Neck Pain

Overview

Neck pain is a common problem in adults and is the most common musculoskeletal problem in people with sedentary jobs. It is also quite common in college students. Neck pain prevalence has been increasing during the past several years, ranking behind low back pain as the most common musculoskeletal disorder. Related facts include:

Studies have shown an increase in neck pain with increased computer usage.  College students therefore are susceptible to having neck and upper back pain because of many hours spent studying, reading, working on computers, and playing video games. They do these activities while sitting in a static position with the head bent forward, often in poorly designed chairs in classrooms, dorm rooms, or apartments. Using laptops can contribute to neck pain since the keyboard and monitor are close together, resulting in a slouched posture.

Neck pain from poor posture can be explained as follows:  in an upright position the head is supported by the spinal vertebrae. Once the head is flexed forward, for instance while using a laptop, the vertebrae do not support the weight of the head as much. Muscles, tendons, and ligaments work harder to hold up the head, which is roughly the weight of a bowling ball. Over time the muscles and other soft tissues tighten up due to the excessive workload required to hold the head in position. The anterior neck muscles become weak from being stretched, and neural structures are kept in less than optimal positions. This chronic overload and tightening of soft tissues may eventually result in decreased blood flow and oxygen to the soft tissues, ultimately causing pain. Besides this, neck joints may be kept in abnormal positions which may eventually cause joint pain and muscle weakness. The manifestation of the above frequently is tension headaches and painful “knotty” spots in the neck and upper trapezius muscles (muscles that run from the neck to the shoulder blade). One may feel that just holding up the head is difficult, i.e., the head “feels so heavy.”  Because of this heavy feeling, the person may maintain a slouched posture, which continues the pain cycle.

Of course, not all pain is postural related. Other reasons for neck pain include:

You should seek health care immediately if you also have a fever, headache, and extreme neck stiffness to rule out something more serious. Also, contact your health care provider if neck pain is not improving after 1-2 weeks or if numbness, tingling, pain are felt down your arm. The provider will rule out any serious conditions and may prescribe medication, offer advice, or refer you to another health care provider. For example, a physical therapist may provide exercise instruction, manual therapy, and education for improving posture and ergonomics.

Tips To Reduce Neck Pain

The following suggestions are useful for someone with chronic, non-traumatic neck and upper scapular muscle pain, experienced, for example, after hours spent sitting at a desk or using a computer.

Posture and positions

  1. Improve your posture. Using a low back support in your chair will automatically help to maintain better upper body and neck posture. Avoid poor prolonged studying positions. Examples include: sitting cross legged on the floor or in bed with books or computer in front of you, and sitting on a soft couch with your laptop in your lap and your feet propped up in front of you. For further postural tips, refer to the McKinley handout Posture and Study Habits Guide, found on the McKinley website.
  2. Change your laptop’s position. Elevate your laptop by putting it on a box or plastic crate so that the top of the laptop is at eye level. Then use an external keyboard and mouse at a level roughly the same height as your elbows.
  3. Consider using a document holder for prolonged reading or computer work.
  4. Keep your elbows/forearms supported on chair armrests or the desk to help relax the neck and shoulder muscles.
  5. Avoid placing the computer keyboard too far forward. Your elbows should be close to your body.
  6. Take a break every 30-45 minutes, even if it’s for a minute or two.
  7. Do some shoulder shrugs, squeezes, and rolls while studying to prevent the shoulders from creeping up.
  8. If lying down to study or watch TV, do not lie flat on your back with your head flexed at an extreme angle. Use a wedge pillow under your upper body.
  9. Avoid cradling the cell phone between the ear and shoulder or holding the cell phone up to the ear for too long, since this may overwork shoulder and neck muscles. Try a wireless headset instead.
  10. Avoid prolonged time spent texting with your head looking down.
  11. Avoid sleeping on your stomach which can strain the neck. Try sleeping on your side or your back with a supportive pillow (see #20 below).

Backpacks

  1. Reduce the weight of items carried.
  2. Avoid carrying bags or packs on one shoulder.
  3. If you carry heavy books, stand those books upright in the backpack, next to your back.
  4. Consider a rolling bag.

Other

  1. Use ice and/or heat. Ice can help decrease inflammation in sore muscles and joints, even beyond the acute phase. Heat will stimulate circulation and help relax stiff muscles.
  2. Wear a scarf in cold weather. It may keep you from hunching your shoulders to keep your neck warm.
  3. Ride a bicycle with higher handlebars or use handlebars with extensions to reduce the strain on the neck as you look ahead.
  4. Wear bras with wider straps to help distribute weight more evenly.
  5. Consider using a memory foam cervical pillow. To see if this will help, roll up a medium sized towel and insert it between the pillow and the bottom edge of your pillow case. This will help to maintain proper alignment of the head and neck with the thoracic spine and will feel supportive to the neck.
  6. Consider a massage.
  7. Consider relaxation techniques.

For a long time, studies have shown that specific muscle strength training can reduce neck and upper trapezius pain. Maintaining neck flexibility is also important. General flexibility and strengthening exercises are listed in the next section. If any of these aggravate the neck pain, or if you need further assistance, contact your physician for further treatment or recommendations.

Stretching and Strengthening

The following exercises target muscles used to maintain good posture and can help to decrease neck and scapular muscle pain. Progression of new exercises should be done slowly to avoid unnecessary soreness or increase in symptoms. If symptoms increase, stop the exercises and contact your health care provider for guidance.

To Strengthen Neck, Upper Trapezius, and Shoulder Muscles:          

Figure standing slightly bent at waist with one foot in front of the other, holding a small weight in one hand, then bending her elbow and lifting the weight straight upwards.
1.  Bent Over Row:
(keep elbow close to body)
Figure standing erect with arms by her side, holding small weights in both hands.
Start position for
2 and 3
Figure standing, lifting a weight out to the side to shoulder level, after starting from a position with the arm straight and weight at her side
2.  Lateral Raise
(raise only to shoulder height)
Figure standing with her shoulders shrugged with both arms straight by her sides, holding small weights in both hands, after a starting position of holding weights by her side with shoulders relaxed.
3.  Shoulder Shrug
(do not stick head forward)

To Strengthen Anterior Neck Muscles:

4.  Chin Tuck and Lift

Figure lying flat, squeezing a rolled up washcloth under her chin against her chest and slightly lifting her head off the bed.
Chin tuck and lift – start position 
Figure lying flat with a rolled up washcloth tucked under her chin.
Chin tuck and lift – finish position

To Strengthen Upper Back, Scapular, and Shoulder Muscles:

Figure lying flat against the edge of a bed with one arm dangling straight over the side of the bed.
Start position for 5 and 6
Figure lying on stomach against the edge of a bed with one arm raised from a dangling position to where the hand is now at the hip, from a starting position of the arm dangling straight down.
5. Shoulder Extension
end position
Figure lying flat against the edge of a bed with arm elevated out to the side with thumb pointing to the ceiling, from a starting position of the arm dangling straight down.
6. Shoulder Abduction
end position

To Improve Flexibility:

Seated figure stretching side neck muscles, having the head bent straight to one side, with the assistance of one hand pulling gently to the same side of the pulling hand.

7.  Upper Trapezius Stretch: Relax neck and pull to side. Hold initially for 10-15 seconds. Gradually increase to 30 seconds as tolerated.

Seated figure stretching her neck, having the head bent forward at a 45 degree angle, with the assistance of one hand pulling gently to the same side toward which the head is bent.

8.  Levator Scapula Stretch: Relax neck and pull diagonally at a 45 degree angle. Hold initially for 10-15 seconds. Gradually increase to 30 seconds as tolerated.


Figure stretching the front chest muscles by standing in a corner with forearms and hands resting on both walls and leaning forward gently into the corner.  The body weight is supported by the legs and not through the arms.

9.  Chest Stretch: Relax shoulders and lean forward. Hold initially for 10-15 seconds.
Gradually increase to 30 seconds as tolerated.

Figure tucking his chin straight backwards, in effect making a double chin, while looking straight ahead and using a finger to guide his motion.

10. Chin Tuck: Move head straight backwards while looking straight ahead (make a double chin). Use your finger to guide you if necessary.
Hold 3-5 seconds, 5-10 reps.


References

Anderson, L. et al. “Muscle Activation during Selected Strength Exercises in Women with Chronic Neck Muscle Pain.” Physical Therapy 88.6 (2008): 703-711.
Falla, D. et al. “Effect of Neck Exercise on Sitting Posture in Patients with Chronic Neck Pain.” Physical Therapy 87.4 (2007): 408-417.
Green, B.N. “A Literature Review of Neck Pain Associated with Computer Use:  Public health implications.” Journal of the Canadian Chiropractic Association 52.3 (2008): 161-167.
Anderson, L. et al. “Effect of Physical Training on Function of Chronically Painful Muscles:  A randomized controlled trial” Journal of Applied Physiology 105 (2008): 1796-1801.