Chronic Neck Pain : Postural Causes and A Unique Fix
The Clues Were Always There: A History of Neck Pain
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." Hunched, stooped, slumped, slouched; all sound bad and all mean the same ugly thing and of course I didn't want to hear it, so I ignored her best I could or hid in my room. I must have 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 you know how that goes, especially when you're a teenager and can't seem to keep at anything for long, whether it's 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 snapped a photo maybe. But I was so dorky looking, overweight, pimple-faced with thick glasses, I didn't look at myself on purpose. Perhaps 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, and stooped over carrying a heavy load of textbooks in my arms—to, from and during school—or reading too much, or slumped on a couch watching too much T. V.—all my favorite things to do—and next to no exercise. Definitely, there was a reason I made it to the bottom of the President's Physical Fitness rankings, which were always posted on the cafeteria wall for everyone to see at lunchtime! But all that is the ancient past.
At 21, I try to be more active and take up dancing, of all things, but strain my neck trying to imitate a head swing. Next morning I can't lift my head off the pillow. Of course, I don't see a doctor (not that it would have mattered). I get better anyway.
Now I'm prone to neck pain. At one point, a particularly severe spasm at the back of my neck sends me to the university health center. They take x-rays and find straightening of the neck's natural lordosis—the graceful inward "C" curve back of the neck, and intervertebral disc degeneration. What did I know at that age? The words sounded bad but hey, I had other stuff to worry about.
At 31, after marriage and a new baby, I develop a paralyzed vocal cord from a viral throat infection picked up in the maternity ward, and need a CT scan. Oh yes, the stubbornly flabby vocal cord is still there, but so are the degenerating spinal discs. "You have the neck of a 50-year-old football player," the Neurologist says. And from what I see in the films, I can't believe my spinal cord isn't squished at the worst of the narrowing. The neurologist shows me isometric exercises for my tight neck muscles, which I barely notice as tight. Keeping my head stationary and straight, I apply pressure with the palm of my hand, 10 seconds each to front, back, right and left sides. He says if I do these exercises every day, I might never have another problem. Maybe the exercises are helping, but I slack off because sometimes they cause worse spasms.
Shoot forward 20 or so years, and at 52, my neck pain steadily worsens. I go to a general orthopedist, who orders my first cervical MRI. The radiology report sounds 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 looks terrible, to the orthopedist too. But the neurosurgeon I'm sent to pays no heed. He sees a dozen scans like mine a week, he says, and sends me to physical therapy and prescribes an NSAID (Non-Steroidal Anti-Inflammatory Drug).
Physical Therapist #1, a trim, petite woman with great posture, something I noticed right away, is obviously an expert at the passive techniques such as spinal segment mobilization, massage and traction. The therapy sessions, complete with moist heat and electrical stim, feel so good it's like being at an expensive spa. And the PT says, like all PTs say, that only strengthening exercises potentially result in lasting pain relief. Yet, it is weeks before she starts them, and once she does, we discover that I can't lift my head from the table when I'm lying on my back. I work at it and with maximal effort I just manage to lift my head the last few sessions. She shows me the rest of the exercises: seated rows, lat pull downs, biceps curls, this and that. I tell her the exercises hurt my neck but she shrugs it off as if that's common and I'll get over it.
After 12 weeks, or maybe it was 16, (at any rate, the maximum allowed at one time by my insurance) I am sent home with large variously colored rubber sashes. They are used as resistance to approximate the exercises I've been doing with weights or machines. But any exercises, which are most of them, that involve lifting or pulling with arms, or the side neck lifts cause neck pain and I can't continue.
After two cervical epidurals, my neck pain isn't too bad as long as I'm super careful about lifting anything, but then I get a serious long term stomach illness (post–viral gastroparesis). Can't eat, have severe heartburn, lose lots of weight. The meds leave me so fatigued I can't keep from nodding off in front of T.V. and one time I hurt my neck. From then on, the pain/spasm/weakness ramps up. I develop strange tingling, pulling sensations that begin just under my left ear, course up the side of my face, and if really bad, across my forehead and down the other side. And my head feels so heavy, I can barely hold it up all day. I keep a cool, moist towel around my neck, and take frequent naps to rest it. I see a new spine surgeon, who prescribes more meds—muscle relaxants, pain meds, and another pain doctor who does more epidurals. In between I see a University Professor/MD of Rehabilitative Medicine, who says the pain at the side of my neck is facet joint inflammation. So my pain doc adds facet joint injections and medial nerve ablations, and sends me to more physical therapy, both for my neck and my painful back, which is acting up because every night I have to sleep motionless on it to avoid worsening the neck pain.
PT #2 says something that sticks in my mind. "Neck muscles are extensions of back muscles," and because my neck is sent into flares of burning pain after he works on it the first time, he leaves it alone and only assigns exercises for back, shoulders, arms and legs. He discovers that my left shoulder blade doesn't move right during arm exercises and I work on improving it by watching in a mirror. The only hands-on are massages and ultrasound for my upper back. He tries to work out the hard, knot-like spots high between my shoulder blades, but they won't release. I do a web search and read about "trigger points" found in Myofascial Pain Syndrome. Maybe that's why my neck joints and muscles are inflamed and I think of going to a doctor to have trigger point injections, but put that off. When these PT sessions are over, I'm only marginally improved and still can't continue any of the exercises at home because of neck pain. (I think this PT was on the right track, but that he didn't know how to apply that knowledge to my problem.)
I go to an acupuncturist. She soothes me with incense, music and needles, but I can't lie face down comfortably, which is the position she needs me to be in to insert the needles. When I get off her table, my neck's always sore, which isn't usual, she says, and also there's something wrong with my shoulders because they keep trying to rise towards my ears. She tapes them down, and says to leave them that way for a few days, but it doesn't help.
About this time I research "trigger points". The "knots" in my upper back between the shoulder blades seems 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 sounds entirely reasonable since I have neck pain at the sides of the neck. But how do I keep my shoulder blades from pulling on the levator? The problem seems insurmountable. I also come across Professor Gwendolin Jul's article about treating neck pain, and one step is realigning the shoulder blades. It's written in technical language that I can't understand, but the shoulder blade relationship to neck pain seems an intriguing clue; I just can't see a way to implement it.
I try to taper off Xanax, because it's affecting my thinking and memory. I'd been taking it for sleep and as a muscle relaxant. But the Xanax is so short acting there's even more rebound muscle spasm than with other muscle relaxants. So my neck freezes up, and I can't turn my head to drive. Desperate, I see a Rheumatologist, who takes pity on me, and prescribes oral prednisone, along with huge doses of Baclofen, another muscle relaxant, and as soon as the inflammation subsides a little, he sends me to more physical therapy.
The 3rd PT is able to work on my neck because prednisone quells inflammation so effectively. She does the heat, the electrical stim, ultra-sound, mobilizations etc. and I do the exercises, same ones as before, but using my arms still makes my neck uncomfortable and my neck starts "crunching." I taper off the prednisone and begin double dose Celebrex. There's minimal neck pain but I develop serious side effects and must go off all anti-inflammatories. The pain returns; I resign myself to it.
I stop going to a 4th PT because again, my neck is too sensitive; the manipulations she does aggravates the burning soreness in the vertebral joints and causes muscular pain and spasm.
The rotator cuffs in both shoulders get "torn" when I pull myself up from a chair with my arms because my back is so painful from my forced sleeping position—always flat on my back, pillow under knees and a pillow propped at both sides to cradle my head so my neck doesn't bend into "forbidden" positions during the night. I go to one of my former Physical Therapists for my "frozen" shoulders, but the pain and limitation doesn't go away. I go to a new orthopedist and a new Physical Therapist to continue my shoulder treatments.
One of the exercises is a new one; he calls it "Fixing the Shoulder Blades," which consists of pulling the shoulder blades down and pinching them together in back. He places one hand on my upper back to help me move the correct muscles. I am never quite sure I'm doing it right unless his hand is there and even then I'm not sure. By the end of PT, the rotator cuff pain and stiffness improves but not gone. However, at home I stop the exercises because most of them hurt my neck. (Only after my posture is much improved and my shoulder blades stabilized, does the shoulder pain leave for good.
It's 6 months later, when I decide, even if nothing else ever improves in my life, I can change my ugly, hunched over, slouched, stooped, slumped posture....
Continue to "Slouched Posture and Pain"