Let’s Get Physical… Therapy! Ringing in the New Year with Neck Pain? What to do about itJanuary 27, 2015
The 411 on neck pain:
Similar to the low back, it’s difficult to determine the definitive cause of neck pain. However, neck pain can present with the following pain problems, with a likely cause listed next to the pattern:
Sharp pain localized to one side of the neck à dysfunction in one of the cervical spinal facets
Stiffness around the neck, often with pain during rotation and side bending the neck à acute or repetitive muscle strain
Pain from the neck radiating down the arm à radiculopathy (i.e. cervical spinal root irritation)
Pain specifically with looking up and/or over the shoulder à discogenic (i.e. irritation from compression of the disc)
Four tricks to combat pain
Regardless of the specific etiology of neck pain, the contributing factors—such as muscle length and strength imbalances—that contribute to increased loading, need to be identified and addressed.
The following are the top four suggestions I make regularly in the clinic when treating neck pain:
1) Examine your sleep posture. (Hopefully) you spend 8 hours a night resting in bed—that’s a third of your day in which your neck posture could be compromised! The goal is to keep your neck neutral, not too flexed and not too extended. If you’re a back sleeper, make sure your pillow is not too thick, causing your chin to tuck towards your chest. If you’re a side sleeper, watch out for the opposite: not having a thick enough pillow. Your pillow should exactly fill the space between your shoulders and head, so you’re not side-bending your cervical spine in your sleep. Also, beware of curling your wrist toward you; this increases tension on your nervous system, which can also contribute to radiating neck pain and carpal tunnel.
2) Support your neck. Most of us exist in a state of perpetual forward head posture (pictured below). This extends the cervical spine, thereby cramming the facets together and compressing the discs between vertebrae. Fix this by performing five chin retractions every hour. To do a chin retraction, sit up tall and bring your shoulder blades together. Bring your chin backward (directly backward—not a downward nod!) until you have an attractive double chin, and hold for three seconds.
3) Address tight muscles pulling on your neck. Many muscles of the shoulder girdle contribute to faulty neck posture. Stretch your pectoralis minor by lying on your back and having a friend push your shoulders towards the floor. Stretch your pectoralis major by lifting your arm to the side 90 degrees and bending your elbow to 90 degrees, see picture below. Place this arm against a doorway and walk forward until you feel a stretch across your chest. Hold both stretches for three sets of 90 seconds.
4) Recruit your shoulders. Many neck muscles cross the shoulder, making it essential to address these in order to attain good neck posture. In addition to performing basic rotator cuff exercises, engage your middle traps and rhomboids with this simple scapular squeeze exercise: Sit or stand up tall, and squeeze your shoulder blades together. Hold for 10 seconds, and repeat 10 times.