Neck Pain: Generalities and My Favorite Neck Exercises
Monday, December 7, 2009 at 4:59PMNeck and upper back pain is in some senses more complicated than low back pain. I still try to think about a similar set of possible pain generators for pain in this region, including: discs, joints of the spine (e.g. facet joints), and muscle or myofascial pain.
Muscle-based or myofascial pain seems to me to be a much more prominent or common pain generator for symptoms in the neck and upper back in comparison with low back pain. There are several factors that could account for this but the primary issue seems to be posture.
We all sit too much and we certainly all have a tendency to slouch too much. These postural deficits frequently lead to overload the muscles that hold our heads up. As a result, tension, pain and tightness is created in the area between the shoulder blades, shoulders and neck generally. Some people say that we “carry our stress” in our upper back and necks. While that may be true, that is a more metaphysical consideration that we can enter into here. Rather, the more likely issue is that we create stress or pain with some of the postural habits that we maintain.
Posture is certainly not the only factor that can cause neck and upper back pain symptoms. Discs and facets can definitely cause their fair share of pain. Posture, though, and the ways that we load our spines certainly is a common thread that ties this area especially together.
As far as general exercises for neck and upper back pain, here are a few of my favorite exercises/interventions. Again, these exercises need to be customized specifically to what causes pain or unloads a pain generator for each individual person (more commentary on condition-specific exercises planned for future blogs).
1. McKenzie chin tuck. This exercise creates extension of the lower cervical spine and flexion of the upper cervical spine. It can be helpful for both lower cervical spine and suboccipial issues. This first image shows Nate, one of the best PTs in our area, standing with a relatively neutral spine posture (though his shoulders are slightly rounded forward).
McKenzie chin tuck stabilization exercise
This image below shows Nate doing the McKenzie chin tuck exercise. This exercise generally should be done multiple times per day. It can help to mobilize tissues and also creates some postural awareness (reminding us how much we often drift into a slouched posture with shoulders rounded forward and head falling forward).
McKenzie chin tuck stabilization exercise
2. Theraband exercisees:
a. Rows: Placing the theraband around a doorknob and then performing a rowing motion, this exercise works on extensors for the thoracic spine and scapular stabilizing muscles. Again, it is a great exercise to work on posture modification.
Theraband rows stabilization exercise
Theraband rows stabilization exercise
b. Middle trapezius activation
Theraband middle trapzius activation exercise
Theraband middle trapzius activation exercise
c. Shoulder external rotator activation
3. Deep neck flexor activation: The deep cervical flexors often get stretched out in our stooped postures. These muscles are major stabilizers for the cervical spine and often need re-education in the context of neck pain.
Reader Comments (2)
I agree, DNF's (Deep Neck Flexors) are extremely important stabilizers of the cervical spine (the core of the cervical spine). I was involved in a study while I was going to US Army Baylor Physical therapy program in assessing DNF endurance and the class before me did a study (Harris et al. that found the normative values for DNF endurance in people without neck pain and with neck pain. Neck flexor muscle endurance test results for the group without neck pain (=38.95 seconds, SD=26.4) and the group with neck pain (=24.1 seconds, SD=12.8) were significantly different (Harris et al., " Reliability of a Measurement for Neck Flexor Muscle Endurance")
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