How Cardio Helps Neck Pain

Chen's (2018) systematic review also found a positive effect of adding aerobic fitness to office workers with neck pain.

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With only about 1/2 of us meeting the World Health Organisation recommendations for weekly physical activity (150 mins of moderate intensity or 75 mins of vigorous intensity per week), there is some serious upside to increasing your daily dose of cardio as a first line treatment for neck pain.

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Neck pain is common, but rarely is it serious or caused by structural problems.

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More often it is related to holding sustained postures for long periods and reduced blood flow to the muscles...which can cause pretty intense pain 💥 but not tissue damage as such.

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3 key benefits of cardio exercise to neck pain:

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✅ Increases blood flow and oxygen 🌲 to the muscles around the neck (and rest of body)

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✅ Stimulates endorphins - our bodies natural pain relievers that are more effective than any synthetic medication 😻

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✅ Gets you out of your mind and into your body, activating the creativity response to help problem solve any issues that might be stressing you out 🌸

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As they say, Movement Is Medicine!

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Reference: Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis (Chen 2018)

#movementismedicine #neckpain #neckpaintreatment #cardiofitness #endorphin #motionislotion

#physio

Shoulder Theraband Exercises: Improve Posture And Reduce Neck Pain

Muscle imbalances are common in the upper body.

Stretching or addressing ergonomic setup alone doesn’t seem to be effective in giving much relief.

However, a systematic review (Chen 2018) showed that by strengthening the smaller stabiliser muscles around the shoulder can relieve pressure in your neck and help manage your symptoms effectively in the long run.

Here’s 5 Theraband exercises that can be done at home, gym or when you’re traveling that will help provide support for your neck and shoulder.

Aim for 2 to 3 sessions per week and it may take 8 to 12 weeks of training to adequately build your capacity and notice a positive difference.

Bonus tip, the research also showed general fitness training was effective in reducing neck pain in office workers. So make sure you’re getting your minimum of 150 mins per week, (as recommended by the Word Health Organisation).

List of exercises:

• T’s

• Shrugs

• External rotation

• Serratus punch

• Rowing

If you’d like a personalised assessment of your posture and management plan set up for you, please use our easy online booking system below to schedule an appointment.

5 Times When Stretching Is Not A Good Idea

“I can’t understand why I’m getting injured so often.

I always stretch before I exercise.

I’m confused!”

A phrase I hear in the clinic on a daily basis.

Just to clarify, in terms of ‘stretching’ we are talking about holding a static muscle stretch.

Optimising mobility, (especially around a joint) is another thing altogether and can be a very useful way to prepare the body for the demands of sport.

Knowing where and when to perform joint mobility exercises and foam rolling can be invaluable - but we’ll talk about that another time.

5 Times When Stretching Is Not A Good Idea

1. Right before a training session/race

There is a growing scientific argument that pre-exercise muscle stretching is generally unnecessary and may even be counterproductive, increasing the risk of injury and decreasing performance.

Researchers have shown that static stretching reduces strength by about 5 percent.

Certainly not an ideal way to start a race, where you will be placing big demands on your muscular system, and creating risk of overload and injury with a weaker muscles.

In terms of performance, a study of runners completing a 1 mile run - those who stretched before hand were slower at running the mile by a full thirteen seconds.

And this study found that runners had who stretched before had a higher rating of perceived exertion during their run.

Stretching aims to loosens muscles and their accompanying tendons.

But in the process, it makes them less able to store energy and spring into action, essentially creating a temporary reduction in available capacity.

Instead of static stretching, focus on a proper warm-up involving running at an easy pace for 10-15 mins (aim to break a sweat) and gradually layering in sport specific drills.

You can tune your body by activating the specific stabiliser muscles that may be required in your sport and create joint mobility where you need it.

Dedicating some time to stretching and mobility work (Yoga, Pilates e.t.c) during the week is a very good idea, just not right before you exercise.

If you need some help with your warm-up routine, just let us know.

2. When you have a painful and irritated tendon

For example if you have hip pain, (often when the hamstring and gluteal tendon have become irritated) - many people intuitively try and ‘stretch it out’ to get some relief.

Stretching can sometimes make you feel better temporarily.

But it’s not until later (often that night) that the pain is becomes a problem.

Aggressively stretching tendons irritates them by compressing them and this can delay the healing process.

The most important thing for tendons is to gradually increase their capacity and tolerance to load, via a graduated strengthening program under the supervision of a Physiotherapist.

3. Chronic lower back pain

Research shows people who focus exclusively on stretching their lower backs actually had a greater risk for developing back pain.

This comes back to a bigger picture view of the body and the role of each segment (see The Joint-by-Joint picture below).

We can see the main role of the the lower back is to provide stability - the core from which the rest of the body can move freely.

Stretching the lower back may feel good temporarily, and there is absolutely no issues with adding stretching to your overall program, especially if it makes you feel good.

But stretching doesn’t build capacity and if you have ongoing back pain, you will need to develop a program of building core strength and capacity to help in the long run.

Getting the balance right between mobility and stability is the trick for lower back pain.

To get you started, check out a 6 Minutes To A Supple Spine routine that you might find useful and you may want to try a KIN Foundation Class.

4. To try and improve your hamstring flexibility

The primary role of the hamstrings in walking and running is to eccentrically control the landing of the foot.

Eccentric refers to a type of contraction where a muscle lengthens while contracting.

Whilst it is important to have adequate flexibility, the actual more important job of the hamstring to have enough strength and capacity to walk and run properly.

If a muscle doesn't have much capacity to contract when needed, it will most likely get overloaded. 

When it gets overloaded, it's muscle fibers contract and knot up, limiting flexibility.

For a runner, strength and stability trumps flexibility everyday of the week.

Hang on a sec...I thought stretching was a good thing!?

Stretching the hamstring in this position, you are actually making the hamstring weaker and sending confusing mixed messages to the brain about what the function of the muscle is. 

Anytime your brain is confused, it's going straight into fight-flight mode and will want to tighten everything up to protect it.

Intuitively stretching feels good and it often does give some short term relief. 

But in the long run, with continued stretching, the hamstring becomes weaker and more likely to become overloaded and tight.  Then you've got yourself into a real pickle. 

The hamstring, once locked down, becomes an inefficient blob that hampers everything you try and do.

Our first step in making friends with the hamstring is to stop making it angry, so no more stretching. 

For more info on how to become friends with your hamstring - please click here.

5. Your sore neck

If you have neck pain, a first line of treatment that many people try is stretching.

But being over-zealous with your neck stretches could potentially do more harm than good.

With too much stretching, we can run the risk of irritating the vertebrae, compressing the discs and pinching nerves.

A general rule of thumb is that your neck stretches should be gentle, never feel painful and avoid pushing to the extreme ends of motion.

If you have any uncertainty in regards to cervical stretches you are currently performing, schedule an appointment to ensure that your neck does not become a pain in the neck.

In the long term, performing exercises to improve your neck and shoulder strength can be more useful than only stretching.

Maintaining good cardio-vascular fitness is extremely important, as well practicing appropriate stress reduction techniques and having a good ergonomic set-up (and not always looking down at your phone!).

Have you any questions about stretching?

Please leave any comments below…

And if you have any ongoing niggles, please schedule an appointment to come in and see us.

We can get to the root cause of your problem and get you back on the fast track to doing what you love.

Get To Know Your Muscles: Upper Trapezius

Get To Know Your Muscles: Upper Trapezius

Upper trapezius trigger points are the primary muscles responsible for neck pain and headaches. The upper traps are also the most reactive muscles in your body to emotional stress.

This blog post discusses:

• how the traps gets overloaded

• symptoms of an overloaded upper traps

• self-care tips

• how Physio can help

QUICK ANATOMY REVIEW:

The traps is the most superficial muscle of the upper back and runs from the base of your skull, along to the tip of your shoulder, all the way down to the middle of your back, (see image below).

FUNCTION OF THE TRAPS:

The trapezius muscle consists of three parts that all have different functions:

• upper part helps raise the shoulder

• middle fibers retracts the scapula

• lower fibers lower the scapula

This blog post will focus on the upper traps.

HOW TRAPS BECOMES OVERLOADED:

The traps can become overloaded from the following situations:

• excessive sitting / computer use

• whiplash (car accident, falling on your head, or any sudden jerk of the head)

• tensing your shoulders

• constantly pulling the shoulders down attempting to have a ‘good posture’

• carrying small children around a lot

• sitting with a chair without armrests, or the armrests are too high

• extended car trips

• looking down constantly at your phone

• any profession or activity that requires you to look down for extended periods (i.e.. dentists/hygienists, architects/draftsmen, and secretaries/computer users)

• bra straps that are too tight (either the shoulder straps or the torso strap)

• a hand-bag or backpack that is too heavy

• anxiety

• recent surgery

• unresolved emotional trauma e.g. PTSD

SYMPTOMS:

The upper traps has an interesting referral pattern, as shown in red in the diagram below.

The upper traps is often the ‘key’ muscle that can trigger other areas such as jaw pain and headaches.

Symptoms of upper traps over-load include:

Upper Traps Referral Pattern (areas marked in red).

• severe neck pain

• a stiff neck

• facial, temple, or jaw pain

• pain behind the eye

• headaches on the temples / "tension" headaches

• dizziness or vertigo (in conjunction with the sternocleidomastoid muscle)

• intolerance to weight on your shoulders

• sinus pain
  
  
  
  

TREATMENT APPROACH:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your traps issue.

Some common manual therapy treatment approaches can include:

• joint mobilisation to the neck and upper back

• dry needling and massage to the traps to stimulate deep blood flow and release the tightness

• addressing any biomechanical issues with stretching, strengthening and foam rolling

SELF-CARE TIPS

• avoid extended periods of sitting

• Think about ‘time in the posture’ vs trying to find a perfect posture e.g. have a short break every 20 minutes

• consider a standing desk

• avoid constantly looking down at your phone

• apply heat to the traps 10 minutes each day to encourage blood flow

• ensure you are getting enough cardio-vascular exercise each day (30 mins minimum)

• take regular breaks on long car trips and consider using a pillow or support under your arm to take the strain off the traps

• learn to breathe through your diaphragm and manage your stress

• Wear bras that fit properly

• If you suffer with anxiety, seek help through your GP or a take a free online course

Some of the following exercises you may find useful:

Pecs stretch - feel the stretch at the front of the shoulder and hold 30 secs

Thoracic foam roller - release your upper back with a few rolls up and down

Upper traps stretch - hold gently 10-15 secs

Diaphragm breathing with legs at 90/90 - helps calm your nervous system

Building capacity in the upper body

Constantly focusing on relaxing and releasing the upper traps can be counter-productive because it isn’t always getting to the root cause.

Focusing on the pain and tightness can keep your body stuck in the ‘zone of stress’ (see picture below).

The only way to get better in the long term, is to gradually start building your physical capacity with a personalised program, so you can create a ‘zone of relaxation’ where you have the capacity to handle all of your daily life without the muscles becoming overloaded.

The trick is to build up gradually - step by step. As soon as you push too far you risk re-activating the tightness by over-loading the muscle.

In the beginning it is best to be conservative.

As your work with your body more, you will get to know and respect your bodies limits.

Some of the exercises you could include would be:

• push-ups

• bicep curls

• triceps

• bent over row

• lat pull downs

• core work

• increasing cardio fitness

Acknowledging underlying emotional issues in chronic pain

When your neck symptoms are chronic, one of the most concerning things is the ongoing pain, which can sometimes go on for months or years, despite seeing multiple health care practitioners and trying different medications.

Understandably, this can create a lot of fear and anxiety about the underlying cause of the symptoms which can keep you in a state of fight or flight (see picture below).

For some people, when they experience pain or injury it may be associated with anxiety and catastrophizing about the pain, like for example whether or not it will ever go away and if it will get worse if they move too much.

Some people become fearful of exercising and being active (known as ‘fear avoidance behaviour' and 'kinesiophobia') and might rely solely on passive treatment and resting, which can have some adverse effects and may lead to decreased function and a lower load threshold which could result in more pain.

As you can imagine, a downward spiral of fear, lack of movement, weakness and de-conditioning can result (see picture below) and become very difficult to break.

Examples of factors that may contribute to dysfunction in the upper trapezius Reference

You are not your scan !

Often there have been some scans showing some damage to a structure such as a disc or nerve issue.

Injuries and structural issues certainly do cause pain initially.

Unfortunately, sometimes the patient is not given a broader context in which to interpret the significance of the results.

The body has a tremendous capacity to heal, and generally tissue damage takes no more than six to twelve months to occur.

If you are still getting pain after this time (and you have been thoroughly investigated by your health care team), your pain is more likely to be coming from a sensitized nervous system (see picture below) than an damaged structural fault.

Maybe the most important picture to understand if you’ve had pain lasting more than six months.

Pain that lasts more than six months is generally related to an overly sensitive nervous system rather than a specific issue in the tissues

(Picture credit: Explain Pain - Butler & Mosely)

One thing is very clear with the recent research is that you can have structural abnormality and have no pain whatsoever (see picture below).

Degeneration, disc issues and arthritis are very common in asymptomatic individuals (i.e. who have no pain - see picture below).

Reference: Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015 Mar 15;40(6):392–8

The ongoing nature of the pain is more often to do with tight muscles with restricted and oxygen blood flow.

Just understanding this process can go along way to resolving your ongoing pain issues, but you will need an experienced GP and Physio to work with to help you diagnose and get you back on the fast track.

Get relief from your neck pain or headaches

We have a special interest in helping people overcome their neck pain / headaches and get back to what they love.

If you think we are the right fit for you and you wish to get 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 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.

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.

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

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

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

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

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.

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.

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.

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.

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.

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

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:

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).

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

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