What Causes Neck Pain & How To Fix It

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When it comes to neck pain and how it is treated nowadays, especially at home, there are so many parallels with back pain. The same sorts of errors are made on the whole, the same sort of “muscle first” treatment instead of considering the needs of the spine and how the cervical spine contributes to injury. The same exercise principles are applied too, the excessive use of flexion to “stretch” those tight muscles that are overworked. You’d be forgiven for asking why we’re saying this, and so in today’s piece, we’ll explore it all and hopefully leave you with a better understanding of your neck pain and how to effectively handle it.

Understanding the structure of your neck

The neck, or rather the cervical spine is very similar to the lumbar spine, in that it should have a backward bend to it. Unlike the ellipse shape of the lower back, the neck should forma circular curve. The top of this curve, where the head sits on the spine, should be over the bottom of the curve, this is vitally important as we’ll see later. The muscles of the neck work to support this alignment very much like the strings on a bow, holding the C-shape, alongside the deep and numerous ligaments of the back of your neck which maintain the alignment more passively. If you’ve seen any of our posts on the lower back you’ll know that it is this balance of ligaments that maintain adequate neck alignment, the muscles can then effectively act on this alignment. Problems arise when the alignment is significantly abnormal. More on that later.

The forces at play here can be quite large, a short google images search will give you a visual of just how small your neck is in comparison to the size (and weight) of your head. Typically the average head will weigh close to the typical bowling ball, and it’s balanced on this tiny little stick of a cervical spine. Yes we have tremendous ligamentous and muscular support. As anyone who’s experienced neck pain will tell you, when your neck is injured you suddenly become very aware of the weight and balance of your head on your neck, even if you don’t have a deep understanding of why it’s so profound.

In the case of the neck, just like the lower back, we also have discs in between all of the vertebra to act like little shock absorbers and spacers for the nerves to exit our cervical spinal column and go down to the shoulders and arms. 

Modern life and its effect on your neck

As time has progressed over recent years there has been an acceleration in change in the way we use our neck and shoulders. Our daily patterns, much like in the case of the lower back, have changed dramatically. Nowadays, even more so, we see children given captivating electronic devices as pacifiers. The use of devices nowadays leaves us perpetually looking down. For some, to the point they struggle to look up!

Our body adjusts to how we use it and our neck is very mobile, much more so than the lower back and for good reason. However, just like the lower back, a “stick” between two large centers of mass, the pelvis and the rib cage, in the neck we have the large rib cage on the bottom and the large head on top, with nothing but muscles & ligaments to maintain the support and structure actively. This is not a problem as we’re designed for great mobility in all directions at the level of the neck. But just like in the lower back, our body starts to check fundamentally when we repetitively put our body in set positions for extended periods of time. 

When it comes to the routine use of smart-phones and laptops, with us looking down all the time, the ligaments in particular on the back of our neck begin to become subject to the effects of ligamentous creep. Remember the natural balance of tension is there to allow us to effortlessly retain good neck posture and resist the load of gravity on this rather vulnerable structure – your neck. As we start to influence the laxity in these ligaments, they start to stretch on the back, elongating and facilitating the looking down posture, making it easier to do. However this comes at a cost, it becomes less stable in the upright position and less efficient to maintain.

One of the things we saw clinically over the years in practice, was a phenomenon whereby as a general rule, people would come into the clinic with significantly worse neck alignment, even a complete loss of neck curve! Their spines would be literally straight or even bending the wrong way, which raises huge challenges for their own body to hold their head – no wonder they have recurring pain and struggle to make progress! It would be very rare to see such a measured change in the lower back! 

How this modern life makes you vulnerable to neck injury

This presence of significant disruption in the cervical spine has impacts far and wide, for example, It puts a permanent stretch through the muscles of the neck and upper back, meaning they’re always in a position of mechanical disadvantage. Having to work overtime just to hold up the head. There is no longer the graceful efficiency of normal neck alignment. Once more the ability to shock absorb now becomes questionable. Before you could very clearly visualise the nice smooth curve accentuating under load and springing back. Now the neck that is straight or bending forwards, has a difficult time absorbing shock without bending the wrong way, focusing pressure onto those discs in ways similar to the lower back, only more pronounced.

It doesn’t have to be a complete loss of curve either, significant loss of cervical lordosis, i.e 40% loss of the curve, although nowhere near at risk of the above forces, still is under the same mechanical stresses, such as elongated neck musculature compared to the normal neck.

Before we move on it’s worth noting that the neck, just like the lower back, has a normal alignment and a significantly large “range” within which the human population can fall. A few degrees difference are perfectly reasonable variations on normal, even 10-20% in many cases is reasonable, either way. There is an unfortunate habit these days for some to exaggerate the significance of small variations in alignment when in reality they are normal variations within a human population. What we’re talking about in the above examples are significant changes. I.e. 40% or 100% or 120% loss of normal curve and the impacts that has on the fundamental mechanics of the cervical spine.

So how are necks injured?

Quite often the sort of neck pain that resolves in a matter of days, is present in the person with more normal alignment, their body has been insulted, just like a cut on the skin, everything is normal and they recover nicely. However, in the more long lasting and repetitive case, there is often a degree of trouble occurring at the level of the alignment. You see, when the curve of your neck is significantly affected, and you injure or tweak your neck, it will be the joints that are affected, be that the facet joint, a bit of intervertebral disc, the reality is that these structures are so interrelated, it is hard to injure just one thing. However, when you injure yourself, in a minor way, you’re more forces at play because of the alignment inefficiencies, often maintained by the way you use your body on a daily basis. 

You often gravitate towards chin tucking exercises, chin to chest stretches and the like. We call these knee hugs and child’s pose for the neck! Stretches that increase the size of the spinal exit foramina, and stretch tissues that are injured, further reducing stability and interfering with the healing process – think picking the scab! We forget about the muscles on the front of the neck that are likely contributing to this bad head and neck posture and changes in the cervical alignment. It feels a nice stretch on the back of the shoulders so we continue. All of this, just like in the case of the lower back, makes the issue worse!

What should you do to help neck pain?

One of the first steps to take is to understand that modern life has us looking down a lot, and that when injured there is an instability created, your neck musculature will get very tired trying to balance with this injury, bad alignment or not. So having a regular way to give the muscles a break is vitally important. A personal favorite, just like in the lower back, is the towel exercise. This has the effect of supporting the normal alignment of the neck, whilst giving the joints and muscles a break. Just lying flat on your back will often flatten the neck curve more, creating trouble, so the towel provides the support for the natural circular curve – the neck lordosis.

Unfortunately some of you will struggle with rigidities in the neck, joints which aren’t moving as well as they should be and when you look up the neck jars, quite painfully. The fix for this to help the bad joints stop making the injured segments worse is to block them. This means using a towel or strong band, pulling through the neck in a back to front direction whereby the band or towel supports the neck curve. Now as you’re gently pulling forwards you can test looking up. This takes a little trial and error, however it is usually just below the focal point of pain that you’ll find when you apply the fix and look up, your pain instantly diminishes. For example, you’ll be able to look up further before the pain kicks in, or be able to look up the same degree with less pain. This as a gentle exercise below the injury, not on the injury often helps with the benefit of the towel exercise mentioned above and also helps reduce stiffnesses that develop from the muscle spasm that can be often problematic. 

Your posture has an influence on neck pain

You cannot get away with it, you’ll also need to work on good posture to make sure you’re putting your head and shoulders in the best alignment possible, working on this now and for the long term you’ll find that the neck and its muscles can adapt to this better posture. And as you start to also work on strengthening the neck muscles you’ll be able to make more progress towards a good head and shoulder alignment and being strong in this position.

Comment of the Week – Janet

“I am so grateful for the relief and mobility that these exercises afford me. Also, by the time my operation date came, I no longer needed the surgery. The exercise programme works…”

3 Steps To Neck Pain Relief

  • Stop doing chin tuck or chin to chest stretches

These stretches only serve to exacerbate the underlying problem and stretch out muscles that are already working overtime!

  • Start some simple relief exercises – relieving the strain on the neck!

The band exercise and towel exercise are a great combination here to provide you with a means to work to alleviate strain on the neck whilst also supporting good alignment, 5-10 reps of the neck band exercise and 3-5 minutes on the neck towel will work great. Just make sure you dismount the neck towel without twisting your neck!

  • Start simple strengthening with the curve in mind.

A great way to start building strength with bands is to do modified chin retractions, not really tucks. Remember you want the band to pull in and support the neck curve whilst the muscles of the neck retract your head into the right, vertically aligned position. The bands will also allow you to scale your progress over time!

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  1. Hi Michael, Thanks for this podcast. I’ve suffered with lower back pain for 25 years (have two prolapsed discs, bony spurs etc.) and also neck pain. I’ll be signing up to your premium membership soon, but I wondered what your thoughts are on the Alexander Technique too as that mainly focuses on posture? I tried to give it a go several years ago but at that point, I was in too much pain to continue the course. I now take Baclofen daily which has changed my life. I’ve gone from not being able to walk, stand or sit to leading a relatively normal life although very restricted but I think I’d be better placed to follow it these days. Do you incorporate any of the AT lessons in your teachings?

    1. Thanks for the comment Caroline, to be honest, we only have a rough idea of Alexander technique, but principally working on good posture is a good move. Fundamentally however, without strengthening good posture is great but missing a “resilience”. I wouldn’t be surprised if there are some significant points of agreement with AT, however there may also be some nuanced differences that will be important too. We look forward to having you part of the group 🙂

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