Neck Pain

The Causes of Neck Pain

Neck pain can appear for a number of reasons. The reasons could include common activities such as spending long periods of time looking down at a computer or reading. Even having a cold with a lot of sneezing and coughing can tighten up the neck muscles. Restless sleeping can also cause or exacerbate the pain in the muscles around your neck, making them grow tight and sore.

Neck pain is a common complaint in the clinical setting. It is estimated that around 1 in 3 people are affected at least once a year.1 In order to treat neck pain, we look at a number of different things to identify the root cause of the pain. We assess a patient's range of motion and look for tightness or complaints of pain during specific movements. Pain during movement can be due to irritated nerves around the joints or muscles. If a patient complains of pain that radiates down into one or both arms, we will look to see if the cause is an irritated nerve in or around the neck. If pain occurs during specific activities, we will assess posture and movement in those specific contexts and make changes as needed.   

Patients often have complaints of headaches along with neck pain. Depending on the location of the headache, the pain may come from any number of sources be it a muscle knot at the base of the skull or even irritation in the joints of the mouth called the TMJ (temporomandibular joint). TMJ dysfunctions in particular can cause issues such as jaw pain, headaches, and difficulty opening and closing your mouth.2  

Pain can originate from many locations. While it can be quite severe, pain is not necessarily as serious as other complaints such as weakness in either hand, changes in hand temperature, or loss of function. These complaints are much less common in the clinical setting than pain. 

There are many different causes of pain in the neck region, including:

1. Disc bulges: A disc bulge is a very common finding on neck MRI images and often exists without causing any pain or discomfort.3 However, the disc can sometimes bulge enough to irritate a nearby nerve, causing pain to start in the neck and radiate down an arm. A disc bulge can cause inflammation which can irritate a nearby nerve and can cause a lot of pain, but it is not a serious condition. It is not serious because a disc can be putting pressure on a nerve for years without any pain or loss of function and, oftentimes, there is no real damage done to the nerve, just irritation and hypersensitivity.
2. Arthritis: Arthritis starts in our spines in our 20s. Arthritis is any change to a joint surface and can refer to small changes in the smooth cartilage that lines the joint surfaces. Sometimes, patients will describe "bone spurs" that were found on x-rays. A spur is a small outcropping on a bone that forms where arthritis is and is not likely to cause any issues at all. Spurs develop in areas of excess stress on the bones from either muscles pulling on their attachments or uneven wearing of the bones. If they rub against other bones or press on nerves, there might be some associated pain and stiffness, but as mentioned, most bone spurs don't cause any problems.4 Remember that wear and tear on joints is a normal part of living in a body and does not have to cause pain or injury to surrounding tissues.
3. Poor posture: Call it cell phone neck, computer neck, what have you, but sitting for long periods of time with our heads in what is referred to as the "turtle position" (chin jutted out and forward) leads to that "hump" at the base of the neck that patients complain does not look good. It also causes tightness at the base of the skull that can cause "suboccipital headaches" or headaches that radiate from the base of the skull to the forehead. Long periods of time in this position can lead to pain and permanent changes in the structure of the neck.5

There are a few easy exercises and activities that we like to give patients to help with neck pain:

1. Posture awareness: One of the easiest activities is developing awareness of posture by standing with your back against a wall or door jamb. Stand with your heels close to the wall, and try to rest your buttocks, shoulders, and back of the head against the wall. Don't let your back arch too much. It should have a natural curve. If this is too hard on your low back, then allow your feet to be a step away from the wall. Your shoulder blades and head should be working to touch the wall. You will probably need to gently push your shoulder blades down and back. You should feel the muscles in the middle of your back working to hold this position. Try to stand here for 15-30 seconds at a time. After 2-3 times, try to maintain this posture when you walk away from the wall.
2. Sitting posture is more difficult to improve than standing posture because people tend to mold their bodies onto the surface on which they are sitting rather than adjust their seat to their good posture. We recommend that you first practice sitting posture exercises without resting your back against a surface. A solution is starting your exercises with a stool or hard-backed chair. Make sure the height of the chair is not so low that your knees are above your hips or so high that your knees are too far down to be close to level with your hips. Once you're sitting with your knees at a 90 degree angle, gently tilt your pelvis forward and backward until you find a "neutral" pelvis position, which simply means a comfortable position in which your back is not humped or overly arched. Next, gently lift your rib cage up and think about placing it on top of your pelvis. This is to keep your upper body from caving in. Next, gently roll your shoulders back to place them in your "back pockets." Lastly, gently tuck your chin back so that your ear is aligned with your shoulder. While this posture may seem awkward at first, it will get easier to stay in over time with practice. Practice for 15-30 seconds at a time, slowly increasing your time as it gets easier. Once you get into this position, you would THEN adjust your seat to accommodate your posture.   

Many neck pain patients complain about tightness in the muscles on the back of their shoulders leading up to their necks (upper trapezius). Often, this tightness occurs because the head and shoulders are held too far forward. This position of the neck and head can not only cause neck pain, but can also contribute to headaches and jaw pain. 

There are a few exercises for upper trapezius tightness that we recommend:

1. Chin tuck/ neck retraction: Have your head upright as you gently pull the chin back as if to give yourself a double chin. If you are doing this exercise correctly, you should feel a stretch at the base of your skull. Pull back gently, hold for about 5 seconds, then release gently. Repeat this exercise 10-20 times a day.
2. Scapular retraction: Keep your head upright and your shoulders gently pulled backward so that you can place your shoulder blades in your "back pockets" by squeezing your shoulder blades gently back and down. Hold for 5 seconds and repeat 10-20 times.
3. Shoulder external rotation: When the shoulders roll forward in a slumped posture position, the stabilizing muscles of the shoulder (the rotator cuff muscles) get stretched and weaker. This not only contributes to neck pain but also to shoulder pain and impingement. This exercise can start without a resistance band as shown in the picture. Keeping your elbows at your side, gently pull on the band and rotate outwards. Repeat this exercise slowly for 10-20 times.
4. Scalene stretch: There are three small muscles along the side and front of the neck which attach down to the tops of the 1st and 2nd ribs. These muscles are called your scalene muscles and can become tight. When they are tight, they can irritate the nerves that travel down the arms. The tightness can be caused by a few things, such as a whiplash injury or respiratory issues. One of the most common causes of tight scalenes is the forward head posture, otherwise known as the "turtle position".6 Stretching the scalenes can be uncomfortable, but it is helpful for getting the head and neck back into upright posture. To stretch them, either use a strap or a towel to keep the shoulder down as you side bend the head and neck away from the shoulder. Hold the stretch for about 30 seconds and repeat 2-3 times on each side.

For all these exercises, we recommend you perform them 2-3 times per day. If you practice this for 2 weeks and continue to have neck pain or you need help figuring out the exercises, then call  206-327-9880 to make an appointment with one of our fabulous physical therapists at Pain Science Physical Therapy.