All of us have experienced that awful stiff neck at some point in our life and know just how draining it can be to our bodies, not just physically but mentally and emotionally. Imagine being like that every day? With the use of computers becoming so much more prominent each year and the introduction of lap tops, IPADS and smartphones, the rise of chronic back pain along with neck and shoulder pain injuries is substantial. If the problem is left unattended, and you just put up with the pain, it can lead to severe injuries that are very difficult to treat and lead to other more serious problems. Disc bulges in the neck are becoming very common, and not just limited to old people. The first thing people normally do is take some anti inflammatory pills, perhaps get a massage and maybe do some stretches and hope it goes away. And while all this gives some relief, it is just a short term remedy. It is really just using a band-aid approach to treating a much bigger cut or bleed. In this article, I will provide you with the knowledge on how neck problems are created in the first place, so you can treat the “real problem”, prevent the onset of chronic pain and get rid of it for good.
Removing The Pain Does Not Mean You Have Removed The Problem
What do I mean by that?
As I mentioned in the introduction many people address their pain or injury by trying to remove the pain. This is true for all injuries, not just neck pain and is why so many people tend to go through life spinning their wheels going nowhere using this approach.
Pain is a signal that something is not right and needs your attention. A bit like a smoke alarm in your house. Now if your smoke alarm started beeping it would not be wise to just remove the batteries to stop it beeping, without addressing why the alarm is going off. The alarm is warning us to address a potential fire that could kill us. But this is exactly what people do when they have a neck problem. The pain is just the signal to address a problem, and often it is nowhere near the area in pain, in this case the neck that the “real problem” lies.
You must treat the cause and not the symptoms! If your problem was caused from a car accident or a traumatic accident then your solution is slightly different to what I will show you in this article. But for 95% of neck problems they have evolved over time from poor habits and not from an accident.
Okay so how do you go about changing this? Where do you look? Where do you start? There is a lot to consider, and I like to use the process of elimination to narrow my search to finding the real problem. So let’s get started.
If You Have A Neck Problem You Most Likely Have A Scapula Problem Too
I don’t want to repeat myself too much in this article as I covered the main reasons for neck pain this article – Why you should stop stretching your neck.
But I do want to stress the point that in almost every case of neck pain you can trace a problem at the scapula and shoulder complex as to where your pain, limited movement is coming from. The muscles that move your head, are also the same ones that lift your arms! Unfortunately it is not as simple as give you a stretch and do this exercise and it is all good. This problem can send you down the rabbit hole once you really start on the process of correcting dysfunction, as you will find there is a lot more to the scapula and shoulder than you think.
Without a doubt the most difficult area to correct, and also one of the most painful and debilitating the longer the problem remains. The shoulder joint is extremely complex, and is very unique in that it is the most dynamic joint in the body, possessing incredible mobility to do amazing things like throw balls, do push ups etc. But this incredible mobility comes at a cost to our stability, in particular the scapula, and this is where many neck pain injuries will emerge.
Lack of stability forcing stiffness in order to stabilize the joint begin to wear out soft tissue ligaments, tendons and cause tremendous pain. Getting a massage, or doing some stretches is not the answer. You will have to find better ways to stabilize this joint with exercises. But, you must be very careful here for if you choose the wrong one or do too many your attempts to correct things will make matters worse and give you, MORE PAIN!
Okay so let’s take a look at the individual steps to take and rule out as potential problems.
Focus On Improving Your Posture
Now I can hear you groaning already saying you already know this and you have tried it and it didn’t work.
Poor positions of the body, mixed with long periods of time stuck in these poor positions is a perfect recipe for a neck or back problem. This also means that the correction is a combination of GOOD positions and habits mixed with TIME! The picture below shows good posture on the left and poor posture on the right that highlights the common posture imbalances we see with people suffering from neck problems.
This is known as Forward Head Posture.
The effects of this muscle imbalance between the trunk flexors (your abs) and trunk extensors (your back muscles) creates a chain reaction of problems.
“Every inch your head moves forward it doubles itself in weight!”
This means your neck muscles which are designed to hold a head, that on average weighs about 5-7kg for most people, now needs to hold a head that weighs 15-20kg! This is the basic laws of levers. These neck muscles are now forced into working excessively hard, ALL DAY! They can never stop for if they become weak you will not be able to look forward, and ultimately function as a human. They learn quickly that the only way to keep your eyesight looking forward is to shorten themselves and become good at doing it.
It is recommended getting a thorough postural assessment from a well qualified therapist or trainer.
The most concerning issue arising from postural faults and imbalance, is not just the area in pain but the risk of further more serious injury in other areas in the body and loss of balance. This is due to the loss of stability and balance. The body will use many protective methods resulting from instability that in turn creates loss of balance and rotation.
For example a forward head posture will increase the thoracic spine kyphosis restricting your ability to rotate, which in turn restricts your balance as you are now limited to correct yourself when you need it. Okay so it is obvious the solution is to correct your posture.
But before you can do that, you need to find out why you adopted this poor posture in the first place! Remember I said you have to find the cause. There are 2 common reasons for this and they are the first 2 things to address.
Step 1 – Assess Your Breathing
What does breathing have to do with neck pain you might be thinking? It has everything to do with it.
Read our article “Do You Know How To Breathe Correctly” to see just how important this is and just how many muscles, organs and systems in the body are affected by how your breathe!
Many neck pain sufferers are poor breathers and unknowingly adopt a method of breathing similar to an asthmatic having an asthma attack by using their shoulders and neck to create respiration. They are often mouth breathers or at best heavy chest breathers, and very poor diaphragm (belly) breathers. There is no point in doing any stretches, exercises or getting massage or chiropractic treatment while your breathing is dysfunctional. You are going to take on average 20-25,000 breaths per day so getting it right is critical.
Learning to breathe through the nose and how to effectively use your diaphragm prevents you from using your shoulder and neck muscles to breathe. Yoga, meditation and Tai Chi are great methods to use here.
For such a simple tip it is so powerful. I cannot tell you how many people have resolved their problem from learning to do this alone!
Step 2 – Assess Your Sitting Posture
Without a doubt sitting is the biggest cause of many problems and for many chronic neck pain sufferers it is almost impossible to do as it brings on their pain straight away and aggravates their condition.
It is not necessarily sitting that is the problem, but more to do with HOW YOU SIT.
This has also become worse in the past 15-20 years with more and more of us using computers, and stuck in sedentary jobs requiring us to sit all day. First thing to do is to avoid being stuck sitting for too long without a break. Take at least a 1-2 minute break to get out of your chair and free up your hips, spine and pelvis at least every 10 minutes. Using stretches regularly throughout the day can help counter the damage of sitting.
What about workstation set up?
Again this is very important to get right and I suggest you go to our article “The Dangers Of Sitting To Your Health” for a full explanation with pictures and instructions on how to do this. Below is an example of how to set up your chair and mouse.
The problem these days is that many people do not even use a workstation!
The use of smartphones, tablets and laptops mean people are in an even worse position than before. Constant flexing of the neck and sitting in very flexed and uncomfortable positions for extended periods it is just a matter of time before a neck problem arises. My advice is to make sure you set up your laptop in a correct position and avoid sitting in poor positions as much as you can when using your phone or tablets.
This is why neck pain is on the rise and will continue to be until we address the real issue. Smartphones, tablets are here to stay, we just need to be aware of the potential dangers and find ways to make using these devices safely.
The first two steps are really about treating the cause of the problem, now we are about to begin treating the effects of this cause which in turn creates the stiffness in the neck.
Step 3 – Improve Thoracic Extension & Mobility
The thoracic spine (upper back) plays a critical role in ensuring the shoulder and neck have optimal range of movement, mobility and stability. When the thoracic spine is limited it severely stiffens the neck and the trunk. If it remains untreated it loses it’s ability to extend itself, a bit like losing it’s memory. The big problem here is it is very hard to stretch, it really needs manipulation, massage and mobility work. This is where the chiropractor, physio and massage therapist can really do great work.
You cannot rely on them though you will need daily exercises to help ensure it remains free. Often it will reset back to the default position within 24 hours of a treatment so if you can use simple exercises using foam rollers and mobility techniques like Feldenkrais you have a better chance of remaining mobile.
It is important to use mobility exercises before stretching for the stretches will be a waste of time if the thoracic spine cannot extend itself. Below are two great videos of how to do some thoracic mobility exercises.
I also suggest to read the article – Why thoracic mobility is so important to the health of the shoulder
Step 4 – Stretching & Self Massage
A good health therapist will prescribe these for you and as we said before you need to mobilize first. If the thoracic spine remains stiff there is no point to the stretches for the spine and rib cage cannot get in the right place for you to execute the stretching correctly. The common tight areas needing to stretch are often the pecs, levator scapula, upper traps and the upper abdominal area.
Also do not discount the role the hip muscles play here. Tight hips often cause the pelvis to tilt too far forward and end up forcing the upper back into a rounded position. A bit like bending a rubber hose. Can you begin to see how just treating the neck is often a pointless exercise that goes nowhere.
The video below shows you how to do a mobility assessment by yourself.
As for self massage there are many tools you can use to assist you with this. Foam rollers and trigger point tools are great. Sometimes stretching will not be enough to release a trigger point and you will need to use some massage type techniques. I use a lot of trigger point tools with my clients and they are extremely helpful at times.
Below is a video of a tool I use to help with pain in the rhomboids and middle traps.
The key to these working however is you MUST FOLLOW UP WITH STABILITY drills straight after doing it. Otherwise the body will just reset back to the way it was for it does not know any other way to stabilize these joints. Have you ever wondered why the massage that felt so good yesterday and relieved all your tension has just gone the very next morning. This is why.
The video below gives you a detailed look at how this works.
Step 5 – Improve Scapula Stability
Now we are at the stage where we can introduce exercises. Again it is VERY IMPORTANT to do these tedious and boring drills and not skip this and go straight to strengthening.
I see so many people rely on just the massage, physio or chiropractor work to fix them only for them to be back to where they were in a few days time. The health practitioner may be doing a great job in releasing the tight muscles and trigger points, unfortunately the person has not enough stability or strength to counter the tight overworking muscles, so inevitably they fall into poor posture the minute they leave after their treatment.
Without doubt one of the best exercises you can begin using is the wall slides drills shown below. These are great exercises for teaching correct scapula movement and encouraging good mobility with stability. This sets you up for the next stage which is strengthening and where you can hold all of your adjustments together.
It is at this point I like to use a lot of simple exercises to address the forward head posture if during the assessment I found it was a concern. It is not always a big problem so you may not need to use this with every person.
Often the muscles underneath the chin known as the hyoid muscles can be very weak leading to increased tension with the levator scapula, scalenes and upper trapezius where the tension and pain is felt. No amount of stretching of these tight muscles is going to make any difference if the hyoid muscles remain weak.
This is where I will use stability exercises seen in the video below to target these hyoid muscles. It is critical that you place the TONGUE ON THE ROOF OF THE MOUTH to activate these muscles correctly. This also explains how TMJD (jaw pain) is closely related to forward head posture and neck pain.
Step 6 – Strength Training
Now that you have some simple mobility and stability exercises in place it is time to strengthen the body.
Notice that this is the last step and not the first.
It is important not to skip the previous steps for if you do you will create more pain and more problems! It is also important to get to this stage too! As mentioned a few times already most people stop at step 3 and wait for the health practitioner to “fix them”.
Our bodies are constantly fighting against gravity and need the strength of our extensor muscles to do this. Using exercises to help them remain strong and last long periods of time can reap massive rewards. Many older adults skip this stage but we find this is of more benefit to them than any of the other stages as they have lost so much muscle and strength. Nothing will change until the try reverse this trend and add some much needed strength to weak, ageing body. Read our article Strength Training For Older Adults for more information on this.
“If there is tight muscles needing to be loosened and weakened, there is also weak lazy muscles that need to be tightened and strengthened”
This is why people so many people never truly get rid of their problem and just manage the pain. They are only halfway with their rehab program. In terms of strength training exercises to do it can get very tricky and it is difficult to give you the exact exercises for your body. It takes a detailed assessment to find this out. Generally you are wanting to use exercises that provide both extension and rotation of the trunk.
And lastly you want to include something to develop strength in the weak muscles of Serratus Anterior and Lower Trapezius for they have a huge influence on the scapula stability that is often a big part of neck pain.
What exercises would I use then?
If I follow on from the wall slides exercise from step 5 and use a strength exercise to do the same role I would use many of the exercises that strengthen the lower trapezius as shown in the video below.
I prefer to start with the single cable pulling exercises first for they are much easier to get right and also come with the least amount of risk. This sets a good foundation for the exercises to come that are a lot harder to get right and can aggravate problems if you get them wrong.
Once I have implemented these I want to develop strength with the pushing action for this is where the serratus anterior will be strengthened the most and get you out of pain for good. However, as I mentioned already these are hard to get right and can be problematic at first so you have to be careful.
I like to use simple floor exercises first before progressing to the single cable push and push-up type of exercises. The video below shows you how I might progress with several serratus anterior exercises.
The push-up itself is a great exercise for scapula retraining but it is often too hard to start with this. The video below gives you a good visual of how the scapula moves during the push-up and how you can focus on protracting more to get optimal scapula stability.
Obviously there would be many other exercises to follow from these to fully finish the job, especially with the overhead movements that would strengthen the upper trapezius. However, if you have made it to this point it is fair to say most of your problems would be resolved by now.
One of the exercises I would use for the upper trapezius is shown in the video below. You can see more in the article – How to strengthen the upper trapezius
Do You Need More Help?
To help you out with a more detailed program using this process I created a detailed shoulder pain report that provides you with all the tests and exercises I might use in a step by step format so you can finally get rid of your problems for good.
To see more about what is included in this detailed report click here and to download instantly click the image below.
Summary
I hope you have been able to find where you need to work the most.
For some it is making some changes to how much they sit down, changing habits with their phone use and lap top set up. Others it is all about trying to improve their mobility and overall strength. For many older people strength and mobility is a big problem as the ageing process has weakened their muscles and bones so much that their posture has worsened to a point where it becomes permanent! You never want to get to this stage as it is almost impossible to reverse when it has deteriorated this far.
If you can do something about your posture and movement now, you must get started. Stop relying on people to fix you, and start taking responsibility for your body by using the strategies shown in this article.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Movement – By Gray Cook
•Corrective Exercise Solutions For The Hip & Shoulder – by Evan Osar
•Back Pain Mechanic – by Dr Stuart McGill
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Low Back Disorders – by Dr Stuart McGill
•Rebuilding Milo – By Dr Aaron Horschig
•Shoulder & Scapula Injuries In Athletes
•Built From Broken – By Scott Hogan
•Anatomy Trains – by Thomas Meyers
•Motor Learning and Performance – By Richard A Schmidt and Timothy D Lee
•Assessment & Treatment Of Muscle Imbalance – By Vladimir Janda
•How To Eat, Move & Be Healthy by Paul Chek
•Scientific Core Conditioning Correspondence Course – By Paul Chek
•Advanced Program Design – By Paul Chek