This past week I started my 2nd internship of my graduate school career. So far it has been an amazing experience full of learning, and exposure to many different patient cases. One very common case I have noticed so far is the prevalence of neck and shoulder pain from either poor posture, stress, muscle tightness, or a combination of all three. So, I started doing some research and I found that an average of 25% of people coming to physical therapy are referred for neck and/or shoulder pain. For this reason, I decided to write a post about neck pain, correct posture, and how to decrease this pain/discomfort.
There are countless causes that can lead to chronic neck pain, but some of the most prevalent cases I have noticed are the 3 I listed earlier: poor posture, stress, and/or muscle tightness.
Until recently, the ideal posture was to sit up straight with a neutral curvature of the spine, shoulders back, and head forward aligned over the trunk. If you absolutely need to stay in one position for an extended period of time, it would be best to stay in this neutral position. However, the best position for you to be in is actually a continuous change of postures sustained only for short periods of time. This means it is best to continuously move around throughout the day rather than “get stuck” at a computer or on your phone all day. While looking at a phone or a computer all day, people tend to get into this forward head/ rounded shoulders position which shortens the muscles at the base of your skull, puts pressure on important structures passing from the neck through the shoulders and down the arms (Thoracic Outlet Syndrome), and creates tension throughout the neck leading to an increased load of the anterior (front) portion of the intervertebral disc.
The best way to prevent this is by changing your posture and standing/walking frequently (about every 15-30 minutes) throughout the day. For those long days at work, school or pretty much anywhere when you have this type of achy neck pain, a great reliever is with cervical distraction, or traction. This is difficult to do by yourself, but a physical therapist developed a device that is great for accomplishing just this, and it is called the Neck Hammock. You just attach it to any door, set your head/neck in it in a supine (laying on your back) position, and it will provide a light pull to decompress those intervertebral discs and help to relax some of the muscles surrounding your neck. This slight distraction force is not only relaxing, but it takes stress off many of the structures that are compressed throughout the day, relaxes muscles, and desensitizes structures supporting the neck and shoulders.
Stress can be the cause of numerous problems in our bodies, often times leading to chronic pain, poor sleep, and depressed moods. This stress can create a cycle of pain leading to trouble sleeping, and in turn a lack of sleep can lead to chronic pain. This is a tough cycle to break, but it is definitely possible with the right mindset and patient education. It is very common for people to carry stress in their upper back and neck leading to headaches, muscle tightness, and again back to a painful/discomfort type of stimulus sent out by your brain.
In order to help break this cycle it is important to get to the root cause of the problem. Often times people are over worked, sedentary, and have two things to do for every one task they finish, leading to a fairly stressful situation. Learning to find time to decompress, stretch, and maybe even meditate with some diaphragmatic breathing techniques can be a great place to start. A great tool again is the neck hammock I mentioned earlier. 5-10 minutes is typically long enough with this light distraction force, leading to a calm, decompressed mind and cervical spine. For more tips on relaxation and breathing, head to my sleep and wellness blog post which is linked here.
With this forward head posture mentioned earlier, your lower cervical region (the lower part of your neck) goes into flexion, but your upper cervical region goes into extension in order for you to keep your head up and look straight ahead (kind of like these two people pictured below). This leads to a constant shortening of the sub occipital muscles (the small but strong muscles attaching from your upper vertebrae in your neck to the base of your skull). When these muscles shorten and get tight, they can compress some of the vascular system going to your head leading to tension headaches (the throbbing/pulsing type of headache).
A great way to reduce these headaches and release some of this muscle tension is to perform a sub occipital release. This is similar to a pressure/trigger point and basically you compress the muscles right at the base of your skull to “release” the tension being held in them. A great way to do this yourself is by taping two tennis balls or lacrosse balls together so they are shaped like a peanut. This Peanut Massage Ball works great too. Lay on your back and place the peanut right at the base of your skull or right under it. The gap between the peanut shape should be over your spine so there is no pressure on it. Lay on them for 15 seconds to 2 minutes and the pressure should begin to decrease. This will help the sub occipital muscles to relax, especially when followed up with stretches and some neck strengthening exercises as well.
Most of the tips previously mentioned in this post are great for relaxation and decreasing pain/discomfort temporarily. In order to resolve many of these problems associated with neck and shoulder pain, it is important, if not necessary, to pair the previously mentioned tips with manual therapy, stretches, patient education, correct biomechanics, and strengthening exercises. I can not wait to graduate this December and have the opportunity to help as many people as I can with issues like these, but for now, looking for a well educated physical therapist is a great place to start. I hope you enjoyed and learned something!
William Schopp, SPT 5/4/18
Disclaimer: This post is written for entertainment purposes only and should never be used as medical advice as exercises and treatments are always evolving with current research. If you believe you have pain, a medical problem, or any other potential impairments, please call your local Physical Therapist or any other medical provider.