Articles on Physical Therapy

Fix Your Own Neck, Upper Back, and Shoulder Pain

Bad Cervical (neck) Discs, Nerve Impingement, Round Shoulders, Upper Crossed Syndrome, Muscular Pain, and "Stress" Pain

Don't Worry - Neck, shoulder, and upper back pain are easy to fix. This article will show you how to easily and quickly stop the source of upper body pain. Then you no longer will get the pain and your neck, shoulder, and upper back can heal.

Neck Pain and Upper Back Pain Why?

Neck and upper back pain is not difficult to prevent or fix. People do an astonishing number of things every day to strain, weaken, and pressure their necks. They stand, bend, sit, and let their head slouch forward all day and shoulders round, all day, every day, then compound the problem with inactivity, holding muscles tightly, and bad exercises that only round the upper back further. They may do physical therapy or exercises, but not be aware that strong muscles will not automatically give you good posture, make you stand and move properly, or make up for all the things you do the rest of the day to hurt your neck. It is no wonder why they still get pain even though they "do their exercises." Many wind up taking pain pills, or in long term or recurring pain, not understanding why their physical therapy or exercise program, or pills, or yoga "didn't work." Your physical terapist should review this with you. At Mile Square PT, we will demonstrate appropriate posture, and teach you stretches and exercises to reinforce appropriate posture throughout your day.

Bad Discs

The pressure of your own body weight on your neck muscles and discs over years of poor sitting, standing, and bending habits is enough to injure your neck as badly as a single accident.

 All this chronic forward bending (flexion) overstretches the muscles and long ligament down the back of your neck, which weakens the neck, and makes room for discs to push outward. It also physically pushes vertebral discs posteriorly (outward to the back).

After years of squashing the discs in your neck with a forward head posture - by letting your head drop forward, the discs in your neck may herniate and press on nerves, sending pain down your arm.

Tight muscles from years of poor positioning and short resting muscle length can also press on the same nerves mimicking nerve impingement pain.

A degenerating disc is not a disease, but a simple, mechanical injury that can heal, if you just stop grinding it and physically pushing it out of place with terrible habits.

  
On the left above is a normal disc between two vertebrae.
On the right is a disc pushed out (herniated) from bad bending habits.
Forward bending gradually pushes discs out to the back.
Lift and bend properly to avoid pushing your discs out of place.

Sitting, standing, and living with your neck and head
forward can eventually push cervical (neck) discs out

The Forward Head

A "forward head" is the source of much neck and shoulder pain. The neck should be on a straight vertical line. Many people let their head and neck tilt forward. This is called a "Forward Head."

Many people are too tight in the upper chest and shoulder
to stand properly. The forward head (left) commonly results in sore
shoulder, neck, and upper back. Such pain is easily fixed.

A forward head can eventually damage neck and upper back structures, as they bend and rub at angles they were not built for. Chronically holding neck muscles in an overstretched position weakens them. The forward head creates shortened, contracted muscles in front, and a stretched, weakened back. Cervical (neck) discs are pressured posteriorly. This creates a cycle of forward positioning that herniates discs and makes sore aching muscles, and the tightness and habits that keep you tilting forward. The result is that the average person has upper body pain from the poor positioning and at the same time, the chronic poor positioning makes them too tight to stand up straight.

Many people do most of their standing, sitting, activity, and exercise with a forward head. No wonder they have pain. Look in any fitness magazine and see all the photos of people doing exercise with their neck tilted forward and chin jutting forward. Look at how people eat. Look at how they carry backpacks and bags - hunching forward against the load instead of using muscles to hold their spine in healthy position. Then they do shoulder stands in yoga, which simultaneously overstretch the ligament, pressure discs outward, and create forces that generate bone spurs. The average person overstretches and unequally stretches their neck and upper body so much, that it is amazing they dont hurt more.

Muscular Pain from The Forward Head

Poor standing and sitting ergonomics are a common cause of numb shoulder, upper back pain, and headache. It makes a classic "tension" pain across the shoulders, in a diamond pattern down the middle of the upper back, in the neck, up the neck to the head, and sometimes down the arm. Forward head is a common source of headache. Yet, after mechanically pressuring their neck all day, people call it stress and do not fix the very forward posture that would give them relief and stop the injury process.

Also keep in mind, that if you sit in a slumped position at the low back, your head and neck are automatically put in a forward head position. 

Surprising Source of Shoulder Pain

The forward head is a surprising hidden source of shoulder pain and impingement. With the head held forward, it rotates the upper shoulder forward (round shouldered) which gets in the way of normal motion when you raise your arm. The upper arm bone squashes the soft structures of the shoulder capsule against the shoulder bone (where the scapula meets the clavicle). This can cause pain, squashing (impingement) and rotator cuff injury. How often does this happen? Every time you wash and comb your hair, pull off a shirt, put away groceries, scratch your head, brush your teeth, and reach for anything - in short, a forward head can cause shoulder and upper back and neck pain many dozens of times a day. The injury adds up over time.

Making It Worse When Trying to Stand Straight

Many people know they should keep their head lifted up and not drooping forward, but the front of their chest is so tight, that when they try to do it, either they arch their back, or crane their neck, or both. "Craning" the neck means "pinching" it back, with the chin and face lifted. Craning the neck is surprisingly common and a big source of neck and shoulder pain. Many people crane their neck to look up, to drink water, to reach overhead areas, even to eat. Check yourself to see if you jut your chin forward or hunch your shoulders up.

Many people are so tight that they crane their
neck to look up, or to try to pull their head back enough to
stand straight. Do the two stretches below to relieve this.

Try This To See What Stretches You Need to Fix Upper Back Pain and Poor Positioning

1. Stand near a wall, with your back to it, but not touching the wall.

2. Back up until something touches. Did your behind touch first, as in the first figure in the drawing below? You may stand "booty out," flexed at the hip.

3. Did your upper back touch first (second figure in the drawing below)? You may stand slouched backward.

Do this wall stand test, described above,
to see if you have the healthy positioning
needed to avoid neck and upper back pain.

Now try to stand with your heels, hips, upper back, and the back of your head against a wall. Bring the back of your head against the wall without raising or dropping your chin, or arching your back. If you can't keep your heels, hips, upper back, and the back of your head comfortably against the wall (third figure in the drawing above), or if you have to crane your neck, you are too tight to stand up straight. Pain results from the resulting bad positioning and slouching your tightness creates all day, every day. This is common. Here is what to do about it:

Exercises to Strengthen and Retrain Muscles

When you stop bending wrong and injuring your back dozens of times each day, it can begin healing with good exercises.

Neck pain exercises are misunderstood. People often injure their neck all day then hope to fix it with a few exercises. They don't understand when this does not work. They lie on the floor to do exercises, then stand up and walk away with no use of the positioning or strength they just practiced. It is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work." The key is what you do all day!!

What To Do Every Day To Prevent Neck Pain.

To restore proper muscle length to allow healthy posture:

• First thing in the morning, don't sit on the bed. Instead of sitting and rounding your back first thing, turn over and lie face down. Prop gently on elbows, but not so high that it strains. It should feel good and help you straighten out first thing. Get out of bed without sitting.

• Don't droop your head forward when sitting and standing. Remember that posture is a voluntary muscular exercise.

With Physical Therapy we can review exercises and stretches for you to do every day, that are appropriate for your condition and your symptoms.      

More Things To Do Every Day to Prevent Forward Rounding from Ruining Your Neck

• Sit without rounding your shoulders and upper back.
• Count how many times you let your head tilt or hang forward each day. Imagine the injury to your neck by doing that many times each day.
• Raise your computer monitor up. Don't just tilt it, use a low shelf or phone books to raise it higher so you don't bend your neck down to work.
• Move your television up higher. Stop curling down and forward to watch.
• Move your desk and car seats closer in. Then sit back, not forward.
• Use your muscles, not joints to hold you up. Its free exercise.
• Do upper back extension exercises provided by your PT. It will feel good.
• When you pull your chin in to fix your posture, don't do it by arching your back. The postural change needs to come from your upper body, not by creating another strain on another body part.
• Don't think you have to live your life "on eggshells" constantly holding yourself rigidly straight. Restricting your movement to limit pain is not how to live, isn't healthy, and isn't fun. Get more active. Learn the principles and apply them, instead of memorizing "rules" and buying expensive ergonomic chairs and beds.
  

Dont Exercise in Ways that Damage Your Neck, Shoulder, and Upper Back

Many people hurt from excessive forward bending all day over their desk, steering wheel, work, and TV. The last thing they need is more upper back and shoulder rounding. Yet, that is usually the first thing they do to exercise or stretch. Many exercises, ironically even those commonly (but mistakenly) prescribed for back and neck pain, often involve more forward bending - toe touches, knee to chest, crunches, and shoulder stands like "the plow" and "The Frog" (lying backward, raising legs over head so that all weight is on your upper back and neck). It is important to strengthen the muscles that pull your upper back and neck the other way. These are called Extension Exercises.

It is common to see people pulling their arm across their body in front to stretch. Most people already are good at rounding their shoulders. They don't need more stretch in back of their shoulder. Round shoulders are part of the problem in the first place. Don't add to your round shoulders with more stretching in back. Instead, stretch the front.

Most people already hold their neck in a forward-stretched position, which is a bad posture called a forward head. They don't need to stretch it more forward. Although it is common to stretch by pushing the neck forward, it adds to existing problems. Adding body weight to this stretch can degenerate the discs in your neck and gradually push them outward to the back (herniate). The pressure on the back of the neck bones from your body weight also can eventually make the bone protect itself by growing a bone spur.

The Point of Neck and Back Exercises

Strengthening and stretchingare crucial, but alone will not change posture or lifting habits, and so cannot "cure" back pain or posture problems. Some may actually contribute to the original problem of over rounding and bad posture. Neck and upper back exercises are supposed to be used to retrain you how you hold your body all the time. Doing exercises for pain is not like getting a shot of penicillin or going to confession. It does not "fix" bad habits the rest of the time. For example, lying down for pelvic tilts, then standing up and letting your back flop into any old bad posture, not keeping the proper tilt. Back exercise is supposed to retrain your thinking and habits *all the time* not just during the hour of worship. Strengthening has no effect on posture if you dont apply the strength the rest of the day to control joint angles for all activities.When you bend over things during the day, don't droop your head forward.

Remember not to crane your neck when doing other stretches. Most people round their back and neck all day. It only adds to the problem to do exercises like this too. Even sillier, by doing the stretch by rounding your neck and back, you lose the stretch on your leg, which was the whole point of doing the stretch in the first place.

Discs Can Heal

Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal - if you let it. Stop damaging your discs with bad bending, standing, and sitting habits and the discs can heal. It takes years to herniate a disc, and only weeks to months to heal it by stopping bad habits.

Muscles Can Heal

When you over-tighten muscles with hunching and bad habits, they can remain too shortened to let you stand properly. Or they stay tightened in "knots" or spasm. This changes their muscle chemistry. When you slouch, you keep muscles overly stretched, which weakens and strains them. Stop straining your muscles and they can heal.

People Let Their Bodies Slump to Wherever They Slump

• Instead of holding body weight up on muscles, they let all weight rest on the joints and discs of their neck.
• Using muscles would burn calories, strengthen, and be a free workout. But instead they grind their neck away.
• Sitting flexed imposes a large stress on the discs of the neck.
• Many simple mechanical factors ruin the back, hundreds of times a day, through ordinary daily bad habits, yet, when many people go to the doctor, the diagnosis is often written off as stress.

Pain When Your X-Ray is Normal

You may be in great pain from simple damaging mechanics. Your X-rays and scans are normal. You may be told nothing is wrong, or to give up favorite activities. Your pain persists from bad postural habits. This is no mystery. Change the bad habits to change the pain.

When Pain Is Not From What's On Your X-Ray

Other times, the scans show some minor problem like arthritis, herniated disc, or degenerating structures. Just like car tires that are mid-life, but perfectly good, some wear may show on exam but this is unrelated to performance or pain. Pain is falsely ascribed to the arthritis or to the disc. Patients feel doomed, and are often told to give up activities. Pain (even the herniation itself) may mostly result from poor mechanics. This is no mystery. Change the bad habits to change the pain.

Sometimes, the scans show some major problem, and major surgery is performed to correct it. When the original problem was from the bad positioning, often pain persists or returns because you never corrected the mechanics that caused it. The defect itself may return from uncorrected mechanics. Surgery can be avoided. Fix the source of the problem and the results of the problem can heal, usually without surgery.

What To Do When You Hurt

• Your Physical Therapist will outline a home exercise program that will work best for you.
• Check what you are doing to injure structures and fix it:  forward head, round shoulders, poor shock absorption when moving.

Don't Complain That It's Work

• Its free exercise.
• Its like learning any other new skill.
• It will fix your neck pain, free.
• It will take discipline. 

How Long Does It Take To Fix Pain?

How long does it take to feel better? Using everything presented above, you should begin to feel the difference in as little as two weeks.  It takes years to hurt a disc and only days for it to start healing once you no longer are injuring it. If you do not start to feel a little better within two weeks, check what you are doing compared to what you have learned above. Make sure there is not something else contributing to your pain. But it is is almost always quick and easy to start getting your life back and start feeling better right now.

Summary

Neck pain is not a mysterious "condition." People spend their day sitting, working, walking, and driving in terrible posture, hunching over the computer, lifting and bending wrong all day, walking heavily, and slouching all day, and then exercise in ways that strain and pressure discs and muscles. They make take exercise classes that are causing them more harm then good.  They take anti-inflammatory medications for mechanical pain that is not inflammatory in nature, try remedies that do not address the cause of the problem, give up favorite activities, have surgery then return to previous injurious habits, then everyone is astonished that they "tried everything and nothing seemed to work." It's like eating butter and sugar all day, then waving your hands in the air for 5 minutes and saying "I don't understands why I don't lose weight, I do my exercises."

• Use healthy positioning to stop the cause of disc damage and discs can heal.
• Pain can be avoided by no longer damaging body structures with poor mechanics.
• It's simple - Dont memorize complicated rules. Just use muscles easily to reposition for daily life.
• Remove the bad mechanics causing damage and pain.
• Then no need for pills or surgery and the injury can heal.
• Postural mechanics is the same as brushing your teeth in the morning - a necessary health activity.

How is your body positioning right now? The whole point of exercise and therapy is missed when exercisers dont learn to consciously use their muscles the rest of the day for standing, sitting, bending, and shock absorption. Use your muscles to stand and bend properly for all daily tasks. Bonus: It burns calories, strengthens, and is a free workout.

You Dont Have To Live With Pain