The neck is one of the most difficult areas to work with as there is so many things that contribute to the onset of pain. Even your thoughts can affect the muscles and create a ton of trigger points and pain! When you consider it is a part of the complex shoulder region you can begin to see why so many people never find an answer to their problems. One of the biggest saboteurs is our instincts to constantly find ways to relieve the pain, instead of finding out WHY the pain is there in the first place. It makes perfect sense as to wanting to find a way to relieve the tension immediately by stretching the area that feels tight, however, when you understand how the neck is reacting to problems elsewhere, you can begin to see how our instincts are betraying us and setting our body up for much bigger problems. In this article, I will explain what the key causes of neck pain are and why stretching the tight neck muscles is not the solution to long term pain.

The prevalence of neck pain is astounding.

Studies show that neck pain has an annual prevalence rate exceeding 30% among adults in the US; nearly 50% of individuals will continue to experience some degree of chronic neck pain or frequent occurrences. Among adults, 20% to 70% will experience neck pain that interferes with their daily activities during their lifetime.

One of the first things we tend to do when we have neck pain is stretch the neck itself. While this seems like a good idea, and may even give you some temporary relief, it is often the worst thing you can do! I know it sounds crazy and many chronic neck pain sufferers have a real hard time getting their head around this.

Firstly, I will say that is okay to stretch your neck if you have nothing wrong. Secondly, it is okay to stretch the neck if you are in pain to assess your current level of mobility.

As an assessment tool the neck stretches can be extremely useful for identifying exactly where your stiffness is located, and to measure the effectiveness of your corrective program. You can see neck stretches we use in our assessment in the article - How to complete a mobility assessment

However, using neck stretching to treat your problems will achieve nothing else except more pain. The real problem will be more to do with instability and weakness (more on this shortly).

Always remember this great quote by Vladimir Janda - "Often the site of pain is not the cause of pain"

The first thing you need to do is to understand how your anatomy works to realize why stretching does very little to address the underlying problem.

Shoulder Anatomy & Mechanics

When you look at a human skeleton you can clearly see how your bones are all stacked upon each other to create stability at your joints. Gravity basically compresses your bones to lock everything into place so you do not fall apart like a bag of bones. The one area that is different to all the others is clavicle (more commonly known as the collarbone) at the front of the shoulder.

The clavicle appears to be the only thing holding up your shoulder as it is not stacked upon other bones vertically like the spine and the lower limbs. The only way it can create stability to hold itself in good position is via use of multiple muscles, tendons, and ligaments.

The clavicle and the scapula appears to be floating in space as neither is connected or stacked upon other bones!

Two of the main muscles that hold these bones in place, LEVATOR SCAPULA and the TRAPEZIUS attach to the neck and the base of the skull. This explains why dysfunctional movement at the shoulder can easily lead to neck pain and headaches. The levator scapula is often the muscle that people feel neck pain with as it is easily overloaded when weakness is present in other muscles.

Mobile phones in particular are a real concern with the amount of time people spend looking down at the phone is considerable. Recent estimates showed that at least 77% of the world's population has their own mobile phone and many studies have been conducted to study the correlation between using mobile phones for texting and both, neck and shoulder pain.

Another study found that children and adolescents spend an average of 5-7 hours a day with their head flexed over, whether reading or on a handheld device, adding up to between 1,825 and 2,555 hours a year. It is estimated that high school students spend an extra 5,000 hours per year in poor posture in addition to the above number!

Most people believe that the upper trapezius is short and tight, when in reality it is the exact opposite, it is usually long and weak. And when that happens the scapula begins to sit too low and disrupt overhead movements forcing the levator scapula to work extra hard to lift your arm. This constant pulling and straining of levator scapula it easily leads to headaches as it attaches to the upper four vertebrae of your neck. This poor scapula position is referred to as a "depressed shoulder" and is associated with many shoulder and neck dysfunctions. This cannot be resolved via stretching for it is a weakness that has led to this dysfunction being created.

The Depressed Shoulder

Below is a picture clearly showing the difference between a depressed shoulder, and a functionally stable shoulder.

The upper trapezius is composed of three parts:

1. The upper trapezius
2. The middle trapezius
3. The lower trapezius

This muscle has many functions such as shrugging your shoulders, tilting, turning and extending your neck and pulling your shoulders back and down. Depending on which action you make is what determines which part of the trapezius is used more. You can read more about the upper trapezius in this article - Releasing upper trapezius is all about strengthening

The other thing to take note here is the rhomboid muscles that begin pull the scapula closer together further limiting your ability to move your scapula when you lift your arm. This leads to the thoracic stiffness that we discussed in the last newsletter and why so many people with neck pain can barely rotate their torso. The simple act of trying to turn your head is almost impossible as the muscles near the neck are on high tension for your upper back muscles are over-active.

If you are not sure where these muscles I am referring to are located here is a picture of them below.

This overworking of the rhomboids leads to winging of the scapula and serratus anterior weakness as the rhomboids inhibit this muscle from firing. The term winged scapula gets its name from its appearance, a wing-like resemblance, due to the medial border of the scapula sticking straight out from the back. It does not always have pain associated with this postural dysfunction, but it does create weakness at the shoulder.

Left untreated it can become a permanent dysfunction, and you are now set up for a stack of problems at the neck and shoulder. Only strengthening of the serratus anterior in combination with good scapula mechanics will restore this back to its optimal function.

It is interesting when you consider the rate of shoulder and neck injuries in males versus females that it is significantly greater in the female population.

Females Are More Prone To Neck Pain

Take a look at the chart below that shows how more prevalent shoulder problems are in the females across all age groups.

There are several reasons this happens.

1. Females have much less muscle mass to begin with and are more prone to weakness and development of trigger points to maintain joint stability.
2. Women are more prone to osteoporosis than males leading to softening of the bones and poor spinal alignment that contribute to hunched postures like the dowagers hump
3. Poorly fitted bra straps can drag the scapula down into retraction leading to depressed shoulders and scapula dysfunction that we have discussed in great detail already.
4. Women tend to carry heavy handbags or purses over one shoulder dragging the shoulder down into depression again.
5. More females attend Yoga and Pilates classes that attempt to stretch more, and emphasize the pulling of the shoulders "down and back" that contribute to depressed shoulders.

Females generally present with greater mobility than males which can be a good thing if the joints are controlled, however it can pose huge problems when poor movement is combined with weak muscles. Click here to see results of a study about this. This is an interesting point to keep in mind for I very rarely find a male outscore a female on our flexibility assessment. Yet the onset of tight necks and muscles around the neck is more common in females!

This is where my mindset has changed from previous years when dealing with neck pain in female clients, especially those who have never spent time developing overhead strength. I am suspecting the stiffness in their neck and shoulder is more to do with weakness than overuse. Whereas males, especially those who lift a lot of heavy weights I am more suspicious of overuse. This is where two people could have the same pain symptoms but completely opposite reasons for it, and completely opposite corrections.

You can also appreciate the danger of "pulling your shoulders down and back" like so many people are told is good for their posture. Remember gravity is already doing a good job of doing this to you, and the fact that so many people sit all day in poor postures with the scapula being dragged down, the last thing you need is to deliberately do more of the same thing. And you definitely do not want to be tugging on your neck as well by using a stretch.

Forward Head Posture

We quickly looked at this earlier with the "text neck" infographic but it is important we discuss the implications of this and the relationship with sitting occupations. The info-graphic below sums up the postures most people adopt during their day. Take note of the head in all of the pictures from side on and how far forward it sits.

If depressed shoulders is the most common type of neck pain I see, then this is a very close second. This type of posture is when the head sits too far forward of the spine and the neck extensors work excessively hard to hold the head up. There is no way these muscles are ever going to stop working or weaken for they are the thing holding your head up so you can look forward.

Research has found that for every inch the head moves forward it doubles itself in weight!

This problem is not limited to sitting, as this can be due to several things we do during the day such as:

• Our posture during walking
• Our posture standing
• Our sleeping position
• Occupations that require you to look down for long periods (eg surgeons)
• Hobbies (eg musical instruments)
• Postures used in various sports
• Poor gym exercises (eg ab exercises)
• Poor exercise technique

Cyclists will also find that the muscles at the base of the neck will become very short and tight as they have to hold their neck in extension to be able to look forwards while they ride. This doesn’t mean they need to give up cycling, but it does mean they need to complete a corrective strength training program to counter the danger this repetitive position places their neck in.

If you are a keen cyclist make sure you get a professional to set up your riding position correctly as this can save you a lot of pain and suffering. I also suggest to read our detailed article about bike set up and how to use various exercises to improve your posture and prevent back pain and neck pain.

Anything that places us in a forward leaning position with our head looking down for hours on end leads to a forward head posture and ultimately neck pain. In order for any corrective exercises to have a chance you have to identify these poor repetitive habits and change them to a good position.

Good article to read on this is - 5 daily habits that ruin your spinal health

Exercises To Correct This Problem

As I am sure you are aware the neck and shoulder are very difficult areas to work with as there is so many moving parts and pieces to consider. To give you a template to follow is impossible as the only way to determine what to do is assess your body first and let the tests dictate what to do.

Two people with identical symptoms may need completely opposing programs. One may need stacks of mobility where the other it may be the strengthening exercises that are of more importance.

You will find tons of ideas of how I might approach this in the articles below

• How to get rid of a stiff neck
• Why I love the serratus anterior wall slides drill
• Releasing upper trapezius tightness requires strengthening
• Case study for neck pain

To help you out with a more detailed program using this process I created a detailed shoulder pain report that provides you with all the tests and exercises I might use in a step by step format so you can finally get rid of your problems for good. To see more about what is included in this detailed report click here and to download instantly click the image below.

Summary

I am sure you would agree that some of this information is completely against your instincts and what you think would be causing neck pain and headaches. It really comes back to understanding how important the scapula is for providing optimal and efficient movement and how easily it can be placed into horrible positions that lead to trigger points and tension in muscles to hold it in place.

Remember the clavicle and the scapula are not stacked upon other joints like you see with the ankle, knee, hip, and spine. They are basically floating in mid-air and require a stack of tendons, ligaments, and muscles to hold it in place. A very delicate area that can easily be thrown out of whack and it is up to us to recognize the potential dangers of our modern lifestyle that wreak havoc on this part of the body. I hope I have explained this complicated topic in a simple manner for you to use this information to help you with your training.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you live in Melbourne and need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.