Neck pain (also known as cervicalgia) is extremely common! At any given point, 30% of people have neck pain and 50% of people have some degree of chronicity of these symptoms.
That's quite a lot of neck pain! What a pain in the neck! (pun intended)
Those statistics mean we absolutely need to address neck pain but first we need to understand it's anatomy and where we can run into problems.
The neck is a very complex area, organized meticulously of muscles, nerves and joints. It gives rise to the nerves that control the arms and hands. Plus, it helps hold up our head! Imagine holding an 11 pound bowling ball up in the air all the time! That's the neck supporting our head. What an important job!
The big MVPs of course, are our muscles! There isn't just one or two muscles. There are layers and layers of muscles that stabilize, rotate, bend and extend the neck!
Superficial: Trapezius (broken into 3 segments: upper, middle and lower), levator scapulae , sternocleidomastoid Intermediate: Splenius capitis, scalenes (anterior, middle, and posterior) Deep: Semispinalis capitis, rectus capitis major and minor, obliquus capitis inferior, longissimus capitis, multifidi (3 layers)
Woah thats a lot of muscles! And we can't forget the connective tissue which has fascial attachments all through the neck and spine. Any one of these soft tissue structures can develop tension or get "hung up".
Finally, our nervous system! Each spinal level has a nerve that exits from the spinal cord, named for that spinal level. For example at C5 (the fifth cervical, AKA neck, vertebrae), there is a left and a right C5 nerve root and a C5 spinal nerve.
The spinal nerves eventually branch off to form the brachial plexus (a huge network of nerves) and they continue to branch again where we get our peripheral nervous system! So there can be issues centrally at the nerve root or spinal nerve, or peripherally at a named nerve in the arm. Your physical therapist is able to help determine where there is an issue.
Many nervous system problems have overlapping symptoms so a detailed history is very important in diagnosing you correctly.
To make matters more confusing, muscles have referral patterns that can go up the neck and down the arm which is why your therapist will also do a thorough hands on exam in combination with the medical history.
Yet we don't always treat our neck as kindly as it deserves. We are all guilty of spending too much time bent over our phone, or working on a laptop for too many hours, or even sleeping on 5 pillows. Forward head posture is far too common these days! >Especially with so many individuals shifting to a work from home job environment, or virtual schooling. We hear time and time again that patients know their desk and computer set ups are not ideal but they continue with them anyways.
A few easy adjustments you can make to your work set up:
Which brings us to an important point in neck health: pillows
It can feel like you are Goldilocks and the three bears trying to identify the best pillow for you. Some are super firm, others are really fluffy and compress down, others are gel memory foam. So many options. How they position you also depends on your mattress type. If you have a firm mattress with a firm pillow it might end up being too much cervical flexion (if you're laying on your back). Just as a softer mattress with a fluffy pillow might compress down too much and give you less support than you need.
Either way, your pillow should position you such that when you lay on your back, your face is parallel to the ceiling. We want to avoid tucking the chin. When you lay on your side your ear should be parallel to the ceiling. You don't want to have too much or too little support that your neck is side bent in either direction.
When you sleep on your side, trying to limit chin tucking (fetal position) is also important to keep in mind. Obviously once you fall asleep it's hard to manage your positioning, but at least attempting to go to bed in an ideal position will minimize the stiffness in the morning.
Keeping the pillow just under your head and neck is also important. Many patients get the pillow under their shoulders which pushes you into more flexion, which we are actively trying to avoid.
You may notice we didn't talk about laying on your belly while you sleep. Because in order to do that, and typically still breathe, your head is rotated to the side in either direction. 7-8 hours of a rotated neck is going to spell out bad news for you.
If you must sleep on your belly, (and we hear it all the time, "I just have to sleep on my belly, I can't sleep any other way") there are a series of small pillows that can position your head and neck in a neutral position and still allow you to breathe. If you don't want to buy something fancy, you can use a hand towel to make a little forehead cushion, to lift your nose and mouth off the mattress enough to breath.
Pillows are definitely trial and error, but eventually you will get to one that is not too hot, not too cold, but just right. When you do find one that works, buy a couple to keep in your closet and don't forget to bring it with you when you travel! Nothing is worse than sleeping badly and having neck pain while on vacation.
Your neck (and really your whole body) will thank you! You are doing this for your future self, in order to stay as active and healthy as you can be
There are some dysfunctions to the neck that we can't always prevent from happening.
Remember that complex organization of bones, muscles and nerves that we talked about? Any of those structures can be injured or gradually deteriorate.
If you have neck pain reach out to our office today!