Neck pain is frustrating. As mentioned in this month’s Perspective, neck stiffness, tension, and jaw pain are common culprits for headaches. Furthermore, this month’s Trifecta demonstrates 3 exercises that help the neck stay healthy and mobile… but why are these exercises important?
IT’S OPPOSITE DAY!
How do you spend your day? Do you drive in a car, sit at a desk, play on your phone, or maybe sit on a couch watching TV after work? There is something in common with these activities: the type of posture we adopt. Specifically, we shift our head forward away from our body to visualize the task at hand which increases tension in neck joints and muscles (Forward head posture [FHP]). An example of forward head posture is shown in the photo in the next section. A FHP is NOT inherently bad – our neck is designed to flex forward and move the head away from the body. A FHP is typically only concerning if we stay in that position for extended periods. Sustaining a FHP for long periods often results in neck muscle tension and weakness that can cascade into issues like headaches. One of the most effective ways to avoid FHP issues is with the “Law of Opposites”. The “law” is simple: move in the exact opposite direction from what you do all day. For example, if your knees are constantly bent from sitting all day, the “Law of Opposites” would suggest to frequently stretch the knee by straightening it. The “Law of Opposites” for the neck is applied by doing the opposite of the FHP - Chin Tucks.
A FHP [forward head posture] is NOT inherently bad – our neck is designed to flex forward and move the head away from the body. A FHP is typically only concerning if we stay in that position for extended periods.
WHAT GETS TIGHT?
As mentioned above, maintaining a FHP throughout the day negatively effects the muscles around the neck, but which muscles specifically? First, it elongates and weakens muscles on the front of the neck called the deep neck flexors (DNF). DNF muscles are important for stabilizing and controlling neck motion, and weakness in these muscles are commonly associated with pain. In fact, up to 70% of individuals with chronic neck pain have decreased DNF strength.[1] Thankfully, there is something you can do to help – strengthening DNF muscles (through exercises like the chin tuck) is an effective strategy for alleviating neck pain.[2–7] Second, a FHP results in muscles tightening on the back of the neck directly below the skull (i.e., suboccipitals). Suboccipitals are important for keeping the head level, and when a FHP is maintained for extended periods these muscles have to work extra hard to keep the head level. Due to being overworked, these muscles often develop “trigger points” or muscle knots. Applying pressure to these muscles (Neck Pressure) with your thumb is effective for reducing pain and improving range of motion.[8]
MOVE IN MULTIPLE PLANES.
The last strategy that helps maintain a healthy neck is to mobilize the neck joints. Mobilizing neck joints is essentially “sliding” joint surfaces across each other. This “sliding” normalizes pressure in the joints, downregulates pain sensors, and improves healthy feedback to nervous system.[9,10] An effective way to performing this “sliding” is with “Towel Turns”.
SUMMARY
Performing chin tucks frequently throughout the workday strengthens DNF muscles, neck pressure to the suboccipitals helps relieve tension by addressing muscle knots or trigger points, and towel turns provides relief by improving joint functionality with gliding joint surfaces across each other.
References
Yip CHT, Chiu TTW, Poon ATK. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148-154. doi:10.1016/j.math.2006.11.002
Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. J Phys Ther Sci. 2016;28(1):269-273. doi:10.1589/jpts.28.269
Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R. Development of motor system dysfunction following whiplash injury. Pain. 2003;103(1-2):65-73. doi:10.1016/s0304-3959(02)00420-7
Chiu TTW, Lam TH, Hedley AJ. A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain. Spine (Phila Pa 1976). 2005;30(1):E1-7.
Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701. doi:10.1016/j.math.2009.05.004
Lee MH, Park SJ, Kim JS. Effects of neck exercise on high-school students’ neck-shoulder posture. J Phys Ther Sci. 2013;25(5):571-574. doi:10.1589/jpts.25.571
Dusunceli Y, Ozturk C, Atamaz F, Hepguler S, Durmaz B. Efficacy of neck stabilization exercises for neck pain: a randomized controlled study. J Rehabil Med. 2009;41(8):626-631. doi:10.2340/16501977-0392
Arjona Retamal JJ, Fernández Seijo A, Torres Cintas JD, de-la-Llave-Rincón AI, Caballero Bragado A. Effects of Instrumental, Manipulative and Soft Tissue Approaches for the Suboccipital Region in Subjects with Chronic Mechanical Neck Pain. A Randomized Controlled Trial. Int J Environ Res Public Health. 2021;18(16):8636. doi:10.3390/ijerph18168636
Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5(6):455-464. doi:10.2217/pmt.15.39
Paquin JP, Tousignant-Laflamme Y, Dumas JP. Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study. J Man Manip Ther. 2021;29(4):244-254. doi:10.1080/10669817.2020.1864960
Healthy Is Wellness, LLC (“Healthy Is Wellness”) is not a health care provider, and does not provide professional medical advice, diagnosis, and/or treatment. THE INFORMATION PROVIDED BY HEALTHY IS WELLNESS IS FOR INFORMATIONAL PURPOSES ONLY.
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