When I was first starting in my physical therapy career, I thought neck pain was always coming from the neck. And, usually from a pinched nerve. I didn’t even consider the pain could be anything other than originating from some issue in the cervical spine. I did the same treatment for everyone with neck pain. The same stretches, mechanical traction, and if I was really busy, hot pack, ultrasound, electric stimulation, and massage. I felt like I was throwing spaghetti at the wall. I want to apologize, right now, if you have ever gone to a physical therapist, and that was how your therapy was provided. Fast forward 33 years, and I’m glad to say, my approach has changed, thank goodness. I will still use hot packs or cold packs if someone tells me that it does help their pain. I rarely use any of the other treatment modalities, and I rarely show people stretches for their upper traps.
I think neck pain needs to be looked at from a whole-body perspective. Some things I now consider are:
How does energy get transferred from the feet up through the neck? Through our fascial system, when the foot hits the ground, energy is transferred up through the body. Do ground force reactions travel well through your body while allowing you to maintain a view of the horizon?
How does stiffness in the thoracic spine affect the neck? Stiffness in the thoracic spine has been shown to contribute to pain in the lower back and neck areas.
How does the coordination of eye movement affect the muscles at the base of the skull? The muscles that move the eyes are connected to the muscles at the base of the skull and people who have sustained an injury to the neck, like whiplash, have less muscle activation in the neck when the eyes move. With less muscle activation, the head can feel too heavy for the neck to carry causing pain and discomfort.
How does gripping of the abdominals affect neck pain and posture? Gripping of the upper abdominals pulls the rib cage downward and then pulls the head forward.
Is “bad” posture really an issue? Studies have shown that forward head posture alone doesn’t always cause neck pain.
Does your bunion or foot supination or pronation have anything to do with your neck pain? A bunion can be a clue into what is happening with the rest of the body. Changes at the foot can affect the neck and tongue due to connections of the deep front fascial line in the body’s fascia system.
How does the pelvic floor and jaw affect your neck? Typically, clenching your jaw and holding tension in the jaw indicates tension in the pelvic floor. Most often, increased jaw tension correlates with increased neck tension.
Do you breathe with your neck muscles? Many people use accessory neck muscles to help them breathe which causes tension and pain because neck muscles are not designed for breathing. When they are being used to breathe, they cannot effectively complete their primary functions.
Does your tongue positioning influence how your neck feels? If your tongue rests at the bottom of the mouth or presses into the back of your front teeth, the sympathetic nervous system is more active. This increases your fight or flight responses and can impact the neck due to increased muscle tension and activation. The upper traps tend to be more guarded, pulling the shoulders up toward the ears.
Here are all of the parts of our body that can refer pain to the neck that I know of (which means that I could be leaving something out, so please do not take this list as absolute)-
Muscles at the front of the neck, sides or back of the neck
Either shoulder
Heart
Lungs
Diaphragm
Jaw/TMJ
Liver/gallbladder
Thoracic spine and rib cage
Some type of restriction or inflammation in the meninges(membranous layers covering the spinal cord and brain)
If there is a problem in the neck/spine, where can it refer pain?
hands and fingers
Elbow/forearm
shoulder
Between the shoulder blades
Upper back
Upper chest
Lower back
Front, back and/or sides of the neck and throat area
Most people rely on imaging, like x-rays and MRI’s to tell them why something hurts, but imaging doesn’t always tell us the truest story of pain and why we experience pain. People with “severe” changes in their spines and discs may have very little to no pain while others with “normal” images are in severe pain. And, remember, there can be normal changes in the spine and discs with aging and that does not mean that you will be in pain as you age.
If a muscle feels tight or tender, understanding what makes it feel that way helps us to discover a process to reduce tightness and tenderness. Sometimes, a muscle feels tight because it is doing the job of another muscle plus its own job. Sometimes, it has been strained or overworked. Sometimes, it is weak and is hanging on or “gripping” for dear life. Sometimes, it’s guarding the area trying to protect another structure that has been injured. Trigger points which are muscle “knots” have specific referral patterns. The physiological remnants of trauma or old injuries can be held within muscles. Muscle pain can typically be described as aching, tight, tender, stiffness, and/or cramping.
The nerves that exit each level of the spine can carry painful signals wherever they travel. Nerve pain is typically described as tingling, burning, like ice water running down the arm, stinging, pins and needles, and/or numbness.
Pain is not an easy thing to always figure out. It’s layered and nuanced. Patterns get built and in dealing with our body, we have to peel back the layers of patterns little by little until we can get to the root of the problem and then solve it. It’s a collaborative effort between you and your healthcare provider(s) and there’s not always a single injection, pill or surgery that will “fix” the pain.
The longer, more chronic pain we experience, pain signals get rewired and remapped as a response to longer lasting pain. As a result, we have a more difficult time in trying to figure out where the pain is living in our body. What started as a dull ache at the base of the neck on one side may become more diffuse and vague covering a large swathe of the upper body. It can become harder for us to tell where the origin of the pain is located.
Neck pain doesn’t always originate from the neck itself, and tuning into your body’s signals can be a great first step in resolving neck pain. If you experience or have experienced neck pain, I’d love to hear your journey and what you have found to be helpful.
Take good care,
Sharon