Neck Pain May Begin In Your Upper Back

In the past months several people have consulted me about aching pain in their shoulders and upper traps. As I  looked at their postures, I found that all of them bent their necks forward, and some of them jutted their chins.  When a person's head is forward, obviously the muscles in the back of the neck have to work harder to keep their head up; ergo, pain in the back of the neck and upper traps.

The first order of business is to give people some relief with Graston Technique or some other deep-tissue therapy and traditional chiropractic therapy if appropriate.  After a treatment or two, most people are feeling much better.  The next step is to figure out a way to balance the muscles (strengthen some and stretch others.)  For many years, I would develop a rehab plan focussing on the muscles in the neck.  This generally works very well.

However, what I am so grateful to these particular patients for, is that they showed me a key to this therapy.  Each of them had a particular stiffness in their spines: The 4th thoracic vertebra (counting down from the big vertebra you feel at the bottom of your neck, i.e. "T4") was unusually flexed forward on the next one down, and its ability to straighten out was restricted for one reason or another.

Think about this situation for a second.  If your back is bent forward and you can't straighten it out, your eyes will be looking at the floor unless you extend your neck and maybe jut your chin.  The kink in one part of the chain means that its motion must be made up somewhere else.  These particular people solved the problem by shifting their heads a bit forward, but unfortunately this solution caused their neck muscles to work overtime and eventually start to ache.

The real solution for them was to concentrate the first portion of rehab on their backs, not their necks.  The vast majority of people do not have changes in their bones that prevent them from straightening up.  Usually it's a simple matter to get things moving properly again.

Now comes the strengthening/stretching stuff.  Everyone's mom told them to sit up straight, and mom was right about the importance of posture.  The problem is that you can sit up straight as long as you're thinking about it, but as soon as your attention wanders, you'll slump into whatever position your muscles pull you to.  The trick is to tighten or stretch the various muscles so that your posture is properly maintained without even thinking about it.  I rely heavily on Egoscue's method because his exercises are very understandable (and people seem to like doing them.)

Moral of story: The place that hurts might not be the place that's causing the hurt, and the thing that's causing the pain might not be painful.

Graston Technique

Graston Technique is a deep-tissue therapy that is extremely effective in healing chronic soft-tissue injury.  It is especially helpful for many of the "-itis" conditions, such as tendonitis, fasciitis and bursitis.  Often, painful conditions that have persisted for months or years improve noticeably in one or two treatments and completely resolve in as few as six.

Most deep-tissue therapies are performed by the clinician, using only his or her knowledge of anatomy and their hands for pressure. Graston is distinguished from these others by the use of small, rigid steel instruments that allow the deep pressure to be more precisely directed to the body structure that needs therapy, sparing other areas from bruising.  The rigid instruments also amplify changes in sensation as they move from normal to damaged tissue, further allowing the clinician to precisely locate the problem area.  The change in sensation is also very noticeable to the patient.

There are several reasons that the deep-tissue therapies are so effective.  I am convinced that the most important is that these therapies break a few capillaries, which liberates the blood-borne growth factors involved in healing, thereby initiating the so-called "healing cascade."  Among these are epidermal growth factor, transforming growth factor, vascular endothelial growth factor, platelet derived growth factor, fibroblast growth factors 1 and 2, transforming growth factor and keratinocyte growth factor.

Although I indicated that many of the conditions for which these therapies are appropriate are  "-itises," in fact, many of them are degenerative conditions rather than inflammatory conditions, (just the opposite,) and properly should be called "-osis" conditions.  Inflammation is inseparable from healing, and many times these conditions really need a bit more inflammation to jump-start the healing process.  Graston and the other deep-tissue therapies provide the needed boost.  The more knowledgeable the clinician, the more the inflammation-boost will be directed to the proper spot, promoting healing where needed, while avoiding damage to healthy tissue.

The deep-tissue therapies are not appropriate for nerve pain (sciatica,) open wounds, new injuries already in the inflammatory stage of healing, or systemic diseases such as cancer, connective tissue disease and others.  Some, but not all people have bruising that might linger for as much as a week or so.  Because the pressure has to go deep, through the superficial tissue, this might be sore from Graston therapy.  But the underlying muscle, tendon, ligament, bursa or fascia that was the reason the patient came for therapy in the first place, often feels dramatically better, even after the first treatment.