We are moving up the spine to the thoracic and cervical spine, an area that is chronically abused by sitting for prolonged periods of time in front of a computer. We put great emphasis on abdominal strength, but fail to evaluate how strong we are in the upper back. A research overview of neck pain found that 1 in 3 people will be affected by neck pain. The symptoms usually clear without intervention, but they may reoccur and become chronic in 1 out of 10 people. [1] As a PT, I usually approach neck pain from 3 areas: posture, exercise and manual therapy (hands on therapy to address soft tissue and joint restrictions that may relieve pain).

Why is posture so important to prevent neck and upper back pain? Your head weighs roughly 10 to 12 pounds; for every inch the head drops forward of your shoulders, it adds 10 pounds to the weight, thereby adding strain to the neck muscles. [2] Proper sitting posture includes sitting upright in your chair, hips back in chair, feet on floor, head aligned over shoulders, computer screen at eye level and in front of you; this allows alignment of your head over your shoulders for reduced neck strain. Neck support while sleeping is also important in the management of neck pain. Your pillow should support the curve of your neck; regardless if you sleep on your back or side, the pillow should support your head and neck keeping it in a neutral position. Need more detailed information regarding sitting posture, please see post from 6/20/18 “Are You A Desk Dweller?”.

Sleeping posture 12-2018.gif — Sleeping Posture

Your pillow should support the curve of your neck. Place the pillow up tot he top of your shoulders with the curve of your neck supported so your spine remains in neutral. The pillow should not be so fat that it pushes your head up, or so skinny that your head drops down. Remember, your neck should stay in neutral, you are sleeping for 4, 6 or 8 hours in this posture, support your neck!

Why is exercise so important in managing neck and upper back pain, and which exercises are the best? Considering your head weighs 10 -12 pounds, we want to build the strength of the neck, upper back and scapular muscles to support the head and shoulders. Research studies have found that strengthening of the deep neck flexors and scapular stabilizers help to alleviate neck pain. One research study found deep neck flexor “activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain” [3]. Another article found that the position of the scapula (shoulder blades) helped to activate the lower and middle trapezius muscle, promoting support to the neck and relieving pain [4] Here is my “beginner’s list” of exercises to promote flexibility and stabilize your upper back and neck.

The deep neck flexors are deep muscles in the front of the neck, you cannot see or touch them to obtain feedback of a muscle contraction, which makes them difficult to strengthen properly. Strengthening them takes focus and patience. Chin tucks are a commonly prescribed exercise and an exercise that is performed incorrectly. It is a subtle movement to be performed gently to engage the proper muscles.

chin tuck.jpg — Chin Tucks

Sitting or laying flat, gently tuck your chin back into your neck like a turtle retracting its head into the shell. Hold for 3 seconds and relax by allowing your head to return to neutral.
DO NOT PUSH YOUR CHIN FORWARD.
*(Starting posture in the picture on the upper left, ending posture is the picture on the right. )*
Perform 10 times twice daily
Photo Credits HEP2GO

The scapular stabilizers are large muscles that direct the position of the scapulae. I tend to focus on the middle trapezius and rhomboids, and lower trapezius. The muscles combined action on the scapulae draw them towards the spine and down away from the ears, thus reducing pressure on the neck.

iron man.jpg — Iron Man

Laying on your stomach with a towel roll under your forehead, squeeze your shoulder blades down and in, then gently lift your arms up with your thumbs pointing up. Hold for 3 seconds, relax and repeat.
Perform 10 times twice daily.
Photo Credits HEP2GO

scapular retraction.jpg — Scapular Retraction

Sitting on a chair, bed or couch, place your hands on the surface with your arms relaxed. Gently squeeze your shoulder blades down and in towards your spine without using your arms. Hold for 3 seconds then relax. This exercise can be performed frequently through out the day and can be helpful for postural correction.
Perform 10 times twice daily.
Photo Credits HEP2GO

Stretching the large pectorals on the front of the chest allows improved movement of the scapula and improved alignment of the head over the shoulders.

Pectoral stretch.jpg — Pectoral Stretch

Standing in doorway, place your hands on the door jamb; step forward with either foot keeping your trunk aligned over your hips, do not arch your back. You should feel a stretch along the front of your chest and upper arms. Hold this position for 30 seconds.
Perform 4 times per day
Photo Credits HEP2GO

pectoral stretch on foam roller.jpg — Pectoral Stretch over Foam Roller

This is a more aggressive approach to stretching the pectorals. Lay on your back with the foam roller aligned along your spine with your head supported and knees bent, bring your arms out to the side and relax. Hold for 30 - 60 seconds.
Perform 2 times daily
Photo Credits HEP2GO

Now you have a complete set of exercises to engage and strengthen the complete “core”. This is not an all-encompassing exercise routine and these are certainly beginner exercises. But this is a wonderful starting point if you are suffering from neck or back pain.

If you are in need of further guidance, please contact me via email or phone for more help.

Happy Holidays to you all! I am hopeful you have gained knowledge and direction for managing your “core” this past month. I’ll be starting off the New Year with a discussion on fitness!

[1] Neck Pain: An Overview https://www.ncbi.nlm.nih.gov/books/NBK338120/

[2] How Poor Posture Causes Neck Pain. https://www.spine-health.com/conditions/neck-pain/how-poor-posture-causes-neck-pain

[3] Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756018/

[4] The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. https://www.ncbi.nlm.nih.gov/pubmed/20663706

Stabilizing Your Spine with Exercise Part II