Coming off our discussion on low back pain, let’s move into another common area of pain, the neck. Neck pain has become more prevalent over the last decade or so, relative to technology and communication. The progression of our everyday tasks being handled by computers, tablets, and cell phones has its advantages, but not when it comes to the health of our necks. The amount of sitting, head positioning, and associated postural stress with the use of these devices has certainly placed an increased physical demand on our neck (cervical spine). As shown below, the greater the angle of the head from the neck the more strain that we will experience on our neck. In fact, the feeling of head weight increases by 10 pounds for every inch the head moves forward of the shoulders. Think about if you had to carry around even a five-pound weight all day in an outstretched arm how your arm would feel. Doing this for even 5 minutes would start to result in discomfort or pain in your arm, yet we expect our neck to tolerate this same amount of strain. This becomes even more concerning when we consider that the muscles in our arms are typically stronger than those in our neck.
In addition to the direct strain on our necks, the increased amount of sitting and associated postural stress in today’s society relative to technology and working in front of computers has other significant effects on our cervical spine (neck). These effects may include the following:
- Increasing forward curvature (kyphosis) of our mid back (thoracic spine)
- Decreasing scapular stability
- Restricts our diaphragm, which can alter our breathing mechanics
Fortunately, we live in a world with gravity, as it would be really hard to get around without it. However, gravity and the pull that it creates causes a significant amount of strain on our bodies. The constant downward pull of gravity makes it challenging for our body to support and stabilize itself in order to keep itself upright when sitting and standing. As a result, we often find ourselves in slouched or lounged postures with sitting or standing. These positions will result in a forward head position, rounding of our shoulders and a forward curve (kyphosis) of our mid back (thoracic spine). We already discussed the impact and strain of a forward head position on our neck. Rounded shoulders and increased forward curvature of our mid back, also impact our neck as a result of inhibiting or shutting down muscles that help with support and stability of our neck. This does not occur as a result of sitting once in a slouched or lounged position, however our body will over time adapt to the stresses that we displace on it. This is known as the “SAID” principle, standing for Specific Adaptation to Imposed Demand. In simpler terms, your body adapts to the specific demands placed upon it, the body is always designed to always get better at whatever it does. The more we sit with poor posture the more our body will maintain these positions with sitting. In contrast, the more we sit with good posture the more our body will train itself to maintain good posture with sitting. Sitting with poor posture over time will likely result in over activation of certain muscles and under activation of other muscles. As you might guess, the muscles that tend to become underactive are muscles that assist with stability of our neck and the muscles that tend to become overactive are the muscles that force our shoulders forward and create tension in our neck. This response is referred to as upper cross syndrome and is shown below:
This mechanism displaces a significant amount of strain on our cervical spine and improperly loads our joints and discs of our neck, which can lead to increased risk of arthritis, pain, and injury to our neck. Mom or Grandmom were actually right and doing us a big favor by telling us to “sit up” when we were younger.
The increase forward curvature of our mid back (thoracic spine) as a result of upper cross syndrome as shown will also result in maintaining our head in a forward position as our upper back (thoracic spine) obviously connects to our neck (cervical spine) and as such the cervical spine will typically follow the thoracic spine when it comes to positioning. Therefore, just like we discussed the thoracic spine having an effect on lower back pain in our previous post, it also has a significant effect on neck pain. Ultimately, when looking at lower back or neck pain, we have to consider the mid back (thoracic spine) as a contributing factor.
The loss of position in the mid back also results in a reduction of scapular (shoulder blade) and core (trunk) stability related to positioning of our shoulder blade. Poor scapular stability will result in compensatory stress to some of the common neck musculature which are recruited to assist in scapular stability. As a result, the overwork that is displaced on the muscles of the neck will further increase strain and tension to these areas that result in a higher likelihood of pain and discomfort.
Sitting in a slouched position will also over time result in a reduction of core (trunk) stability. The rounded position of our shoulders and mid back (thoracic spine) will inhibit our trunk stabilizers from being able to work effectively. As a result, they will become inhibited and reduce our ability to maintain an upright or neutral spine position. This increases more strain and demand to our neck and shoulder region with activities such as lifting and reaching as we will limit our ability to incorporate our lower body into these activities forcing our upper body to handle a greater portion of these activities leading to increased workload and demand increasing the likelihood of fatigue and injury.
The final area we will discuss relative to postural strain and neck pain is how poor posture can result in modifying our breathing mechanics. Ideally, with breathing we should move air into our lower lung fields first (what many refer to as “belly” breathing) prior to moving air into our upper lung field (what many refer to as “chest” breathing) In order to properly move air into our lower lung or “belly” breath we need to have the ability to move our diaphragm. If you are slouched, your diaphragm cannot easily move. This leads to a transition from normal deep breathing (“belly” breathing) to short and shallow breathing (“chest” breathing).
As a result of the inability to move our diaphragm and the need to move to predominantly chest breathing, we will have to make use of our accessory (or backup) muscles for breathing. These accessory muscles are found around the neck and are the same muscle groups that are already tense and possibly tired due to forward posture and upper cross syndrome, as explained above.
These neck muscles are not very efficient for breathing and are not designed for controlling breathing long term (on average we take 17,000 breaths per day!) As a result, tension will build in these muscles with potential trigger points that can lead to headaches, jaw, and neck pain.
In addition to seated posture, sleeping posture can also be a contributor of neck pain. I’m sure many who are reading this post have woken with a stiff or sore neck in the past. Unlike sitting, we often are unaware of our exact sleeping posture as hopefully we are sleeping and in an unconscious state at the time we are in these postures. We often hear that sleeping on your stomach is not good, this relates to how this position affects our neck. In order to sleep on our stomach and breathe we have to have our head rotated, or turned, to the side (either right or left) maintaining this position for several hours as we sleep is very strenuous on our neck. The muscles of our neck are maintained in a shortened or lengthened position as we maintain our head in a rotated position when sleeping on our stomach. This displaces a significant amount of strain to our neck musculature given the duration of time we are typically in this position with sleep. In addition, it also affects the natural position, or curvature, of our neck, which puts more pressure on the joints of our neck. All of this increases the potential for a sore and stiff neck upon waking in the morning. Our mattress and pillow choices can also have an effect on our neck. Lying on your back or side is preferred compared to your stomach in helping to reduce strain to your neck with sleeping. However, when lying on our back or side, we want to make sure that our head and neck are in good position relative to the rest of our body. This is often dictated by pillow choice. First and foremost, you should always focus on using a single pillow and not stacking multiple pillows to rest your head on. When using multiple pillows, we often find our head in an elevated position relative to the rest of our body, which affects the natural position of our neck and displaces more pressure to our neck and strain to our neck musculature. Again, increasing our likelihood of waking with neck pain and stiffness. Those who prefer to have multiple pillows to rest their head on to sleep are often those who tend to sit in a slouched posture as they tend to want to maintain this same posture with sleeping, which involves the head being in a forward head position as is the case when resting on multiple pillows. In this case, it is easy to start to understand how chronic neck pain can occur.
For the reasons stated above, posture and maintaining good posture in both sitting and lying is very important to the health of our neck. In addition, proper breathing mechanics are also very important to reducing unnecessary strain to the muscles of our neck that can result in increased tension and pain.
Obviously, we can get neck pain relative to injury or trauma. Common traumas that can result in neck pain include motor vehicle accidents, collision sport injuries (football, hockey, soccer, etc.), and falls. These types of neck injuries often require medical attention and should be assessed and treated appropriately, often with pain management, conservative options (chiropractic, physical therapy), and in some cases surgery. The full spectrum of neck injuries associated with trauma including sprains, strains, herniated discs, dislocations, and fractures are beyond the scope of this post. However, they are certainly sources of neck pain that require attention and therapy. Our discussion today is focusing on the everyday mechanical stresses that we can modify to help reduce strain on our neck and decrease our risk of neck pain.
The first step in determining what the best treatment approach for neck pain will be is to discover what is causing or contributing to pain. This is done through a thorough evaluation that not only assesses the area where pain is presenting, in this case the neck, but also areas that could contribute to neck pain. Since neck pain, has many factors that could be causing more stress to the neck, some of which we have discussed, we need to assess the whole body from the ankles to the neck to discover the underlying issues that are displacing more stress to the neck. Once determined we are ready to devise a treatment plan with a focus on long-term change by correcting the underlying deficiencies to reduce strain to the neck and allowing it to function as intended.
Obviously improving posture and breathing mechanics is an important component of helping to reduce or correct mechanical neck pain related to everyday stress, especially postural stress. Mechanical therapy in the form of stretching, massage, and mobilization-based techniques (chiropractic, physical therapy) can have a profound impact on helping to reduce muscular tension and improve overall joint health and mobility. Additionally, improving core and scapular stability to assist with improving our ability to maintain a neutral spine with sitting and standing along with unloading the muscles of our neck that often compensate for lack of scapular stability.
To learn more about improving scapular and core stability, review our previous posts on these topics by clicking on the link below:
We hope that this post has provided some insight into some of the common factors for why neck pain can be so prevalent in our society today. There is certainly a need for all of the treatment options that we have today from the most conservative to the most invasive, however determining what the best option is for the individual by way of understanding what the causative factors of their neck pain are and not just treating them from a symptomatic standpoint is the key to having better and more positive outcomes. Along with reducing the potential for future recurrencies.
…Till Next Time
