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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Links

1. Websites and Articles Related to Posture and/or Pain
2. Finding Help
3. Health-Related Websites
4. Posture and Pain Books

 

1. Related to Posture and/or Pain

Bookspan, Dr. Jolie."How to Fix Neck Pain, Upper Back Pain, Shoulder
     Pain, Rotator Cuff and Tightness"

"After years of squashing the discs in your neck with a forward head posture...so that the weight of your head unevenly presses the vertebrae and the disc between them, the discs start to be pressed outward toward the back. They break down and bulge in the direction you've been pushing them."

"...it is not a matter of strengthening muscles to stop pain. Strength does not make you sit or move in healthy ways. Many people do strengthening exercises and become stronger people who still slouch."
She mentions that a degenerating disc can heal with proper posture. But discs and cartilage are notorious for slow healing. Bony changes also are unlikely to reverse. I did look for a reference about the healing of intervertebral discs, and apparently herniated and torn discs can somewhat heal. See the next reference.

Eveleigh, Janice PT. Stretching-Exercises-Guide

A comprehensive guide to stretching. Includes the science, the how to's, when not to stretch, and precautions. Includes types of stetching, and stretches for specific areas of the body, for muscular conditions and injuries, and specific sports. And a section for posture and posture improvement exercises.

Fitzgerald, Matt. "Balance Your Blades: 3 Corrective Shoulder Exercises"

"Healthy shoulder blades are a rarity in our society. The problem is the amount of time we spend sitting in front of computers and steering wheels. The hunched position we tend to assume in these situations leads to a more or less permanent forward rounding of the upper spine, called kyphosis.'

"It doesn't stop there. In the keyboard-typing and steering-wheel-grasping positions because we hold our arms out in front of us, typing and driving etc, our shoulders are internally rotated and protracted (pushed forward) for long periods of time. This leads to laxity and weakness in the muscles that externally rotate and retract (pull back) the shoulders."

"This posture inhibits the ability of the scapula to tilt backward and create space for the rotator cuff in the shoulder joint when the arm is lifted overhead. As a result, the rotator cuff gets pinched, causing tissue damage."

Eric Goodman. Foundation Training Program

He promotes strengthening the true core: the posterior chain muscles attached to the pelvis—the back extensors, gluts, and hamstrings; and stretching the front of body by lifting the chest, widening the rib cage, and lengthening the distance between bottom of ribcage and hips—to improve posture and lessen or eliminate back pain. Several videos on his website explain his reasoning and main exercise, the Founder, which is a type of squat with arms extended forward and upward. His book, Foundation Training, also includes variants of "good mornings," planks, and a prone back extension exercise similar to one shown in this video. Also foam roller exercises, discussions of interval training, training zones and nutrition. See Dr. Mercola's comprehensive article on Foundation Training. [I strongly agree with Goodman's approach to tackling back pain by strengthening the posterior of the body, which naturally improves posture. He does not mention stabilizing the shoulder blades, but then his concern is not with neck pain, but with lower back pain.]

Todd Hargrove's blog at BetterMovement.org

Many interesting and thoughtful articles that challenge accepted beliefs about exercise, posture, spine pain and the way we move in general. Also he cites and explains academic research studies to support his "arguments". Two good blog entries are: "Fatigue is an Emotion" where he cites an article by Timothy Noakes "Fatigue is a Brain-Derived Emotion that Regulates the Exercise Behavior to Ensure the Protection of Whole Body Homeostasis" and "Is "Efficient" Movement Unsafe" (Poor movement, posture etc may "...reduce energy demands on local muscles because they transfer the work of stabilization to ligaments and other connective tissues. This saves on energy expended by local musculature but creates mechanical stress because body weight is just “hanging” passively off the ligaments and connective tissues. ...  [Poor, lazy movement and posture] are not actually energy efficient at all, because they sacrifice the stabilization and proper bony alignment that is the key to efficient movement and posture," and avoidance of acute and chronic musculo-skeletal damage)

Jull, Gwendolen et al. "A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache" Spine 2002:27:1835–45.

"In the presence of neck pain and headache, weakness has been identified in the deep neck flexor muscles (bend forward), and patients show increased activity in their superficial flexors, presumably as a compensation strategy."

"Atrophy has been shown in the suboccipital extensors (back neck muscles), and thus the deep muscle sleeve, important for active support of the cervical segments, becomes impaired."

"increased activity has been shown in muscles such as the upper trapezius (and levator scapula—shoulder girdle muscles) in patients with neck pain during functional tasks, which may cause unnecessary loading on cervical structures."

 "One of the more commonly observed postural faults is the protracted (abducted or farther apart than normal) and downwardly rotated position of the scapula."

"Regaining control of scapular orientation is begun from the outset."

"Re-education of control of posture begins from the first treatment. Frequent correction to an upright neutral postural position serves 2 functions. It ensures a regular reduction of adverse loads on the cervical joints induced by poor spinal, cervical, and scapular postures. Most importantly, it trains the deep and postural stabilising muscles in their functional postural supporting role." 

Jull, G. Interview: Rehabilitation of the Cervical Spine. (No longer available, what follows are my notes)

In the past, manipulative therapists gave little attention to muscle systems, but the recurrent nature of neck pain showed something was missing. Manipulation, strengthening and stretching exercise is not enough.

Deep neck flexors become deficient in neck pain. Neck pain patients try to use superficial neck flexors, which aren't adequate. Professor Jull noticed neck pain patients could not do exercises that normal people did easily (such as lifting the head off the pillow—neck flexion against gravity).

In rising to a standing position, neck pain patients don't use their postural stability muscles well. If they can't facilitate their spinal multifidus, they can't activate their deep neck flexors.

Downwardly rotated scapular position is common in neck pain. Patients may have scapular muscle strength but under low load (like sitting at the computer) they fatigue easily. Jull is looking at scapular control and orientation in further studies.

Painful neck joints that come from muscle overload (e.g. working on the computer for hours with the head craned forward, which stresses back neck extensors) won't be helped long term by manipulative joint therapy unless the muscle (postural) rehabilitation is addressed first to reduce load on joints.

60 - 80% of whiplash patients do well with Jull's program but at least 20% have an augmented pain process, are hypersensitive to cold, lightheaded, unsteady and have eye movement control problem, PTSD/anxiety symptoms. She is conducting further research.

Jull, Gwendolen, Whiplash Injury Recovery: A Self-Management Guide—free download. Explains the neck flexor strengthening exercise and gives several other stretches and strengthening exercises. Also discusses and gives tips on maintaining good posture.

Jull, Gwendolen et al., "Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?" Pain 129 (2007)28-34. Study of whiplash pain patients. Jull's physiotherapy treatment helped patients but pain relief was marginal in the patients with widespread mechanical and cold hyperalgesia.

Kaiser Permanente "Neck Pain, What You Can Do" (PDF)

A simple, comprehensive booklet that emphasizes correction of posture to improve neck pain. Gives great tips for improving posture in sitting and standing.

Kelty, Dr. Robert, Videos on YouTube

Includes helpful information on the spine and health that Dr. Kelty uses to help his patients. Included are videos explaining how to do low back, shoulder and neck exercises. Of particular note is a video on improving sitting posture to avoid neck and shoulder pain due to prolonged desk work, computer and mobile device use. Another video shows how to avoid back pain from bending and twisting during yard work. Another explains the importance of bending at the hips rather than bending at the "belt" to avoid strain to the lower back.

King, Dr. Neil, King Chiropractic

Posture improvement videos: Stabilizing the Lower Back, Pull Shoulders Back, Strengthening the Legs and Hips (sacro-illiac exercise) and Back Extension and Abdominal Strengthening (However, he states that "posture is resting on the ligaments. [and that] It should not take any muscular involvement at all for you to stand up and look better and feel better...." Resting on the ligaments may apply to poor posture but not good posture. The point is to correctly align the joints by increasing muscle tension in some muscles and relieving it in others, and thereafter, muscle tension, which is mainly antagonist co-contraction maintains the improved posture. That muscle tension/work eventually becomes a habit, which is largely subconscious.

Jill McNitt-Gray,PhD and Witaya Mathiyakom, PT, PhD, "Preventing Shoulder Injuries:  Recognizing muscle tightness and reducing muscle imbalance through exercise can keep your shoulders healthy" in Dimensions of Dental Hygiene.

Excellent article for dental professionals with advice about upper body posture, therapeutic exercise and how to test for muscle imbalance. Good illustrations of the exercises.

Mullen, G. John, DPT, Pain in the Neck: Fixing the Problem at its Root

Symptoms, tests and treatment of postural neck pain. Instructions for a deep neck flexor test. Also included is a corner stretch for tight front shoulder (pectoralis) muscles and a shoulder blade/scapular squeeze exercise. However, the armpit sniffer, scalene stretch, upper trapezius stretch would have flared my neck pain in the past, and are still impossible for me. But still, I wish I'd had him as my physical therapist 7 years ago. Also tips for holding proper posture while at the computer or sitting down.

Osar, Dr. Evan – Fitness Education Seminars:

a wide range of free videos devoted to the reasoning behind and proper performance of many important exercises including strengthening/stabilization of core, spine, hip, shoulder and foot.

Pashman, Robert M.D, eSpine: Flatback Syndrome

"In many individuals, lack of lumbar lordosis does not produce symptoms. Those patients who are symptomatic however, can be treated ...initially with physical therapy. The emphasis of therapy should be on strengthening of the gluteal, low back, abdominal and hamstring musculature (hip flexors too?)....When conservative methods fail and the patient is symptomatic to the point of dysfunction due to the pain, surgery is indicated....Flat back occurs most commonly in patients who have had previous spinal fusions. To recreate balance, it is necessary to break the fusion mass (osteotomy) and re-fuse the spine in a more balanced position.(rc. restore lordosis)"

Practical Pain Management:

A medical journal with current pain treatment articles in Resources including Bracing/Splinting (role of body posture, lumbar back supports etc.); Alternative Treatments (acupuncture, diet/weight goals, meditation, Chinese Medicine, stem cell prolotherapy, coping skills, etc.); Hormone Therapy (neurohormones, testosterone etc.); Nutraceutical (diet, vitamin D, amino acids, supplements etc.); Massage/Manipulation; Pharmacological; Psychological and Rehabilitation. (Click on upper right gray box on opening page to make sure you are on the "For Professionals" version to see complete website resources.)

Paula Moore at Posturevideos.com:

Forward Head Posture Correction, Shoulder Rolls to Relieve Shoulder Tension, Shoulder Pain Relief for Laptop Posture

Medscape, What is Intervertebral Disc Degeneration, and What Causes It?

All you'd ever want to know about Intervertebral Disc Degeneration, also known as Degenerative Disc Disease (DDD).

DailyHealthPost, article on anterior pelvic tilt

"Do you Have an Anterior Pelvic Tilt? It May be the Cause of Your Hip and Lower Back Pain"

 

Finding Help

Betterhelp.com for help managing chronic stress, depression, anxiety and other mental health concerns.

Please see this article: "How Do I Find A Therapist Near Me?"

Mental Health Resourses for help managing chronic stress, depression, anxiety and other mental health concerns. Also a source of unique greeting cards for a loved one with a mental health issue—Anne Cummings Studios.

 

Bodyzone.com

Their Posture Professional Locator might help in finding a health care provider who considers posture correction to be essential in the treatment of chronic musculo-skeletal pain.

No matter who you see for treatment of musculo-skeletal pain, insist on a posture evaluation at the onset. After evaluation of posture and the specific complaint, make sure the therapist explains and shows, using a model or illustration, what the problem is and what needs to be done. When exercises are prescribed, the reasoning behind choosing those particular exercises should be explained along with an explanation of which muscles are being strengthened or stretched. If the therapist is not forthcoming, then you need to ask questions. How will that specific exercise help me? Please tell and show me which muscles need to be activated? And so on. ...Now you might be thinking that the therapist will consider you a pain in the ass. But believe me it's better than getting zero results or developing a related problem months later. I wish I'd done more question-asking instead of dumbly following "the program." I cannot emphasize enough that you are not being a "pain" for asking questions! The therapist wants the therapy to be successful, and you definitely want to get better—pain is a great motivator. If you understand the why, how, and action of the muscles, that will help you visualize the problem and the exercises. Visualization has been shown to aid in recovery. And visualizing a muscle contracting and the joint moving, activates the same parts of the brain as doing the exercise. Doing both the visualizing and the exercise make the exercise even more effective. Watching in a mirror while doing the exercise is a further powerful aid.
The United States

Colorado:
Rick Olderman in Denver. See his website: Rick Olderman.com for contact information, his blog, links to his books and articles such as Fixing Neck Pain and Headaches. [from a reader: Rick is an awesome and nice guy. He was pretty empathetic about the pain I was having. He did some stuff called somatics (Hanna Somatics) to gently release some of my muscles but was surprised by the amount of muscle tension I had. One of my hips was up (right) and left was rotated forward (so our guess/discussions were correct!) and he did some release stuff to gently coax them back. I have been doing the exercises and pain is less so i think things may be better. Unfortunately, the time frame (even with a week and several visits) was simply too short to get more than some great tips. So he suggested that I try alternative therapies to cool my nervous system down & even he was wondering how I got my pelvis out of whack.]

Florida:
Dr. Kim Scales, a physical therapist at In Balance Rehab in Cocoa Beach, Florida is highly recommended by a pain management doctor, who doesn't want his name used. Bur his patients were highly pleased with the results Kim got. This Pain Management Doctor says "she has been the only person that I have known who is looking out for all the points you mention in this very comprehensive website." [I would refer to this doctor, but he will soon be on staff at a VA hospital.]

Illinois:
Chicago Integrative Movement Specialists, locations in Chicago and Evanston. Dr. Osar emphasizes posture, stability and functional movement. Sign up for his video newsletter on the website. Example issue: Simple Things to Save Your Spine with Chicago Chiropractic Physician, Dr. Evan Osar. Also wide range of useful videos: Chicago Integrative Movement Specialists on YouTube

Missouri:
Physical Therapy Program at Washington University School of Medicine in St. Louis — The clinic is attached to one of the highest ranking physical therapy schools in the U.S. (US News and World Report), and where Shirley Sahrmann, the author of Diagnosis and Treatment of Movement Impairment Syndromes is on the faculty. Daniel said, "I’ve actually recently visited their PT clinic at the Washington School of Medicine (top ranked in the nation every year). It’s for a reason."

Oregon:
Dr. Robert Kelty: A Chiropractic doctor in Eagle Point, Oregon. He emphasizes correct posture, movement and nutrition. Excellent videos on his website (See dropdown menu for "Get Moving!" on the navigation bar.)

Washington State:
Dr. Joshua G. Schkrohowsky, MD, Specializes in Sports Medicine at Methow Institute of Sports Traumatology, 505B Highway 20 Winthrop, WA 98862, (509) 341-4357 (Office) [Comment from a site visitor: ("...my wife who has struggled with shoulder, back, neck and arm pain for 20+ years, is currently missing a lot of work due to nearly constant headaches. She has been to everyone from her PCP to chiropractic, acupuncture, acupressure, massage etc... She was actually disappointed to find out that the neurosurgeon could not help with her condition. Finally she got a referral to an orthopedic surgeon in Winthrop, WA (Dr. Joshua G. Schkrohowsky) who diagnosed her scapula instability and she will be starting PT with a therapist in Winthrop."]

 

Australia:    

Queensland
Gwen Jull, Professor of Physiotherapy at the University of Queensland, Australia. Emphasis on posture alignment first, specific corrective exercises and then manual techniques. For those who live in other areas of Australia, Dr. Jull does refer to a closer therapist, if needed. e-mail: g.jull@uq.edu.au

Melbourne
Helen Fleming, Specialist Musculoskeletal Physiotherapist, at Complete Physio in Melbourne, Australia, is a therapist who takes posture and its relationship to pain seriously. Dr. Jull refers patients to Helen, and one patient writes "I have been seeing Helen for the past year and have progressed significantly."
phone number: (03) 9495 6996
email: info@completephysiomelbourne.com.au

Help me find more outstanding practitioners! Have you been treated by a physical therapist or other practitioner, who was able to help you overcome chronic neck, back, shoulder or hip pain? Tell us about his or her approach. Include whether you were shown or told what the specific problem was, and how that problem was addressed with exercise or other modality to achieve the solution. Was posture alignment considered in the evaluation and treatment? Was there something in particular about this individual's or facility's approach to your treatment that made it successful? Submit to fixtheneck@gmail.com. If you've had negative experiences with the listed practitioners please email me.

 

Health-Related Websites:

American College of Gastroenterology News and also the Digestive Health SmartBrief: a twice weekly newsletter.

BrainandSpinalCord.org Blog: News stories and articles about brain and spinal cord injuries, diseases, research and treatments. Four years of posts on topics such as Alzheimer's and chronic head trauma, promising therapies, rehabilitation and injury prevention.

Do you Have an Anterior Pelvic Tilt? It May be the Cause of Your Hip and Lower Back Pain

Medical News Today: Hourly health news from well regarded medical journals and articles written by staff members.

Medpage Today: Sends a daily newsletter with a wide variety of medical news stories. And also includes a newsletter from KevinMD.com, with posts written by physicians.

Medscape: News and valuable medical reference articles. You can arrange for email alerts on new articles in specific subjects to be sent to your inbox.

Practical Pain Management: Recent articles on Pain Treatments including Bracing/Splinting (role of body posture, lumbar back supports etc.); Complementary Treatments (acupuncture, diet/weight goals, meditation, Chinese Medicine, stem cell prolotherapy, coping skills, etc.); Hormone Therapy (neurohormones, testosterone etc.); Nutraceutical (diet, vitamin D, amino acids, supplements etc.); Massage/Manipulation; Pharmacological; Psychological and Rehabilitation.

Science Daily: The latest research news in Health & Medicine, Mind & Brain, Plants & Animals, Earth & Climate, Space & Time, Matter & Energy, Computers & Math, Fossils & Ruins.

Today's Dietitian Article Archive: Complete articles from previous issues of the magazine. Cites current research and easy to read.

Psyblog, Understand your mind: What recent psychology research tells us about how our minds work. Interesting posts by Jeremy Dean on the shortcuts our minds use, how we can persuade others or others persuade us, changing habits, dealing with stress etc etc. (I enjoyed his new book, Making Habits, Breaking Habits: How to Make Changes that Stick)

MyErgonomicChair.com: 105 Office Ergonomics Tips - After reading these, I found myself making several of the suggested changes to my working environment!

 

Posture and Pain Books:

Cailliet, Rene, Neck And Arm Pain, 3rd edition, 1991—Part of a series on pain, injury and disability. Delves into the complexities of all the varieties of neck pain: spinal, muscular, nerve impingement, whiplash, cervicogenic headaches and myelopathy etc. One chapter is devoted to posture. His commentary on degenerative disc disease is an eye-opener. Makes a complex subject readable and understandable. Many illustrations. Available used (as low as 1¢) on Amazon—see link above. Discusses Posture Extensively! (Also see an article by Rene Cailliet with free access to the complete article, Pain in the Neck and Arm—Diagnosis by History and Examination.

Carey, Anthony B., The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder, and Joint Pain, 2005 - One of the best books I've found on treatment of chronic musculo-skeletal pain. Carey definitely puts posture and alignment first, and the exercise regimes he recommends are based on the specific type of faulty posture present.

Goodman, Eric, Foundation Training: Redefine Your Core, Conquer Back Pain, and Move with Confidence - Flashy book with lots of photos. Not a lot of info and mostly variations on a few well-known exercises such as squats, good–mornings, prone back extensions, and planks, but if done correctly these should greatly improve strength in the true core - the posterior chain of muscles that hold us upright. See above entry with videos from his website.

Jemmett, Rick, Spinal Stabilization: The New Science of Back Pain, 2011—Jemmett, a Canadian physical therapist explains the importance of strengthening specific spinal stabilizing muscles when spinal joints loosen and become more unstable with age and arthritic degeneration. The Australian Approach theorizes that positional information from nerve endings in discs and ligaments is compromised in various spine pathologies, causing poor activation of protective spinal stabilizing muscles. These small, deep muscles are supposed to tense just before trunk movement takes place, but since they may not (especially with a painful back) more superficial muscles are recruited to stabilize the spine; not being well-suited to that role, they end up tightening in spasm, which does stabilize the spine, but not in a healthy way...it's just too darn painful to move. Waking up the positional sense nerves is done with off–balance type exercises such as standing on one leg with eyes closed etc. And the Multifidus and Transversus muscles are re-educated in their primary roles as spinal stabilizers by deliberately learning to contract them. (R.C.—The exercise to activate the transversus abdominis was doable, but activating the multifidus just by willing it to would have been very difficult if I hadn't already been practicing using Jim Johnson's instructions in The Multifidus Back Pain Solution book.) Spinal Stabilization is a short, easy read (124 pages). About half is devoted to explaining the concepts, and half to a program of familiar exercises done while activating the Multifidus and Transversus. Several are position sense exercises: such as standing on one leg with eyes closed, sitting/kneeling on a Swiss Ball, bridges, and then there are knee and leg lifts — all strengthening-the-core-type exercises. The more advanced exercises (some shown on the cover) are not designed for an older person with thinning bones (such as myself). And No Mention of Posture at all! Strengthening spinal stabilizing muscles helps hold the spine erect, but if postural imbalances remain, such as tight hamstring group muscles, there will still be flat back/sway back, and if tight quadriceps then there'd still be lordotic back (which is a strong lower back already) and etc. Back pain worsened by poor posture, won't be addressed by these exercises.

Johnson, Jim, The Multifidus Back Pain Solution, 2002—Johnson, a physical therapist, explains that weakness in the Multifidus, many small muscles that extend the length of the spine and interconnect the vertebra, is hypothesized to lead to back pain. The book includes several good multifidous strengthening exercises. The last one in particular can be done by anyone able to sit or stand. (This exercise(#6), in spite of neck and back pain, I could always do.) Also good discussion of how some degree of nerve compression doesn't necessarily result in pain unless the nerve is inflamed. Extensive references. No Mention of Posture Here, either! (See comments for Jemmett's book, above)

Kendall et al., Muscles: Testing and Function with Posture and Pain, 5th edition, 2005—A classic text, which covers muscle testing, and the evaluation and treatment of postural conditions.

Rick Olderman, MSPT, CPT; Fixing You: Neck Pain and Headaches. Mainly devoted to Droopy/Depressed shoulder, where neck and shoulder pain are accompanied by horizontal collar bones and low set shoulder blades. However, I believe that more commonly, shoulders are not depressed but even held a little higher because of upper trapezius dominance, weak lower trapezius and lower serratus anterior. Unless one specifically has depressed shoulders, his book won't be as much help. Though there are some interesting discussions about how shoulder blades are supposed to move and function.

Rasch, P. and R. Burke: Kinesiology and Applied Anatomy, 3rd edition, 1967.— An older but very thorough textbook on Kinesiology.

Sahrmann, Shirley: Diagnosis and Treatment of Movement Impariment Syndromes, 2001. A classic physical therapy text—Includes evaluation, treatment and detailed descriptions of exercises.

 

 

 

                                         

 

 

 

 

 

 

 

© 2017 Rochelle Cocco