The 5Ws of neck pain
2020 & 2021 have got us sitting more than ever before and all this sitting is bound to have an affect on our bodies, right?
My name is Dr. Donald Littlewood and I am a chiropractor in downtown Toronto. My clinical focus lies in treating the LGBTQ+ community, headaches & neck pain, which is what I am here to talk to you about today - the who, what, when, where & why of neck pain.
But, before I do, let’s do a disclaimer. This blog post is for information only. This does not replace medical advice. Please consult your doctor or another registered health professional for medical information.
Neck pain :: the who
In the grand scheme of things (ya know: a pandemic & domestic terrorism in the US), neck pain may not seem like the end of the world, but it is something that takes a significant toll on the individual & on society as a whole.
There is a wide range of prevalence studies on how many people experience neck pain. In any given year, between 6-22% of the population will get neck pain. If you take that prevalence and transfer it to the entire population without a year stipulation, up to 75% of people will get neck pain at some point in their life.
Neck pain :: the what
So we got the who out of the way, now let’s talk about the what.
What the heck is causing my neck pain?
In order to explain this, I like to use the analogy of a group project. Hear me out on this one!
The group project is movement and there are three people involved in this project: the
muscles, the nerves & the joints. Let’s go through them:
The job of the muscles is to move the joints. They do this by contracting and then subsequently relaxing.
Let’s take a simple movement like a biceps curl as an example. When performing the movement, the biceps muscle on the front of the arm contracts and the triceps relaxes, thus bringing the hand toward the shoulder. When you want to straighten the arm again, the muscle on the back of the arm, the triceps, contracts & the biceps relaxes, straightening your arm.
The same thing happens with every joint movement; a muscle contracts and the muscle that does the opposite function relaxes, allowing for the movement to happen.
The joint is where two bones meet. There are different types of joints that are specific to different types of movements: hinge, glide, ball & socket, etc.
There are different types of joints in the neck (& rest of the spine), but the main movers are the facet joints which are gliding type joints. These facet joints allow for the muscles to move the neck in all the directions we need them to.
Nerves are the communicators between the brain and the muscle, as well as skin & other organs. Sensory nerves receive information from the skin (& other areas: organs, inside joints, etc) and bring it to the brain. Motor nerves take the information from the brain and send it to the muscles to tell them how/when to move.
There are also nerve fibres found inside the joints themselves. These are proprioceptive nerves which essentially communicate with the brain to tell you where your neck is in space.
So back to my group project analogy. Reminder: the goal of the group project is movement. Sometimes the joints don’t want to move despite what the nerves are telling them and the action(s) that the muscle(s) are trying to take.
The little proprioceptive nerves in your joints are telling your brain that there is something wrong and that the joint is not moving well. Because the joints aren’t moving well on their own, the muscles have to do extra work on the group project which makes them unhappy & causes pain.
So remember: when doing a group project, do your part!
Neck pain: the when
Neck pain can happen to pretty much anyone. It affects men, women & nonbinary people to the same degree. Research says that it is more frequent in the 30s & 40s, but I have seen people of all ages with neck pain. With everyone in Ontario [who can] working from home, anyone & everyone is getting neck pain.
[Fun fact: I don’t treat children, but my colleagues who do say that more and more school-aged children are coming to them with neck pain because of increased screen time.]
Neck pain :: the where
Now obviously when you have neck pain you feel pain in the neck, but this isn’t the only place you might feel it. This is what we call referral pain.
This happens due to a concept called convergence. Let’s take the upper trapezius muscle as an example. The upper traps is a flat muscle that starts at the back of your skull and out to the tip of the shoulder [other parts of the trapezius muscle extend further down the back]. This muscle transmits sensory information to the brain through C3 & C4 spinal nerves.
There are tons of other structures that transmit sensory information through these nerves: joints, muscles of the head, skin along the back/side of the neck, etc. The nerves collect all this information, bundle it up into a nice little package and send it up to the brain & brainstem for processing. Once it gets there, the brain can’t really distinguish exactly where the information is coming from, only the generalized area.
The most common places people feel this referral pain [when talking the neck] is the head [most often the side & front], down the arm/hand and down into the midback.
Neck pain :: the why
Why does neck pain like to rear its ugly little head?
Well there are a few reasons:
Injury/trauma: this is probably the most obvious; if you fell & hit your head, were in a car accident, etc., and you have subsequent neck pain, that is likely the cause. You definitely want to get it checked out in this case.
Poor positioning: this is kind of an overarching poor posture/slept funny type situation. This is a really common cause of neck pain.
Repetitive movements: I like to think of this one as the straw that broke the camel’s back. Likely none of the movements you were doing were particularly wrong per se, but the accumulation of many sub-optimal movements or positions can eventually cause neck pain. This is by far the most common cause I see in my practice.
Neck pain :: the how [we resolve it]
When I set out to write this blog, this section was going to be all about what I do in practice to help with neck pain. But after a little bit of IG crowd-sourcing, I realized that’s not what you want & I am here to give the people what they want.
So instead, I am going to give you some self-release techniques that you can use on your own to help with your neck pain. Before I start, let me run through some supplies you’ll need.
Lacrosse ball. Golf balls are too hard & tennis balls are too soft, so we need the Goldilocks of sporting equipment for this one: the lacrosse ball.
A dowel. If you don’t have a dowel, unscrew that broom head and use a broomstick.
Just a disclaimer before we begin: if any of these elicit pain that is higher than a 6/10, you are pushing too hard. Discomfort is okay, pain is not.
Self release :: upper trapezius
Why do I keep harping on the upper trapezius? Well it’s a doozy and [in my experience] is sore in pretty much everyone who has neck pain.
For this one, you’re not going to need any equipment, just your hands. Starting at the base of your neck, poke around out toward the tip of your shoulder to find a sore spot. Then you are going to lean your head toward that side, press on the sore spot, and lean your head away from it.
This one commonly goes up into the head and around the ear, so no worries if you feel that, as long as it goes away when you stop pressing.
Lacrosse ball release :: levator scapula
The levator scapula (or lev scap as I call it) runs along the side/back of the neck and connects to the top inside corner of the scapula (i.e., the shoulder blade). The lev scap is one of those muscles that tells us exactly what it does: it elevates the scapula.
In order to treat this one yourself, you are going to take that trusty lacrosse ball and place it in the belly of the muscle (where you see the X on this photo). It’s going to be just below the junction of your neck & back and just off to the side a little bit.
Place that lacrosse ball there and lean against the wall.
For some, that will be sufficient and you won’t need to add any movement. If you do want movement, look down toward the opposite armpit while also raising the arm in the air [doesn’t need to be high; shoulder height is more than enough]. So if you are pushing against the right levator scapula, look down toward the left armpit and raise the right arm.
This technique is for the suboccipital muscles which sit at the back of the skull connecting it to the neck. These muscles play a big role in headaches, eye movement, proprioception & neck pain.
This one is pretty simple, but it might take some trial & error to get the right spot. Using your hands find the bumps on either side of your head and fall off them into the squishy part right underneath your skull. That is where the suboccipital muscles live. Then you are going to take the broomstick with both hands and push the broomstick into that area.
You may feel this one go up into your head and into the eye. Again, this is totally normal as long as it stops when you release the pressure.
Before I sign off of this [long, sorry about that] blog post, I wanted to answer a common question I get: how do you know whether or not to get your neck pain checked out. My answer is this: the quicker the better. In general, if you have neck pain, head to your favourite registered health professional and they will be able to check it out for you. The sooner you see someone about it, the less likely it will become something that bothers you long term.
Neck pain is something that the majority of people will experience at some point in their lives. Knowing & understanding what is going on, and knowing what you can do to help is two-thirds of the battle. The other third is getting it checked out by a registered health professional - chiropractor, physiotherapist, massage therapist.
I have also created a really great free resource for you [in addition to the self-release techniques]. In this resource are my favourite quick exercises you can do in order to decrease your neck pain. They are really easy and you can do most of them sitting at your desk waiting for that Zoom call. You can get them here: www.drdonaldlittlewood.com/neckexercises