Relieve and prevent neck stiffness and pain

Is your neck stiff, uncomfortable and painful?

When driving is it more difficult to turn your head?

Neck and shoulder pain affect more than 30% of people (Fejer et al, 2006; Cohen, 2015).  This blog explores some strategies to reduce or prevent neck stiffness and discomfort and suggests practices to reduce discomfort and increase flexibility if you already are uncomfortable.

Shifts in posture may optimize neck flexibility

In our modern world, we frequently engage in a forward head position while looking at electronic devices or typing on computers. Prolonged smart phone usage has the potential to negatively impact posture and breathing functions (Jung et al., 2016) since we tilt our head down to look at the screen. Holding the head in a forward position, as displayed in Figure 1, can result in muscle tension in the spine, neck, and shoulders.

head forward alignedFig 1. Forward head and neck posture in comparison to a neutral spine. Source: https://losethebackpain.com/conditions/forward-head-posture/

Whenever you bring your head forward to look at the screen or tilt it down to look at your cellphone, your neck and shoulder muscles tighten and your breathing pattern become more shallowly.  The more the head is forward, the more difficulty is it to rotate your  head as is describe in the blog, Head position, it matters! (Harvey et al, 2018). Over time, the head forward position may lead to symptoms such as headaches and backpain. On the other hand, when we shift to an aligned upright position throughout the day, we create an opportunity to relieve this tension as shown in Figure 2.

EMG head forward uprightFigure 2. EMG and respiration recording from a subject sitting with a forward head position and a neutral, aligned head position.  The neck and shoulder muscle tension was recorded from the right trapezius and left scalene muscles (Mason et all, unpublished).    .

The muscle tension recorded from scalene and trapezius muscles (neck and shoulder) in Figure 2 shows that as the head goes forward or tilts down, the muscle tension significantly increases. In most cases participants are totally unware that their neck tightens. It is only after looking at the screen or focus our eyes until the whole day that we notice discomfort in the late afternoon.

Experience this covert muscle tension pattern in the following video, Sensing neck muscle tension-The eye, head, and neck connection.

Interrupt constant muscle tension

One possible reason why we develop the stiffness and discomfort is that we hold the muscles contracted for long time in static positions. If the muscle can relax frequently, it would significantly reduce the probability of developing discomfort. Experience this concept of interrupting tension practice by practicing the following:

  • Sit on a chair and lift your right foot up one inch up from the floor. Keep holding it up? For some people, as soon as five seconds, they will experience tightening and the onset of discomfort and pain in the upper thigh and hip.

How long could you hold your foot slight up from the floor?  Obviously, it depends on your motivation, but most people after one minute want to put the foot down as the discomfort become more intense.  Put the foot down and relax.  Notice the change is sensation and for some it takes a while for the discomfort to fade out.

  • The reason for the discomfort is that the function of muscle is to move a joint and then relax. If tightening and relaxation occurs frequently, then there is no problem
  • Repeat the same practice except lift the foot, relax and drop it down and repeat and repeat. Many people can easily do this for hours when walking.

What to do to prevent neck and shoulder stiffness.

Interrupt static muscle neck tension by moving your head neck and shoulder frequently while looking at the screen or performing tasks.  Explore some of the following:

  • Look away from the screen, take a breath and as you exhale, wiggle your head light heartedly as if there is a pencil at reaching from the top of your head to the ceiling and you are drawing random patterns on the ceiling. Keep breathing make the lines in all directions.
  • Push the chair back from the desk, roll your right shoulder forward, up and back let it drop down and relax. Then roll you left shoulder forward up and back and drop down and relax. Again, be sure to keep breathing.
  • Stand up and skip in place with your hands reaching to the ceiling so that when your right foot goes up you reach upward with your left hand toward the ceiling while looking at your left hand. Then, as your left foot goes up your reach upward to the ceiling with your right hand and look at your right hand.  Smile as you are skipping in place.
  • Install a break reminder program on your computer such as Stretch Break to remind you to stretch and move.
  • Learn how to sit and stand aligned and how to use your body functionally such as with the Gokhale Method or the Alexander Technique (Gokhale, 2013; Peper et al, in press, Vineyard, 2007).
  • Learn awareness and control neck and shoulder muscle tension with muscle biofeedback. For practitioners certified in biofeedback BCB, see https://certify.bcia.org/4dcgi/resctr/search.html
  • Become aware of your collapsed and slouching wearing a posture feedback device such as UpRight Go on your upper back. This device provides vibratory feedback every time you slouch and reminds you to interrupt slouching and be upright and alighned.

Improve ergonomics

Arrange your computer screen and keyboard so that the screen is at eye level instead of having to reach forward or look down. Similarly, hold your cell phone so that it is at eye level as shown in Figure 3 and 4.

laptop ergonomicsFigure 3. Slouching forward to see the laptop screen can be avoided by using an external keyboard, mouse and desktop riser. Reproduced by permission from www.backshop.nl

Cellphone

Figure 4.  Avoid the collapsed while looking down at a cell phone by resting the arms on a backpack or purse and keeping the spine and head alighned. Photo of upright position reproduced with permission from Imogen Ragone, https://imogenragone.com/

Check vision

If you are squinting, bringing your nose to the screen, or if the letters are too small or blurry, have your eyes checked to see if you need computer glasses.  Generally do not use bifocals or progressive glasses as they force you to tilt your head up or down to see the material at a specific focal length. Other options included changing the display size on screen by making the text and symbols larger may allow you see the screen without bending forward.  Just as your muscle of your neck, your eyes need many vision breaks.  Look away from the screen out of the window at a distant tree or for a moment close your eyes and breathe.

What to do if you have stiffness and discomfort

My neck was stiff and it hurt the moment I tried to look to the sides.  I was totally surprised that I rapidly increased my flexibility and reduced the discomfort when I implemented the following two practices.

Begin by implementing the previous described preventative strategies. Most important is to interrupt static positions and do many small movement breaks. Get up and wiggle a lot. Look at the blog, Freeing the neck and shoulder, for additional practices.

Then, practice the following exercises numerous times during the day to release neck and shoulder tension and discomfort. While doing these practices exhale gently when you are stretching.  If the discomfort increases, stop and see your health professional.

 

REFERENCES

Cohen, S.P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90 (2), 284-299. https://doi.org/10.1016/j.mayocp.2014.09.008

Fejer, R., Kyvik, K.Ohm, & Hartvigesen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834-848. https://doi.org/10.1007/s00586-004-0864-4

Gokhale, E. (2013). 8 Steps to a Pain-Free Back. Pendo Press.

Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.

Mason, L., Peper, E., Harvey, R., & Hernandez, W. (unpublished). Healing headaches. Does success sustain over time?

Peper, E., Krüger, B., Gokhale, E., & Harvey, R. (in press). Comparing Muscle Activity and Spine Shape in Various Sitting Styles. Biofeedback.

 Vineyar, M. (2007). How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery. Boston: Da Capo Lifelong Books.


Optimize success: Enrich treatment with placebo-the body’s own natural healing response*

When randomized controlled studies of pharmaceuticals or surgery find that the treatment is no more effective than the placebo, the authors conclude that surgery or drugs have no therapeutic value (Moseley et al, 2002; Jonas et al, 2015).  Even though the patients may have gotten better, the researchers often do not explore questions such as, why did some of the patients improve just with the placebo treatment; what are the components of the placebo process; and, how can clinicians integrate placebo components into their practice to enhance the body’s own natural healing response.

To explore these topics further, listen to Shankar Vedantam’s outstanding podcast, A Dramatic Cure, from the NPR program, Hidden Brain-A conversation about life’s unseen patterns. Also, read the background materials on the website https://www.npr.org/2019/04/29/718227789/all-the-worlds-a-stage-including-the-doctor-s-office

Presentation1Placebo effects can be a powerful healing strategy as demonstrated by numerous research studies that have persuasively explored the central features of the placebo effect. The research has found that the more dramatic and impressive the procedure, the more powerful the placebo effect.  For example, branded medicine with brightly colored packaging is more effective than generic medicine in plain boxes, an injection of a saline or sugar solution is more effective than taking a sugar pill, and placebo surgery is more effective than simply receiving an injection (Branthwaite & Cooper, 1981; Colloca & Benedetti, 2005).  For a detailed exploration of placebo, nocebo and the important role of active placebo, see the blog, How effective is treatment? The importance of active placebos.

To see the effect of the placebo in action, watch the well-known British stage hypnotist and illusionist, Derren Brown’s video, Fear and Faith  (https://www.youtube.com/watch?v=hfDlfhHVvTY).  He magically weaves together a narrative that  addresses the powerful influences of the natural, physical, and clinical environment and language used during a ‘therapeutic’ interaction. He shows how the influences of role modeling, the words that increase hope, trust and social compliance, and other covert factors promote healing. It uses the cover of a drug trial to convince various members of the public to overcome their fears using a placebo medicine called “Rumyodin” (which is a made-up name of a fake pharmaceutical) and demonstrates that the limits of experience are the limits of your belief.

This blog post serves as a reminder to ask ourselves as educators and therapists, ‘what can I do to include placebo enhancing components into my practice so that my clinical and educational outcomes are more effective?’  Explore ways to optimize your clinical environment, language use during  ‘therapeutic’ interactions, and role modeling to increase hope, trust and social compliance and thereby optimize your clients’ own natural healing response.

References:

Branthwaite A, Cooper P. (1981). Analgesic effects of branding in treatment of headaches. Br Med J Clin Res Ed. 282, 1576-8

Colloca, L. & Benedetti, F. (2005). Placebos and painkillers: is mind as real as matter? Nat Rev Neurosci. 6, 545-552.

Jonas, W. B., Crawford, C., Colloca, L. , et al.(2015). To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open, 5: e009655. doi:10.1136/ bmjopen-2015-009655

Moseley, J.B., et al, (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine. 347(2), 81-88.

*I thank Richard Harvey, PhD., for his constructive feedback and James Fadiman, PhD., for reminding me to reframe the term placebo into “the body’s natural healing response.”