Self Help Series: Neck Pain
Anna Staehli Wiser, DPT, FAAOMPT
Background:
Neck pain is a widespread condition, with a high prevalence in the general population. “Among all musculoskeletal disorders, low back pain (ranked first) and neck pain (ranked fourth) are the most common worldwide”1. According to the World Health Organization (WHO), about 222 million people experience neck pain in any given year. It is estimated that approximately 50% to 85% of people will experience neck pain at some point in their lives1. Neck pain can affect individuals of all ages, but it is more commonly reported in adults and tends to increase with age2. Certain occupations, such as those involving prolonged sitting, repetitive movements, or poor ergonomics, may contribute to the development of neck pain3. Office workers, computer users, and individuals with sedentary jobs may be at a higher risk4. Interestingly degeneration of the cervical disc has not been proven to be a risk factor 5. Neck pain is reported more frequently in women than in men6. While many cases of neck pain are acute and resolve on their own or with conservative treatment, some individuals may experience chronic neck pain. Chronic neck pain is generally defined as pain persisting for more than three months. Many cases of neck pain are self-limiting and can be effectively managed with conservative measures such as rest, physical therapy, and pain management. If you are experiencing persistent or severe neck pain, it is advisable to consult with a healthcare professional for a proper diagnosis and appropriate treatment.
Anatomy:
The cervical spine, also known as the neck, is a crucial part of the human spine that consists of seven vertebrae labeled C1 to C7. These vertebrae support the head and provide flexibility to the neck. Here's a brief overview of the anatomy of the human cervical spine:
Understanding the anatomy of the cervical spine is essential for diagnosing and treating various neck-related conditions, injuries, and disorders. It also provides insight into the complex interplay of structures that allow for the neck's range of motion and overall functionality.
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Self Help Treatment:
Current recommended treatments for neck pain include acupuncture/ dry needling, manual therapy, exercise therapy, and posture therapy7. While these conservative treatments are very effective, many cases of neck pain can be resolved with some simple exercises and modifications to posture and positioning. Here is a list of things to try at home to help your neck:
Posture: When sitting, add a lumbar support cushion, such as a small pillow, behind your lower back. The lumbar support cushion will elevate your rib cage and allow your shoulders to relax down and back which reduces tension in the upper trapezius muscles and therefore in the neck. When your torso is in a more optimal position this facilitates the neck to be also in a more optimal resting position and therefore leads to relaxation of the supporting muscles and ligaments. if you are sitting at a computer, make sure that the monitor is at eye level and is close enough so that you do not feel the need to lean forward to see what is on the screen. the use of a lumbar support cushion is not just limited to when you are sitting at a computer desk. Sitting with lumbar support is also very important when you're in one position for a long time such as riding in the car, going out to eat, or even watching a movie.
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Sleeping Position: Sleeping position is crucial for a happy neck. The idea is to maintain your cervical spine in a neutral resting position whether you are on your side or on your back. Sleeping on your belly is strongly discouraged because it puts the muscles and ligaments in an end range position for a long period of time and usually leads to a stiff neck in the morning. Try using a rolled up towel to support the cervical lordosis or the natural curve in the back of your neck. If you are lying on your back you may only need a flat pillow or maybe no pillow at all, but the towel roll should always be used. If you are on your side you will need a thicker pillow to support your head in a midline position. Keep the towel roll under the neck as you lie on your side so that the cervical spine does not shift and sag into a side bent position as your muscles relax when you fall asleep.
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Neck Strengthening: There is some very good evidence that neck strengthening exercises, specifically of the deep neck flexors, is helpful with chronic neck pain as well as headaches 8–10. Typically, deep neck flexor strengthening begins in supine with a simple chin tuck exercise. The idea is to be able to maintain a chin tuck as you lift your head off the table about 1 inch. if you can maintain the chin tuck for 30 seconds with your head off the table one inch you are doing pretty good. Most people cannot even come close to this. The ability to maintain a chin tuck is very important for keeping the cervical joints in optimal alignment during functional activities throughout the day. Many people who say they wake up feeling pretty good but then neck pain gets worse as the day goes on are usually experiencing some sort of fatigue that causes the neck to slip out of alignment and then cause irritability of the joints and surrounding soft tissues. Refer to my video below for more information on how to perform neck strengthening exercises correctly.
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Stretching: Gentle stretching exercises can be helpful with certain types of neck pain. generally older individuals with stiffer joints tend to find neck stretching to be more helpful than younger individuals with more mobile, and often times hyper-mobile joints. interestingly, the underlying cause of muscle pain in the neck, shoulders, and upper back is due to an improper length-tension relationship where the muscles are actually in a prolonged position of over-stretch throughout the day which causes fatigue, ischemia, and pain. Therefore stretching them further can be less helpful than you might think. Nevertheless, stretching can be helpful in certain types of neck pain. Generally speaking, neck stretching involves tilting the head to the front or to the side and combining these movements with rotation one way or the other until a stretch is felt in the desired area. Stretches are usually held for 10 to 20 seconds and repeated three to five times on each side. Refer to my video for further instruction.
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Thoracic Mobility Exercises: Dysfunction in the thoracic spine, the area of the spine that has ribs attached to it, just below the cervical spine, is strongly associated with neck pain. Many of the muscles that originate in and around the thoracic spine go on to terminate in the cervical spine, therefore, if there are problems with these muscles, the problems will translate up into the neck. The thoracic area of the spine is notorious for being stiff, partly due to the rib attachments which protect your internal organs. This is why performing mobility exercises is very helpful for this area of your back. Rolling on a foam roller and performing the side lying thoracic rotation stretch are two of the top exercises for improving thoracic mobility. Refer to the video and click on the link below for further instruction on these exercises.
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What to do if your neck pain persists despite trying the home treatments listed above:
This is when osteopractic physical therapy may be needed. Dr. Anna Staehli Wiser will perform a comprehensive evaluation that includes analysis of posture and movement. An individualized treatment will be designed, however, most people with neck pain respond very readily to a combination of spinal manipulation, soft tissue massage, and dry needling. Although spinal manipulation is usually thought to be synonymous with chiropractic care, osteopractic physical therapists and osteopathic doctors are trained in spinal manipulation as well. Soft tissue massage is usually thought to be exclusively performed by massage therapists, but this is a technique that the osteopractic physical therapist is also well trained in. Lastly, dry needling is very similar to acupuncture in that both techniques employ the insertion of acupuncture needles and share the goal of promoting healing and reducing pain.
With osteopractic physical therapy, the patient gets a session that includes all the best treatments in one visit. So, if you are struggling with nagging neck pain, fear not - Dr. Wiser is here to help!
If you know someone who is struggling with neck pain, please forward this email on to them!
References:
1. Verhagen AP. Physiotherapy management of neck pain. J Physiother. 2021;67(1):5-11. doi:10.1016/j.jphys.2020.12.005
2. Childress MA, Stuek SJ. Neck Pain: Initial Evaluation and Management. Am Fam Physician. 2020;102(3):150-156. https://www.ncbi.nlm.nih.gov/pubmed/32735440
3. Touma J, May T, Isaacson AC. Cervical Myofascial Pain. In: StatPearls. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/pubmed/29939602
4. Jahre H, Grotle M, Smedbråten K, Dunn KM, Øiestad BE. Risk factors for non-specific neck pain in young adults. A systematic review. BMC Musculoskelet Disord. 2020;21(1):366. doi:10.1186/s12891-020-03379-y
5. Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population. Eur Spine J. 2008;17(S1):39-51. doi:10.1007/s00586-008-0624-y
6. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858. doi:10.1016/S0140-6736(18)32279-7
7. Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021;25(2):275-295. doi:10.1002/ejp.1679
8. Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701. doi:10.1016/j.math.2009.05.004
9. Edmondston SJ, Wallumrød ME, Macléid F, Kvamme LS, Joebges S, Brabham GC. Reliability of isometric muscle endurance tests in subjects with postural neck pain. J Manipulative Physiol Ther. 2008;31(5):348-354. doi:10.1016/j.jmpt.2008.04.010
10. Cagnie B, Dickx N, Peeters I, et al. The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. J Appl Physiol. 2008;104(1):230-235. doi:10.1152/japplphysiol.00918.2007
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