What to do with a "stiff neck"?: stretches versus strengthening

My uncle the other day asked for suggestions on what to do for a chronically stiff neck.  He is not alone in his struggles with neck discomfort.  We all sit at computers too much, slouch too much, and create situations that can overload tissues and joints in the neck that lead to neck pain or stiffness.

I have a related post on neck pain and exercise that I will refer to for part of this discussion at www.backexercisedoctor.com/journal/2009/12/7/neck-pain-generalities-and-my-favorite-neck-exercises.html.  Obviously my uncle’s question was not addressed with this prior post so I will try to provide some additional information.

A study in the Journal of the American Medical Association (JAMA) reported that “Neck pain has been the most common chief complaint among working-aged women visiting their physician.”  [JAMA. 2003; 289:2509-2516.] 

A related study reported that 54% of the general population had experienced neck pain during the past 6 months, and approximately 5% were highly disabled by neck pain.”  [JAMA. 2003; 289:2509-2516.]

Of course, there are a lot of different pain generators in the neck and different possible sources of neck stiffness.  A treatment plan needs to be individualized for each specific person and the individual postural or biomechanical deficits.  However, my recommendations for people with neck symptoms usually fall into three lines of intervention that can help address the underlying source of the trouble.

1. Sit up straight

 A common pattern of postural deficit is to have forward rounded shoulders and a forward flexed neck (pictured above).  This position tends to put a lot of stress on the neck muscles that keep our heads from falling forward, some of the joints that stabilize the spine (especially the mid to upper cervical facets), and discs.

Imagine your head weighs about as much as a bowling ball (which it does).  The muscles in the neck that connect into the upper back are straining all day to keep that ball so to speak from falling forward.  This strain becomes exaggerated in this slumped posture that we all assume at times.

2. Consider ergonomics

Surveys report that an average person spends about 4-6 hours per day in front of a computer.  I will leave a more in depth discussion about ergonomics for another post, but monitor height, chair height and type and a host of other factors can feed into neck issues.  A reasonable resource for ergonomic recommendations can be found at

 www.osha.gov/SLTC/etools/computerworkstations/index.html.

3. Strengthen the upper back and neck

A fourth recommendation may relate to stretching for the neck.  Other people may jump to stretching first, considering that if a neck is stiff it just needs to be stretched out.  I see a lot of patients that have been to physical therapy and all they walk away with are some simple stretching recommendations.  The evidence, though, is not that strong for stretching (especially as a sole intervention) in the relief of neck pain.

A study in JAMA looked specifically at this question of stretching alone as an intervention for neck pain versus strengthening program (plus some strengthening).  [JAMA. 2003; 289:2509-2516.]  These investigators found that “Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain.”  They continue, “Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.” [JAMA. 2003; 289:2509-2516.]

That being said, I will post below some stretches that can be helpful for neck ROM and pain.

[Pictures forthcoming]

I highlighted a few of my favorite neck/upper back strengthening exercises in a prior post (www.backexercisedoctor.com/journal/2009/12/7/neck-pain-generalities-and-my-favorite-neck-exercises.html) but will include some of those here again:

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.  Pictured below Nate is standing with a relatively neutral spine posture (though his shoulders are slightly rounded forward). 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 exercise

McKenzie chin tuck exercise 

2. Theraband exercises:

•  Rows

Rows theraband stabilization exericse

•  Middle trapezius activation

Middle trapezius activation stabilization exercise

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.

Deep neck flexor stabilization exericse

Deep neck flexor stabilization exericse neck pain

 

Soon I hope to have video posted on these issues with illustration of these exercises.  This hopefully will prove a better tool to review some of these issues and exercises.

Comments

[Neck Stretches]

Nice post.I like the way you start and then conclude your thoughts. Thanks for this information .I really appreciate your work, keep it up.