Neck Pain Advice From a Physical Therapist in Sterling, VA

As a physical therapist, neck pain is one of the most common diagnoses that I encounter. Neck pain can range from a small tweak to 10/10 pain that stops you from turning your head. I wanted to discuss the most common causes of neck pain that I see in my practice, Eclipse Wellness, each day. I also wanted to highlight some exercises and rationale that I use to decrease and prevent neck pain.

What Causes Neck Pain?

There can be many causes of neck pain, but I want to break them down into 2 reasons: muscular tightness and joint tightness. Those can go hand in hand as one may cause the other. It is important to note what does not cause neck pain: poor posture.

I see many clients who believe that their posture is a cause of their neck pain. This is not the case based on research evidence as well as anecdotal evidence. Research shows that there is not a significant relationship between posture and pain. Also, your poor posture has probably been the same for a long period of time. If your posture has not changed for years, then it seems highly unlikely that it is the cause of your pain.

Posture may play a role in neck pain in the sense that it creates a movement pattern for your body. Your pattern could be flexed, extended, or a bunch of other movement options. The issue comes when you are unable to exit your posture and move in different directions. All of us hunch at the computer, but we should be able to straighten up. If you are unable to change your neck position because of stiffness resulting from your posture, then that may be causing your pain.

Stiffness or a lack of mobility can cause pain as it relates to the muscles and the joints. Tight muscles can often cause neck pain. A tight muscle can build up inflammation through the formation of trigger points, and movement is restricted by these trigger points. The lack of movement causes further muscular tightness, which leads to a cascade of tightness and pain.

2 common muscles that can cause neck pain due to tightness are the upper trapezius (upper trap) and the sub-occipital muscles. The upper trapezius is located on top of your shoulder and it runs from the shoulder to the cervical spine. Tightness in one or both upper traps causes asymmetry and pain within the neck. Bending your head forward or to the side can become limited due to tightness in the upper traps.

The sub-occipital muscles are a group of 4 muscles connecting the base of the skull to the upper cervical spine. They are responsible for bending your upper neck as well as allowing over 50% of rotation throughout the neck. Tightness in these muscles can result in pain at the top of your neck or headaches.

Finally, joints can have limited mobility as well. The joints of your neck are very small and involve nerves and other sensitive structures between them. Restricted cervical joints can cause pain in the neck or even refer it down the arm. Tight joints can come from tight surrounding muscles, and any treatment should encompass muscle and joint mobility to ensure full treatment of the neck to get rid of pain.

When discussing joint tightness, it is important to note the role between the thoracic and cervical spines. If you have stiffness in the joints of your thoracic spine, you can experience limited mobility in the cervical spine. A thorough examination by a healthcare professional should study thoracic mobility, as it is often limited and playing a role in neck pain.

How Can I Fix My Neck Pain?

Fixing your neck pain involves identifying the cause of the pain. This is best accomplished with a thorough evaluation by a healthcare provider, hopefully a physical therapist. Finding the exact muscle that is limiting movement is important. Similarly, understanding why the muscle is tight is crucial. This could be due to a lack of mobility or strength. I see many clients stretching their upper traps for hours a day with no relief. If they took the time to understand that strengthening the upper traps and avoiding excessive stretching can actually help, they may finally get rid of their lingering pain.

A situation that I often see involves someone complaining of pain and tightness through their upper traps. They have been told that they have poor posture and they need to keep their shoulders down and back. Throughout the day, they are constantly stretching their shoulders down and back, which creates more stretch on the upper traps. Imagine a hamstrings strain. Would you repeatedly stretch your hamstrings to its full length? You would probably avoid doing that because of the pain and irritation of the muscle. I see many clients who think that they need to maximally stretch their upper traps to promote “good” posture, and this in turn causes increased pain and stiffness through the muscles and the neck.

If muscles are simply tight from wear and tear, manual therapy is an important part of your treatment. I utilize trigger point dry needling every day in my clients with neck pain. Dry needling in conjunction with massage, scraping, and other manual therapies can help speed up  the healing process and get rid of tightness in the affected muscles. It also prepares the neck for loading with exercises. Manual therapy is great to mobilize the muscles, but it is not addressing the root cause on its own. These techniques open up a window of greater mobility and decreased pain so that exercises can be more beneficial.

If you are trying to strengthen your upper traps, lateral raises are a great exercise. These help build the shoulder muscles including the upper traps, they are simple to perform, and they promote good scapular movement. One of the first exercises I will give people who are stuck in the idea of needing to improve their posture are lateral raises. These force you to elevate your upper traps and your scapula in order to perform the movement. This allows for strengthening and mobilizing of the affected muscles.

If you are looking for Increased mobility and strength in the sub-occipital muscles, then a chin tuck and lift is great. Simply lie on your back, tuck your chin to your chest, and lift your head an inch from the ground and hold it. This helps stretch the sub-occipital muscles in the back of your neck, but it forces them and the other stability muscles of your neck to work hard and get stronger. You would be surprised how many clients I see struggle with even lifting their head, showing the extent of the muscular weakness that they are experiencing.

An exercise that I love to target both the upper trap and the sub-occipitals is a sidelying cervical rotation. In this exercise, you will lie on your side and keep your head elevated and flat. Slowly turn it towards the sky and ground as far as you are comfortable. This creates stability in the sub-occipitals and upper traps, while addressing general cervical rotation mobility. This is another exercise that looks easy but is challenging for many.

If you are limited due to thoracic joint restrictions, the easiest remedy is utilizing a foam roller for your thoracic spine. It is important to try and isolate the thoracic spine with this exercise, so if you are able to tuck your pelvis or at least keep your lumbar spine steady, that is ideal. Rolling along the thoracic spine with occasional extensions over the foam roller are ideal for creating mobility.

If your limitations in the thoracic spine come from tight muscles, I love the prayer stretch. Have both knees down and your elbows on a low chair. Put your hands together as if you are praying, sit into your heels to round your lower back. Sink down and let your hands go over your head. Once in position, try and take deep breaths and push your chest towards the ground with each exhale to maximize your stretch.

Hopefully, these exercises and techniques have given you some ideas if you are suffering from neck pain. As I mentioned, the best answer is to find a medical provider who can perform an individual assessment and identify your problems. In the meantime, try these exercises to improve your mobility and strength and hopefully get rid of any nagging neck pain!

Interested in hearing Dr. Danny discuss this topic in video form? Check out our YouTube video with full demonstrations of each exercise here!