Overcoming Chronic Neck Pain

Fix the Shoulder Blades

Fix the Posture–Upper & Lower Body

   –5 Posture Types in Profile

   –Left-Right Asymmetry

More Posture Exercises

Posture and Pain

Posture Topics

Thoracic Outlet Syndrome

Articles: Posture, Pain etc.

Fight Chronic Inflammation

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Overcoming Chronic Neck Pain

Always seek medical advice first. Consultation with an orthopedist or neurologist, and imaging studies such as MRI or CT scans are crucial when evaluating spine-related pain; and more so, if there is nerve pain down arms or legs, numbness, weakness, or bladder and bowel control issues. Severe nerve root or spinal cord impingement needs more than exercise or any passive therapies.
If surgery is recommended, explore all options. Some spinal surgeries, such as fusions, change spine mechanics and may hasten degenerative changes in the segments above and below the fused segment. Always try conservative therapies first, such as shown in this Back Pain Therapy Guide at InspiredSpine.com. Before proceeding with surgery, obtain 2 or 3 additional opinions from surgeons, who have lots of experience doing your particular surgery.

I am a former pain patient, not a health care professional. My history of neck pain began at age 21 with a severe neck strain from doing head swings for a dance step. What followed were 30 years of neck pain, and trying to avoid the activities that triggered neck pain. I had to be careful using my arms, especially my left arm—for lifting, pulling or pushing anything—actions you pretty much have to do with 3 young children. To treat the pain, I wore soft-collars and used ice and heat packs, which sometimes helped and sometimes worsened the pain.

MRI cross-sectionFor many of those years the pain came and went. But in time the pain stayed. That's when I saw an orthopedist. An MRI showed how bad the arthritic changes in my neck were. At 3 levels, the discs had flattened, and from their ends, bone spur complexes poked into my spinal canal close to the spinal cord. In other MRI cross-sections of that area, bone spurs narrowed the spaces called foramina through which nerve roots left the spinal cord; this narrowing was a major cause of the nerve pain radiating down my left arm—along with neck muscle spasms that clamped the vertebra together.

MRI cross-sectionIt seemed obvious that there wouldn't be a miracle cure, yet I was hoping for some kind of pain relief. So my quest began and over the next six years I saw two neurologists, three spine surgeons, a neurosurgeon, two pain doctors, a professor of rehabilitative medicine, a rheumatologist, four physical therapists (for neck, shoulder and back), and an acupuncturist. Treatments included four courses of physical therapy for my neck, two for my torn rotator cuffs, one for my back and one for hips and knees; six weeks of acupuncture; repeat MRI's; a CT scan; numerous epidurals, facet joint and trigger point corticosteroid injections; steroid dose packs, three months of oral low-dose corticosteroids; pain medication; antidepressants; muscle relaxants etc. Some treatments brought temporary improvement, but by the end of six years of going full bore trying to find relief, my neck still wasn't much better, and now I had unresolved pain and limitation in both shoulders, my back, hips and knees. All I'd managed to do was spend tens of thousands of my insurance company's money plus thousands in co-pays from my own pocket.

Both pain doctors and at least one, if not all of the physical therapists, believed my next step was neck fusion surgery. But all three spine surgeons said that surgery was not warranted yet. My spinal cord didn't show the internal changes that signal severe compression in the MRIs—even though from C4 thru C-7, the bone spur complexes pushed against the lining or thecal sac of the spinal canal and at C5-6 was up against the spinal cord. I also did not have arm numbness or weakness from the severe narrowing at the left C-5 nerve root, though I did have the chronic nerve pain down my left arm into my thumb. (See my MRI report)

So I was not going to have surgery, but I was still in pain and still a "neck cripple." What else was left to try? I'd had the usual therapies except chiropractic, which the first spine surgeon wouldn't prescribe because my neck arthritis was too severe. Besides, I couldn't tolerate any direct work on my neck. The pain ramped up severely with neck massage or manipulation of neck vertebrae, and also with any neck or arm exercise.

Hopeless. Anytime I used my arms, even to lift a dinner plate or change the bed sheets, my neck spasmed. Getting through each day took huge effort. Add to that, back pain caused by the only sleeping position—motionless on my back—that didn't leave me with a worse neck in the morning; then the lingering shoulder pain from torn rotator cuffs, which I didn't know what happened to cause them. On top of that was hip and knee pain. And then while the neck/shoulder/back thing was on-going, I caught a stomach virus from a family member that turned into a serious long term illness that partially paralyzed my stomach (gastroparesis). For over 2 years I had severe heartburn, stomach pain, limited ability to eat, weight loss, and weakness... like having stomach flu, 24/7. Then came a three month course of oral prednisone for my neck pain/stiffness followed by a COX-2 non-steroidal anti-inflammatory (Nsaid) and that jump–started a mast cell activation disorder (MCAD) with episodes of anaphylaxis and.... I really was a total hopeless mess.

But the wheels were turning and one day, as I happened to look at my profile in the fold–out mirror that was opposite a wardrobe mirror in my bedroom, I had an epiphany—not that I could cure my neck pain—but that I needed to look better; I needed to stand up straighter and stop looking like a tired, hunched over, old woman. I pulled back my shoulders and was reminded of an exercise a physical therapist had shown me months before, not for my neck, but for my torn rotator cuffs. He called it "Fixing the Shoulder Blades." I had done the exercise when the physical therapist was touching the right spot on my upper back and gave verbal feedback, but I couldn't get the feel for what my shoulder blades were supposed to be doing on my own. But now, in front of a mirror and able to visualize my back in the reflections, I could see exactly what my shoulder blades were supposed to be doing. I turned to look at my profile as I did the exercise and was amazed at how much better and younger I looked: shoulders back, chest higher, neck over my shoulders instead of out front. Even my head seemed easier to turn, almost as if the joints were oiled.

I did the shoulder blade exercise several times every day—and didn't just go through the motions, but worked hard at gaining control. I held the "pull-down" as an isometric exercise to get the surrounding muscles to tense and "pop out." Very importantly, I reminded myself frequently to straighten my back—so I wasn't bent forward all the time—and to lift my chest upwards with a breath—not just a few times a day but all the time, every day. (Even now, I find it hard to believe I had that much motivation. But it was me, not my mother or anyone else, telling me to change.)

It was about two or three months later that I realized....not only did I look better and feel better, but surprise, surprise...my neck pain was GONE. So were the headaches, the strange facial pains and twitching, and the crunching in my neck when I turned my head. And best of all, I was able to use my arms again to carry almost anything, within reason, without my neck going into spasms. I could pull down the lift-gate of my van, grocery shop on my own, carry a purse on my shoulder, do some gardening. And as long as I took breaks, I could sit at my computer and get work done ...without pain. And finally, I was able to lie on my side to sleep, instead of rigidly on my back; so my morning back pain was gone. FOR THE FIRST TIME IN OVER 6 YEARS, I COULD DO THINGS, EVERYDAY ORDINARY THINGS, WITHOUT PAIN!!!

A simple exercise, a decision to improve my posture. And finally, my chronic neck pain was gone.

Sounds too easy, doesn't it? But it did take determination. Along the way, I also realized that I needed to work on my lower body posture. flat back posture There is supposed to be an inward curve (lordosis) in the lower back that shifts the upper body back over the hips for support. Because my lower back was flat (see image), my entire upper body leaned forward, not just my head. I had assumed that my flattened back was from arthritic degeneration because the MRI of my lumbar spine looked almost as bad as the scans of my cervical spine; but all it took was stretching short, tight hip extensors at the back of my thigh (the hamstrings) to release the pelvis, which had been "locked" in tilted-back position and with my butt tucked under and flat. Now that my lordotic curve had returned, my upper body was securely over pelvis and hips—the ideal position of support. [Of course not everyone has a flat back, and other specific exercises are needed depending on the particular type of faulty lower body posture. See Effect of Pelvic Tilt and Hip/Knee Hyperextension on Lower Body Posture.]

"The best doctors teach their patients" — James Salwitz MD
   ...and so should the best physical therapists!

Why this web site? I'm astonished and kinda angry that such a simple, basic fix eluded me for so long and also the many medical professionals I sought help from, especially the physical therapists. If the first physical therapist had evaluated me for what turned out to be faulty posture alignment of my entire body, and treated me for the resulting muscle imbalances, my neck pain would have been fixed, and the torn rotator cuffs, the back, hip and knee pain would never have happened. Neither would the 6 years of pain and limitation, the tens of thousands spent by my insurance company, my thousands in co pays, all the paper work—the insurance company's, and the thick binders that PTs filled with evaluations, treatment plans and progress reports. Not that other patients won't benefit from those same treatments, many probably do, but they were wasted on me. All I ask of medical professionals, especially the physical therapists, is that when treatments aren't working, stand back and really look at me, at my specific deficiencies. If my posture is terrible, tell me, and explain why it is important to correct it and then what measures will help. (Don't assume I know the extent of my poor posture, I need to be shown how bad it is. And don't assume that I could easily change my posture if I wanted too, because it isn't easy when the muscles needed are too weak and the opposing muscles too strong.)

Don't keep throwing out the usual one–size–fits–all treatments without getting at the root cause of the problem. Maybe the physical therapists would say they are only allowed to do treatments the doctor orders. Well give the doctor feedback. You, the PT, are the one who received in depth training in recognizing and treating postural imbalance and the physical problems it leads to. And likely one of your textbooks was the classic reference — Muscles: Testing and Function with Posture and Pain by Kendall et al. (5th edition, 2005) — which details much of what you needed to help me. If the doctor's prescription needs changing, so you can do what needs to be done, get it changed! Take the initiative!

Why this web site, part 2. My neck situation seemed hopeless and as hard as I tried, I could not find the help I needed. Oh, I had plenty of "healthcare"; I was "practiced on" by the "best." But maybe I was "the zebra" with the rarely encountered problem; and the treatments I received work for 99.9% of neck pain patients, and I just happened to be in the insignificant 0.1%? If so, maybe no one else needs to read any further. But just in case there are others out there like me—in the same seemingly hopeless situation—maybe some of this information will help.

Please remember, as with all information, no matter how competent or assured the messenger appears, always take with a large dose of skepticism. Everyone's situation is unique and no one solution works for all. Ultimately, each person takes from all the advice and all the possible therapies out there, and assembles his or her own solution. Also, there are severities of neck injury, degenerative disc disease, and orthopedic problems beyond the scope of any strengthening exercise or correction in posture.

Recommendation #1: Make the most of physical therapy for neck and/or back pain. Ask the doctor to include postural assessment, and treatment if imbalance of postural muscles is found. Ignoring poor posture will delay or prevent healing of both traumatic and overuse neck, shoulder and back injuries. Improving poor posture will also help prevent other posture-related injuries, such as rotator cuff impingement from forward rounded shoulders, and toe/foot pain from forward-shifted center of gravity (more weight borne on the forefoot).
— In my experience, physical therapy for neck pain will not give lasting relief unless hunched upper body posture and weakness in upper back muscles, especially those stabilizing the shoulder blades, is addressed early on.
Recommendation #2: Since faulty posture creates imbalances in muscles that stabilize and move shoulder, hip, and knee joints, physical therapy for these should also include a posture assessment and treatment. Treatment without addressing postural misalignment is counter-productive and a misuse of healthcare dollars. See "Fix the Posture"
May we all be works in progress forever, and celebrate the fact that we are—Marc and Angel Hack Life

Index:

*Fix the Shoulder Blades — The exercise that fixed my neck pain. Why it works and how it's done.

Fix the Posture: Upper and Lower Body — Upper Body Posture in side view/profile; And lower body in profile; Role of pelvic tilt, and angle of hip and knee joints. Wall-standing exercise. Types of faulty posture and specific corrective exercises to rebalance postural muscles.

Fix the Posture: 5 Posture Types in Profile — Ideal or Balanced Posture, Flat Back Posture, Sway Back Posture, Kyphotic-Lordotic Posture, Hyper-Kyphotic Back: and corrective exercises.

Fix the Posture: Left-Right Asymmetry — Handedness Posture, uneven shoulders and hips, postural leg length discrepancy, malrotated pelvis, and corrective exercises.

Posture and Pain — Pain in Neck, Shoulder and Upper Back Muscles; How Forward Head Causes Pain; How Destabilized Shoulder Blades Cause Neck and Upper Back Pain; How Poor Posture Causes Worsening of Radicular Pain; Cervicogenic Headaches, Shoulder Pain: Rotator Cuff Tears and Frozen Shoulder; Thoracic Outlet Syndrome – Numb Fingers, Hands and More; Aggravation of Big Toe Arthritic Pain and Arthritis; Chronic Pain Worsens Posture

Posture Topics — Restricted breathing, Tendency of body to lean forward, imbalance of hip muscles, Slouched Sitting Posture, and the best sitting positions to reduce neck and back pain. The Aging Disc, Degenerative Disc Disease, Mechanics of Spinal Injuries, Effect of Posture on Discs, Slouched Posture into old age. Straightening and loss of the normal lordotic curve of the neck.

Articles...Rear and Side View Car Mirrors, comment on Todd Hargrove's "Is "Efficient" Movement Unsafe? My First Fitness Class, the good and the bad. Habit Formation, Exercise and Posture, Neck Pain from Cell Phones and Tablets, About Pillows and Mattresses, Yoga Injuries, Do Glucosamine and Chondroitin help arthritis?  References for two studies on Surgery versus Nonoperative Treatment for Sciatica and Lumbar Spine Stenosis.

Fight Inflammation-Induced Pain — Reducing body–wide inflammation may lessen arthritic  inflammation. The 4 pillars of anti-inflammation: Diet, Exercise, Sleep and Stress Reduction. Mast Cell Activation and release of inflammatory mediators. Histamine Intolerance.

    —Food Intolerances — More detail on specific food intolerances that may increase body–wide inflammation. Possible connection between dietary lectins specific for acetylglucosame and arthritic and intestinal inflammation. Other specificities of lectins, sulfites/sulfates, processed oils and methods of cooking and AGEs. Oxidized polyunsaturated oils and sulfites, histamine intolerance.

    —References for Advanced Glycated End Products (AGEs) — Links to abstracts and journal articles about the connection between AGEs and Inflammation, Aging, Chronic Illness, high levels in diabetics and also found in foods etc.

    —Metabolic Pathways — Methylation and folate cycle, transulfuration, urea cycle, histamine metabolism etc.

    —Risk Alleles — Based on 23andMe snps for the above metabolic pathways included methylation (MTHFR).

Links — Links to References and books, includes excerpts and comments.

My Neck Pain History — The Clues Were Always There

 

 

 

 

 

© 2017 Rochelle Cocco