Has your neck suddenly hurt? It is impossible to turn your head either to the right or to the left, and the slightest movements cause acute pain? Severe muscle spasm prevents you from leading a normal lifestyle and persists for more than a week? Don’t rush to take painkillers or apply cold (and especially hot) compresses! If the neck is “jammed”, that is, there is a “lumbago” in this projection, it is necessary to urgently contact a professional.
Medical specialists will help determine the exact causes of the phenomenon when a person’s neck is “jammed. Based on an accurate diagnosis, comprehensive treatment and prevention will be prescribed.
This phenomenon is considered a consequence of muscle spasm or the so-called cervical lumbago. The condition may worsen with certain pathologies of internal organs or systems. It is important to understand what caused the lumbago and plan treatment correctly.
General characteristics of pain syndrome
A pinched neck is a pathological condition in which turning and tilting the head is accompanied by severe pain. The sensations can persist for a long time, aggravated by referred pain in the back, shoulders and arms. The nature of the pain is often asymmetrical, intensely expressed only on one side. The pain increases with palpation or turning the head.
A characteristic behavior when pinched is the rotation of the head along with the body.
Pain in the cervical spine (cervicalgia) is a signal of a negative process affecting the body from the inside or outside. Pain syndrome develops in response to a number of irritants, including:
- physiological factors;
- some inflammatory and degenerative diseases.
Unpleasant sensations can be nociceptive and neuropathic in nature. The type of pain is determined by the provoking factors.
Treatment of physiological pain
Advertising:
The most common causes of pinching are physiological factors. These include:
- Uncomfortable body position during sleep
. A bad pillow and an uncomfortable sleeping place keep the neck muscles tense even during sleep. - Sitting for a long time
. Sedentary work leads to poor posture, redistributing the main tension from the back muscles to the cervical spine. - Physical overexertion
. Strength exercises and hard physical labor keep muscles in constant pathological tone.
Muscle hypertonicity is often observed after waking up. The symptom complex can be acute or chronic.
Neuralgia is a serious disease that can affect any part of the body. Treatment of neuralgia should be carried out under the strict supervision of a doctor, but it is quite possible to carry it out at home. Read more in the article: “neuralgia: what to do at home.”
Treatment of physiological muscle-tonic disorders consists of relieving pain and optimizing loads. At home, ointments, compresses, and medications are used to alleviate the condition. To alleviate the condition and prevent nociceptive cervicalgia, self-massage is performed.
Elecampane is a medicinal plant that is widely used in various fields of traditional medicine. Its beneficial properties have been known to mankind for hundreds of years and help against various diseases, from colds to cardiovascular and gynecological diseases. Read more in the article: “elecampane: medicinal properties and contraindications.”
Ointments and compresses
Since the source of pain from physiological pinching is increased muscle tone, the main aspect of treatment is relaxation of tense muscle fibers. As a local remedy, it is recommended to use warming or cooling ointments and compresses.
You can buy such products at a pharmacy or make them yourself.
Cooling agents reduce the activity of nociceptive receptors, which are responsible for pain.
There are several gels, creams and ointments that can be used for home treatment. These include:
Advertising:
- balm Zvezdochka;
- Capsicam;
- Finalgon;
- Apizartron;
- Reparil-gel;
- Refit;
- camphor ointment.
External soft agents help restore normal blood flow, reduce swelling and relieve the feeling of stiffness. Apply them 2-3 times a day until the condition improves.
Features of compresses
The therapeutic effect of compresses is similar to the effects of ointments. The difference between lotions is the way the active ingredients penetrate the skin. Compresses are made on the basis of liquid products that penetrate the epithelial layer more easily. Compositions made from the following components have a warming effect:
- alcohol-containing liquids (medicinal and formic alcohol, vodka);
- medicinal herbs (mustard, angelica, ginger, sage, mint).
The compress is applied to the neck in the area where the pain is most intense. To enhance the effect, the lotion is covered with plastic wrap and secured with a warm woolen scarf or scarf.
Advertising:
The product for compresses and rubbing Menovazin has a complex effect. Immediately after application, the solution cools the skin, providing a mild analgesic effect. When completely absorbed, the medicine begins to warm up the tissues. Heat relaxes muscles, relieving pain and restoring normal tone of muscle fibers.
Medications
To reduce hypertension and relieve attacks of cervicalgia, medications can be used. Pharmacological agents for home treatment and their purposes are given in the table.
| Group of drugs | Name of tablets | Purpose |
| Antispasmodics | Drotaverine (No-shpa) | Elimination of muscle spasms, restoration of normal blood flow |
| Spasmalgon | ||
| Galidor | ||
| Painkillers | Ketanov | Pain relief |
| Nalgesin |
The use of tablets should be minimized. Taking medications orally is recommended only if there is no improvement after using external remedies.
Neck massage
If your neck is stuck after sleep or physical activity, self-massage of the collar neck will help restore normal condition. It is performed while sitting, with a straight back and legs. If the pinching radiates from the right side, massage is done with the left hand; if the pain is localized on the left, then the right hand is used. During the first procedures it can be very painful, so the massage is carried out with the utmost caution.
Advertising:
The self-massage technique is very simple - with an open palm, clasp the opposite side surface of the neck and gently rub it. The movements should go from the middle of the base of the skull to the throat. At the next stage, you need to place your palms on the top points of your shoulder blades, bending your elbows and raising them up. In the starting position, stretch a little and spread your bent arms, pressing your elbows to your sides (palms will be at shoulder level).
Features of treatment for stress
Among the physiological factors that provoke increased muscle tone, stress is also highlighted. A state of increased tension occurs when the body’s adaptation mechanisms to the effects of stressful situations are activated. In this case, additional methods are introduced into the treatment complex for cervicalgia:
- meditation;
- yoga classes;
- aromatherapy.
Such methods allow you to minimize the negative effects of stress factors and significantly alleviate your general condition.
Ointments with non-steroidal anti-inflammatory drugs
Local treatment of diseases of the cervical spine begins with the use of NSAIDs in the form of ointments, gels or creams. The advantage of transdermal agents in this group is low absorption into the bloodstream and rapid penetration into joint structures, usually into synovial fluid. Pharmacokinetic features ensure not only the absence of systemic side effects, but also the development of skin allergic reactions. The best effect of nonsteroidal anti-inflammatory drugs in therapy is observed in patients with moderately severe neck pain in the presence of pathologies without radicular syndromes, as well as in people leading an active lifestyle. The mechanism of action of NSAIDs is to block the enzyme cyclooxygenase. This biologically active substance is involved in the production of the main mediators of pain and inflammation - prostaglandins. Even a single application of ointment with NSAIDs improves a person’s well-being and normalizes the range of motion in the joints. The greatest therapeutic effectiveness is typical for ointments with the following active ingredients.
Ketoprofen
Ointments for pain in the neck of varying severity with ketoprofen have anti-inflammatory, analgesic and decongestant effects. The main mechanism of this NSAID is the inhibition of prostaglandin synthesis by platelet cyclooxygenase, which causes a decrease in thromboxane production. Clinical studies have proven the ability of ketoprofen to relieve pain much faster than its group analogues (Diclofenac, Indomethacin, acetylsalicylic acid). According to its chemical structure, it is a derivative of propionic acid, therefore it is concentrated mainly in inflammatory foci, and not in nearby soft tissues. Ketoprofen actively stabilizes lysosomal membranes and inhibits the action of bradykinins. NSAIDs are included in the following ointments, gels and creams:
- Fastum gel (from 190 rub.);
- Febrofida (from 180 rub.);
- Artrosilene (from 220 rub.);
- Bystrumgel (from 165 rub.);
- Ketonal (from 190 rub.).
When prescribing a local remedy to eliminate pain in the neck, preference is given to gels, the most successful forms of anti-inflammatory treatment. Most of them contain an alcohol solvent, which ensures rapid absorption of the active ingredient and the highest possible bioavailability. When forming the gel base, many manufacturers used triethanolamine, which creates a pH corresponding to the acidity of human skin. And the chemical composition of the drug Fastum includes essential oils for a cooling and distracting effect.
Ketoprofen is one of the few NSAIDs that are not transformed into active metabolites during conjugation in baked structures. This type of detoxification is the safest and does not provoke the development of significant side effects.
Diclofenac
Ointments with diclofenac are characterized by rapid blocking of inflammation in the synovial membranes and other elements of the cervical joints. NSAIDs reduce the production of prostaglandins, inhibit the migration of leukocytes into inflammatory foci, effectively suppressing their locomotor function, reducing the expression of molecules to enlarge and reducing the production of cytokines that control the processes of migration and activation of cells of the innate and adaptive immune system. A course of topical diclofenac helps prevent further tissue damage.
The peculiarity of this NSAID is its pronounced analgesic activity. A decrease in pain intensity occurs both due to inhibition of cyclooxygenase and as a result of a complex effect on the biochemical mechanisms of perception of discomfort by the autonomic and central nervous systems. Diclofenac is the main component of such drugs for local application:
- Ortofena (from 25 rubles);
- Diklaka (from 185 rub.);
- Diclofenac (from 18 rubles);
- Voltarena (from 195 rub.);
- Diclogen (from 120 rub.);
- Diklovita (from 140 rubles).
The bioavailability of external products with diclofenac is 5-6%. This concentration in the joint tissues of the neck affected by inflammation is sufficient to provide an analgesic effect. But the doctor must take into account before prescribing drugs that any biological barrier in the body is not an obstacle to this NSAID. Therefore, ointments and gels with diclofenac are excluded from therapeutic regimens for pregnant or breastfeeding patients.
There have been isolated cases of the development of systemic side effects after the use of Diclofenac. Neurological disorders (dizziness, migraines, headaches) and digestive disorders (excessive gas formation, nausea, heartburn) occurred after applying the products to large areas of the skin for a long time.
Nimesulide
Nimesulide is characterized by good tolerability, which distinguishes it from other external NSAIDs available in pharmacies. Like other non-steroidal drugs, it suppresses the activity of cyclooxygenase in inflammatory foci. The pharmacological action of nimesulide also consists in demonstrating a number of effects that do not depend on its specific group and determine a wide range of therapeutic activity. For example, NSAIDs suppress the synthesis of anti-inflammatory cytokines and inhibit metalloproteinases involved in the destruction of hyaline cartilage. After applying the ointment or gel to the neck area, the phosphodiesterase enzyme is blocked, which reduces the activity of neutrophils and macrophages, which are cells of inflammatory aggression, which explains their antihistamine effectiveness. Nimesulide is included in the following products for local application:
- Nemulex (from 225 rub.);
- Naiza (from 190 rub.);
- Nimulida (from 270 rub.).
That part of nimesulide that penetrates the systemic circulation is metabolized by liver cells and then evacuated from the body in feces (30-35%) or urine (65-70%). The duration of the therapeutic course is 7-10 days. The use of ointments and gels with nimesulide helps to significantly reduce the dosage of drugs in tablet forms and in the form of injection solutions, and prevent their unwanted side effects. Drug therapy is carried out under constant medical supervision if the patient has a history of chronic diseases: hepatitis, nephrosis, fatty liver, renal and liver failure.
The average weight of an adult's head is 5-7 kg, which corresponds to 7-9% of the total body weight. Therefore, the muscles of the neck and shoulder girdle are constantly overstrained, provoking destructive and degenerative changes in the joints, often accompanied by an acute or chronic inflammatory process.
Measures for myositis
Myositis is an inflammation of the muscles of the cervical spine, which is accompanied by shooting pain. Pinching due to muscle inflammation prevents you from turning your head, and in some cases makes it difficult to swallow. Severe inflammatory processes are accompanied by high body temperature and tissue swelling. Pathology appears when there is a draft in transport or under air conditioning, as well as as a result of infectious diseases of the upper respiratory tract, traumatic exposure or toxic intoxication. Self-treatment of muscle pinching of inflammatory etiology is aimed at:
Advertising:
- relief of the main symptoms;
- restoration of normal muscle condition.
The medications and methods of home treatment are completely identical to the treatment of physiological pain in the cervical region. In addition to pharmacological agents, exercise therapy and self-massage are used for recovery at home.
Tablets for hyperthermia
With myositis, hyperthermia often occurs, in which the use of combined medications is justified. Adult patients can take Next or Panoxen tablets, which are combined antipyretic and anti-inflammatory drugs. For treating a child, Ibuklin is better suited, as it quickly relieves fever and is suitable for young children.
Selection of pharmacological drugs
Ointments for neck pain as a monocomponent therapy are used to treat pathologies in the initial stages, when destructive and degenerative changes in the hyaline cartilage have just begun to develop. Symptomatic treatment with external medications allows you to quickly stop the inflammatory process and prevent its spread to healthy joint tissue. Independent choice of ointment is inappropriate, since without preliminary diagnosis it is impossible to determine the cause of the pain. For example, the use of chondroprotectors for myalgia will not bring relief due to the pharmacokinetics of glucosamine and chondroitin. And the use of ointments with capsaicin during an acute inflammatory process will provoke rapid progression of the pathology.
Pain in the neck is the most common complaint with which 75% of patients go to medical institutions. Their frequency increases with age as a result of a decrease in the functional activity of this part of the spinal column. The causes of neck pain are often injuries and degenerative changes, but differential diagnosis can also reveal benign and malignant neoplasms.
Neck pain becomes not only a sign of acute and chronic pathology, but also a multi-stage psychophysiological manifestation, accompanied by a whole combination of regulatory mechanisms and the formation of emotional, motor, humoral and hemodynamic processes. Neurophysiological biochemical mechanisms affect peripheral, segmental, suprasegmental structures. When choosing an ointment, doctors take into account many factors, but the etiology and pathogenesis of pain in the cervical spine become decisive. They are classified as follows:
- somatogenic . Painful sensations are provoked by injury, inflammation, ischemia, damage to bone, joint and muscle tissue, and skin;
- neuropathic . The causes of pain are damage or decrease in the functional activity of the structural elements of the autonomic or central nervous systems at various levels, accompanied by a violation of the processing of sensory information;
- psychogenic . The development of discomfort is not influenced by somatic, visceral or neuronal damage, but only by social and psychological factors. The main mechanism of pain formation is reflex muscle tension caused by an emotional factor (for example, experiencing severe stress).
When choosing an effective ointment for neck pain, the doctor takes into account the stage of the pathology and the degree of complications that have already developed. Acute discomfort is a normal protective reaction of the body to damage to soft, bone or joint tissues, disappearing as they regenerate. And chronic pain occurs due to constant irritation of nociceptors.
Pain syndromes of this nature gradually lose their protective functions, signaling values and activating influence on the mechanism of eliminating the algogenic factor. M. L. Kukushkin gave a name to this uncomfortable sensation, which has a pathogenic effect and provokes maladaptation - “pathological pain.”
| A group of local pharmacological drugs and dietary supplements for eliminating neck pain | Trade names of pharmacological drugs and dietary supplements |
| Nonsteroidal anti-inflammatory drugs | Ketonal, Fastum, Voltaren, Nimesulide, Nise, Meloxicam, Dolgit, Dolobene, Diclogen, Diclofenac-gel or ointment, Ortofen, Artrosilene, Ibuprofen, Ketoprofen, Indomethacin, Piroxicam, Finalgel, Deep Relief |
| Chondroprotectors (glucosamine, collagen, chondroitin, hyaluronic acid) | Theraflex, Arthrocin, Chondroitin-Acos, Chondroitin, Doloron, Arthro-Active nourishing, Chondroart, Shark oil |
| Ointments, gels, creams and balms with a warming and (or) distracting effect | Nayatox, Apizartron, Finalgon, Capsicam, Revmalgon from the 911 series, Dikul balm, Efkamon, Viprosal, Toad stone, Arthro-Active warming, Viprotox, Menovazin solution, turpentine ointment, Nicoflex, Espol |
When prescribing an ointment for neck pain, the doctor takes into account its origin. If discomfort is provoked by destructive-degenerative changes, then NSAIDs are recommended to the patient at the beginning of treatment, and then chondroprotectors are included in the therapeutic regimen. And for pain caused by an inflammatory process, it is advisable to immediately use ointments with non-steroidal anti-inflammatory ingredients. Effective topical agents must meet the following characteristics:
- accelerate the healing of damaged tissues;
- stop inflammatory processes;
- prevent subsequent damage to joints, bone structures, soft tissues;
- reduce the intensity of pain;
- restore blood circulation and microcirculation in the neck.
;
Only a doctor is responsible for prescribing daily and single dosages and the duration of course treatment. Despite the insignificant degree of penetration of the active ingredients of external agents into the systemic bloodstream, cases of side effects have been reported. Their causes were overdoses, excessive frequency of use, and application of drugs to large areas of the skin.
Symptoms for spinal pathologies
Neck pinching is often a concomitant symptom of spinal diseases. Constant pain and limited mobility occur with degenerative-dystrophic and inflammatory-articular pathologies localized in the cervical-brachial region. Factors that provoke cervicalgia are:
- osteochondrosis;
- osteoarthritis;
- uncovertebral arthrosis;
- spondyloarthrosis;
- radicular syndrome.
Advertising:
Cervical lumbago occurs as a result of compression of nerve endings. If you get a severe headache when muscles are pinched, then compression of the nerve is a consequence of swelling of inflamed tissues or tight contact of deformed joint-connective tissues. Such pinching is characterized by increased pain when turning the head sharply, coughing or laughing.
Medicines
Home methods of recovery for inflammatory and degenerative diseases of the spine consist of the following steps:
- Inflammation suppression
. To reduce inflammation and swelling, non-steroidal drugs for external use are used: Diclofenac, Voltaren, and indometacium ointment. - Restoring muscle tone
. To relax spasmed muscles, use ointments Vipratox, Viprosal B, Apizartron and other soft agents that are suitable for physiological pinching.
An additional therapeutic effect is provided by compresses with Menovazin and alcohol compresses based on warming herbs.
Medicines for lumbago
If the pain spreads to the tissues adjacent to the cervical region, take oral or intramuscular antispasmodics, painkillers and NSAIDs. The table shows some drugs that can alleviate acute cervicalgia.
| Pharmacological group | Name | Purpose |
| Muscle relaxants | Sirdalud | Reduction of increased muscle tone, analgesic effect |
| Mydocalm | ||
| NSAIDs and NSAIDs (non-steroidal anti-inflammatory drugs) | Ibuprofen | Suppression of inflammation, reduction of swelling, pain relief |
| Xefocam | ||
| Movalis |
Muscle relaxants are taken only if other means are ineffective. Restrictions on the use of these drugs are due to their effect - the medicine can lead to loss of mobility and difficulty breathing.
Physical therapy exercises
Relaxing tight muscles is a key element of home recovery efforts. Relaxation occurs both with a massage, which you can do yourself, and with a series of physical exercises. There are several main types of training:
- turns the head (chin parallel to the shoulder and horizontal to the floor) alternately in both directions;
- tilting the head to the shoulders;
- circular rotations with outstretched arms.
A complex of therapeutic and preventive exercises (PT) increases the elasticity of muscle fibers and promotes decompression of pinched nerve endings.
It is necessary to do physical therapy exercises at a slow pace so as not to increase the pinching.
A set of dynamic and static exercises normalizes increased muscle and vascular tone. Relaxing-mobilizing loads evenly involve all muscle groups of the cervical-shoulder girdle, restoring neural conductivity. Recommended training plan if a nerve is pinched:
- in the stage of intense cervicalgia for 10-15 minutes up to 5 times a day;
- increasing and decreasing load during each exercise (peak intensity in the middle of the procedure);
- repeat the exercise 4-6 times.
After the symptoms have eased, the duration of the warm-up is increased to 40 minutes. Exercise therapy is also performed after improvement, in order to maintain normal tone and mobility of the neck.
Ointments with a warming and distracting effect
Ointments for neck pain have an analgesic effect and have the ability to increase blood supply to damaged tissues, which is actively used in the treatment of diseases occurring against the background of destructive and degenerative changes. Thanks to thermal effects, a number of physiological processes develop: an increase in the rate of enzymatic reactions, activation of metabolism, expansion of large and small blood vessels, hyperemia, increased blood flow. The inflammatory foci begin to receive a sufficient amount of molecular oxygen necessary for rapid regeneration. The warming effect of ointments, gels and balms relaxes muscle fibers and increases the extensibility of connective tissues in muscles and joints. To form the basis of the drugs, manufacturers use auxiliary components that provide the active ingredients with the maximum possible transdermal and transepidermal absorption.
Neurologists, vertebrologists and traumatologists recommend using ointments and gels with snake or bee venoms only for young people to eliminate neck pain. Elderly and senile patients are usually prescribed distracting cooling agents (Menovazin, Ben-Gay cooling).
After applying a warming or distracting ointment to the area of the cervical spine, blood circulation sharply increases, nutrients are supplied to the affected tissues, and the final and intermediate products of the inflammatory or degenerative process are removed from the foci of pathology. During the therapeutic effects of external agents, painful clinical manifestations also disappear, and joint mobility increases significantly. The greatest analgesic activity is characteristic of the following ointments:
- Finalgon (from 285 rub.). The maximum therapeutic effect of the ointment is provided by two active ingredients: nicoboxil dilates blood vessels, facilitating the penetration of nonivamide into tissues. The last component in its chemical structure is a derivative of capsaicin, an organic compound synthesized from hot red pepper. Due to the stimulation of blood circulation and stimulation of visceral receptors located in the dermis, the analgesic, antispasmodic and vasodilating effect of Finalgon occurs 20-30 minutes after applying the ointment;
- Capsicam (from 290 rub.). The composition of the external agent includes benzyl nicotinate, camphor, dimethyl sulfoxide, nonivamide, turpentine oil. The combined ointment has an analgesic and irritant effect, normalizes microcirculation in inflammatory lesions, and ensures the supply of biologically active and nutrients to them. After lightly rubbing Capsicam ointment into the area of pain, a slight burning sensation is felt, which is replaced by a feeling of warmth. The drug is prescribed to patients for the treatment of not only joint pathologies, but also pinched nerves of the hip joint, inflammation of muscle tissue, including from exposure to low temperatures;
- Apizartron (from 260 rub.). The warming effect of the ointment is based on its constituent components - allyl isothiocyanate, bee venom, methyl salicylate. By strengthening lysosomal membranes, bee venom exhibits pronounced analgesic and anti-inflammatory activity, inhibits the growth and reproduction of pathogenic microorganisms in the infectious etiology of destructive and degenerative changes. Mustard seed extract provides deep heating of damaged tissues, stimulation of blood supply and elimination of muscle spasms. And methyl salicylate (a non-steroidal anti-inflammatory drug) prevents the production of mediators of pain and inflammation - prostaglandins;
- Viprosal (from 255 rub.). The ointment contains camphor, salicylic acid, turpentine and viper venom. The product for local application quickly stops chronic inflammatory processes and reduces the intensity of pain. All active ingredients of Viprosal ointment have an analgesic, decongestant and relaxing effect. Persistent expansion of blood vessels allows you to remove waste and toxic compounds from joints affected by inflammation and improve tissue trophism. Camphor is also characterized by a distracting effect due to irritation of receptors located in the subcutaneous tissue and upper layers of the epidermis;
- Efkamon (from 115 rub.). An ointment with a multicomponent composition, including camphor, methyl salicylate, essential oils of clove and eucalyptus, natural mustard oil, menthol, hot red pepper extract. Efkamon is prescribed by doctors to patients to reduce muscle tone caused by spasm, increase blood circulation in areas of pathology, improve tissue nutrition, and prevent the spread of inflammation to healthy tissue. Essential and cosmetic oils promote rapid transdermal absorption of active ingredients and have a pronounced antiseptic and bactericidal effect.
The use of warming ointments to relieve neck pain is not indicated for everyone. People with sensitive skin will have to avoid most of them, since after rubbing the product in, an unbearable burning sensation will occur. Do not apply ointments with capsaicin, camphor, essential oils, turpentine to skin with any microtraumas: scratches, cracks, small wounds. When purchasing an external warming agent without prior consultation with your doctor, you should take into account that one of the main contraindications to its use is the presence of an acute inflammatory process in the cervical spine.
Before rubbing ointments with bee and snake venoms, capsaicin, and essential oils into the skin, it is necessary to conduct preliminary testing. Apply a small amount of product to the crook of your elbow or wrist and wait 30 minutes. In the absence of redness and rashes, you can use ointment to eliminate cervical pain.
Features of treatment at home
The neck often becomes stiff and painful from improper body position or from a draft. In inflammatory diseases, there is increased pain when moving the neck and body, and spread of cervicalgia to the shoulders and other adjacent muscles. With a long course of cervicalgia, the likelihood of developing myofascial syndrome increases. Pinching can be successfully treated at home using several therapeutic methods.
The effectiveness of home treatment is due to a calm environment and the ability to regulate stress. For all types of neck pain complicated by difficulty turning the head, the following methods are used:
- rubbing with heating and cooling agents;
- compresses;
- medications for pain, spasms and inflammation.
An additional effect is provided by a course of massage (self-massage) and regular exercise therapy.
