeping, it can cause neck pain and low back problems that may go undetected for years. Stomach sleeping, no matter how comfortable, is never good for your spine. You may balk at this statement, especially if you prefer to sleep on your stomach, but I can tell you that breaking this habit is easier than you think. The interesting thing is that most of us start out lying on our side only to end up on our stomach because the pillow is too flat.

Once you get a thicker, firmer pillow that supports your spine horizontally while keeping your spine and head aligned, your muscles can relax. This eliminates the strain and discomfort that causes the rolling into the stomach sleeping position.

Here's what to look for in a pillow.

If you are a side sleeper, you'll need a pillow that keeps your head up and level with the rest of the spine. You want your head  in a neutral position with regard to tilt and rotation. The position should be very comfortable and the pillow should be easily positioned low enough to support the neck. The pillow may be made of cotton, rubber or a blend.

In many cases, memory foam is too soft to support the head in a side laying position, so to be safe I'd avoid it.

If you prefer to lie on your back, you're going to want a slimmer pillow that supports the neck without raising the head past the chest (unless you have heart or lung conditions and then you want to be sure to prop up from your chest).

Your head should again, be aligned with your spine. The back sleeping position requires a pillow that is for the sole purpose of supporting the head and not lifting it.

If you toss from your back and side, you're going to want to pick a pillow that supports you in the position you prefer or spend the most time in. I have not seen many patients who are able to find a pillow that supports them in both of these positions.

If you are like me and wake up when you turn over, it is easy to change pillows especially if they are light-weight (unlike the water filled pillow). I sleep on a dense 3-inch diameter foam roll while on my back. This foam roll pillow is similar to the pillows that are made with a center hole cut out of it.

These pillows (often known as D-core) are for back sleeping. I would not advise using either of these things without having worked up to this type of "severe" support. Most people are not used to proper neck suport and such a drastic change can create muscle woreness.

If you want to use this type of pillow, which in my opinion is the best for back sleeping, you'll want to use it for small periods of time initially to see if you are sore.

If you sleep on your side or your back and have a pillow sized (and shaped) to accommodate you in that position, you'll most likely feel the difference right away.

If these things have not resolved your neck pain. I would advise you to see a doctor.

Ergonomics is your workstation correct?

Posted: September 26, 2015
By: Dr Nicole Mastando

According to Bureau of Labor Statistics (BLS), musculoskeletal disorder (MSD) cases accounted for 33 percent of all worker injury claims in 2011.

Musculoskeletal disorders include everything from repetitive use injuries to low back pain. Low back pain is reported by almost 30 percent of the adult population per two national health surveys. It is also the most common reason why patients visit their doctor.

Prevention of pain is better and usually cheaper than a cure.Research shows that ergonomically designed work areas can reduce the number MSDs, which means decreasing time lost from work. An improperly set up work station can easily lead to headaches, spinal pain and musculoskeletal disorders (MSD).

Ergonomics is the scientific study of workers and their environment, which includes everything from physical stressors to the quality of the air. Ergonomics is applied in an effort to increase productivity, efficiency and quality of work while reducing injury.

By properly fitting your workstation to your body size and shape you may also reduce pain in your wrists, shoulders, neck and back.

First, you need the appropriate chair. The proper chair is different for everyone. The chair should accommodate several factors: Desk height, leg (femur) lenght, and lower leg (Tibia) length.

The proper fit puts the feet flat on the floor and the knees at a 90 degree angle, while supporting the majority of the thigh. The chair (bottom cushion) should not stop in the middle of the thigh.

It has been my experience that when the chair fits the leg in a way that allows not only your buttocks to touch the back but also maintains contact with you leg to just behind the knee, maixmum support is achieved. This allows for maximum relaxation and minimal muscular strain.

Try this exercise. Sit in a chair and adjust the height so that it is in the lowest possible postion theerby creating a change in the knee angle from 90 degress. Notice how this affects the pelvis and low back. It actually decreases the normal low back arch and may even round it completely. Sitting in a chair that causes a flattening or a rounding of the low back (slouching) will create a severe spinal misalignment, and ultimately cause degenerative changes in the spine.

Now try the opposite position. Put the chair at its highest setting and notice the pelvic angle has been increased, which increases the low back arch. This actually pulls on the low back creating muscle strain.

Now try to find the neutral position by creating a 90 degree angle at the knee by adjusting the chair again. Notice that when the knees are at a 90 degree angle there is no strain on the low back. Usually a comparison needs to be made to detect it, but the strain is there. Avoid it by following these guidelines. You'll be glad you did.

There are adjustable platforms that can be placed under your feet that may help achieve the proper knee position. Next is lumbar support. Almost all office chairs have lumbar support built in, but there is often confusion about  ergonomically shaped chairs. A chair may be marketed as ergonomic, but because people come in all shapes and sizes, there is no one size fits all.

Lumbar (low back) support should actually come high enough that it erects the torso while sitting. In my opinion, the lumbar support should start at the sacral base and should go as high as the lower mid back. Many chairs offer lumbar support that does not go high enough to support the trunk properly.

Finally, the shoulder blades. The chair, in relation to the keyboard , should be at a height that keeps the elbows at a 90 degree angle. This helps keep the shoulder blades in a neutral position and the muscles as relaxed as possible once the arm is extended outward or raised upward the muscles that stabilize the shoulder blade have to suport the wieght of the arm, which can cause upper back, shoulder and neck pain.

Chairs with retractable armrests should be considered when the armrests and the desk are the same height. A keyboard drawer placed under the desk is also a good option to maximize desk space, as long as you observe the 90 degree rule.

Recently I saw a foam cushion being sold on TV. This is an excellent alternative to hard or concave chairs when getting a new chair isn't an option. Some chairs offer less cushion while others were not designed to be cushioned at all. Cushions easliy make bleachers, wodden chairs and car seats more comfortable and spine friendly.

As for your car, most new cars have the option of additional low back support and for most people it is adequate. For others, there is an easy fix to back pain that comes on or is aggravated by driving. There are soft foam rolls that can be used as an added lumbar support and may be easily purchased online. A rolled up towel is a good substitute for the foam roll if necessary.

The angle of the bottom part of the seat is to be conisidered in the discussion of lumbar support because when the angle of the pelvis is changed the lumbar spine is directly affected. Some cars have the bottom seat tilt option. If your seat does not raise the knees electronically, you can also use the towel for this purpose as well. Raising the seat at the knees will flatten the low back and lowering the seat at the knees will increase the angle of the lower spinal bones. The angle of the torso will also affect the low back.

Reclining the upper portion of the seat while lowering the knees will increase the angle of the low back. The opposite is also true.

If, for example, your are one of the few who feel better with less lumbar support you should raise the knees and put the torso a bit more upright. If you require more lumbar support than just pumping up the lumbar option, try lowering the seat at the knees and slightly reclining the torso. If that is not enough you may use a rolled up towel.

Smartphones and the physical consequences

Posted: September 26, 2015
By: Dr Nicole Mastando

"Text Neck" refers to the pain injury and spinal misalignment associated with looking down for long periods of time, say from the use of digital devices like smart phones.

According to a recent study (, the average person spends 90 minutes a day on their phone. Whether it is texting, game playing or web browsing, Americans are clearly obsessed with their smartphones.

Looking down for extended periods of time will eventually cause a decrease in the normal neck curve, which is called a lordotic curve or lordosis. A decreas in lordosis can cause serious and irreversible damage like Degenerative Disc Disease, Osteoarthritis, herniated discs and a secondary misalignment of the upper back.

Being that the spinal cord is surrounded and protected by the spinal bones, it is quite possible a decrease in the neck's natural curve can effect the function of the spinal cord.

Symptoms of text neck included chronic headaches, neck pain, upper back pain, muscle weakness, shoulder pain and even numbness.  If you have any of these symptoms, it is important to have a doctor take an X-ray of your neck to see if the lordosis is in tact.

Your Immune System

Posted: March 4, 2015
By: Dr Nicole Mastando

Did you know that some 70% of your immune system lives in your digestive tract or gut? Our gut flora is the security that takes action when it finds any foriegn bacteria that presents a threat to our health. It is a very important function that we want functioning at it's optimum.

Here are some tips to help enhance your immune system:

1. Eat as clean as possible. Remember to put whole nutritional foods in your body and be aware of sensitivities to dairy, wheat.

2. Fish Oil, taking fish oil can be  so benenficial for systemic inflamation.

3. Probiotics. These are a live microbial food supplement  that improve the host's (you) intestinal health. You don't have to take it everyday of your life if you have a healthy lifestyle but it is recommended during stressful times, after antiobiotics or if you're feeling under the weather.

4. Get enough sleep. Your body needs to rest, reset and recharge. Five hours is not enough you should shoot for eight hours, use dark shades avoid artificial light and interruptions.

Keep your immune system healthy and it will do the same for you!

Pain when you wake up?

Posted: August 20, 2013
By: Dr Nicole Mastando

Many patients come to me with pain that occurs when they wake up.  They'll leave my office pain-free, go about their day and slep without a single symptom; until they get out out of bed.  Here is what you need to know.


Reasons for waking with pain:


1) The most obvious reason is that your bed sags.  How to determine if your bed sags?  Put a broom stick across your mattress and if there is an inch or more of space between the stick and the bed, your need to replace the matress or turn it over.  Some mattresses are not made to be flipped.  If you have one of those, then the mattress eeds to be replaced.  How does a new mattress sag?  First, I have found (from discussing this with patients for 10 years) that the most common sagging bed is a pillow top.  This includes my first pilow top that I had for less than 3 years before it sagged.  It was purchased for $1500 and I think that qualifies as "not cheap."  I've also been told by manufacturers that folding the mattress during delivery to get it through doorways internally damages it and causes premature sagging.


2) Stomach sleeping can cause many types of pain including sciatica, neck and low back pain.  Stomach sleeping can even cause headaches.  How?  Sleeping on your stomach twists the spine and if that isn't bad enough, there is added twisting from using a pillow to tilt the head.  This causes spinal injury and even if the pain is gone, the misalignments it causes need to be removed by a spinal adjustment.

3) The pillow you are using is either too high or too low.  This not only encourages stomach sleeping, but it kinks the neck and upper back.  Niether the muscles nor the spine were designed to be torqued and, therefore, pain, spasms and inflammation occur.

If you have further questions about waking up with pain, please call me directly at 781-834-7300.  I recommend a spinal check up to remove your misalignments and reviewing with you your specific reasons for pain.