Neck Pain and Text Neck - a Chiropractors perspective
As a Musculoskeletal Chiropractor and soft-tissue therapist, one of the most common complaints the author sees in the clinic environment is neck-related pain. 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 fifteen years and has seen a gradual increase in the number of people experiencing such 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 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 pain, shoulder pain 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).
Bowling balls, gravity and adaption
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 adaptions, 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, which frequently can result in pain, discomfort and reduced mobility. The article about Tissue Adaption - a Chiropractors perspective has a more detailed explanation of adaptive changes.
So what can we do - Strategies to avoid neck pain
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 onset of neck pain. 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, adaption 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 (biotensegrity), 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 adaptions that can occur over such a time. Equally, it can be challenging to resolve neck 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.
Identify possible irritant factors/variables:
Habitual behaviours, Work setup, Hobbies, Interests etc. Keeping a diary of when symptoms are worse and related activities can help narrow down variables to control. Diaries do not necessarily have to take a written form, and most mobile phones can record verbal notes. The "detective" work that a diary produces can be invaluable in identifying seemingly trivial and possible irritant factors.
One can then list the identified possible irritant factors/variables in order of most probable to least.
Controls are ways of reducing a potential or identified risk. One could remove the risk or reduce the impact of it by applying risk mitigation strategies. For example, if one identified a particular habitual behaviour as the factor causing neck pain, then one could stop the habit. That said, habits are not always that easy to break. Based on clinical experience, habits can easily return over time, along with the same neck pain symptoms. Equally, one can look at doing hobbies, interests etc. in a slightly different way, though one should look at any potential consequences (good or bad) of making any such changes. There may be perceived benefits from a particular hobby or interest and rather than having to stop doing it; risk mitigation may be an option. Some hobbies may have social benefits but equally, have a highly likely irritant factor as found during the risk management process. For example, computer gaming may have a major social benefit for somebody, yet the nature of the hobby could certainly cause and aggravate neck pain. Hence, mitigation strategies could involve; creating an ergonomic gaming setup, taking regular breaks, ensuring one is well hydrated and moving, limiting the time gaming, or even attempting to make tissues more resilient the loads placed on them (physical training and or stretching). Many people may not realise how important hydration is to musculoskeletal or health in general, but dehydrated tissues tend not to function as well as sufficiently hydrated ones.
Monitor and Adjust:
It is always important to monitor any changes that one makes, as sometimes the actual irritant factor/variable can be hard to identify and again keeping a diary can help at this stage. As a Musculoskeletal Chiropractor, the author prefers to try and identify as many possible irritant factors or variables at the earliest opportunity. Equally, it is particularly useful if all or the majority of the identified variables can be removed or controlled in the short-term. One can put variables back into the equation as time progresses and symptoms improve. The critical thing is removing irritant factors/variables and thus allowing tissues to heal and adapt. Sometimes, there can be an element of trial and error concerning identifying all the possible variables, as clinicians only have a relatively small window into a patients life. Clinical experience can help provide patients with many potential variables or factors to look at in the first place and manage accordingly.
Why bother seeking external treatment help?
As briefly mentioned earlier, many injuries and symptoms can occur over time, which creates adaptions, affecting biotensegrity (see article). 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 Chiropractor and soft-tissue therapist, the author would struggle to treat his neck, shoulders or back effectively. Equally, 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 cause of neck pain and then physically treat the related structural and functional changes. Equally, prescriptive exercises alongside treatment can help speed up the entire recovery process and help with risk management/prevention. Even if one works with a professional, then chronic neck pain or any chronic conditions is not likely to resolve in a single treatment, due to the various adaptions 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 adaptions 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.
The article was written by Dr Terry Davis MChiro, DC, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
About the Chiropractor Author
The author possesses an unusual mixed background for a Chiropractor (McTimoney). His education, training and practical experience span over two decades and relate to both physical and mental aspects of health. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain’s elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications. His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry’s combination of knowledge through, education, training, his elite military experience and personal injury history have paid dividends for the patients he sees and has treated. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.