Early this week I was treating a patient that has been having neck pain for several years. She has been discouraged because she has not been able to manage her pain on her own and although she responds to help from physical therapy, Chiropractic or massage, she came to me hoping for a home program where she could learn to manage on her own.
Today I am going to try to provide the basic guidelines that I use when I am evaluating a patient. I have been specializing in treating back and neck pain for the last 20 years and the most important starting point for everyone that has neck pain is how they hold their posture.
There are a lot of opinions on what “proper posture” is, but I have found that the best posture for you may not be the best posture for me or anyone else. So rather than trying to figure out how to look like someone else or what someone else thinks you should look like, learn what you ideal posture is and work on that!
When it comes to neck pain I believe your thoracic spine posture is the starting point because if you have lousy thoracic spine posture it is difficult or impossible to have healthy neck postures. (If your lower back posture is lousy then it makes it hard for your thoracic spine to be healthy.)
I would like to draw your attention to the sternum (the breastbone). A typical “slouched” posture is one where the sternum is facing forward and in some people facing down. (Smartphones are making this problem even worse.) The thoracic spine rounds when you are sitting slouched. This in turn pitches the head forward resulting in strain to your neck joints and strain to the muscles that support the head and neck. The bottom line: “Slouchy = ouchy!”
I often meet patients that immediately try to use the muscles of the upper back to “straighten” the thoracic spine and to pull the shoulders back. I do not recommend this strategy. First of all the muscles are not meant to be the main source of your posture. I recommend lifting the sternum so that it points slightly upward. This is more effective and easier than trying to engage muscles that are not capable of sustaining the position you are artificially achieving by activating them.
The act of lifting the sternum is as simple as reaching your hands over your head toward the ceiling. This is one way to make sure that your thoracic spine lifts and it is as easy as it sounds. Once you reach up your sternum lifts automatically. Next, bring your arms down but keep the sternum up and then ease up just slightly.
If you have shoulder problems then all you have to do is sit all the way back in a chair and lean your shoulders back as far as you can. Notice that when you sit back and your back fully touches the back of the chair, your shoulders automatically come back….and your sternum faces slightly upwards. Keep this position whether sitting or standing.
Your posture is most important because it is the safest thing you can do and over a long period of time, it will be the thing that helps the most. The difficulty patients have with maintaining posture stems from poor habits and the length of time it takes to have significant improvements.
The next part of treating your own neck is to establish baselines. There are two baselines that I focus on:
1. Stationary baseline
2. Movement baseline
In both cases you are checking how you feel. What are your symptoms? Whatever your symptoms, the important aspect is whether or not your symptoms change.
I was taught to use the following language with my patients:
1. Do your symptoms INCREASE?
2. Do your symptoms DECREASE?
3. Do your symptoms REMAIN THE SAME?
So to be more specific when you are still...either sitting, standing or lying without moving, then you are assessing your “Stationary baseline.” I use this to draw people to what is happening at this moment. Often we remember what has happened or we are fearful of what could happen and we end up not noticing what is happening. So this step is for you to stop and notice how you feel.
Next, notice how you feel when you move. In regard to the neck, there are six movements that I check. I watch patients turn to the right, then the left. I have them side bend (touch the ear to the shoulder) to the right then the left. Finally I have my patient bend forward and bend backwards. This is how you check your “Movement baseline.”
When checking your “Movement baseline,” it is important to notice how you feel and how you move...meaning how far you are able to move. This is important because often patients that hurt are also not able to move a lot. This is also important because it helps to clarify what is actually happening at the neck. It makes it easier to discern the condition you may have based on how you are moving.
When you notice that you have difficulty moving more to one side than another it typically means your issue is coming from the joints themselves, even if you have a lot of muscle tension, and the solution is to restore your motion. The movement that I have found to be the most effective is the “retraction” motion.
The best way to perform this movement is to get in a chair that hits you about the middle of your back. If you have all high back chairs it is very difficult to so place towels or blankets down to prop you up in the chair. Then simply lean back as though someone were trying to kiss you that you did not want to kiss.
Repeat this movement 5-10 times then recheck your “Movement baseline.”
You are checking to see if you move better and/or feel better. I recommend doing activities that help you move better and feel better. I recommend avoiding activities that make you feel worse or reduce your motion...no matter what the activity is.
I have found that for those individuals wanting to help themselves, the best advice is to work on your posture. Remember to lift the sternum when trying to help your neck. It is also important to restore your motion if you notice that it one direction is worse than another (either more painful or less motion). Once your motion is restored then focusing your attention on your posture will have the biggest affect.
Thanks for reading my article. Please contact me through my new and improved website goodemotept.com. If you would like to speak to me or would like me to come speak to a group please feel free to contact me by email This email address is being protected from spambots. You need JavaScript enabled to view it.;
