In terms of the most prevalent types of spinal pain affecting the general population, neck pain closely trails lower back pain.
For the low back (lumbar spine) it’s easy to see why pain in this area is common: the lumbar spine bears the weight of your upper body in the standing and sitting positions and is a fulcrum point of body movement, so it is a workhorse that gets quite a beating.
But the neck (cervical spine), while smaller than the lumbar spine and less burdened by body weight (just the weight of the head) has certain characteristics about it that make it prone to pain as well.
Here’s a breakdown of those unique characteristics:
- The cervical spine is comprised of seven vertebrae. The first two under the skull are the only set of vertebrae in your spine that does not have a connecting disc. This enables greater range of motion compared to the thoracic and lumbar spine regions.
- More movement comes at a cost of less strength. The cervical spine therefore cannot bear forces as well as the rest of the spine and is more vulnerable to injury/ mechanical problems (whiplash, sleeping on a bad pillow, etc).
- Forces that act on the cervical spine include gravity, repetitive axial forces from walking running and jumping; abnormal static posture/ sleep positions (stomach sleepers) and trauma from car accidents, falls and sudden jolts.
- Structures in the neck affected by these forces are the facet joint surfaces in the rear of the cervical spine; the uncinate joints to the sides of the cervical spine; cervical discs, spinal cord, nerve roots, muscles, fascia, and even esophagus and throat.
- Osteophytes, or spondylosis occurs when projections of bone develop usually from abnormal movement over time. Problems occur when these bony protrusions encroach on nerve tissue.
If you have neck pain, chances are it is related to mechanical dysfunction. But you must also be aware of other conditions that can generate pain and/or tenderness in the neck, and rule these out with your physician if the causation/source of your pain is not clear.
Causes of Neck Pain
Red flags (requiring immediate attention) include:
- bone tumor
- spinal cord tumor (syringomyelia)
- onset of rheumatoid arthritis
- esophageal varices
- vascular disease (atherosclerosis)
Viral infections are sometimes associated with stiff and deep aching pain in the neck
Primary hyperkalemic paralysis—a rare condition usually triggered by extreme exercise, characterized by high or low levels of potassium, an electrolyte involved in muscle contraction. Causes severe pain and spasm initially, followed by muscle atrophy and loss of tone and contraction. The condition usually resolves after a few weeks. It can occur in the neck, and other muscle groups as well.
Neck Pain of Musculoskeletal Origin
- Myofascial pain related to previous trauma. Trigger points and scar tissue are characteristics of MP.
- Sprains and strains from injury (whiplash, direct trauma)
- Generalized muscle pain from muscle tension, fatigue or spasm related to poor ergonomics, bad posture and often stress
- Spondylosis, osteophytes (osteoarthritis related to degenerative disc disease)
- Spinal stenosis – the narrowing of passageways where nerves pass
- Disc bulge or herniation
- Cervical radiculopathy (compressed cervical nerve roots from spondylosis or disc bulge)
Living in a modern society where sitting at a desk looking at a computer monitor in front of you or work papers down in front of you is the origin of many cases of neck pain.
This unnatural position of craning your neck forward while seated, over time, degrades good posture. It is unnatural because the human body is optimally designed and meant to stand and walk.
Exercises to Reduce Neck Pain of Musculoskeletal Origin
First, determine if you have a muscle imbalance, where your anterior (front side) neck and trunk muscles are overpowering your posterior (back side) neck and upper back muscles, pulling your head forward of the spine. Do a posture check, visualizing plumb lines from front and side. This abnormal posture is referred to as Anterior Weight Bearing of the Head (AWB). Another term for this is Forward Head Posture (FHP).
If you have AWB, the force to your cervical spine (and muscles) more than doubles compared to if your head’s center of gravity was directly over your torso/ axis of spine. This is because the weight of your head and the forward angle of the neck in AWB combine to create a moment force.
To get an appreciation of this, imagine holding an eight-pound shot put directly over your head, arm extended. It should be fairly easy to do. Then, while still holding it above your head, move the shot put just 5 degrees forward, simulating AWB of the head. Your arm muscles will quickly fatigue and even develop pain.
The increased forces to your neck in AWB of the head get absorbed by your neck muscles, your discs and vertebrae.
Use the diagram below to evaluate your posture (you may need help from another person to view your posture from the side).
If you have AWB/FHP, engage in exercises to counter and correct AWB/FHP, with the goal being to reduce the amount of it:
Neck extension exercises – While lying face down on a mat, arms to side, contract your posterior neck muscles and lift your head straight up without arching it, as high as you can. Hold for four seconds; repeat 12 times 3x/ day.
Neck mirror image posture correction exercises – If your neck tilts to one side abnormally, stand with the opposite side shoulder contacting a wall. Using your neck muscles opposite the side of abnormal tilt, pull your head sideways towards the wall without bending your neck (keep your head level during the exercise). Hold for four seconds, repeat 12 times 3x/day until your neck is centered. Repeat as needed.
Wall angels. See this video of me demonstrating this exercise.
Isometric strengthening exercises for neck – Find a small child’s inflatable ball and place it against a bare wall, head level. Using different parts of your head each time (forehead, side of head, crown of head), press the ball against the wall and hold for 10 seconds. This isometrically contracts your neck muscles, strengthening them.
Rolled towel exercise to improve curvature- Roll up a towel to about a 5″ diameter, or better, buy a cylindrical neck pillow. Place it underneath your neck as you lie on your back. Arch your neck over the pillow and press the crown of your head onto the floor; hold for five seconds and repeat ten times. Next, with the roll still under your neck turn your neck as far as you can to the left, then right, five times for each side.
Thoracic outlet exercises: shoulder circles, corner stretches
Quadriceps stretch – Tight or shortened quadriceps muscles (your lap muscles) can rotate your pelvis forward causing your upper back to lean forward which can strain your neck as it tries to correct. To stretch, while standing bend your leg at the knee straight up keeping your knee pointed down. Grab your instep with the same side hand (balance yourself, as you will be standing on one leg) and pull it straight up. You should feel a stretch to your quadriceps muscle. Hold for ten seconds; switch sides. Repeat five times each side.
Core exercises – It’s important to have a strong core to support the lumbar spine properly, which fosters better posture overall. Do crunches, medicine ball exercises and planks to strengthen your core.
If you have any history of previous neck trauma such as sports injuries or repetitive movements, car accidents, falls etc., or spend a lot of time at a desk in a static neck posture, it’s possible that one or several of your neck vertebrae have locked together or have lost some movement which can have the effect of perpetuating discomfort. Chiropractic adjustments can be helpful in restoring motion to these segments and when combined with rehabilitative exercises, can usually resolve cases of general neck pain.
Lastly, a great way to discourage formation of AWB and encourage good posture is using a standing desk. The VariDesk is a quick and affordable solution to standing while working. Lower it, and you’ve got a traditional sit down desk; raise it (takes 5 seconds) and now you’ve got a standing desk. Alternate between sitting and standing throughout your day and notice your neck and back pain and stiffness improve!
If you have neck pain and you aren’t certain of the causation/origin, see your doctor and rule out red flags.
X-rays are helpful in assessing the state of your cervical spine (alignment, disc spacing, bone density, abnormalities, level of decay).
Countering anterior weight bearing/ forward head posture, strengthening the neck muscles, improving your cervical curvature, stretching your leg muscles and strengthening your core will improve your posture and reduce strain and pain to your neck.