Chronic Neck Pain : Postural Causes and A Unique Fix
Your Comments, Stories and Tips:
Yvonne: Thank you for your extensive descriptions. Like you, I had frequent commands from mom to “keep the shoulders back” and developed a host of kinetic chain dysfunctions over the years: back, neck, shoulder, hips, knees and ankles. Spending too much time lugging heavy books or talking with a phone cradled to my ear (or worse, my shoulder) helped further set me up for cervical and shoulder issues. Spending hundreds of miles hunched over a bike or hours at a desk further added to forward posture. Having my leg run over by a bus at age 12 did not help with my muscle imbalances either, nor did two car accidents in my 40’s. Working out in the gym just aggravated the dysfunctions.
I, too, had some good physical therapists over the years, but I never learned about maintaining proper muscle tension relationships until I took a sports medicine program at a local 2-year college (West Valley College in Saratoga, CA) which was based on the NASM model (National Association of Sports Medicine). The program has a huge emphasis on building endurance, strength and power from a solid base of stability. It does not look at isolated joints, but always looks at what is happening above and below. I like your preference of ‘balanced spine’ over ‘neutral ‘as well, because the spine must balance over the Lumbar Pelvic Hip Complex. No one ever fully explained underactive and overactive muscles to me until I took time to study it as you did, and all the pieces of the past finally came together. Being proactive about my health helped me recover from a rare nervous system disorder following removal of a mass in my leg, and put me in touch with the right people to rehabilitate. While most take years to recover from the condition, if at all, I was back to 30-mile bike rides within 4 months. But now I do a mix of cycling, Pilates and flexibility work.
Thank you for sharing your knowledge so people don’t have to return to painful habits. A poor posture is hard to undo, but better to finally fix it in my 50’s before it turns into cement! I now try to add a balance of activities so they are not all in one forward plane of motion. And I strengthen the core to keep the spine erect and the shoulders and neck back. A few sleep disorders further contribute to muscle tightness but thanks to reminders like yours, I will continue my quest until my body naturally knows what it feels like to have a balanced or ‘neutral’ spine without always having to remind myself. Balanced feels so much better!
Daniel: Pec minor stretch you indicate can be a beneficial stretch for those that DO NOT have depressed or protracted scapulas. Patients with these dysfunctions will tend to stretch their anterior shoulder capsule rather than their pecs due to the fact that their humerus will fall into anterior glide. I know because a few PT's had me doing this as well and I began to lose sensitivity in my hand. A good way for people like who I 'used to be' is to have someone sort of pin down the scapula to the floor then employ the stretch. Even better would be to have someone do some manual therapy to loosen up that pec minor while pinning down the scap and stretching the pec. I've gathered this information from the Washington University PT department's treatment program for those with dysfunctions of the upper extremities. (I agree, so I've removed the Unilateral Pectoralis Minor Stretch.)
As for the hips, if you can, buy Dr. Shirley Sahrmann’s ‘Diagnosis and Treatment of Movement Impairment Syndromes’. This book saved my life, physically and mentally. I don’t want to get into depth on what was going on with me, but it was not good at all. This treatment protocol is revolutionary. I’ve actually recently visited their PT clinic at their Washington School of Medicine (top ranked in the nation every year). It’s for a reason. The cervical and thoracic extremity book is good too, but the one for the hips and shoulders will blow you away (it’s actually a textbook for DPT students, haha). If you can, buy it, it may save your hips (and back, seeing as they are so related).
(R.C – I agree with Daniel's comment on the possibility that pectoralis minor stretching (unless done manually) may overstretch the anterior shoulder capsule if there is anterior glide of the humerus in the shoulder socket, so I have eliminated the pec minor stretch. But I learned this stretch (the corner stretch) from a physical therapist and was given no instruction about avoiding anterior glide of the humerus.)
Kate: Qi Gong helped my posture! It's gentle too—although I also like hiking, running, and zumba, the Qi Gong helps lift your spinal column and stretches in a helpful way. My 85-year old mother had the same good experience. I think there are some good DVD's and of course classes. Hope others may enjoy some help from this.
Jean's Ongoing Back Pain Story: Eight months ago (in early 2011) she tore 2 lumbar discs lifting her young grandson from a playpen. The pain was so great that she fell to the ground and couldn't get back up. Lucky she had her cell phone on her and managed to call her daughter to come home. In the next few months she saw a General Orthopedist, had an MRI and then Physical Therapy, which immediately worsened the radicular nerve pain down the front of her thigh, and the constant spasm of front hip flexor muscles (less common manifestations of lumbar nerve root impingement but just as painful as sciatica). She began to drag her "bad" leg. Finally, the PT admitted he couldn't help, and Jean couldn't bear the sessions anyway, so no more PT. After that came four epidurals, three of them in quick succession—one a week—but that didn't help. (The Spine Surgeon later said she should have had the epidurals before the Physical Therapy, not that that would have helped her.) Surgery seemed the only alternative, but not being emotionally or mentally prepared for that grueling prospect or the huge co-pay, she put it off and put it off. I would ask her about the pain and she always said she'd gotten used to it, but from her eyes and the way she moves I know differently. She says she only permits herself one day's pain vacation a week when she takes a Vicodin (or whatever passes for Vicodin these days) on Saturday nights.
Jan. 2012 — Now after all these months, she's again considering the back surgery—a two level fusion. But she's been to the original orthopedist, and he says that a recent study shows that (5?) years later patients undergoing the type of surgery considered for her don't do much better than patients not having surgery. He sends her back to physical therapy. And lo and behold, the first session seems to help, at least it doesn't make her worse. Maybe time is the great healer, even of torn discs.
2/3 — Well she's been to more physical therapy sessions, and instead of improving, the pain in both her back and leg has worsened; the nerve pain down the front of her thigh is so painful she jumps when the PT touches it, and now she has sciatica. She's thinking of quitting.
2/6 — Jean, no longer able to tolerate the increasing leg pain, quits physical therapy. How long can she hold out before having back surgery?
4/18 — No surgery yet. She's been trying to get some walking in but that causes her lower back to burn. Her thigh remains terribly painful from radicular pain. I've suggested that she try to walk more lightly and tighten her abdominal and butt muscles so there's less jarring side-to-side hip movement every time she takes a step. She says she has to walk in a very deliberate manner because of the pain, or is it nerve damage weakening the hip and leg muscles? But I imagine the shock waves going into those inflamed lumbar discs with each step.
9/18 — Now 5 months later she is attending an adaptive physical education class at a community college and exercising on a treadmill and doing some upper body weight training. Her lower back and left leg still hurt but aren't significantly worse with the exercise. But what worries her is a new pain in her right leg. But she trudges on without surgery and mostly without pain medication.
4/20/2013 — She hurt her back two or three weeks ago while playing with her grandchildren. She explained that the pain was always there anyway; but this incident made it much worse and also her sciatica flared up and isn't improving. Sometimes she has to use a cane to get around. More and more it looks like surgery is becoming inevitable.
9/21/2013 — She's in school almost full time. And never mentions her back unless I ask. But with all her going back and forth to school and the work involved, I think at most that her pain is only a dull ache; she does not take pain meds at all. Once in a while she'll mention having surgery before she transfers to a 4-year college. But there's no conviction in her voice.
4/20/2014 — Jean once again has asked a spine surgeon about back surgery, and this time, he says it is best for her not to consider it; spine surgery doesn't always help and more often than not, more surgery is needed down the road. Currently she is functioning without much pain medication, and has a busy schedule as a student. It's just that she always has a persistent level of pain, and she is lost as far as figuring out how to improve it. At the same time she is not trying to find other therapeutic approaches, doing her own research or taking advice from others. She is stuck in "the abyss," the term Dr. Hanscome uses to describe the mixture of anger and hopelessness at being trapped in a state of chronic pain with no end in sight and limited treatment options. Chronic pain and the effect on patients’ families.
11/2014 — She is losing weight, has major stress over a divorce, and still has chronic back pain that often flares into something worse. Her main exercise is walking, but she doesn't have the time nor does she believe that specific exercises will help strengthen her back enough so that flares become less frequent. Her unbelief probably rests on her experiences with physical therapy, but also she has been told, based on the MRI (which to my untrained eye doesn't look much different from mine), that her problem is beyond what exercise can help, yet the orthopedist won't operate because he says that won't help either. Her current method of coping with back pain is to ignore it, not talk about it, or seek further help. She is not taking pain medication as far as I know.
To be continued....