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.

Yoga, Pilates and PT Compared for Chronic Low Back Pain

Chronic low back pain is a confounding problem.  Every time we think we've got it figured out, something comes along that trips us up again.  Three recent studies indicate that scientific exercise programs like physical therapy ("PT") are not all that good at controlling chronic low back pain, and that Yoga and Pilates might be better.

The new issue of Physical Therapy, (Nov.2009) found that twelve sessions of physical therapy, including core-strengthening exercise, produced benefits in people's perception of their recovery and their activity, but did not reduce pain.  At least these benefits seemed to last at least a year.

On the other hand, an older study in Annals of Internal Medicine (2005) found that Yoga was more effective against low back pain than either PT or a self-help book.  The superiority started at twelve weeks, PT caught up over the next twelve, but after that, Yoga pulled out in front again.  And Pilates turns out to be even better than Yoga.  The Journal of Orthopedics and Sports Physical Medicine, (2006) found that a four-week program of Pilates (on their specialized training equipment) significantly helped people with chronic low back pain.  Better yet, the improvement was maintained over a twelve-month follow-up period.

So what does all this tell us?  First of all, do things that are known to prevent low back pain in the first place.  An important thing to remember is that the ligaments that hold your spine together actually stretch while you're sitting, and they take 10-20 minutes of activity to regain their former tautness. During this period, your spine is less stable and more prone to injury. Therefore, if you sit a lot, or especially if you drive a lot, do NOT just stand up and start deep stretches!  Instead, start off with walk-around breaks before you stretch.

Keep yourself in shape with regular strenuous exercise (if it's safe for you,) while avoiding jarring or one-sided motions.  I don't think you'll be surprised if I suggest Yoga or Pilates.

If you already have low back pain, there are many necessary and important therapies that Chiropractors or PT's can offer.  There are many causes of low back pain that are well-understood, and respond remarkably well to manual medicine.  But in addition, a Yoga or Pilates program is likely to be a real benefit to you.