Neck Exercises for Neck Pain
Neck exercises are a common part of almost any treatment program for neck pain. A
typical neck exercise program will consist of a combination of stretching and
strengthening exercises, aerobic conditioning, and possibly trigger point
exercises.
This article focuses on neck exercise to relieve
neck pain caused by posture problems, and includes instructions for specific
neck stretches, neck strengthening exercises, aerobic exercise and trigger
point exercises.
Benefits of Neck Exercises
Chronic or recurrent neck pain can be severely debilitating and
can also be accompanied by upper back pain, shoulder blade pain and
headaches. These symptoms, along with tight neck muscles and stiff joints, can
make even the simplest daily activities painful.
An appropriate neck exercise program can address
most of these symptoms as follows:
Neck Stretches
Flexibility and stretching exercises can expand or preserve the range of motion
and elasticity in affected cervical (neck) joints, and thus relieve the
stiffness that leads to pain. As a general rule, stretching is best done
everyday, and some stretches should be done several times a day.
Neck Strengthening
Specific strengthening exercises will help maintain improved posture, which in
turn will lessen or eliminate recurrent flare-ups of pain. As a general rule,
strengthening exercises should be done every other day to allow muscles time to
repair themselves.
Aerobic Conditioning
Aerobic exercises increase blood flow to the muscles and soft tissues of the
neck and upper back, which can help loosen the muscles and increase range of
motion. In addition, endorphins are also produced after about 30 to 40 minutes
of aerobic exercise. Endorphins are the body’s natural painkillers and they can
help reduce neck pain.
For many, before starting an exercise program it
is necessary to first get the pain under control. Gradual joint motion and
stretches to increase range of motion in the neck over time will reduce the
pain of normal activity.
Pain Control for Neck Exercises
The variety of options available to manage neck
pain is extensive, including:
·
Apply a heating pad
prior to exercise to warm up stiff muscles and joints and make it easier to
stretch.
·
After exercise, apply a
cold pack (or frozen bag of peas wrapped in a towel) to reduce inflammation in
the joints and muscles.
·
Use prescription
anti-inflammatories and pain medications (corticosteroids, COX-2 inhibitors),
as necessary, to manage severe pain.
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Before beginning any neck stretching or exercise program, patients
are advised to consult a health professional, such as an appropriately trained
physical therapist, physiatrist or chiropractor. The goal of a health
consultation is twofold:
1. To get an accurate diagnosis for the cause of
the neck pain or stiffness, as different clinical diagnoses will dictate
different types of exercises.
2. To learn the correct form when doing the
exercises, as doing the right exercises but with the wrong form is a common
mistake and can lead to either lack of improvement or even increased pain and
symptoms.
Depending upon the specific diagnosis and the
level of pain that the patient is in, different exercises may be recommended
for neck pain. It is important for patients to seek a cervical spine specialist
who is trained to evaluate neck pain and develop an individualized exercise
program.
Because the vertebrae of the neck are influenced by so many different muscle
groups (such as the back, shoulder, chest, and neck), it may also be necessary
for patients to have a practitioner perform soft tissue work such as massage
and manual stretching, in conjunction with neck exercises. A practitioner or
healthcare team trained in both soft tissue work and exercise prescription, can
provide both rehabilitation and pain relief for neck problems and may include
physical therapists, chiropractors and physiatrists among others.
How Poor Posture Causes Neck Pain
Most neck pain that is not caused by whiplash or other trauma has a postural component as part
of the underlying problem. Sitting atop the body, the health of the neck is subject
to the curvature of the spine below and the position of the head above.
The neck muscle pain can be caused by the
following neck muscles becoming tight:
·
Scalene muscles (three
pairs of muscles that help rotate the neck)
·
Suboccipital muscles
(four pairs of muscles used to rotate the head)
·
Pectoralis minor muscles
(a pair of thin triangular muscles at the upper part of the chest)
·
Subscapularis muscles (a
pair of large triangular muscles near each shoulder joint)
·
Levator scapulae muscles
(a pair of muscles located at the back and side of the neck).
If the alignment of the head and spine is not
optimal, the neck can be predisposed to injury and/or the degenerative effects
of wear and tear over time.
Forward head and shoulder posture
The most common condition that contributes to
neck pain is forward head and shoulder posture. Forward head posture is when
the neck slants forward placing the head in front of the shoulders. This head
position leads to several problems:
·
The forward pull of the
weight of the head puts undue stress on the vertebrae of the lower neck,
contributing to degenerative disc disease and other degenerative neck problems.
·
Similarly, this posture
causes the muscles of the upper back to continually overwork to counterbalance
the pull of gravity on the forward head.
·
This position is often
accompanied by forward shoulders and a rounded upper back, which not only feeds
into the neck problem but can also cause shoulder pain.
The more time spent with a forward head posture,
the more likely it is that one will develop neck and shoulder problems.
The part of the neck that is particularly
vulnerable to forward head posture is the lower part of the neck, just above
the shoulders. The lower cervical vertebrae (C5 and C6) may slightly slide or
shear forward relative to one another as a result of the persistent pull of
gravity on a forward head. This shear force can be a problem for patients with
jobs that require them to look down or forward all day, such as pharmacists who
spend many hours counting pills or data entry workers who look at a computer screen.
Prolonged shearing of the vertebrae from forward
head posture eventually irritates the small facet joints in the neck as well as
the ligaments and soft tissues. This irritation can result in neck pain that
radiates down to the shoulder blades and upper back, causing a variety or
potential conditions, including:
·
Trigger points in the
muscles - points of exquisite tenderness that are painful to touch, along with
limited range of motion
Neck Stretches
When the head and shoulders drift forward, certain muscles shorten
and become tight. This perpetuates theposture that causes neck pain.
The following stretching exercises can help
relieve neck pain:
Corner Stretch
A basic exercise that is important for
stretching the chest and shoulder muscles is the corner stretch. It is
performed in the corner of a room.
This neck stretch is done as follows:
·
Patients stand
approximately two feet back from the corner, facing into the corner.
·
Feet should be together.
·
Forearms are placed on
each wall, and elbows are a little below shoulder height (Figure
1).
·
Lean in as far as
possible without pain. Patients will feel a stretch in the front of the
shoulders and chest (Figure 2).
·
Hold the stretch for
about 30 seconds to a minute.
This stretch can be performed 3 to 5 times per day.
It should be done before doing any neck strengthening exercises.
Levator
Scapula Stretch
The levator scapula stretch is also important
for eliminating neck pain. The levator scapula is a muscle that often becomes
tight and may be very tender where it attaches to the shoulder blade. This
stretch can be performed while sitting or standing.
o Lengthen the muscle by raising the elbow above
the shoulder on the side to stretch.
o In this position, first rest the elbow against a
door jam. This rotates the outside of shoulder blade up and the inside of it
down, which lengthens the levator scapula muscle (Figure 3).
o Second, turn the head away from the side that is
stretching and bring the chin down, stretching the back of the neck (Figure
4).
o Third, place the fingers of the other hand on
the top of the head and gently pull the head forward increasing the stretch
slightly (Figure 5).
o Hold this for about 30 seconds to a minute.
Some
studies have shown that it is important to stretch tight muscles before
strengthening the weak muscles. It is believed that tight muscles after being
stretched can then relax making the subsequent strengthening exercises more
effective.
Stretches for the neck should
never be done to the point of pain or soreness. As previously mentioned,
appropriate pain management is
often an important part of any neck stretching routine.
Neck Strengthening Exercises
The
scalene and suboccipital muscles are most effectively stretched in conjunction
with strengthening of the weakened postural muscles including the upper
thoracic extensors and the deep cervical flexors.
The following neck strengthening exercises can help relieve neck
pain:
Chin Tuck
One of the most effective postural exercises for combating neck
pain is the chin tuck exercise. This exercise not only helps strengthen the
muscles that pull the head back into alignment over the shoulders (upper
thoracic extensors) but it also stretches the scalene and suboccipital muscles.
The chin tuck exercise can be done numerous times throughout the
day, such as while sitting in the car or at the desk at work. The repetition of
this exercise throughout the day also helps develop good postural habits. It is
especially important to perform this exercise when the neck and shoulder blades
first begin to hurt.
To perform the exercise for the first time it is often recommended
that patients stand with the spine up against a door jam and the feet out about
3 inches from the bottom of the door jam (Figure 1).
·
Keeping the spine
against the door jam, pull the upper back and head back until the back of the
head touches the door jam. It is important to make sure that the chin is down
so that the head is pulled straight back and is not looking up (Figure
2).
·
Hold the head against
the door jam for 5 seconds.
·
Repeat this ten times.
·
After performing this
exercise in a door jam about ten times, start doing the exercise in standing or
sitting without a door jam.
·
The exercise can be done
5 to 7 times per day.
·
When in the car, use the
headrest as a point to aim for when pulling the head back.
Patients may feel some stretching of the muscles
on the side of the neck that go down to the collarbone. These are the scalene
muscles. These muscles along with the muscles at the top of the neck at the
base of the skull are generally the tight muscles. The muscles in the front of
the neck and muscles of the upper back are generally the weak muscles that need
to be strengthened.
In cases of extreme forward head posture,
patients may not be able to pull their head all the way back to the door jam
when they first start. In these cases it is advisable to pull the head back as
far as possible without pain.
Prone Cobra
A more advanced exercise that strengthens the
muscles of the shoulder girdle as well as the neck and upper back is the prone
cobra exercise. This is done lying on the floor face down. The face down
position uses gravity as resistance in the strengthening process.
·
Lying face down, place
the forehead on a rolled up hand towel for comfort.
·
Place the arms at the
side, palms down on the floor.
·
Place the tongue on the
roof of the mouth (this helps stabilize the muscles in the front of the neck to
assist in strengthening) (Figure 3).
·
Pinch the shoulder
blades together and lift the hands off the floor.
·
Roll the elbows in,
palms out and thumbs up (Figure 4).
·
Gently lift the forehead
about an inch off the towel keeping the eyes looking straight at the floor (do
not tip the head back and look forward) (Figure 5).
·
Hold the position for 10
seconds.
·
Perform 10 repetitions.
Back Burn
Another important postural exercise is the back
burn exercise. This exercise is done standing with the back up against a large
flat wall and the feet about 4 inches out from the bottom of the wall.
·
Assume the same position
as the chin tuck exercise with the back of the head against the wall.
·
Try to flatten the lower
back against the wall.
·
Place the elbows,
forearms and the backs of the hands and fingers on the wall with wrists about
shoulder height (Figure 6).
·
Keeping the arms, hands,
head and fingers all touching the wall as best possible, slowly slide the hands
up above the head (Figure 7) and slowly back down (back to Figure 6).
·
Repeat this 10 times, 3
to 5 times per day.
Trigger Point Exercises for Neck Pain
Trigger points in the
muscles around the shoulder blades may be the result of irritation to the facet joints of
the lower cervical vertebrae. Relieving trigger
point pain can also help with a neck and upper back problem.
Trigger Point Exercises
Two effective exercises to relieve trigger point
pain include exercises using a foam roller and a racquetball:
Foam Roller
A full-length, 6 inch diameter foam roll can be used to work out some of the
trigger point pain that often accompanies neck pain.
o Place the foam roll on the ground.
o Lie on it lengthwise.
o Place the hands on the hips.
o Roll slowly sideways keeping the torso parallel
to the ground until the foam roller rolls over the scapular muscles where the
sore trigger points are.
o Slowly roll 20 times to each side.
Racquetball
A racquetball can be used to self-massage shoulder blade trigger points as
well.
o While leaning with the upper back against the
wall, place the racquetball between the tender muscles of the shoulder blades
and the wall.
o Using the legs to move the body, roll the ball
up and down on top of the muscles for about 2 minutes.
Workplace Ergonomics and Neck Pain
It is often important to look at the workplace ergonomics as part of treatment and prevention of neck
pain. Perhaps the placement of the desk, computer workstation and/or placement
of the computer monitor and keyboard can be improved to encourage improved
upper back and neck posture.
When sitting erect at a desk and looking
straight ahead:
·
Eyes should point
directly at the top third of the screen.
·
Forearms should be
approximately parallel with the floor when typing.
·
Elbows should be at the
side.
·
Feet should be flat on
the floor with the thighs parallel with the floor.
If patients have a standing work station or
perform other sorts of sitting or driving tasks, make sure that one side of the
body is not constantly rotated more than the other side, and that there is as
much symmetry in repetitive tasks as possible.
Persistent movements to one side or constant rotation of the neck
and back to the same side can often aggravate joints and soft tissues causing
neck and back pain. Some patients can develop poor posture of the head, neck, and shoulders through
repetitive work tasks and/or poor sitting habits.
There are stretches and exercises that are
effective at helping restore good posture, thereby taking pressure off the neck
and relieving pain.
Pillows Management
Rest and sleep are the body's chance to heal
itself from the postural, physical and nervous insults of the previous day. The
use of some of the following pillows can improve the quality of rest and
repair, allowing one to wake up more rested and ready to face another day.
Pillow Choice Should be Based on Personal
Preference
It is important to note that not all pillows
work well for everyone. A short trial of one week should be enough time to
decide whether or not the pillow is providing benefit.
Knee pillows. Using a traditional (mattress top) pillow either between the
knees (when sleeping on the side) or below the knees (when sleeping on the
back) is important to alleviate strain on the lower back.
·
When sleeping on the
side, bending the knees and placing a pillow between the knees prevents the
knees from coming together and keeps the spine in the neutral position. When
there is no support between the legs, the upper leg rotates downward, pulling
the pelvis, and distorting the natural line of the spine. Adding support between
the knees can prevent back pain induced by these types of forces and allow the
back to heal and more properly rest while sleeping.
Usually, a firm pillow between the knees works
better than a softer pillow because it serves somewhat as a kickstand to keep
the upper leg from rotating over the lower leg.
·
When sleeping on the
back, placing a pillow underneath the back of the knees helps reduce the load
on the lower back. Some people even prefer to have two pillows to elevate their
knees higher. With two or more pillows underneath the knees, the lumbar spine
is flattened, putting less force on the pain sensitive facet joints of the
spine.
This position is the best overall to help the back rest comfortably, and many
people find that this is the only way they can sleep during an acute phase of
back pain or while recovering from spine surgery.
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·
Different Types of Pillows
Body pillows. A pillow that is as long as the body can serve several functions
for people who prefer to sleep on their side, as the top portion can be used to
support the head and neck, while the bottom portion supports the knees and
legs. Some people find this more comfortable than using separate pillows for
the head and knees. In particular, women who are pregnant may find that a body
pillow that provides added support for the abdominal area helps them rest
comfortably. Throwing the top leg over the body pillow while side sleeping
should be avoided, as this places torque (twisting force) on the lower thoracic
and lumbar spine.
Neck pillows. A pillow that is contoured to fill the spaces under the head and
neck can be helpful for people with neck pain. Also called cervical pillows or
orthopedic pillows, this type of pillow has a deeper depression where the head
lies, and extra support under the neck. People with neck pain may favor these
pillows, as they fill the hollow space created by the neck and help keep the
neck in alignment with the spine. Some orthopedic pillows tend to wear out
after one or two years and may need replacing.
Travel pillows. A "U" shaped pillow that is curved to fit snuggly
around the neck can be used for sleeping or supporting the head when in a seated
position. This type of pillow prevents the head from bending too far to one
side or the other. It also creates a support so that the weight of the head is
partially taken care of by the pillow. This relieves some of the work done by
the muscles keeping the head up and may be beneficial while sleeping in a
sitting position, such as in an airplane or in a car.
Lower back support pillows. A lower back support pillow helps provide
support for the inward curve in the lumbar spine. Sitting for extended periods
of time without any lower back support can create muscle tension and pain in
the lower back and legs (e.g. sciatica). Used when in a seated position,
a lumbar support pillow fills the natural gap that is created between the lower
spine and the chair.
Lumbar back support is also helpful when sitting
in a car. When the lumbar curve is supported, the downward forces of gravity
and driving are absorbed much like a coiled spring, as opposed to a
non-supported straight or slouched lumbar spine.
Donut pillows. As the name implies, this is a donut-shaped pillow that is
placed on the seat portion of a chair. With either a depression or a hole in
the center of the pillow, one can sit with much less pressure in the coccyxregion (the tailbone). People who
have suffered a broken or bruised tailbone or have coccygeal pain (such as coccydynia) may need this type of pillow in order
to sit without pain.
Summary of Pillow Support and Comfort
Use of a variety of pillows for both comfort and
support can make a big difference in alleviating or avoiding back pain or neck
pain and getting a good night’s sleep. For people with spinal disorders, the
right type of support can be especially important in helping the spine rest
comfortably.
For example, most down or feather pillows offer very little
structural support compared to pillows filled with firmer materials. People who
suffer from moderate or severe spinal disc degeneration, spinal stenosis, myofascial pain, or trauma often
seem to experience a more restful night’s sleep with a firmer pillow. Pillows
filled with grain or buckwheat hulls are often effective for people with any of
the above-mentioned conditions.
Points to take care
I have had neck pain for most of my life. Even as a young child, I can recall waking up in the morning with a neck so stiff and sore that even looking down at my feet was impossible. As an adult, I have at least three ruptured discs in my neck. Two of those discs have been surgically removed and the bones of my spine fused together. However, I continue to have a problem with reversed curvature of the spine in my neck, more discs becoming ruptured, and the formation of bone spurs that become arthritis. In short, this will be a chronic condition.
I never wanted to be able to predict the weather, but I am unfortunately a member of that club. When a cold front or wet weather head my way, I know it a few days in advance. However, with over two decades of experience in dealing with this issue, I have developed many tips and tricks for coping with chronic neck pain and living my life in spite of it.
As with all body-related suggestions, please use good judgment and always check with your doctor before trying any of these things. I offer these suggestions as something to bring to your health care manager in order to start a good conversation on what you can do to help yourself.
1. Know when to warm it, and know when to ice it.
It is important to learn the different sensations associated with bone/arthritis pain and muscle pain or spasms. Although it may seem counter-intuitive, it is better to use ice on spasming muscles. Heat feels warm and relaxing, but it also increases the blood flow to a problem area, which can make the spasms even worse. But if you chill those muscles, blood flow decreases and reduces the intensity of spasms. On the other hand, if it is bone pain that is bothering you, moist heat is the best and quickest relief. I recommend using a corn or rice bag heated in the microwave. The steamy heat of these bags penetrates much more effectively than the dry heat of an electric heating pad. Whether using heat or cold therapy, apply for 15 minutes and then take a 15 minute break at least. Check with your doctor on this, sometimes he or she will want to adjust treatment timing to better suit your condition.
2. Straighten Up.
Whether your problem is
arthritis or muscle pain, fixing your posture can yield relief in a very short time. In correct posture, your ears should be even with your shoulders, and your shoulders should be even with your hips. Tuck your chin, even up your ears, shoulders and hips, and try to maintain this posture as much as possible. I can sometimes get relief within 15 minutes just by fixing my posture.
3. Strengthen your weaker muscles to balance your stronger muscles.
Maintaining an equal strength in your muscles can prevent a stronger muscle from pulling you out of alignment. Many people tend to hang their head forward, which eventually leads to weakness in the muscles used to pull your head back. I have two favorite exercises for balancing my trapezius muscle. Again, check with your doctor to see if there are special suggestions for your specific condition.
a. The Towel Pull-Down: Straighten up your posture. Take a bath towel and twist it into a rope. With one end of the towel in each hand, raise your arms above your head, palms forward. Adjust your grip on the towel so that your hands are roughly the same distance apart as the outer edge of your shoulders. Now form a resistance by pulling your arms apart, as if you are trying to tear the towel in two. Slowly pull the towel down behind your head as you pull apart. Be careful not to led your head hang forward as you bring your arms down. Slowly come down, then slowly raise your arms back up, keeping up the resistance. Do ten repetitions and then take a break. Do this as often as you need to in order to relieve tension in your neck and shoulders.
b. The Head Press: Straighten your posture. Raise your arms and clasp your hands behind your head, cupping the back of your head in your hands. Keeping your elbows pointed outward rather than forward, gently press your head back into your hands. Maintain pressure for a few seconds and then slowly release. Repeat 5 times. This can also be done as often as necessary to relieve tension.
4. Take your vitamins.
A lot has been said lately about glucosamine and chondroitin, and these nutrients are wonderful for maintaining joint flexibility and movement. Of course you already know that it is important to get enough calcium to prevent brittle bones, which can cause your spine to deteriorate and lead to increased back pain. However, most people don't pay any attention to their Vitamin D intake. If you do not drink a lot of milk, which is fortified with Vitamin D, you may not be able to process your calcium efficiently. Your body naturally produces Vitamin D when exposed to sunlight, but many of us are using a
sunblock daily, and this inhibits natural production of the vitamin. If you are not getting your calcium from fortified milk, it is important to assess your diet to be sure you are getting enough Vitamin D to help your body use the calcium. Look into your daily diet, and if you have doubts about whether or not you are getting enough Vitamin D, talk to your doctor about a possible daily supplement.
5. Use it or lose it.
Pain and stiffness are great de-motivators when it comes to exercise. However, regular stretching and resistance training can help you to keep the mobility you currently have and possibly increase it. Yoga and
Pilates are both wonderful techniques for maintaining and increasing your flexibility, as well as strengthening
the muscles that hold your body in proper alignment. Take it slow and do not hesitate to modify your moves if they are painful. Talk to your instructor and get suggestions for alternatives to any moves that don't work for you. Also check with your doctor to be sure there are no specific moves you should avoid. If at all possible, bring materials to visually demonstrate the different moves for your doctor, to help them serve you best.
In addition to the tips here, you may already be taking medications to help you with pain and muscle spasms. None of these tips will interfere with your medications, but it is important to be aware that combining over the counter medicines with your
prescriptions can cause problems. People often rely on acetaminophen, ibuprofen and naproxen to relieve pain. However, many prescription pain relievers may be related compounds, and using the over the counter remedies along with them can lead to an overdose. Depending on the medicines you are taking, this can cause stress to your liver or kidneys, or other organ systems. It can also cause problems with blood clotting. Think carefully about taking that naproxen tablet for your headache when you have already taken your anti-inflammatory arthritis medicine for the day. Check with your doctor and pharmacist to be sure that all your medicines are safe to combine.
