Neck

Neck Pain Triggers and How to Avoid Them

Persistent neck pain can be really frustrating but it’s very common.

One of the main issues is that neck pain can be triggered quite easily.

You can have the best treatment and exercise program in the world, but if you inadvertently trigger it day after day, it simply will not get better.

This goal of this blog post is to help identify some common triggers of neck pain.

If you can identify the main triggers, you will get to the root cause of the problem and reduce the likelihood of getting a flare-up.

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Who gets neck pain?

Studies have shown around 65% of us will experience an episode of neck pain every year.

Once you’ve had an episode of neck pain, it’s common (about 50% the time) to experience further flare-ups down the track.

The research shows neck pain is more common in:

  • office and computer workers

  • women aged between 30-50 years old

For some people, the pain can last a few weeks and is only a minor inconvenience.

For others though, the pain can last many months and develop into a chronic pain cycle of pain, weakness and fear of ongoing damage.

First things first: Get Yourself Checked Out

If you’ve had ongoing neck pain for sometime, you will need to get a check-up with your GP or Physio to rule out red flags.

Red flags make up about 1% of neck problems and can include things such as:

  • nerve impingement

  • disc related pain

  • inflammatory pain

  • auto-immune disorders

  • hyper-mobility

  • arthritis

  • cancer

We tend to fear neck pain more than other pain

Ideally, the neck is highly mobile that allows us to see in all directions.

Evolutionary speaking, if we are unable to see potential dangers around us, our nervous system goes into a strong protective response.

This may include:

  • increased muscle tension

  • increased anxiety

  • increased pain and perception of threat

Some of the neck pain you feel may be related to this increased nervous system sensitivity.

It’s important to be aware of this extra sensitivity, otherwise you will mistake the pain for ongoing tissue damage.

Left unchecked, these ongoing negative thoughts about the body can do much harm in the form of fear, avoidance of movement and increased anxiety and depression.

If you have ongoing neck pain and you’ve been assessed by a Physio / Doctor and found to have no red flags or structural issues, it’s important to understand that most neck pain is coming from the muscles.

Muscles of the neck

The neck is designed for movement and is made up of 44 muscles which help control movement of the head.

When the muscles become overloaded, they become tight and reduced movement results.

Lack of movement means the muscles have a reduced blood and oxygen supply.

If the muscles continues to get overloaded for long enough, the muscle fibres form a trigger point / knot that can cause ongoing pain.

Each muscle has a typical referral pattern, where the pain spreads into a different part of the body (see picture below of the common trigger point in the upper traps).

The most common trigger point in the  Upper Trapezius  muscle that refers up to the temple and behind the eyes.

The most common trigger point in the Upper Trapezius muscle that refers up to the temple and behind the eyes.

A note about imaging findings

If you’ve had x-rays or a CT/MRI of your neck, it most likely picked up some findings in the neck such as disc bulges, degeneration and spurring.

Whilst these things can definitely trigger off a pain response initially, it is unlikely to be the major cause of ongoing pain.

The good news:

Many people have these changes on scans, but most people have minimal or no pain (see table below).

The majority of the degenerative features are likely part of normal aging process and unassociated with pain.

As you can see in the study below, disk degeneration is present in 68% of 40 year olds who are completely asymptomatic.

As you get older, the chance of having a disc bulge around 70% by the age of 60.

Once again, this is in a group of people who don’t have any pain.

Be careful  who you listen to in terms of how you’re scan results are being  interpreted.    Source: Brinjikji W et al

Be careful who you listen to in terms of how you’re scan results are being interpreted.

Source: Brinjikji W et al

The most common triggers of neck pain and how to avoid them:

1. Lifting heavy / awkward things that increase the strain on your neck

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Lifting heavier things that you’re used to can cause overload of your neck muscles and joints.

This might be at the gym, carrying groceries in from the car or lifting young children.

Just to clarify, you can still lift heavy things, especially if you have a good capacity built up gradually over the years.

It’s just best to avoid carrying heavy things that you are not accustomed to.

“It’s not the load that breaks you down, it’s that load you’re not prepared for” - Tim Gabbett

So take care in the gym, and know your limitations. If you need to, have some sessions with a trainer who who help show you the right technique.

I know it’s a hassle, but take a bit of extra time to make a couple of trips (or ask someone to help) to carry your groceries. It can make a world of difference to the health of your neck.

2. Sustained Positions

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One thing the neck hates is being is locked in one position for than 20 minutes at a time.

Holding sustained positions for long periods of time tends to increase the tightness in muscles such as the upper trapezius (top of your shoulder) and sub-occipital muscles (base of your skull).

The most common sustained position is from looking down at your phone constantly.

We know (from the picture above) that the further down you look, the bigger the strain on your neck (up to 30kg of pressure when looking right down). Our necks are simply not designed for this.

Make sure to bring your phone up to eye level, otherwise you will place considerable strain on your neck muscles.

Make sure to bring your phone up to eye level, otherwise you will place considerable strain on your neck muscles.

What is the best sitting posture?

A key point to keep in mind, is there is no one perfect posture.

Don't get fooled into thinking you have to always have a perfectly upright posture all the time.

Some people who follow this line of thinking get very anxious if they don’t have perfect posture.

This anxiety can further increase the muscle tension and pain in the neck.

Rather than focus on finding the one perfect posture, always remember:

“The best posture is your next posture”.

Meaning that you need to keep yourself moving and changing positions frequently.

If much of your work is based around a computer, a sit to stand desk would be a very good investment.

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3. Inefficient Breathing patterns

Test your breathing patterns.  Place one hand on your upper chest and one hand lower.   Take 3 deep breaths and notice which hands lifts up first.

Test your breathing patterns. Place one hand on your upper chest and one hand lower. Take 3 deep breaths and notice which hands lifts up first.

We take approx. 21,000 breaths per day.

Each one sending a message to your nervous system - either a message of 'safety' or 'danger', depending on the pattern.

Habitual shallow breathing and subconscious holding of the breath can maintain a sympathetic (fight/flight) dominant state.

This is common in people who have neck pain - and they tend to breathe more using the upper chest muscles. These are known as the accessory breathing muscles.

These accessory breathing muscles are the scalenes, sternocleidomastoid, pecs and lats that attach from the ribs to the spine.

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If they are constantly working through upper chest breathing, they become overly tight and can cause the neck to become tight and painful.

Learning how to breathe efficiently through the diaphragm is the foundation of optimal movement and recovery.

Take your hands around the bottom of your rib cage and as you breathe in expand outwards, like you’re trying to blow up a balloon.

Feel your lower ribs expand from the front, back and sides - that is your diaphragm muscle.

If you’re feeling a lot of neck pain, try taking 5 deep breaths into your diaphragm.

Breathe in for 5 seconds and then out for 5 seconds.

Keep your upper chest and shoulders relaxed.

“As you become more mindful of your breathing, you will find you become more present, gather all your scattered aspects back into yourself and become whole”. ~ Sogyal Rinpoche.

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4. Stress

Aside from injuries and poor posture, stress also plays a big role in ongoing neck issues. 

When we get stressed, the 'fight or flight' system is activated in our bodies, sending messages to our muscles to contract. 

As this muscle tension becomes chronic, the tightness reduces our flexibility and produces pain.

Stress can come from many sources such as:

  • relationship probems

  • financial strain

  • lack of close support networks

  • poor nutrition

  • not getting enough exercise

  • not understanding why you’re in pain and being constantly worried about it

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If you are feeling anxious or stressed in other areas of your life, this can increase the sensitivity of your nervous system.

Like a magnifying glass, it amplifies the sensation you feel.

If you have a lot of underlying stress in your life, sometimes a minor twinge in your neck can be perceived as extremely painful.

Your capacity for dealing with muscular tension issues can be dramatically reduced.

The way to move forwards from this is to take note of all your stressors and try and address them as best as you can.

Very often some support from a qualified psychologist can be extremely helpful and you could speak to your GP about getting a referral.

Other tips for decreasing stress in your life:

  • take time for you - everyday - to do something you enjoy

  • exercise more - at least 30 - 60 minutes per day of vigorous exercise

  • eat well - take the time to prepare healthy meals at home

  • get out in nature as much as you can

  • ask for support from those around you - don’t be a martyr

  • see the bigger picture - there’s always someone worse off that you and life is too short to not be enjoying it every day

5. Poor Quality Sleep

It's important to invest in a good mattress and pillow, as we spend one third of our lives in bed.

These pillows are recommended by the Australian Physiotherapy Association:

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Finding the right pillow is a very individual process so you may need to experiment with a few different types in order to find the one that fits you best.

Check the distance between the side of your neck and your shoulder. That gives you an idea of the pillow height you need to keep your head and neck supported when you sleep on your side.

Getting enough sleep is important.

If you’re burning the candle at both ends, you can’t expect your body to be able to re-charge and perform optimally.

If you have insomnia related to an ongoing pain issue, follow these sleep hygiene tips:

  • wake up early (no later than 6am) and get moving by exercising for 45 -60 minutes. Find an exercise that you can do that increases your heart rate without stressing your body too much. It might be swimming, hiking or jogging.

  • don’t nap during the day as you’re trying to build your ‘sleep pressure’ so when your head hits the pillow at night, you will go straight to sleep

  • avoid caffeine after midday

  • take a warm bath an hour before bed

  • don’t drink and fluids after 7pm to avoid bathroom breaks in the middle of the night

  • get into bed around 9pm and quietly wind down so you’re feeling sleepy at 10pm

Physio treatment of neck pain - what works?

Our approach is to resolve acute neck pain quickly and return to doing what you enjoy, but we also have a focus on getting to the root cause of the problem and limit recurrence.

Personalised Exercise Programs

Exercise is beneficial in people with neck pain.

There is good evidence to show that exercise and building capacity is the best approach to helping reduce neck pain in the long-term.

The best exercise is based on our personalised assessment with a Physiotherapist.

A comprehensive program will involve a combination of stretching, strengthening and improving joint mobility.

Some PDF of some common neck stretches we prescribe can be downloaded for free here.

Dry Needling

This study recommended dry needling for immediate pain reduction in upper body myofascial trigger point dysfunction. It certainly can be quite intense and can take a few days to work itself out, but we find dry needing to get the most effective release of the muscles.

Using heat on the neck via a wheat pack is really helpful, especially in the evening before bed.

Prognosis: What To Expect

In an ideal world, pain would get better progressively step by step.

Reality though can be very different, and more often than not, we see a two step forward, one step back sort of pattern (or a bit more dramatic as in the picture below).

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The thing to keep in mind is staying positive, (and it can help to lower your expectations a little).

Life can easily get in the way of stopping you from doing what you need to do to get better.

If you’re really committed to overcoming your neck pain, make getting better a priority in your life, (for at least for a 3 month period).

Often that is about the right amount of time to significantly build your foundation and capacity.

“Long term consistency trumps short term intensity” - Bruce Lee

Conclusion

With the right management plan in place, neck pain is very manageable.

If you’ve had neck pain for a long term, we expect there will always be some ups and downs.

But overall you should be very hopeful of making a significant recovery and getting back to enjoying life again.

If you’re after some more personalised advice and treatment for your neck and you wish to get some relief right away, use our simple online booking system to make an appointment. 

If you would prefer to speak to us directly,  call us 1300 657 813


Neck pain? Try these 4 simple exercsies

Neck pain is really common. 

Thankfully, most neck pain is not related to anything structurally wrong, but more a warning sign from your body telling you, "it's time to move".

Your muscles don't like stagnant conditions, as the blood flow is restricted and creates acidic conditions in the tissues which contributes to the pain experience. 

If you can, pay close attention and become aware of the early stages of stiffness building up in your neck and shoulders. 

If you can get moving as soon as possible, there's a good chance you can avoid the downward spiral that often involves more intense neck pain, restricted movement and headaches.

These set of four exercises targets the upper back (thoracic spine), which is often very stiff in people who experience frequent bouts of neck pain. 

Cat-Cow

Start on your hands and knees with your back in a neutral position. Arch your back, lifting your head up and pushing your tail bone out, making a dish with your spine. Hold this position for one breath.

Start on your hands and knees with your back in a neutral position.
Arch your back, lifting your head up and pushing your tail bone out, making a dish with your spine.
Hold this position for one breath.

Next, arch your upper back by tucking your head and tail bone in and pulling your belly button in towards your spine, making a curve through your back.  Exhale completely as you activate your deep core stabilisers. Repeat x 10 times

Next, arch your upper back by tucking your head and tail bone in and pulling your belly button in towards your spine, making a curve through your back.  Exhale completely as you activate your deep core stabilisers.
Repeat x 10 times

Thread The Needle

Bring yourself up onto your hands and knees. Your hands should be under your shoulders and your hips over your knees. Take one hand off the floor and reach in and through between your other hand and leg on that side. Allow your shoulder and head to follow, moving down towards the floor as your hand reaches through. Allow your upper back to twist and rest your head gently on the mat.  You should feel a stretch in your upper back and shoulder blade. Hold for 30 seconds and then repeat on the other side. 

Bring yourself up onto your hands and knees.
Your hands should be under your shoulders and your hips over your knees.
Take one hand off the floor and reach in and through between your other hand and leg on that side.
Allow your shoulder and head to follow, moving down towards the floor as your hand reaches through.
Allow your upper back to twist and rest your head gently on the mat. 
You should feel a stretch in your upper back and shoulder blade.
Hold for 30 seconds and then repeat on the other side. 

Push-Up To Side Plank

Push yourself up into a plank position with your hands under your shoulders and Perform a half push up.  As you're coming up, rotate your body, turning one arm up towards the ceiling. Allow your head and body to follow the movement. Your may rotate a little on the balls of your feet. Return your hand to the floor and repeat on the other side. Repeat x 3 each side.

Push yourself up into a plank position with your hands under your shoulders and
Perform a half push up.

As you're coming up, rotate your body, turning one arm up towards the ceiling.
Allow your head and body to follow the movement.
Your may rotate a little on the balls of your feet.
Return your hand to the floor and repeat on the other side. Repeat x 3 each side.

Thoracic Mobilisation On The Foam Roller

Lie with a foam roller in your mid-back, and hug your arms across your chest to open up the upper back. Lift your hips off the mat, and roll back and forth for about 30 seconds, pushing with your legs.  You may feel a few cracks and pops which is a great sign your are releasing the joint stiffness.

Lie with a foam roller in your mid-back, and hug your arms across your chest to open up the upper back.
Lift your hips off the mat, and roll back and forth for about 30 seconds, pushing with your legs.  You may feel a few cracks and pops which is a great sign your are releasing the joint stiffness.

Try spending 5 mins every morning and night and see how it helps your neck pain.

If you have any questions please contact us dan@kinfolkwellness.com.au

If you'd like to get a more personal assessment and treatment of your neck pain, please use our easy online booking system below to make an appointment:

Top 10 Muscles That Respond To Dry Needling

Top 10 Muscles That Respond To Dry Needling

One of the benefits of dry needling is it's a very precise way of releasing a muscle. 

Compared to massage, getting a twitch response out of a muscle gives a very predictable and effective release, deep from within the muscle belly.

In this post, I wanted to give you some insight into some of the best responding muscles that dry needling can help with.

If you want to learn more about exactly how dry needling works, please read more here.

Of course dry needling can be done to any muscle.   The following post is to give you some insight into some commonly treated muscles that give especially good 'bang for your buck'.

*Please also see some important notes at the end of the post.

1.  Deltoids

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In terms of shoulder pain, the deltoid is a very under-rated muscle.

The deltoids include three sections (anterior, middle and posterior) that sit superficially around the shoulder.  The deltoid is involved in almost all shoulder movement.

The way the it wraps around the shoulder makes it a very difficult muscle to stretch and it is prone to building up tension.

Trigger points and knots often develop in the deltoid that can give rise to shoulder pain (see pic above). 

This pain can be quite severe and unrelenting and stubborn to usual treatment.

A common history is over-doing some push-ups and waking up the next day with pain in the front of the shoulder. 

Or someone who has done a lot of heavy over-head weights (Cross fitters...!) over the years and doesn't do much stretching. 

Sometimes it's the last small movement and final straw the breaks the camels back so to speak.

Dry needling the deltoid often gets some powerful twitch responses. 

Expect soreness and a dead arm feeling for a few days before things settle down.

2. Latissimus Dorsi

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The latissimus dorsi is a fascinating muscle. 

It has attachments to the hip, shoulder, upper back, lower back and rib cage - and that makes it the largest muscle in the upper body.

Tightness in the latissimus dorsi has been shown to be an important cause of chronic shoulder pain and chronic back (especially upper back) pain.

Because of its extensive attachments, it can be another difficult muscle to stretch effectively. 

Dry needling gets in there and gets the job done.

If your lats are tight, you will need to add in some regular childs pose and over-head stretching, in addition to foam rolling your upper back.

3. TFL / ITB

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The fastest way to release your ITB

Release the under-rated small muscle that attaches to it, called the Tensor Fascia Latae (TFL).

The TFL is a small but powerful hip flexor and usually tight from excessively sitting, walking, running and cycling.

When overly tight, can contribute to knee pain by causing mis-tracking of the kneecap. 

Combine dry needling with some specific gluteal activation and you will be well and truly on the way to saying goodbye to your ITB pain and tightness. 

If you look after your TFL well, there's a good chance that excruiating ITB foam rolling will not be required.  Happy days :-)

4. Glutes

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One of the cool things about dry needling is that we can access deep points in a muscle that you would otherwise be unable to access.  

The gluteus medius is an interesting muscle that can be dysfunctional in chronic lower back pain, hip pain and knee pain.  

Dry needling can immediately 're-set' the glutes and allow for a graduated re-loading program. 

Long-term, a well functioning gluteus medius will protect your hips, knees, ankles and lower back. 

5. Calf - Gastrocnemius & Soleus

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Calf muscle tension and limited flexibility is especially common in the modern age. 

When tight, the calf muscles are prone to cramping and eventually tearing.

Deep tissue massage can be effective, but can be very painful, bordering on intolerable.

Dry needling to the calf muscles, whilst intense, is quicker and more effective in its release. 

Expect some treatment soreness for 1-2 days post-needling.

And don't forget to re-build your calf capacity with an appropriate strengthening program.

6. Upper Trapezius

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Much like the calf above, the upper traps can be loaded with tightness. 

Causes can include poor posture, lack of physical activity and prolonged stress. 

Heavy handed massage can stir up more irritation in the muscle.

Dry needling is more like using a sniper approach - with a few direct releases, you can release the traps and get the blood flowing much more effectively and deeply. 

This study recommended dry needling for immediate pain reduction in upper body myofascial trigger point dysfunction.

Using heat on the traps via a wheat pack is really helpful, especially in the evening before bed.

Also make sure you are getting enough down time as chronic upper traps tension is a sign of sympathetic over-activity.

7. Infraspinatus

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The infraspinatus is a sneaky little muscle that sits behind your shoulder blade. 

It is often weak and gets overloaded when using your arm and shoulder.  

When the infraspinatus gets tight, you'll often feel pain in the front and deep part of your shoulder.

Dry needling de-activates the trigger points quickly, but be prepared for a dead arm for a few hours.

Don't forget to re-build with some simple strengthening exercises with a thera-band.

 

8. Wrist Extensors

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Tennis elbow is a very common condition that primarily affects the extensor tendons on the outside of the forearm. 

The pain often drags on for months and years due to a very poor blood supply in the elbow tendons.

The research shows that dry needling releases a very specific chemical, known as Platelet-Derived Growth Factor (PDGF), that produces a strong increase in blood flow into the muscle.

In effect, blood is a healing agent, bringing oxygen and critical healing chemicals to the damaged cells.

No other technique that I know of is capable of doing this.

9. Biceps

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When was the last time you stretched your bicep muscle?  

Another muscle that gets used a lot, and builds up a great deal of tension. 

You'd be surprised how that niggling pain in the front of your shoulder improves after your biceps is released through dry needling.

10. Hamstrings

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Tight hamstrings are pretty common. 

Stretching them normally does more harm than good (see here).  

Dry needling produces a quick and effective release.

Specific strengthening exercises that lengthen the muscle gives the best long term solution. 

Conclusion

Dry needling certainly isn't for everyone, but it can be a very effective and powerful treatment in the right context. 

Two quick notes:

1.  There are different types of dry needling and this blog refers to the type that activates a local twitch response. 

This is very different to acupuncture and dry needling where the needles are inserted superficially and left in for 20 minutes as the practitioner leaves the room. 

2.  Dry needling is always used as part of comprehensive treatment approach

This includes assessing your thoughts and beliefs about your injury, movement patterning and general health considerations. 

Specific exercises targeted towards your individual needs will help give you the best long-term outcome.

If you have any questions about dry needling - please feel free to give us a call 1300 657 813.

If you'd like to schedule a dry needling session and start feeling better straight away, please book online below:

How Foam Rolling Can Help With Headaches

Many headache sufferers we see in the physio clinic have a very stiff Thoracic spines.

This is the part of the back that runs from your upper shoulder blades down to the upper waist line. 

**The thoracic spine is designed to move and be mobile**

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Unfortunately for many of us - through excessive sitting, driving and generally poor posture, this part of the spine has lost its flexibility. 

In particular the upper back starts to round over time.

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This stiffness then leads to compensations - commonly tightness felt in the neck, shoulders leading to chronic headaches. 

These foam roller exercises are designed to improve your posture, increase mobility through the thoracic spine and decrease the pressure on the head and neck.

If you are a headache sufferer, please give these exercises a try and let me know in the comments how you get on.

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