This blog is for Sarah Davidson from http://helpmyneckhurts.com/. She asked me to write a blog post about how to prevent neck pain when working out - I thought it was a great topic so here I am!

I am going to be talking about the following things:

1. What causes neck pain
2. The principles I use when prescribing exercise for those with neck pain
3. Ideal postures during exercise for neck pain patients

If you have any questions, just ask away below 🙂

What Causes Neck Pain?

Neck pain has many different causes. I break them down like this:

1. Muscles/connective tissues (Myofascial)
2. Bones/Joints/Ligaments (Articular)
3. Nerves, coordination, and brain issues (Neural)
4. Medical reasons (tumors, blood vessel problems, psychological conditions etc)

Myofascial Reasons for Neck Pain:

This is the one of the most common reason why people get acute neck pain - muscle strains, "knots", overactive muscles, etc.

Quite often, these soft tissue injuries present with a "stretch" pattern of pain - e.g. bending your head forwards and to the left will produce pain in the back of the neck on the right.

Interestingly, if a patient of mine has muscular/myofascial neck pain, I often want to look to see why - why is it that they strained a muscle or their muscles are always tense?

If you have myofascial neck pain, it often feels better after a massage but it is short lived relief unless you deal with the underlying causes of the myofascial strain.

Articular Reasons for Neck Pain:

This is one of the most common reasons for chronic neck pain - arthritis, bone spurs that pinch nerves, discs that are strained etc.

Articular reasons for neck pain tend to present with a "compression" pattern of pain - e.g. bending your head back and to the right will give you pain in the back of the neck on the right side.

Your neck joints have to support the weight of your head, provide a total of approximately 180 degrees of rotation from side to side and 180 degree of movement looking all the way to looking all the way down. This requires all those moving parts to be working optimally...which they often aren't...so why do you develop these articular changes?

Neural Reasons for Neck Pain:

I find that THIS is the most common underlying problem which leads to either a pinched nerve, sprained joint or strained muscle - poor coordination. This classification also includes pinched or irritated nerves as well as disorders of the central nervous system that can amplify normal sensations and interpret them as painful.

For your neck to work properly, the brain needs to coordinate the action of the muscles to move and control the joints to produce the desired movement. It is often the inability to coordinate the muscles and joints that leads to shearing (sliding) and straining of the joints. This often leads to protective muscle spasms which are painful. It can also lead to joints getting "jammed" which required release.

Ignoring these signs in the long term leads to muscles being weak, imbalanced, or tight, Joints can become stiff compared to other joints which forces the other joints to work harder and can lead to joint and muscle strains and pains.

A Word On Core Stability:

"Core stability" is one of those unfortunate terms that gets thrown around and people think it means many different things. What the essence of what it means to us Physiotherapists is the ability to control the shear forces placed on joint...the ability to control the position and movement of the joints being observed. For the neck, it means that the movement is smooth, full and fluent. Lateral shearing and displacement in the neck is often seen in people doing exercises. This is a loss of control of the neck joints and leads to strained muscles, joints and nerves.

Medical Reasons For Neck Pain:

It is beyond the scope of this article to discuss the other reasons for neck pain. A component that must always be explored is to determine if someone has centrally sensitized pain. This occurs in those who have chronic pain for over 3 months and is often seen in those with whiplash that do not respond to conventional treatment. Mentioned above in neural reasons for pain, Central Nervous System pain

The Principles I Use When Prescribing Exercises For Those With Neck Pain

1. Increase the mobility and flexibility of the neck at the same rate as stability
2. Learn and maintain the neutral position in sitting and standing
3. Learn how to move your trunk while maintaining limbs (arms and legs), trunk and neck stability
4. Learn how to move your limbs while maintaining limb, trunk and neck stability
5. Learn how to move your trunk and limbs in one, then two and then three dimensions while maintaining trunk and neck stability
6. Learn how to move your neck with step 5 above
7. Add load gently and progressively

I could write a whole blog post on each of these steps. I will just write something short on each one...

Increase the mobility/flexibility of the neck at the same rate as stability

• This principle is basically saying that to stretch without learning how to control the new range of motion is a recipe for disaster.
• Conversely, getting stronger without increasing your range of motion to normal levels will result in the same problems of decreased range of motion.
• Both mobility and stability go hand in...both need to be addressed

Learn and maintain the neutral position in sitting and standing

• Sitting and standing is what most humans do for work and leisure when awake.
• Learning these positions provides the foundation for your neck to work optimally
• Most people are taught this poorly and most health professionals teach this poorly as well
• DO NOT PULL YOUR SHOULDERS BACK AND DOWN...this is rarely the problem - see here for more details as well as here...

Learn how to move your trunk while maintaining stability

• Changing the angle of your trunk while keeping your spine, pelvis, hips, knees, ankles, feet and shoulders in good positions
• It includes bending over, leaning forwards/backwards/sidewards and trunk rotation

Learn how to move your limbs while maintaining stability

• Starting off in neutral sitting or standing posture, learning how to move 1-4 limbs while maintaining stability
• Progress into 4 point kneeling and lying supine
• This is not as easy as it sounds but it is hard to show you without you seeing and feeling how specific I am with what I want 🙂

Learn how to move your trunk and limbs while maintaining stability

• Starting off in one dimension/plane of movement helps to maintain stability
• As you get better, you can add another plane of motion
• Lastly, you should be able to move in 3 dimensions while maintaining your neck in a neutral posture

Learn how to move your neck, trunk and limbs while maintaining stability

• As above but the complexity has increased to include the neck in positions out of neutral spine and movement
• All positions and movements are testable for stability
• By the time you are here, you should have a good grasp of when you have placed yourself in positions that are inefficient
• I find people are progressed here either too quickly or not at all in their exercise programs

Add load gently and progressively

• Hand weights, back packs, bags, boxes, etc - basically anything you would use in real life is fair game.
• The load must be challenging but not so heavy that your technique or form suffers
• Eventually I expect you to be lifting weights, swinging kettlebells, doing body weight exercises etc etc
• The typical program for the typical patient can vary from a couple of weeks to get to this point to lots of months - each patient has their own challenges and starting levels so it is hard to be specific with how long someone will take to get better.

Ideal Postures For Neck Pain Patients During Exercise

• Neutral spine in sitting and standing with the head over the thorax which is over the pelvis
• Shoulders need to be square...not with scapulae depressed or retracted nor protrated and elevated.
• Your hips and pelvis needs to be able to remain square and the pressure in the socket needs to remain centered.
• Avoid excessive extension, especially if you have any narrowed foraminae or pinched nerves. The most common one i see is the poked-neck posture aka forward head posture
• Use supported positions until you develop the strength to maintain those positions yourself.

An Example of Poor Neck Posture During Squats

The original post was here...