Long-standing Neck Pain? Here’s What Your Rehab Plan Might be Missing.

Neck or traps tension while hiking? Past whiplash or fall? Are standard physio exercises not fixing the neck pain?

In this blog, I’ll focus on the effect that neck imbalances can have on the body and how we can help diagnose and reset these neuromuscular changes. I will also provide a few tips for how you can feel for tension and ease it yourself. 

Following a fall or whiplash, even if this took place more than 20 years ago, the body reacts and guards specific movements to protect at-risk structures. If rehabilitation at the time or since then did not fully identify the imbalances, you may still be suffering from such an event from neuromuscular and sensory points of view.

Changes that can occur in the neck include:

  1. Muscle fatigue
  2. Reduced endurance
  3. Reduced activation of the deeper stabilizing muscles
  4. Dominance of the upper part of the cervical spine during movements

As a result, the basic neck range of movement exercises that are routinely prescribed may not be targeting the specific limitations mentioned. We may need to offload tension in certain areas initially, prior to stabilizing the neck. We may also need to mobilize the lower areas of the cervical spine with manual therapy in order to reduce the dominant use of the upper cervical spine.

A simple way you can feel for upper neck tension is to place your fingertips on the back of the neck just under the skull. Now, complete a simple functional movement, such as a sit to stand. 

The aim is to feel for these muscles contracting prior to or during this movement. If there is an imbalance in the neck or high tension, these muscles will likely contract prior to the movement and may stay contracted throughout the sit to stand. These superficial muscles are then inhibiting the deeper stability muscles, and hence these stability muscles over time become weak leading to pain, tension and stiffness.

Some ways to start targeting these imbalances and to reduce tension include:

1. Tuck the chin in while lifting the crown of the head to the ceiling. This will help offload the tension and start targeting the deeper stability muscles. Try and adopt this position during daily tasks, when sitting at the computer, cycling or hiking for example. Start off simple by trying to keep this position for 10 minutes every couple of hours and gradually increase.

2. Take caution when squeezing the shoulder blades too far back when attempting to improve your posture. This position can increase the pull of the muscles on the back of the neck creating even more tension. Instead, find a more neutral position of the shoulders that feel comfortable making sure the trapezius muscles are relaxed.

3. The large superficial muscles on the side of neck called sternocleidomastoids need to be relaxed prior to an exercise or functional task, otherwise they will take over from the stability muscles – you may need to wait 20 seconds initially before movement to learn to disengage these muscles. Palpate these superficial muscles, keep the head neutral, bring in some simple breathing exercises, and then complete the exercise only when these muscles feel relaxed. You could also look at the activity of these muscles in the mirror whilst completing the exercises to see how dominant they are.

The neck is a complex area and so further assessment from a physiotherapist is recommended, especially if you have had the neck complaint for some time. Additionally, assessment of the neck musculature via pilates reformer can also be completed, as this is a great way to see how you move and which muscles may be dominant resulting in imbalances and neck tension.

Our physiotherapists at Alaia can help. Book in for a Physiotherapy assessment to further understand the origin of your neck tension.