UNDERSTANDING AND TREATING CHRONIC NECK PROBLEMS

Copyright ) 2002, E. Franklin Livingstone, M.D,

The neck is one of the most vulnerable parts of the body in terms of the propensity for problems. Almost everyone, at one time or another, will develop neck problems. These problems will sometimes occur as a result of injury or overuse, and at other times they may be slowly progressive, and for no apparent reason. If ignored, these problems will often worsen and can become a source of persistent difficulty.

Many people have chronic neck problems which lead to many unsuccessful attempts at treatment, including prolonged chiropractic manipulation. Understanding your neck and preventative maintenance can go a long way toward preventing progression or recurrence of problems, while establishing a healthy, fully functional neck.

Neck problems can occur at any age and as we grow older, deterioration of the joints is very common and often progressive. In addition, poor neck posture is a very common aggravator. The neck is a common site for subconsciously directed tension involving the muscles, particularly in the back and base of the neck. There are of course many other causes of neck and back problems, including poor sleep patterns and poor posture or positioning. If you have poor posture and you position your neck incorrectly as a habit, you are almost guaranteed periodic or chronic neck problems. The good news is that there is much you can do to eliminate neck problems and prevent them from recurring. The treatment will take days or weeks and your expectations should be that you will have to put a great deal of emphasis on correcting the problems that cause your neck pain, as well as improving the flexibility and strength of your neck.

You must have a working knowledge of the anatomy and biomechanics of your neck. Your neck supports your head allowing it to twist and bend in all directions: all of these motions provide a great deal of stress. The backbone of your neck is the cervical spine which is a column of seven vertebrae separated by the intervertebral discs which act as shock absorbers. Each vertebrae connects to the one below and the one above through numerous joints. Most commonly, injuries to the neck affect ligaments and muscles, but they may also affect discs, bones and occasionally nerves. In order to have a healthy, pain-free neck, it must have a slight natural curvature. This curvature is called lordosis and is the same type of curvature as at the hollow or small of your lower back. When you have good posture and are in a standing position, the curves of your back allow for the hips, shoulders and ears to be aligned, one directly above the other.

Strong and flexible muscles are imperative for a normally functioning, pain-free neck. Any muscle shortness or spasm, including abnormal muscle tension, will contribute to problems at the neck, and can be important in the development of chronic neck problems. These neck muscles are closely associated with the muscles of the upper shoulder and upper back. Problems will progress to include all of these groups eventually.

The spinal cord is protected by the vertebral column. Nerves leave the spinal cord and travel through grooves in the vertebral bones out to the muscles and skin of the neck, upper back and shoulders. Infrequently, nerves are "pinched." This may be the result of disc injuries or arthritis of the vertebral joints. Most frequently, however, the tingling or "numbness" sensations often felt in the upper extremities are caused by muscular problems and most specifically to myofascial pain syndrome or fibromyalgia. These are painful conditions of the muscles in which they are maintained in an unhealthy deteriorative state.

There are many different treatment modalities that may be prescribed for neck problems, some more beneficial than others. Probably the most overprescribed treatment is heat. Heat is comforting and it does relieve pain, however, it really does not do anything to cure the pain. The only reason the pain is relieved is because there is so much temperature stimulation of the skin that it fills up all the sensory channels to the brain, not allowing the pain to come through. So, when you take the heat away, the pain returns in 15 or 20 minutes and you are really no better off than when you started. If you are going to use heat, however, you should use it for only very brief periods, 15 to 20 minutes at a time and you should resist the temptation to use heat for prolonged periods of time, as this only "masks" the pain. Heat can cause problems and may, in fact, cause slow progression of your problem rather than resolution. Heat may be prescribed as "hot packs" or various other modalities including ultrasound, microwave and shortwave diathermy.

Another often overprescribed technique for treating neck problems is immobilization. Frequently, following a neck sprain, a cervical collar of one type or another is used and is used too much and incorrectly. If you are going to use a "soft collar," remember that the wide part of the collar goes in the front and the fastening is in the back. If a collar is used for immobilization, it is probably more reasonable to use a rigid type brace such as a Philadelphia collar, than to use a soft collar, which really doesn't do much good except to show those around you that you have a problem. Generally, it is much more important to exercise and stretch the neck appropriately, than to immobilize it. Immobilization may cause more problems for you down the line.

Cold therapy, also known as cryotherapy, can be very effective and does have a curative effect on muscular problems, including fibromyalgia, and is generally under prescribed. Ice packs are very helpful in reducing pain. However, ice is not immediately comforting like heat, and you must be aware of the fact that it will be cold for awhile, then it will cause a progressive sensation of burning and then aching, until after 6 or 10 minutes, it causes numbness and reduction of pain. Ice or cold therapy should always be used in preference to heat at the onset of neck or other musculoskeletal problems. A simple ice pack made with crushed ice and a little water in a plastic bag that is sealed can be very effective if properly applied. A gel-type cold pack is much more convenient and much less messy if one is going to use it again and again. You should only use cold therapy for 20 to 25 minutes at a time, allowing at least two hours between cold therapy sessions. In addition, you should never use cold therapy over pain that is unexplained or undiagnosed: see your doctor.

Cold therapy helps in many ways. It reduces swelling and pain, and if enough cold penetrates to the involved muscles, tension or spasm will diminish. In addition, when the cold is taken away, there is a reflex increase in blood flow to the tissues that have been cooled and this aids in reestablishing the normal health of these muscles.

Rest is another important treatment modality with neck problems. As with many other musculoskeletal problems, it should only be used in relatively short bouts. Rest is no substitute for gentle strengthening and stretching activities. Remember that inactivity, if prolonged, has a detrimental effect on musculoskeletal health and function.

Massage can also be effective and often relieves pain temporarily, but it acts similar to heat in that the massage stimulates so much sensory input to the spinal cord that is blocks the pain signals from being transmitted to the brain. So after the massage, like heat therapy, the pain often returns. Deep massage and stretching after cold therapy can be particularly beneficial if performed correctly.

By far the most important aspects of control and prevention of neck problems are understanding the frailness of the neck, its anatomy, and the important postural relationships along with the development of a well balanced exercise and stretching program, to include periodic cold therapy and relaxation.

RANGE OF MOTION (FLEXIBILITY)

Range of motion (stretching) exercises are extremely important and should be performed frequently for short periods of time everyday. Flexible muscles and healthy joints require this and because of the numerous joints and muscles in the neck, care must be taken to do this properly. With neck exercise or stretching, always start with the head straight up before moving through one motion or another.

  1. Bend your head forward, trying to touch your chin to chest.
  2. Return to upright and bend your head backwards as if trying to touch the back of your head to your upper back.
  3. Return to upright and bend your head sideways without twisting, trying to touch your ear to your shoulder.
  4. Return to upright and bend your head in the opposite direction, trying to touch the other ear to shoulder.
  5. Return to upright and twist your head, trying to touch your chin to shoulder.
  6. Return to upright and repeat in the other direction.

After completing this series, your have put your neck through a full range of motion. As you get more comfortable with this, you will be able to progress further with increasing flexibility. Approach these activities with caution, gradually increasing duration and intensity. If the motions are painful when using your neck muscles to move your head, then lie down and use your hands and arms to move your head while trying to relax the neck muscles. This may take a bit of practice, but will help in developing optimal control of neck muscle relaxation. If you have forgotten how to thoroughly relax muscles, if you have a lot of stress related tension, or if there is muscle spasm, it will be difficult at first to relax these muscles, but with practice you can gain more and more control.

STRENGTHENING EXERCISES

Strengthening of the neck muscles is vital to a healthy, normal functioning neck. The stronger your muscles are the more healthy and flexible they will be and the better they will support your head and neck in a balanced position of good posture. To improve strength, we emphasize isometric exercise. Isometric techniques stress the muscles without much neck movement and protect the many joints from excessive wear and tear. These exercises are easily performed and require no equipment. You may sit or stand when performing these exercises, but it is safer if you are sitting. You may do these exercises anywhere in a matter of just a couple of minutes. Always maintain a straight up head position when performing these exercises.

  1. Place your hands to the back of your head pulling forward, while pushing backwards with your head against your hands. If correctly performed, your head will not move significantly.
  2. Then, with your hands pushing backward on your forehead, push forward with your head against your hands so that there is no net movement of your head from the straight up position, but so that the muscles in the front of your neck are straining very hard. Hold this for 3 to 5 seconds and then slowly release the pressure.
  3. Now move one hand to one side of your head and do the same thing. Push against your head and your hand while resisting with your head causing the muscles on the side of your neck to become very tense and work very hard. Hold this contraction for 3 to 5 seconds and then relax.
  4. Repeat this exercise with the other side of the head to strengthen the muscles on the other side of the neck. You should do 3 to 5 repetitions of this series of exercises and gradually build in terms of the pressure that you develop between your hands and your head, and the length of time that you hold the contraction, as well as the number of repetitions that you do.

As your neck gets healthier and you are having less problems with it, then you can start doing these isometric exercises with your neck bent to the side, forward or backward. This strengthens your muscles in different positions. Isometric exercise is one of the most rapid ways to cause muscular strengthening. Usually you should do this when you are in a sitting position, since you may lose your balance if you try this while standing.

In addition to neck exercises, you must also exercise and stretch your upper back and your shoulders.

  1. Start in a sitting or standing position with good posture. Raise your arms above our head and try to extend them backwards, so that you are reaching upwards and backwards as far as you can.
  2. Bring your arms forward and downward and once again extend them backwards, reaching downwards and backwards and try to stretch this position as far as you can. Hold these positions for 3 to 5 seconds and as you get better, you may progressively hold the position longer.
  3. Bring your arms around to the front and cross them, grabbing your right shoulder with your left hand and your left shoulder with your right hand. Try to pull your shoulders forward, pulling your shoulder blades apart and feel the stretching in your back. Hold this position for 5 to 8 seconds and gradually release it.
  4. Now , extend your arms backwards and try to touch your elbows to each other behind you. Most of us will not be able to touch our elbows together, nevertheless the exercise causes a beneficial stretching of many of the muscles in the upper back and shoulders.
  5. Next you should do some rotational exercises for the back. While in the sitting position, simply hold your pelvis still, rotating the upper body so that you are looking over our shoulder as far as you can. Do this for 5 to 8 seconds and then repeat the exercise in the opposite direction.

Developing a regular and frequent exercise and stretching schedule for your neck can go a long ways towards correcting your problem and preventing recurrence. Even after you are getting better, you should continue to do these activities for strengthening and flexibility. Eventually, if you do well with this, you will not need to perform these exercises but perhaps twice a day, once in the morning and once at night. However, if you are having problems with your neck, you have to exercise more frequently for short periods of time. You should not exercise to the point of aggravation, and you should exercise within the therapeutic range, that is so that they will be of benefit to you and not detrimental.

AVOIDING AGGRAVATING ACTIVITIES

If you are having problems with your neck, there are certain things that should be avoided. Avoid prolonged static positioning of your head, especially uncomfortable positions. Avoid tilting your head backwards and holding it in that position for long periods, just as you should avoid holding your head bent forward for long periods. You should avoid tilting your head to the extreme, as well as, you must be careful whenever rotating your head to extreme rotational positions. You should turn your body instead of trying to look over your shoulder. You should avoid reaching for items that are at excessive heights and again, watch excessive tilt of our head backwards.

You must make a priority of your neck if you want these problems to resolve and not recur. When your neck is in good posture and you have been treating the muscles well, you should be comfortable. However, your neck may still not tolerate the extremes of positioning and rigors that a normal, healthy neck can tolerate. With time and continued diligent effort, you will become more and more tolerant of extremes of neck functioning. You must become good at recognizing the aggravators of your neck. Is it prolonged sitting or standing that is a problem? Do you tend to have this problem while talking on the phone? While driving? While washing dishes or while reading? You must become an expert at recognizing aggravating activities so that you can modify or pace the activities to better tolerate them while still accomplishing tasks without aggravation of your neck. Use an appropriate chair when sitting and get close to your work, but avoid leaning forward and craning your neck over your work. When lifting and carrying, keep the item close to your body and maintain proper spinal alignment and curvature. When sleeping, use an appropriate pillow that gives good support to your head and neck, but that does not cause craning of your head to one side or forward. Do not work on objects that are over your head. Use a step stool or ladder so that you are at eye or chest level with your work. When doing overhead work or while shaving your neck or while drinking from a soft drink bottle, avoid prolonged and extreme extension of the neck, that is, bending the neck backwards and tilting the head up.

DRIVING

One common difficulty for neck sufferers is prolonged driving of an automobile. You must avoid sitting in your car with poor back posture and with your chin up to compensate for this poor posture. Change your back posture and sit up. If you need a low back support, use a rolled up bath towel or purchase a low back support cushion. Sit up tall with your chin down, not up.

Driving for long periods will cause problems. Stop periodically, every 15 or 20 minutes for a short exercise and stretching routine as we have described. This will only take a couple of minutes and can prevent the development of aching and stiffness. Avoid turning and looking over our shoulder, use your mirrors. When you are getting into your car, sit down first, then lift your legs and turn your body, swiveling on the seat. Adjust your seat forward so that you can easily reach the pedals and so that you are not reaching for the steering wheel. Sit up straight with your back supported against the car seat back and maintain good back posture. Be sure that you have a head and neck restraint on the back of your seat to help protect you from further neck injury in the event of a collision. Be sure that it is strong and well adjusted, it should extend up to the back of your head when you tilt your head backwards.

As with most musculoskeletal problems, you are the key to control and resolution. You cannot cure a problem of your back or neck without learning to control it first. You must develop a thorough understanding of your neck and its mechanical properties so that you can systematically eliminate those factors that tend to cause recurrent aggravations. Only with elimination of these factors can full healing occur allowing resolution of discomfort and impaired function.

Remember to modify or discontinue exercises or activities that cause you to have more discomfort. Remember to approach any new activity or exercise very cautiously and to start gradually, slowly building intensity and repetitions. Exercise frequently for short periods, start with a few minutes. Pace yourself in your daily activities, and learn to modify those activities that tend to cause more problems. You must listen to what your body is telling you. It is always cueing you when there is poor positioning or overuse. Often these cues are ignored until the problems are rather severe, you must not allow yourself to continually do this or you will not get better.
Remember, your brain is either your best friend or your worst enemy with musculoskeletal problems. You must use your brain to your advantage, learning everything you can about your problem and how to control it. Then you must use your intelligence to put into action into those maintenance and protective interventions so as to gain control and eventually, you must use your neck problems. In order to do this effectively, you must become good at identifying the activities and positions that aggravate your neck and eliminate them for your daily living. This will require modification and pacing of many activities, but this is part of what has to be done in order to gain control and resolution.

RELAXATION AND STRESS REDUCTION

There is one more aspect of chronic neck problems that I would like to discuss. That is the topic of stress and relaxation. The neck is a common site for tension to develop, tension that is subconsciously directed from the brain. This often relates to psychological or emotional tension, stress, or conflict issues. The key is understanding that stress and tension do play a part in chronic neck problems and sometimes are a major reason why the neck problems persist for so long, in spite of the fact that the body is always trying to heal the damage that they cause. Relaxation is a learned skill. In our society we are constantly bombarded with stimuli that cause stress and tension, but seldom do we receive stimuli to relax. This is why some people become very good at being stressed and tense while they lose the ability to fully relax.

There are many ways to deal with this, but ignoring or denying these problems will ensure that they worsen with time. Most important initially is that you recognize this as a problem if it is, so that you can deal with it effectively.

Biofeedback is a technique for helping you to become more in touch with your body and more able to relax muscles involved in tension patterns. Meditation techniques can be very helpful, and there are many different relaxation techniques to experiment with and choose from. There are dozens of audio tapes on the market to choose from that can aid relaxation. These may be purchased at most large book stores and include voice-talking you through relaxation techniques or nature sounds such as rain falling, or waves and surf. Many of these tapes can be useful in the redevelopment of effective relaxation. A good combination of techniques is to use a gel-type cold pack over the tense, aching muscles while also using a relaxation tape or technique.

Another aid to relaxation and stress relief is to develop a walking program, walking a comfortable distance twice each day, morning and evening. This provides excellent cardiorespiratory and musculoskeletal exercise and is an exceptional way to relieve the superficial stresses that often tend to accumulate over the course of the day. A combination of a walking program, other relaxation techniques, periodic cold therapy and frequent short bouts of exercise and stretching, while maintaining activity levels within the therapeutic range can work wonders for you.

Here you have all the tools you need to improve your neck function and reduce your discomfort. This can also help eliminate tension headaches that often originate from the back of the neck and progress up over the head. The only excuse you have is an unwillingness to try to work out these problems for yourself, you are the only person who can do this. There are many of us properly trained to be of some help to you, however, in the final analysis you are the one with the problem and you are the only one with the cure, it rests within you.

GOOD LUCK, REMEMBER, FOR THE MOST PART WE EACH MAKE OUR OWN LUCK.

Copyright 2002, E. Franklin Livingstone, M.D.

Permission is granted to use this information for personal use. Any other use requires expressed written permission from the author.