Neck
Muscles in the neck
The main functions of the neck are to support the weight of the head (~5kg), and protect all the nerves and blood vessels that travel to and from the head. While doing that, it has to be flexible to allow a large range of movement in many directions yet strong enough to hold it stable throughout its range. Because the neck is so flexible the body often uses the neck to compensate for unresolved issues occurring in the body below. The time to seek treatment for neck pain is when the pain is not easing up, getting worse or you getting numbness or tingling in your arms or hands.
In the clinic, I have seen patients often reporting the following issues relating to the neck: -
> limited neck movement ie left, right, up, or down
> Neck pain or stiffness
> Whiplash after trauma to the neck
> Wry neck and having trouble moving it
When I treat someone I always ask myself, why does this area need to be treated? Just because you have pain or tightness in your neck muscles, this may not be the origin of the problem, its just where you feel it. There are three other things I consider when working with tight neck muscles.
A fact that not a lot of people realise is when we look at an object, we always want to keep our eyes horizontal. For example, imagine you have a short leg so one side of the body will be higher than the other. To keep our eyes horizontal the neck will bend to compensate, on the shorter side of the neck will be stretched, and the other side is compressed. If I massage or treat the muscles of the neck it will become loose but the neck tightness will soon return, until the origin of the problem is resolved, in this situation the short leg.
Another reason the neck could be tight is the way we breathe. If you take a big deep breath, you will feel the effort in your neck muscles, these muscles are called the “Accessory muscles of breathing “. It is very rare to find someone who breathes this deep with every breath, but many people involve these muscles with every breath. Using these accessory muscles to breathe, I liken it to doing a shoulder shrug exercise, when you do it once there is no strain. However, we breathe about 12- 20 breaths a minute which translates to 17,000 to 28,00 times a day, now that is a lot of shoulder shrugs and could explain why the neck muscles could be tight.
Posture also plays a large role in neck pain. When I treat someone, I ask questions about activities they do that could impact the neck. The first thing that comes to mind is a young person spending a lot of time on their phone with their head down looking at the phone, a term to describe this is "Tech Neck". It is also relevant for a person who reads a lot, as their head is down a lot too. Sometimes seniors are known to fall asleep in the chair and for several hours their neck could be in a bent position. The weight of the head is about 5 Kg but with you looking down at 45 degree the effective weight of the head is over 20 kg. For your neck muscles, when you are looking down its 4 times harder to support your neck. I can work on the muscles of the neck to loosen them but If we don’t address the posture issue the problem is sure to return.
Acute Wry Neck & facet strains
Wry neck is described as temporary pain and stiffness in the neck. Most of the cases of wry neck I see in the clinic have a sudden onset, normally after sleeping in an awkward position and is present on waking. An acute wry neck can also occur from a quick flicking action of the head, viruses can also mimic the symptoms of a wry neck[1].
What you feel: There can be generalised stiffness and pain when you turn your neck, typically worse on one side. When the pain occurs it does not extend further than the shoulder.
What is happening: There are two structures implicated in the Wry neck, one being the muscles of the neck, tight muscles will restrict the movement of the neck. The other is the bony surfaces of the adjacent vertebra, these surfaces called facets should slide on each other smoothly, but sometimes they can get stuck and restrict movement of the spine (called a facet lock).
How I might treat this. My priority is first to soften the muscles, then check the quality of vertebral movement. The techniques I could use on the muscles are massage, cranial, functional and counterstrain techniques. If required to work on the vertebra, I would use non-forceful techniques such as muscle energy, functional and cranial techniques and avoid the use of cracking techniques. If it was appropriate I would prescribe relevant exercises to aid the recovery.
Whiplash
When the neck is forced into excessive forward (hyperflexion) or backward (hyperextension) or rotation of the neck, these forces overload the soft tissues. This is most evident in rear-end car accidents but can also occur in sporting accidents and other traumas like falls when there is sudden forceful head movement. In some cases after a whiplash, there may be damage to the lower parts of the spine as well.
What you feel: The symptoms of whiplash often become aparant hours or days after the event, but in some cases, depending on what has been injured it may take many weeks before you are aware of it. The symptoms in the neck are pain and stiffness but it can affect the shoulders and the arms as well. Whiplash symptoms can also be dizziness or blurred vision. There is no medical imaging to identify whiplash, imaging is done to exclude broken bones or disc complications that may also cause neck pain. Patients with whiplash often want a massage to loosen their neck as it feels so tight but if the underlying cause is not treated the massage will only give temporary relief.
What is happening: Using a motor vehicle accident as an example. The person is sitting and stationary when the car is bumped from behind. Sitting on the seat, all the parts of the body on the seat are moved forward together. The upper back not supported by the seat moves back relative as the spine below it moves forward. Once the upper spine segment has moved as far back as it starts over-stretching the soft tissue structures that connect this vertebra to the body below. Then the vertebra above is forced back as far as it can and this continues up the spine until the head moves back as far as it can. Because of the ballistic motion, each level of the spine is forced backwards beyond its normal range motion, overstraining the muscles, ligament & fascia. If the person's neck is rotated at the time of the incident then more damage occurs to the joints of the spine[2].
How I might treat this: Things you can do to help yourself is to keep active doing as much as you can but ensuring it doesn’t cause pain. So in the initial phase you may have to modify or avoid some activities to keep pain at a minimal level[3]. Then gentle movement to improve the pain free range of motion, then gentle exercises slowly building up strength. exercises building up gradually. In my approach to working whiplash injuries, i would use soft tissues techniques working on the residual strains left in the muscles, ligaments and fascia. Techniques I could use massage, cranial, functional, balance ligaments tension and counter strain. If it was appropriate I would prescribe relevant exercises to aid the recovery.
[1] https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/neck-pain