This is the start of a series of blogs on the most common causes of muscular pain and how to avoid it. Some of the advice is stuff you can do for free at home and some, depending on the health care system in your country, is stuff you'll have to pay for. The good news is all the info in these blogs is free so you can just follow the bits you want to. Today we are going to look at neck pain which includes pain extending out to the shoulders, upper back and head (tension headaches not other types of headaches).

There are a series of muscles around the head, neck and shoulder area that can become painful, most commonly this is due to trigger points in the muscles. These are tight "knots" in the muscles which are tender to touch especially with increasing pressure and are capable of referring pain to other areas of the head, neck, upper back and arms the more irritated ("active") they become. There appears to be a close relationship between muscle trigger points, shiatsu points and acupuncture points which may help explain to the more sceptical amongst you why (besides placebo effect) some people have success with such alternative therapies.

There are a number of different reasons why trigger points become "active" (start producing pain). Posture is perhaps the most common reason for the neck particularly sustained bad postures such as working at a computer, reading in bed, slouching on the sofa, driving long distances and playing on tablets. The further your head (measure from ear holes) is in front of your shoulders (acromion, bony point in middle of shoulder when viewed from side) the greater the weight of your head pulls on your neck and upper back. This makes the muscles in that area work extra hard and surprise, surprise they get angry after a while. Also you joints gets stiff and your GP will tell you its your age you have arthritis and shove painkillers down your throat!

Everyone suffers from some level of degenerative joint disease ("arthritis") as they get older, there is no cure for it. BUT the more injuries you have to the neck (eg whiplash) and the worse your posture is on a regular basis (eg office workers) the quicker the arthritis will set in and the more severe it will become unless you do stuff to slow the progression down. Even though I mentioned there is no cure there is a lot you can do to slow the progression of symptoms and some of it is free and none of it involves pharmaceutical drugs.

There are 3 key things to work on: mobility, stability and movement patterns (including posture).

1) Mobility - You should be able to comfortably (I mean without pain) get your chin to your chest standing or sitting (neck flexion), comfortably get your forehead parallel to the sky when standing (neck extension). Sideways you should be able to rotate your neck so your nose goes behind the front of your shoulder comfortably in both directions (neck rotation) and you should be able to angle your nose at least 45 degrees to each side (move ear towards shoulder - neck lateral flexion). If you cannot achieve all of these you have a problem with neck mobility and in most cases you could improve that with exercises.

The first area to address is actually your mid and upper back, if that area is too hunched over (thoracic kyphosis) then you will always be limited in you neck movements. Exercises like reaching your arms behind you as far as you can or the brugger (see my video on basic neck stretches - only do crunches at end of vid if you have mastered neck control) are good starting points. Using rolled up towels, foam rolls or tennis balls under your mid/upper back whilst you lay over them (face up) will really help increase thoracic mobility especially if you lift your arms up and over your head as you do it. 

Along with thoracic mobilisations you can do neck stretches like in my video I mentioned above. Please do not roll the head/neck during these stretches, move slowly in and out of end range of motion and do not use weights or your hands to stretch further. If your neck is ready to increase its mobility it will do so over time with regular slow and controlled exercises. If it is not ready to loosen up that way you need to see a manual therapist like a Chiropractor, Osteopath or Sports therapist (in the UK - other countries may have different professional names).

2) Stability - You may have heard the term "core stability" referring to the way your abdominal and lower back muscles brace your spine in the lower back area. Well your neck has a similarly unstable curve to your lower back (lordosis) and also needs some muscles to brace it when it is under load. The best muscles for doing this are the group under your chin known as the deep neck flexor muscles. If you tuck your chin in like in my video I mentioned earlier you are activating these deep neck flexor muscles and reducing the amount of work your larger posterior and lateral neck muscles have to do (the ones that usually hurt from doing too much when your posture is rubbish!).

Chin tucking is much less effective with a hunched over mid/upper back so as I already mentioned that is number one priority but neck stretches and mid/upper back mobility are less effective if you aren't also using your deep neck flexors so chin tucking is a very important thing to learn. Simply lay on your back with a cushion/pillow to support your neck/head with forehead parallel to sky. Tuck your chin towards the ground giving yourself a double chin holding for up to 10 seconds. You can also do this standing or seated making sure this time you keep the top of the head parallel to floor (looking straight forward).

3) Movement Patterns - This includes breathing patterns and posture. One of the best exercise regimes for this is the Alexander technique (The guys in this video might seem nuts but the exercises are very effective). Pilates kind of touches on it but often encourages too much flexion in most of its exercises so personally I would not recommend Pilates unless the instructor really knows what they are doing. You might be surprised how simple breathing exercises can help to relax your neck muscles and the ideal static posture is a slight chin tuck with the ear holes in line with the shoulders which are held back and down with a lifted up chest.

Even that ideal posture can be painful if held for too long however as your muscles love to move so if you have a job that involves little activity (ie office jobs, reading, gardening, driving) try to have mini breaks every 15-20 mins (or every 2 hours driving) and run through some of the exercises above. Remember exercises aren't always going to be enough. To work out those active trigger points more you can try applying pressure to them until they relax (usually takes around 30-45 secs). This can be done with a hard ball and either leaning on it against a wall or on the floor. If this still isn't working then it's time to bite the bullet and let a professional (Chiro, Osteo or sports therapist) have a go, remember these people have gone to university for several years to learn about this stuff they are probably a lot better than you at it and they have put a lot more time into learning about it than your average GP or NHS physio!

Not all neck, shoulder and head pain is caused by muscle trigger points and joint stiffness so these methods won't work every time but they are safe to try and if they're not working you know it's time to get it looked at by someone in the know. The other good home help you can try is ice for 10 minutes at a time, at least 3-4 times per day if the pain is predominantly inflammatory (worse in the mornings and when you have been inactive for a while, pain radiating down the arm). If the pain is more of a general ache that creeps on during the day it is very likely muscular so you when doing the stretches above you could get more out of them if the muscles are warm so apply a heat bag or do them in the shower.

If you currently have no neck problems but want to avoid having them in the future then try to perform at least some of these exercises each week. Just like going to the dentist to get your teeth checked every few months or years it may also be worth having a therapist loosen up the area every few months to slow down the progression of "old age". If you want any more info check out my neck pain page from my website or contact me online.

Published by Paul Hindle