What a Pain in the Neck!

Do you have pain in the neck?

Pain and tension in the neck, upper traps, shoulder, and upper back region are unfortunately so common across most age groups. Often people will experience a sensation of tightness in the front of the shoulders and pectoralis region, as well as the back of the neck, and weakness in the front of the neck and upper back. We exacerbate this "upper-crossed" syndrome constantly by slouching forward with the upper back rounded, shoulders internally rotated, head tipped downward, and pushed forward daily from looking down for many hours every day. Consistently being in the same posture without breaking out of the position reversing the joint angles compounds tension, creates excessive muscle tension, and eventually becomes pain throughout the region. This pain can feel be achy and deep, sudden and sharp, or an electric shock from the neck to the arm and upper back. This can be caused by prolonged straining postures like looking down at the phone or up at a movie screen for long periods, sleeping in an uncomfortable position, emotional stress, or prolonged loading such as holding heavy bags or overloading a workout.

Neck pain can be either axial neck pain where it is localized mostly in the neck or radicular neck pain where it shoots into other areas like the shoulders and arms. Acute pain will last for a few days up to around 6 weeks, and chronic pain lasts anywhere from a few months to years. Many people experience episodic chronic pain where the pain may be managed for a while and then reoccur from a physical or emotional stimulus.

For most people sitting at the computer all day causes and exacerbates neck pain, reducing the range of motion (ROM) when turning the head, lifting the arms overhead, or reaching behind the body. As these positions become tighter it becomes harder and harder to regain proper ROM, eventually limiting what's available for the body. It's true that if we don't use it we lose it, and it's challenging to regain lost mobility, taking time, patience, and persistence.

Ideally, when someone first starts noticing discomfort or tension in the neck and shoulder region, they would start a mobility and strengthening program to combat the issues to reduce the likelihood of it turning into more intense pain or becoming functionally limiting. However, most people either don't know what to do or don't realize that they have control over the situation of how painful and debilitating neck pain can become.

When dealing with pain in the neck, upper back, shoulder, and upper arm it can be difficult to figure out where the initial problem began. Where we feel the sensation of pain is not necessarily where the problem area is located. For example, a lot of pain felt in the back of the neck and upper trapezius can be initiated by tension in the front of the neck and tight pectoralis muscles. So, we can stretch the back of the neck for days and still not relieve pain if we're not also stretching the front of the shoulder girdle as well.

Pain and stiffness can simply be excess tension within the local tissues and tendons, but we want to combat it before it evolves into something else like neurogenic thoracic outlet syndrome, cervicogenic headaches, or frozen shoulder. First, we feel stiffness in a region that will then turn into stronger tension, which will pull at the surrounding structures becoming painful, if left to continue, the body will try to protect the region by tensing up further, reducing ROM, increasing pain, decreasing strength, and the cycle continues.

Ideally, we would all modify our lifestyles and do all the proper exercises to counteract daily stressors, but that is simply not realistic. Even movement specialists have pain and injuries. Some people are more prone to certain injuries naturally, others have developed certain issues and triggers from their environment over time. So, the best we can do is to become mindful of the body and learn to stretch what feels tight, move what's stiff, and strengthen what's weak.

The most effective method of combatting tension and pain is a combination of 1. releasing, 2. mobilizing, and 3. reinforcing the surrounding tissues. To reduce stiffness, the goal is to counteract the joint angles associated with the problematic or prolonged posture, focusing on oppositional movements and gentle strengthening that supports the position periodically throughout the day, and consistently over time.

Release work is first in order to relax the surrounding tissues and deescalate the nervous system that is holding those tissues in an alerted state. The release step can be a massage with a manual therapist, or self-myofascial release, placing gentle pressure into the tender or tense areas with either a small ball, foam roller, or percussive massage equipment like the Hypervolt or Theragun. The pressure can be held in place on the region, or the tool can be moved over the area, back and forth, up and down, or circular.

After the local area is released, the tissues have more pliability to be able to more comfortable and safely work through the region. So next is the mobility step. Most people think of this as stretching, which can be done either statically by holding a stretch, or by actively moving through the tissues to create elongation. There is much debate over what is best, so I believe the combination of both static and active stretching to be ideal. Mobility work should move the joint into the greatest range that is possible with support, without losing proper placement in the rest of the body. The kinetic chain should stay properly placed while stretching, never compromising proper placement for a greater range of movement.

Finally, the new release and mobility found are reinforced with strengthening movements to teach the body how to support its range and flexibility. Reinforcing movements add a gentle load to a position, either a resistance band, a spring such as on the Pilates Reformer, a dumbbell, or the body weight held against gravity. The amount of load must be proper for the individual's unique needs. With too much load or too many reps for the exercise, the body will strain to maintain causing tension that will again need to be released.

A strong muscle will feel pliable, supple, and capable, a weak muscle will feel grippy, tight, and protective.

When working through the pain we need to be able to move through sensation. We don't need to be afraid of pain and sensations in the body but should use them as a guide to finding the proper amount of pressure and movement. Move through sensation, and bump up to the pain where it is still a tolerable sensation without forcing through sharpness or severe discomfort. Every day is different and we have to meet our body and our client's body where we/they are for the day.

The body is remarkably resilient and doesn't get injured easily, even though sometimes it seems like everything hurts. When we're in pain it can feel scary to try to move as we assume it will cause damage and more pain. At times, it is good to rest and let the body recover but mostly, and especially in the case of chronic pain, we can't rest away the pain. Proper movement and release work will help the body feel better afterward. Pain and tension emerge after years of compounded exacerbation, so we can't expect it to go away overnight. But, with a consistent practice of counteracting the stressors our body faces in our everyday postures, we can reduce that tension and with time and practice, we will feel better.

Releasing:

Foam Roller Thoracic Extensions

Lacrosse Ball Massage-laying supine on mat or standing against a wall

Traction

Tens Unit

Mobilizing:

Chin to chest Nods

Head Tilts/Head Circles-w scapular depression-2x30sec

Chin retractions laying supine or seated

Shoulder shrugs supine

Pec and front of shoulder stretches-2x30sec

Quadruped pushup plus-2x10

Ulnar Nerve Glider-2x10 slowly

Radial Nerve Glider- 2x10 slowly

Thoracic Rotations-3x each side

Puppy dog pose-2x20sec

Thoracic extension, elbows on wall or bench kneeling

Reinforcing:

Shoulder External Rotation-band or arms-2x15

Neck Isometrics-Anti-extension, Band-5x5sec

Prone extensions, prone arm lifts, prone chin tucks

*Videos of exercises can be found on my Youtube channel

*Best to consult in a private session to confirm proper position and technique for individual needs

*Learn proper breathing techniques. Breathing improperly primarily uses the Scalenes and Traps which strain the neck and can create pain and tension. Breathing deeply into the diaphragm activates the abdominals and keeps the neck and shoulders relaxed. Lay down supine (on the back) and take a few breaths in and out. Notice where you're breathing from. If your neck feels stiff on the inhale and/or if the chest lifts considerably more than the belly moves then you're breathing from too high in the body. Try to take an inhale expanding the belly sideways and backward. The diaphragm and lungs move in all planes to the front, side, and back. Mostly we forget that we can expand laterally and posteriorly. The constant focus on anterior movement places more strain on the frontal neck structures which can then turn into pain, and if there is already a pain in the neck, breathing from the Scalenes increases pain and tension in that region by continuously firing up that muscle group. Breathing properly is actually quite a challenge, and you may notice a feeling of becoming lightheaded or dizzy. Try to take a slow inhale for 4 counts, hold at the top for 2, and exhale for 4 counts. Focus on the inhales expanding the lungs, and the exhales tightening the belly while continuing to keep the neck relaxed and shoulders heavy into your mat behind you.