Neck pain- it can be a pain in the neck!
Neck pain is one of the most common things I see in my clnics. Most people I treat have had pain in their neck at some stage in their lives.
The two main cases I see are the one-off episode of pain (“woke up and couldn’t move my neck!”), or people who has had problems over many years and just put up with stiffness until it gets so bad or they start getting nerve related pain (arm pain, pins and needles or numbness).
There is another sub-group who are those who don’t even know that they’re neck is stiff, I often find these patients if they come in with a problem in their shoulder.
Scenario one (woke up with a stiff neck) person is quite often a quick fix; heat pads, gentle movement, manual treatment (getting the neck movements by a physio), and massage. This is normally painful for a few days and then if you keep it moving will tend to improve. In my experience hands on treatment is actually very effective for this problem and helps it resolve quicker.
Scenario two is a little trickier, I remember talking with a spinal surgeon who said that there was some evidence showing that neck pain is hereditary. This touched a nerve with me as I have always had problems with my neck even from my early twenties. I always put it down to my tall lanky posture, but my mom has a bad neck and my sister suffers from neck related migraines. So maybe there is some truth in it. I believe that the shapes of our spines are inherited.
So, our spines may be predetermined to be a problem just as your knee cap angles may predict that you may suffer with knee pain. But often it is a combination of many factors that will lead to the pain.
Chris, is an IT specialist he works from home 2 days a week and long hours at work in Peckham the rest of the week. His work is spreadsheet based and involved intricate mouse work. He’s not aware that his neck is stiff but suddenly started to feel pain in his right shoulder blade and travelling down his arm. He also noticed some numbness into his index finger. Chris had also been cycling twice a week to work as a way of fitting exercise in. He used to be very active before he had kids and now he just tries to fit it in around his life.
Chris’ pain was quite severe that he couldn’t work when I first saw him.
If you were to look at his MRI this showed a small disc at C5 (at the nape). This disc was compressing onto a nerve which was giving him the numbness and arm pain. Chris’ MRI is quite common as the nape is where your neck does a lot of work especially if we start getting stiffer lower down in the mid back.
Talking in medical terms about the neck
Normal changes due to age will cause greater stiffness of the joints in the neck, alongside flattening of discs, osteophytes or lipping of the joints can get in the way of movement and press on to nerves.
When is neck pain serious?
When Chris came to see me originally, he was in a lot of pain, his MRI showed compression, but the spinal surgeon was happy to give his symptoms a little more time to ease. Generally, things will settle down if you do all the right things but if they don’t and your symptoms are worsening then it’s an option to look at a medical intervention (this could be injections to start and then surgery). With Chris a series of physiotherapy sessions focusing on getting his neck moving and working on posture, and time paid off and he improved. He did take pain relief which was prescribed which can also help dampen down the symptoms.
If you are getting any weakness with gripping or clumsiness of the hands, glove like numbness or unsteadiness of your walking then this will warrant a prompt investigation. (Myelopathic changes)
It is rare that things get that bad with most people. With a mix of the following guidance and manual therapy most neck problems get better over a few sessions. Often though, as with most conditions we have, you will need to do work to maintain your neck’s health.
What factors affect neck pain
Sitting at your computer
You may start to see the pattern with my blogs and my dislike of sitting. For necks, sitting for long periods especially on computer or driving can put strain on the neck. The trick with sitting is to bring your lower back more upright and naturally your head sits more on top of your shoulders. When your head leans forwards in front of your body this can increase the strain through your neck.
You need to break regularly, move and get up, do some arm exercises or just go for a walk. Standing desks are cheaper and easier than ever. Get your boss to invest in a standing area. You can even get one for your home office.
Driving and neck pain
I certainly notice that if I am driving I will automatically start getting discomfort in my neck. This maybe due to your arms stretched out in front of you. Look at your driving posture, sit more upright and if you have to do long distances regularly bring yourself closer to the wheel. It is a tricky one to manage and sometimes we just need to be aware that it may upset your neck and plan for it!
Sleep and neck pain
Here’s my thoughts on sleep and neck pain, if you wake up most mornings with a stiff and painful neck then its worth looking at your sleeping position and pillow set up. Its always best to try out a pillow and see what feels comfortable and if things feel better in the morning. Currently I use a Putman Pillow with a small roll for the neck. But I can still wake with a very stiff neck so moving the neck first thing is a must. I will often get my neck moving in a hot shower and this can set me up for the day.
Tight neck muscles and Stress
Part of the problem with the neck is that your shoulder muscles can get very tight and these all attach to the neck. Pain in the neck, in my opinion, can stem from muscle pain as well as joint or nerve pain. The neck muscles are just under a considerable pressure with our working lives and are also carriers of stress. This viscous cycle can be hard to break which is why I recommend regular sports massages. Now this can be as and when you feel you are getting tight (which is what I do) or have a maintenance programme say every 4-6 weeks. Stretching may also help, I have noticed that when I don’t do my Pilates regularly my neck becomes tighter.
Effect of Posture (rounded mid back) on neck pain
Posture is an interesting topic, I do believe that your posture will have a knock-on effect to your neck and low back and the key is to get the mid back moving. This is a very specific area that gets stiffer with age. Mid back exercises can be seen in Pilates or Yoga and you can also work the muscles in the gym.
Heavy arm weights and neck pain
I think that weights will generally help with posture and movement but be aware that if you are lifting heavy weights, you may be over using your neck muscles and making them tighter. So, if you feel your neck is stiff after a weight session then have a look at your technique.