Overcoming Chronic Neck Pain

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My Neck Pain Story

Sometimes you can't see the answer staring you in the face.

How many times did my mother tell me: "Stand Up Straight, You're Always Hunched Over." Of course I didn't want to hear it, so I ignored her. I think I always had bad posture—my shoulders curled forward, my chest sunk in, head down, eyes to the ground. Maybe sometimes I tried to straighten up, but that never went anywhere. I was a teenager and couldn't seem to keep at anything for long, whether it was exercise or a diet or posture. Besides, in front of a mirror, you don't see "hunched," you see "straight." "Hunched" is only in profile, and how often do you see yourself in profile? If someone snaps a candid photo maybe. But I was so dorky looking, overweight, and pimple-faced with thick glasses that I didn't look at myself on purpose. Maybe I could blame my poor posture on sitting all day in school hunched over a desk, and afterwards slouched at my own desk doing homework. Or that I was stooped over carrying a heavy load of textbooks in my arms when I walked to and from school. Or that I read too much, or was always slumped on a couch watching too much TV, and got next to no exercise. There was a reason I made it to the bottom of the President's Physical Fitness rankings list, which was posted on the cafeteria wall for everyone to see! I made an effort not to be last again, but I was still close to it.

At 21, I tried to be more active and took up belly dancing—of all things, but strained my neck trying to imitate a Berber head swing. Next morning I couldn't lift my head from the pillow. I didn't see a doctor, but the pain and stiffness lessened after a week or two, and was gone.

From that point on, my neck was prone to stiffness and pain. Without understanding what I was doing, I took up weight training. But one repetition of a posterior military press caused a severe spasm at the back of my neck. I "ran" to the university health center. The doctor said the X-rays showed straightening of the neck's natural lordosis—the inward "C" curve back of the neck, and spinal disc degeneration. He didn't suggest any treatment; I didn't ask any questions. What did I know at that age? The words sounded bad but, hey, I had class work and exams to worry about.

At 31, after marriage and a new baby, I had what I thought was laryngitis from a sore throat picked up in the maternity ward. But who has a month and a half of laryngitis? It was a paralyzed vocal cord. A CT scan of my neck showed the flabby paralyzed vocal cord, and behind the larynx were the degenerating spinal discs. "You have the neck of a 50-year-old football player," said the neurologist. My spinal canal looked so narrowed from bone spurs that I didn't understand why my spinal cord wasn't squished. How was I even walking around? But the neurologist didn't seem concerned. He showed me isometric exercises for my tight neck muscles, which I had barely noticed as tight. Keeping my head stationary and straight, I was to apply strong pressure with the palm of my hand for a count of 10 to the front of my head and then repeat, with the back, right and left sides, several time a day. If I kept at the exercise, he said, I might never have another problem. At first, the exercises did seem to help, but as usual I slacked off and then when I restarted sometimes I got worse spasms.

At 52, my neck pain steadily worsened. I went to a general orthopedist, who ordered my first cervical MRI. The radiology report sounded dire: three levels—moderate to severe stenosis at nerve root foramina and spinal canal, desiccated discs, bone spur complexes, subluxation, pre-existing developmental narrowing of the spinal canal etc., etc. To me the degeneration looked terrible, to the orthopedist too. He though I needed fusion surgery. But the neurosurgeon wasn't impressed. He claimed to see a dozen scans like mine a week. He prescribed physical therapy and a strong NSAID (Non-Steroidal Anti-Inflammatory Drug).

Physical Therapist #1 was a trim, petite woman with great posture, something I noticed right away. She proved to be an expert at the hands-on techniques such as spinal segment mobilization, massage and traction. The therapy sessions, complete with moist heat, ultrasound and electrical stimulation, felt like an expensive spa treatment. But she said, just like all PTs, that only the strengthening exercises potentially resulted in lasting pain relief. Yet, it took weeks for her to begin them, and once she did, we discovered that I could not lift my head from the table while on my back. I worked hard at lifting my head, which seemed impossible, but with maximal effort I managed to do it the last few sessions. She showed me the rest of the exercises: seated rows, lat pull downs, biceps curls, this and that. When I told her that the exercises hurt my neck, she shrugged it off as if pain during the exercises was common.

After 12 weeks, or maybe 16 (whatever the maximum allowed at one time by my insurance), I was sent home with long, colored rubber sashes to be used as resistance to approximate the exercises I'd done with weights or machines. But any of the exercises that involved lifting or pulling with my arms, and the side neck lifts, still caused neck pain that worsened. I couldn't continue.

My new spine surgeon sent me to a pain specialist and after two cervical epidurals, my neck pain improved, and overall I felt better, more confident; I remember standing taller as I left the last follow-up visit. That didn't last. Within a week, I'd come down with a serious long term stomach illness (post–viral gastroparesis). Couldn't eat, had severe heartburn, and lost lots of weight. The meds left me so fatigued I couldn't keep from nodding off in front of TV; and one time I woke up with pain in my neck. From then on, the pain/spasm/weakness ramped up. I developed strange tingling, pulling sensations that begin just under my left ear, coursed up the side of my face, and if really bad, across my forehead and down the other side. And my head felt so heavy, I could barely hold it up the entire day. I kept a cool, moist towel around my neck, which helped a little, and took naps to rest it. My spine surgeon prescribed more meds—muscle relaxants, pain meds, and sent me to another pain doctor who insisted I take anti-depressants "because all chronic pain patients are depressed", and then did more epidurals. In between I saw a University Professor of Rehabilitative Medicine, who said the pain at the side of my neck was facet joint inflammation. So my pain doc added facet joint injections and medial nerve ablations, and sent me for more physical therapy—both for my neck and my back, which was in severe pain, because every night I had to sleep motionless on it to avoid worsening the neck pain.

Physical therapist #2 said something that stuck in my mind. "Neck muscles are extensions of back muscles," and because my neck was sent into flares of burning pain after he worked on it the first time, the only hands-on therapy was massage and ultrasound to my upper back. He tried to work out the hard, knot-like spots high between my shoulder blades, but they wouldn't release. These were like the "trigger points" found in Myofascial Pain Syndrome. I wondered if that was why my neck joints and muscles were so inflamed, and that maybe I should find a specialist to do trigger point injections. but never went.

This PT discovered that my left shoulder blade didn't move during arm raises. I worked on improving it by watching in the mirrors that lined the room. But soon enough these pt sessions ended too; I was only marginally improved and as before, couldn't continue any of the exercises at home because of neck pain. (This PT seemed to realize that working on my shoulders and back would help my neck pain but couldn't apply it effectively or make the connection with my poor posture.)

I went to an acupuncturist, who was a former physical therapist. But I couldn't lie face down comfortably, which was the position she needed me in to insert the needles. When I got off her table, my neck was always sore, "which isn't usual," she said, and also "there's something wrong with my shoulders because they kept trying to rise towards my ears." She taped my shoulder blades down, and said to leave them that way for a few days, but it didn't help.

About this time I researched "trigger points". The "knots" in my upper back between the shoulder blades seemed to coincide with the insertion (attachment) point of the levator scapula, a muscle, which connects (its origin) at the four upper neck vertebra and extends down the side of the neck to insert at the shoulder blade. If the shoulder blades rotate down and to the side, the levator is pulled taut causing neck pain. All this sounded entirely reasonable since I had neck pain at the sides of the neck. But how was I supposed to keep my shoulder blades from pulling on the levator? The problem seemed insurmountable. I also come across Professor Gwendolin Jul's article about treating neck pain, and that the first step was realigning the shoulder blades. It was written in technical language that I can't understand, but the shoulder blade relationship to neck pain seemed an intriguing clue; I just couldn't see a way to use it.

I was on Xanax as a muscle relaxant and for sleep, but was trying to taper off it because it was affecting my thinking and memory. But Xanax is so short acting, there was even more rebound muscle spasm than with other muscle relaxants. So my neck froze up, and I couldn't turn my head to drive. Desperate, I saw a rheumatologist, who prescribed 3 months of oral prednisone, along with huge doses of Baclofen, another muscle relaxant. As soon as the inflammation subsided a little, he sent me to more physical therapy.

The 3rd PT was able to work on my neck because prednisone quells inflammation so effectively. She used the heat, the electrical stim, ultra-sound, mobilizations etc. and I did the exercises, same ones as before. but as before, using my arms still made my neck uncomfortable. A new symptom arose, my neck started "crunching" which was disturbing.

After two months on prednisone, I was tapered off the prednisone and began double dose Celebrex. The neck pain returned but not as bad as before, but I developed serious side effects on the Celebrex and the other replacement NSAIDs. I couldn't take any of them and the pain returned.

I stopped going to a 4th PT because, again, my neck was too sensitive; the manipulations she did aggravates the burning soreness in the vertebral joints and caused muscular pain and spasm.

Then the rotator cuffs in both shoulders got "torn" when I pulled myself up from a chair with my arms because my back was so painful from my forced sleeping position—always flat on my back, pillow under knees and a low pillow under my neck and propped at both sides to cradle my head so my neck wouldn't bend into "forbidden" positions during the night. I went to physical therapy for "frozen" shoulders, but the pain and limitation didn't go away. I found a new orthopedist and a new physical therapist to continue shoulder treatments.

One of the exercises was a new one; he called it "Fixing the Shoulder Blades," which consisted of pulling the shoulder blades down and pinching them together in back. He placed one hand on my upper back to help me know when I'd pulled down my shoulder blades. But I was never quite sure I was doing it right unless his hand was there, and even then I was not sure. By the end of this bout of physical therapy, the rotator cuff pain and stiffness improved but was not gone. Again at home I stopped the exercises because most of them hurt my neck. (Only after my posture was much improved and my shoulder blades stabilized, did the shoulder pain leave for good.

It was 6 months later, when I decided, even if nothing else ever improved, that I could change my ugly, hunched over, slouched, stooped, slumped posture....

 

 

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© 2017 Rochelle Cocco