Archive for May, 2014

Neck and Shoulder Pain

Why is my Neck So Sore?

More than half of the people who visit me as massage clients have a sore neck and/or shoulders.  It’s a common thing for the modern person and related directly to two things as a rule.  Our static use of the head and neck muscles in the way we live, and the incorrect sleeping position many of us take at night.  The combination of those two things can leave us with chronic neck and shoulder tightness (hypertonicity) that doesn’t go away without intervention.  Symptoms go from just a feeling of tightness and stiffness, to torticollis where you wake up with a stiff neck, to headaches and neck pain that rarely go away. In any of those cases, the longer it goes on, the harder it is to treat and the more intervention you will need.  The secret is to understand how it happens and prevent it getting worse whilst you have it treated.

The Neck and Shoulder Anatomy

The neck and shoulder is a complex set of bones, muscles, tendons and ligaments.  The move from being on all fours to standing has compromised the design of the joint, and really, given that there are positions we use as modern humans that aren’t supported by the anatomy, it fair to say it’s not yet finished in terms of its evolution. If we leave the shoulder girdle out of things for the moment, the neck and shoulder interaction uses many small muscles working together to maintain posture.

Posterior_and_Side_Views_of_the_NeckOn the outside, the trapezius muscle assists with elevation of the shoulder.  Inside that, the levator scapula and posterior scalenes control forward head hold, and inside that, the capitis muscles provide stability in whatever position you hold your head.

The role of the trapezius muscle is easy enough to understand because we can see that as we get stressed or tense, we tend to contract it which raises our shoulders and makes us ‘feel’ tense.  The other underlying muscles are harder to understand in terms of function.  The most obviously tight muscle for me to touch when you come in for a treatment is the levator scapula muscle.  This muscle attaches to the top of the scapula and then at the top of the neck at c1,c2, c3 and and c4.

LevatorScapulaIts role is to control forward head movement just like the reins on a horse.  As you move your head forward it contracts eccentrically to hold your head in place.  The change in length of the muscle is minimal unless you push your head a long way forward, and this is important in terms of why it gets so tight, as I’ll explain later.  You can also contract one side without the other to assist in side bend of your head, and in turning.

Under this muscle is the scalene group, in particular the posterior scalene which assists the levator scapula in forward head hold.  It attaches on the ribs below your neck and again at c2, c3 and c4.  Again, it works eccentrically when you sit at a desk or drive a car with your head forward of your shoulders, and again, the change in length during contraction is small compared with other skeletal muscles.

ScaleneMuscles

 

So what goes wrong?

Before we developed desks, computers, cars and soft bedding we would have had less trouble with our head and neck.  The head and neck areas would have had plenty of movement during manual work when our life revolved around movement.  But now we spend lots of time with our head and neck still and in a fixed position.  The muscles in our neck above, instead of working regularly in a fashion that involves movement, contract in a static position without much change in length during contraction.  If you contract any other muscle, such as your bicep in your arm, as you contract it, the muscle shortens considerably, and as you relax it it gets much longer.  This shortening and lengthening of the muscle assists in pumping blood through the muscle during the contraction. Blood flow assists in the removal of the waste products (such as lactic acid) produced by contraction so that unless you are working your bicep more than you normally do, the blood flow created is sufficient to remove all of the waste product.

However, with the small muscles in our neck, the contraction is either eccentric, or most of the time, static – that is – a contraction with no lengthening or shortening of the muscle whilst you hold your head in a static position.  Which means that these small hard working muscles produce waste product during the contraction but don’t get the assistance of the blood pump from the change in length.  As a result, the lactic acid remains for longer in the surrounds of these muscles and sticks the muscle fibres together like glue.  Given the high number of nerve endings in the head and neck, this manifests itself in pain every time you move.  Movement causes the fibres to try to separate from each other, which pulls on nerve endings just like pulling the hair from your skin during waxing.  Except that it’s muscle tissue, it’s more internal and it hurts more.

This is exacerbated by your sleep position if it’s not ideal.  It’s very important to sleep with your head in a neutral position.  Your pillow must fill the gap between your head and the mattress without an up or down angle, like in the picture here:

pillowheight (2)Many people have a too small pillow or use two pillows because they think it is more comfortable, but it’s only comfortable for your neck until you fall asleep.  After that, you will unconciously attempt to hold your head in a neutral position, so if the pillow is too high, the inside of your neck will statically contract, or if it’s too low, the outside will contract statically.  Static contraction for six to eight hours produces a lot of lactic acid and absolutely glues the neck muscles together to the point where you can’t even turn your head when you wake up.  Torticollis (that’s what we call it) can last up to a week or even longer without intervention.  I can usually free it up in a session or two for you.

So What Should I Do?

Prevention

Ensure you have the right pillow.  Your pillow should be firm without being a rock.  The height should be such that it holds your head in a neutral position on your side with your neck neither cranked up or down.  The pillow should be able to remain the right height all night – that is – not compress as you sleep on it.  Memory foam pillow are generally the best for this, but remember the height of the pillow is more important that what it is made of.  You may have to try several pillows before you find the right one for you.

Get up and move around if you’re in front of a computer all day.  The recommendation is 5-10 mins per hour, so if you can do it, every hour spend that time rotating and stretching.  Look below for some ideas.  If you’re driving all day, get out every hours for 5- 10 minutes and do the same.

Remain aware of your head and neck tightness.  If you feel you are getting tighter spend a few days doing the movements and stretches below – perhaps three times a day – until you feel you are back to normal.

Treatment

If the situation gets such that the tightness is ongoing, perhaps you can’t sleep on one shoulder in particular, or you are getting headaches from the tightness, or maybe you wake up with a torticollis episode then  you’re going to need treatment.  Torticollis involves two treatments within 5 days where I free up the area with neural stretching and massage.  I give you the treatment protocol below to use in between and after the sessions until it goes away.  Generally speaking the pain will subside twice as fast as if you just let it fix itself.  If it’s a bad case, then it will be fixed faster than twice as fast.  If you have a general head and neck tightness caused by work conditions as above, then a treatment once a week for three weeks will usually produce significant improvement.  Then it’s a matter of management over time with a monthly treatment and the protocol below.  If you’ve had it for a long time, we may need to treat it longer to get the result you would prefer, but as long as there is only soft tissue damage and no disc injury or nerve compression we will get a result.

To assist your recovery and perhaps if you only have minimal tightness and you’re looking for a home treatment, this is the protocol to follow:

1. Apply heat to the area with a wheat bag for 15-20 mins.  You can purchase wheat bags shaped for your neck for this purpose. or just move one of the usual ones around to fit your neck best.

2. Warm up the head and neck with this warm up set of movements:

3. Use these stretches to improve the mobility of your head and neck

Ideally you should do these two or three times each day until the symptoms are gone, and then once a day for a few weeks afterwards, or even better, from this point on.

Good luck and get moving!

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