Neck Pain Treatment

One of the most common complaints the author sees in the clinic environment is patients seeking neck pain treatment and related issues. Such pain may also include shoulder pain, upper backache and even headaches (tension or migraine). The author has been treating within the musculoskeletal / MSK field for nearly sixteen years and has seen a gradual increase in the number of people experiencing such problems. Consumer's seeking treatment for unresolved neck injuries and persistent pain are all too common, (see the article on Persistent Pain for further details on aspects of such conditions and treatment). Such patients often require a slightly different approach, yet results can be very positive, even for very long-standing problems. Many musculoskeletal type injuries can often occur for one or a combination of reasons, such as lack of use, misuse, overuse or abuse (as noted by the late Osteopath, Leon Chaitow).

However, modern-day life and habitual behaviours (habits), what we do, and how we use our bodies plays a huge part. The advent of smart devices and the amount of time spent using such devices can certainly place a great deal of additional strain on the musculoskeletal system. Terms such as "Text Neck", have become a popular way to describe the resulting neck-related conditions/symptoms associated with the modern way of life. It also worthy of note that "stress" can have a significant impact on the musculoskeletal system and result in a combination of neck, shoulder and even tension or migraine-type headaches. Further details about the human stress response, what happens, the impacts on the body and techniques to help manage stress can found in the three articles about the topic. Please follow the link to read the first article on stress Stress, the Individual, Wellbeing, Performance and the Workplace (Part One).

People often forgot that our limbs are relatively heavy and external forces such as gravity are constant. Muscles and other structures within the body, work together to maintain any given bodily position but have a finite capacity to do so (postural fatigue). How quickly tissues fatigue will be dependent on multiple variables/factors including strength, conditioning of said tissues, given position, previous injuries, existing adaptations, specific medical conditions, hydration etc. In some respects, the adult human head is similar to a bowling ball in weight 10 lbs plus. There are a large number of muscles involved in maintaining normal head carriage, and these vary in size, strength, anchor points (origins and insertions) and thus endurance ability. Trying to keep a set or given position for hours on end and without moving can in many respects be equivalent to making said muscles run a preverbal marathon. However, the act of running involves movement and a carefully coordinated combination of muscles contracting and opposing muscles relaxing. Equally, there are different types of muscle contractions (concentric, eccentric, isometric), and movement typically involves a combination of these.

Sitting for long periods requires the body to hold specific joint structures against the forces of gravity and in a set position. Specific muscles perform a stabilising function during any given movement. However, when maintaining a fixed position, all muscles involved in holding that position will be providing a stabilising role and isometrically contracting. In effect, prolonged isometric contractions do not give muscles or tissues a break, unlike when one moves. Just imagine trying to hold a feather at arm's length and without any form of support? Regular movement is also critical for veinous and lymphatic circulation of nutrients and waste products around the body. The flow is achieved via muscles contracting and relaxing, which is very different from prolonged isometric contractions. The foam roller article has more of an explanation about how muscle actions squeeze fluid through the veinous and lymphatic systems. Excessively prolonged isometric muscles contractions are generally not a normal thing for the body to be doing, and the tissues adapt accordingly. As tissues start to fatigue, head carriage changes and other tissues and structures are affected. The human body then has to adjust to the new demands placed on it. Such changes can result in pain, discomfort and reduced mobility and myofascial trigger points (MTrP)'s. For a more detailed explanation of adaptive changes (see related articles - Tissue Adaptation). Hence, the reader might see some reasons that pain can become chronic, and as a musculoskeletal professional, the author sees such issues all too commonly. Research has shown links between Trigger points and myofascial pain affecting the neck, shoulders and some forms of headaches and migraines.

One can apply basic principles of risk management to help identify and help limit the occurrence of neck pain or other such musculoskeletal related conditions. There can be a considerable number of factors or variables concerning musculoskeletal conditions, and there is no difference with neck pain. Over the years, the author has developed a great deal of understanding about the types of things (factors) that can play a part in pain onset. In some, cases, there is an apparent either direct or indirect injury mechanism, and in other cases, there is not. By indirect, the author means some form of historical injury, adaptation (see related articles - Tissue Adaptation) or combination of such factors which results in biomechanical changes elsewhere within the body. Such changes can over time have an impact on other areas of the body, and in some cases, it may take years before the patient notices any pain or symptoms with the neck or elsewhere. Typically, active people, in particular, tend to pick up on small and noticeable changes earlier on, especially elite level athletes. Active people use their bodies a lot, and so problems can tend to become apparent much sooner, but equally many such people have a high level of self-body awareness.

Resolving neck pain can sometimes be challenging, especially when chronic (over six months), due to a large number of tissue adaptations that can occur over such a time. Equally, it can be challenging to resolve neck-related pain or other musculoskeletal issues if one cannot identify the probable cause "irritant" factor. One cannot manage risk if one does not know what the risk is, and there can be a vast number of variables at play. A relatively common reason for neck and back pain (see the related articles - back pain) can relate to an incorrect work setup, which is likely to lead to quicker muscle fatigue. One can create a simple and ergonomic computer setup with little cost or effort. An ergonomic computer setup should help, though one should still take breaks and other measures. See related articles and setting up ergonomic computer setup.

As briefly mentioned earlier, many injuries and symptoms can occur over time, which creates adaptations, affecting biotensegrity (see related articles - Biotensegrity). Although there are various self-treatment techniques, there are always limits as to the effectiveness of said methods in a self-help context. Even as a Musculoskeletal and soft-tissue therapist, the author would struggle to treat his neck, shoulders or back effectively. It can be quite easy to make symptoms far worse by attempting to self-treat; if one has not identified the root cause correctly, if one applies the wrong treatment intervention for the given symptoms, or if the correct technique is applied incorrectly. A professional can help identify the reason for symptoms of neck pain and then physically treat the related structural and functional changes. Myofascial release techniques can be very effective for treating acute and chronic neck pain symptoms, especially when combined with other treatment methods. Techniques such as Gua Sha can also effectively treat neck pain symptoms. Prescriptive exercises alongside hands-on therapies can aid recovery, help with risk management/prevention and produce better treatment outcomes. Even if one works with a professional, then chronic neck pain or any chronic condition is not likely to resolve in a single treatment due to the various adaptations that have occurred.

It is always worth bearing in mind how long it took for symptoms of neck pain to manifest and thus, how much change can happen within the body in that period. It may be possible to get somebody out of neck pain in a single treatment, but that certainly does not mean that the other adaptations have resolved. Unfortunately, there seems to be a common perception that there are only issues if there is pain, or that things will sort themselves out. The author often sees many problems and which could have been avoided with some simple and occasional maintenance work. Preventative work also helps identify potential issues, manage those and help patients develop a better level of body self-awareness. Hence, it is worth finding a good and ethical patient-centred practitioner, See the article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective for some tips.