Chronic Neck Pain : Postural Causes and A Unique Fix
Overcoming Chronic Neck Pain: When Surgery Isn't Indicated and Other Treatments Don't Help
First off, I am not a health care professional, but a former pain patient. My neck pain history began at age 21 with a severe neck strain from practicing head swings for a dance step. What followed was 30 years of chronic neck and shoulder pain, as well as nerve pain that radiated down my arm to my hand. Also were the years of self-imposed limitations trying to avoid spasming my neck. For many of those years the pain came and went, but eventually every day was pain-filled. Then I finally went to an orthopedist, and had an MRI, which revealed that the neck arthritis — desiccated discs, bone spurs, stenosis — was extensive (see my MRI). Obviously I wouldn't be looking for a miracle cure, but I was hoping for some pain relief. So began my journey and over the next six years I was seen by two neurologists, three spine surgeons, a neurosurgeon, two pain doctors, a professor of rehabilitative medicine, a rheumatologist, four physical therapists, and an acupuncturist. Treatments included four courses of physical therapy; six weeks of acupuncture; repeat MRI's; a CT scan; numerous epidurals, facet joint and trigger point corticosteroid injections; oral corticosteroids; pain medication; antidepressants; muscle relaxants etc. Some treatments brought temporary improvement, but by the end, my neck spasm/pain/weakness, shoulder soreness, daily headaches, weird facial pains etc, weren't any better.
The pain doctors and a couple of the physical therapists believed that my next step was fusion surgery. But all three spine surgeons said that surgery wasn't indicated because my spinal cord wasn't yet compressed though there was "mass effect" meaning that the bone spur complexes were right next to, if not touching, the spinal cord. Also I only had radicular pain down my arms and not arm weakness from the severe narrowing at my left C-5 nerve root. (See my MRI report) So no 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 my main spine surgeon wouldn't prescribe because, he said, my neck was too sensitive. Indeed, the pain ramped up severely with any kind of massage, manipulation or neck exercise.
What a hopeless mess. Anytime I used my arms, even to lift a dinner plate or change the bed sheets, my neck spasmed. Getting through each day was an effort because within a few hours of waking my neck would feel too weak to hold up my head. I' had to lie down to rest at every opportunity. A pharmacy–bought soft collar irritated and burned. And forget strengthening exercises; the everyday "mere" discomfort and soreness flared up painfully every time. The neck spasms got to the point I couldn't turn my head. 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 torn rotator cuffs in both shoulders, and on top of that, 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 called gastroparesis (partially paralyzed stomach). 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.... Oh yeah, 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 (which was opposite a wardrobe mirror) in my bathroom, I had an epiphany – not that I could cure my neck – but that I needed to change my tired, hunched-over posture. I pulled back my shoulders and was reminded of an exercise a physical therapist had shown me months before, not for the neck, but for torn rotator cuffs. He called it "Fixing the Shoulder Blades." Even though I had done the exercise during PT, I could never get the feel of it. But now, in front of a mirror and able to visualize my back, I could see exactly what my shoulder blades were supposed to be doing. And I was amazed at how much better my profile looked: shoulders back, chest out, neck less forward — more in line with my back. 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 over them, holding the "pull-down" and getting the surrounding muscles to tense and "pop out"— and very importantly, I reminded myself to straighten my mid-back and lift my chest — 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 myself I had to change.) And it was about two, two and a half 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 most anything I wanted 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, go back to 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; and 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 and a decision to improve my posture. And finally, my chronic neck pain was gone.
Sounds too easy, doesn't it? But it did take constant attention and effort to change my upper body posture. In addition I worked on lower body posture. There's supposed to be a inward curve (lordotic) in the low back that brings the upper body slightly back and squarely over the pelvis. But my low back, it seemed, had always been flat (see flat back posture), which caused my upper body to lean forward and added to the off-balance state of my head and neck. I assumed that the flattened back was due to degeneration because my lumbar MRI's look almost as bad as my cervical ones; but all it took was hamstring stretches to release my pelvis, which had been "locked" into a tucked under/flat butt position by short, tight hip muscles (see dead-lift hamstring stretch). With my lordotic curve returned, my upper body could be brought squarely over my pelvis—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!
...skipping steps in an explanation...translates to less that complete understanding
— which translates to less than complete ability to follow recommendations...especially those that
cannot be connected to the consequences of not following them.
— Ilana Yurkiewicz
Why this web site? Well, aside from the usual reasons ...I'm astonished and kinda angry that such a simple, basic fix eluded me for so long and also the many medical professionals I went to, especially the physical therapists. If they had evaluated me for what turned out to be a postural cause for my neck pain, and treated the resulting shoulder blade instability, and other muscle imbalances (that ultimately led to torn rotator cuffs, back, hip and knee pain, and more courses of physical therapy for those body parts), then the years of pain and limitation, the tens of thousands spent by my insurance company, and my thousands in copays, and all the paper work, the insurance company's, and the thick binders that PT's filled with evaluations, treatment plans and progress reports, would have been avoided. Not that others don't benefit from those same treatments, many 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 help me. (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. And since posture change takes great effort, I need to know why I should change, I'm hard-headed that way.) Don't keep throwing out the usual one–size–fits–all treatments without getting at the core problem. (Maybe 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 on 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.—which details much of what you needed to help me. If the doctor's prescription needs changing, 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." Or maybe I was the one, "the zebra", with the rarely encountered problem; and the treatments I received work for 99.9% of neck pain patients, and I just happen 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 — this website is for them.
But 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 possible therapies, and assembles his or her own solution. As well, there are severities of neck injury, degenerative disc disease, and orthopedic problems beyond the scope of any strengthening exercise or correction in posture.
May we all be works in progress forever, and celebrate the fact that we are!
—Marc and Angel Hack Life*
*Fix the Shoulder Blades — The exercise that fixed my neck pain. Why it works and how it's done.
Fix the Posture —Posture of the upper and lower body. 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.
More Posture Exercises — Off-Balance Exercises for the Core. Multifidus and back extension exercises for strengthening the back, and perhaps also helping to prevent osteopororetic spinal compression fractures. Newer: Dr. Kelty's Good Sitting Posture video, New: Transversus Abdominis Activation (a component of the Australian Spinal Stabilization Method)
The Connection Between Slouched Posture and Pain — The varieties of pain and conditions that can be worsened or are caused by habitual slouched posture: Radicular pain, Headaches (cervicogenic), Torn Rotator Cuffs and Frozen Shoulder, Thoracic Outlet Compression Syndrome (includes Numbness and Tingling of hands at night). In turn, Chronic Pain of any kind can worsen posture.
How Slouched Posture Causes Pain — Forward Head, Destabilized Shoulder Blades, role of the Levator Scapula and Upper trapezius in neck and shoulder pain. How improving posture helps eliminate neck pain and strengthen the neck. How restabilizing the Shoulder Blades helps to prevent neck pain and spasm when the arms are used for lifting or pulling.
More Effects of Slouched Posture — Restricted breathing, Tendency of body to lean forward, imbalance of hip muscles, weakness of abdominals, 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. Loss of the normal lordotic curve of the neck.
Of Interest...Now a Blog— Newest: Rear and Side View Car Mirrors, and 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.
Living an Anti-Inflammatory Life — Speculation that reducing body–wide inflammation may lessen arthritic inflammation. Factors —foods, medications, environmental conditions—that may lead to Mast Cell release of inflammatory mediators. Histamine Intolerance. New: Mindful eating
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. New: Oxidized polyunsaturated oils and additions to sulfites, also additions to 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.
Annotated Links — Links to References and books, includes excerpts and comments. Newest: Several New Links including Dr. Kelty's website and videos. New: Comments on Rick Jemmett's book, Spinal Stabilization: The New Science of Back Pain, 2011.
The Clues Were Always There — A History of My Neck Pain
Your Stories — Pain fixes you've found helpful, or therapy pitfalls and other situations to avoid.
Neck/Back Pain Support Groups — Where to find help and advice from those who've been there, done that.