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Neck Pain

Neck pain is very common in our society and many individuals experience neck pain on a daily basis. Some people have neck pain related to certain movements, some have neck pain while working on their computer, and others while sleeping. Neck pain is often treatable with physical therapy and specific interventions. In rare cases one needs surgical intervention for their neck in order to become pain free. When one experiences neck pain, it is important to note if the cause of the pain is an issue with mobility, stability and motor control, or posture.

There may also be mechanical causes of neck pain, meaning that the source of the pain is the result of something not working properly in the spine and/or its supporting structure. Mechanical neck pain can be a result of a disc herniation, muscle or ligament issue of the spine. There can also be chemical causes of neck pain, meaning inflammation in the neck. In any case, there are specific interventions that can decrease the pain in the neck and return to normal functioning.

To provide some background and general anatomy, the skull sits on top of the “neck,” aka the cervical spine. The first vertebra is labeled C1, also known as the “atlas.” The neck consists of vertebrae C1-C7. Each vertebra connects with the one above and below it, and forms a “joint.” Below this region is the upper and mid back, called the thoracic spine, with the vertebrae labeled T1-T12. There are five lumbar vertebrae below that, then the sacrum and coccyx regions.

The main movements of the neck are flexion (nodding), extension (looking up), rotation to both sides (looking over one’s shoulder) and sidebending to both sides (bringing the ear to the shoulder). There can also be combined movements of the neck in any of these directions. There are many muscles that connect the head to the neck and neck to the shoulders and thoracic region. These provide dynamic movement and stability and help to keep one upright against gravity. There are also many ligaments that provide static stability of the neck and aide in shock absorption. Between each vertebrae there is a vertebral disc, as well as the spinal cord and spinal nerves that run through this region.

If a lack of mobility is the main cause of the neck pain, then a thorough evaluation of the neck should be performed. It is important to determine if the lack of mobility or range of motion of the neck is because the actual neck joints are not moving well. A physical therapist will determine if the neck moves appropriately both actively and passively, and which segments are “stuck.” Poor flexibility and shortening of muscles or fascia may also cause a lack of mobility in the neck, thus the tissue extensibility of the neck should also be determined. Specific techniques to get the joints moving properly will be administered and/or proper stretching techniques for the neck as needed. Often, hands-on techniques are very successful in the neck region and will assist with the mobility of the joints and the muscles.

Often, the mid back or “thoracic spine” can be a culprit in neck pain. If the thoracic spine is locked up and not moving well, then the neck does not function well and can become painful and out of proper alignment. We often see that when the thoracic spine is treated and becomes more mobile, the neck pain is eliminated. The thoracic spine is considered a base of support for the neck. If the origin of the neck pain is actually the thoracic, then the person may continue to be in pain until the proper region is treated effectively.

Proper stability and motor control are essential for a healthy and pain-free neck.If someone is holding their head in a strange way, or not keeping proper posture throughout the day then they will often experience neck pain. At times, the body will subconsciously compensate or begin to move in inefficient and ineffective patterns of movement. This person actually has the proper mobility, flexibility or range of motion but their body has simply forgotten the proper way to move or the proper posture to hold their neck in during the day. This person benefits from specific strengthening, stabilization and/or motor control exercises in order to re-pattern their body and movements. They essentially have to “re-learn” how to move in the right way again.

Again, the thoracic region can have an effect on the neck in terms of the stability and motor control deficits. If the person does not have the proper strength, stability, or motor control patterns in this region, then they may feel neck pain. Proper “scapular stabilization” and proper postural support in the mid and upper back is essential for spinal health in the neck. Being able to keep the shoulder blades together and down, open and flexible in the front of the chest and keep the head in line with the body are key. Often, when someone is weak in their postural muscles they will develop “winging” of the shoulder blades. This looks like the shoulder blades coming outwards from the body, especially with the hand behind the back or when the arms are lifted up and over the head. They may also experience “forward head posture” whereby the head is in front of neck and may cause dysfunction.

Mechanical neck pain can be caused by the discs, muscles, or ligaments of the neck. If the discs are being compressed or if there is a disc herniation or bulge, then this can cause neck pain. This can be treated with physical therapy, often focusing on techniques to restore proper mechanics of the spine and proper posture. At times, chin retractions are effective in treating disc issues in the neck. The muscles may be tight and restricted and need to be treated in order to attain proper extensibility and flexibility. The treatment is often multifaceted and a thorough evaluation of the items listed above is warranted in order to determine an effective and efficient plan of care.

Another factor that is often related to neck pain is the scapulothoracic region. The scapulothoracic joint is formed by the posterior thoracic cage and the surface of the front of the shoulder blade. If this region is either stiff and not mobile or weak and not stable, then the neck may be affected. Often, the neck muscles overcompensate for this region. Specifically, the upper trapezius muscles and levator scapulae muscles start to aide too much in lifting the arm up and out or up and over the head, and pain develops. These neck muscles become very tight and can develop painful trigger points. Essentially, the shoulders and shoulder girdle can affect the neck and cause the pain to develop.

Lastly, repetitive motions of the neck and spine and poor ergonomic set up can cause neck pain as well. It is so important to have proper ergonomics at your work-station, with eyes level and head on straight. People working on computers or laptops are often culprits of poor ergonomics. One should invest in an ergonomic evaluation and use a laptop holder with a separate wireless keyboard and mouse that helps them keep proper posture through the neck and shoulders. Watch for repetitive motions and movements and address this as able so that you are not consistently moving from the same places in the neck or spine. For example, if you have two monitors then be sure you can move your entire body rather than just always your neck movement. Repetitive reaching motions can also affect the neck, and overhead reaching or work above the head can also put strain on the neck and cause pain.

Prevention of neck pain is key. Get up and move during the day, reposition and watch your head, neck and spinal positions. Watch your posture, and make sure you have proper strength and stability in your neck, shoulders, and thoracic spine. Attain proper strength in your neck and postural muscles and be sure you are using the correct patterns of movement in daily life. Watch your ergonomics and do not get stuck with repetitive movement or requirements. Check your pillow and be sure this keeps your head and spine in a neutral position and do not sleep on your stomach as this is a difficult position for the neck.

If you have neck pain, get evaluated thoroughly to determine which aspects you may need to address. Every individual is different and unique, so be sure that you ask a healthcare professional for help. Your neck pain most likely can be treated effectively with the appropriate interventions, and it may take some work on your part with specific exercises if it is an issue of a weakness or poor flexibility. Another key is to develop good posture and ergonomics now so that you do not develop neck pain in the future. Take care of that neck, it will help you keep you “level-headed”- literally!