THINGS YOU CAN DO NOW TO REDUCE NECK AND SHOULDER PAIN
Tobin D Forbus, PT, DPT, MS
Table of content
1. Consider how you sleep. 2. Posture Matters. 3. Address the stress. 4. Keep your neck warm and don’t be scared of the cold.
4 6 8
9 10 11 12
5. The heat or ice debate. 6. Stretching is your friend. 7. See a physical therapist.
I t’s probably safe to say that most of us, at some point in time, have woken up with neck pain or can recall an event or injury that resulted in significant neck or shoulder pain. In fact, at any given time, 13% of American adults suffer from neck pain, and up to 26% have shoulder pain. Over the course of a year, that number increases to 30-67% of all Americans who struggle with neck or shoulder pain. Women, and those from 30-50 years old, tend to have the highest incidence of neck pain. Men over 50 tend to have the highest incidence of shoulder pain. This is unfortunately, a very common problem, and if you are currently suffering with neck or shoulder pain, you are not alone. Risk factors that increase the chances of neck and shoulder pain include: obesity, smoking, poor posture, stress, repetitive motions, and improper vision correction. These are only a few main risk factors, but obviously there are many more reasons such as falls, car accidents, sports injuries, arthritis and muscle strains that can lead to shoulder and neck pain as well. Since neck and shoulder pain are so commonplace, it is helpful to have some “home remedies” to try first before seeking professional help. The following list of 7 suggestions are things you can try to manage your symptoms, but please do not ignore severe injuries, and when in doubt, always error on the side of having a professional check you out. Remember that you can be seen by a Physical Therapist in Virginia without a Physician referral, so if you need help, you can call us directly and not wait to get a referral from your family MD or specialist. Give some of these tips a try and see what a difference some simple changes can make to your neck and shoulder pain. To Your Health,
Dr. Tobin Forbus Doctor of Physical Therapy
1 . Consider how you sleep. The quality, amount, and position of your sleep can have a big impact on the amount of neck and shoulder pain you experience. While this likely goes without saying, sleep is important! Recent research confirms that sleep is critical for proper memory, mood, performance, and affects your healing processes, muscle recovery and many other health factors. Inflammation is often increased or unbalanced in individuals with sleep-related disorders including insomnia, sleep apnea, and restless legs syndrome. While everyone varies to some degree, most adults over 26 years old need 7-9 hours sleep and the US Center for Disease Control and Prevention states that 30% of us are getting less than 6 hours. If you are struggling with neck and shoulder pain, make sure you address this issue.
Ok, but as someone who has experienced a rotator cuff tear with surgical repair, in addition to a cervical disc herniation, I know some of you are likely saying, “Nice idea, but I can’t sleep BECAUSE of my neck or shoulder pain!” I can relate, truly I can, but read on to find some other ways to manage your pain BEFORE you try to fall asleep. For shoulder pain, try to sleep on your uninvolved side and prop your painful arm up on 2-3 pillows in front of your torso, or roll a towel up and prop it up under your armpit. When your arm is straight down at your side or falling down in front of you, the blood flow to your rotator cuff tendons is decreased and these positions can lead to pinching or impingement of the tendons leading to aching, throbbing night-time pain. Avoid sleeping with your arm under your pillow. Worst case scenario, the recliner can help you get some rest, but don’t settle to stay in the recliner for long, get some help if you can’t get comfortable enough to sleep in bed. How many have awoken to the dreaded “crick in the neck?” To prevent this and reduce neck pain, you’ll need to be introduced to the idea of “neutral spine”. Your neck should naturally have an inward curve we refer to as lordosis. This position is what we call neutral and we need to maintain a neutral position while we are sleeping. This means your pillow and head position are critical. If you are waking with more neck pain than when you went to bed, something has to change. Ok, now I make some people unhappy… no more stomach sleeping! It is literally impossible to sleep with a neutral spine lying on your stomach unless you have a hole cut into your mattress. You’ll need to adjust to side or back sleeping. Which is best? It depends… but, the same pillow will rarely ever be suitable for both positions. If you are struggling with nighttime neck pain, you’ll need to commit and find a pillow that fits your neutral spine position. A water pillow or crushed memory foam are my favorites.
2 . Posture Matters. If you are an avid websurfer or Google MD as many of us are today, you may have read that some research has stated that posture doesn’t have an impact on spinal pain. If so, you are getting a twisted representation of the truth and should reconsider. This research was looking for a correlation between people with poor posture and pain, and when it found some people with poor posture didn’t have pain, it generalized to say that posture was not a relevant factor. I could not disagree with this generalization more! During a therapy session, I can find a painful motion of the neck or shoulder, manually correct the postural deviation and retest the motion often reducing the pain 75% or more from a simple postural correction. Posture is VERY important when you are in pain! It is very easy to become overwhelmed with the amount of postural tips and suggested corrections. I subscribe to the less is more philosophy. If you change a few simple things about the postures you spend the most time in, you will have much greater success than trying to change 50 different smaller things.
Here are my key tips: 1.
Take Breaks. Any posture is ok for limited amounts of time. If you move regularly you can undo much of the negative consequences of any posture. If you are required to sit for long periods, set a timer to remind you to take a break every 25-30 minutes. Stand up, lean backwards, squeeze your shoulder blades together, tilt your head side to side and breathe deep. Do this for 30 seconds every 25-30 minutes of sitting. If you are worried that this will make you less productive, the opposite is actually true. Those who do this will be more productive in their work. So, bring in a timer from home, use your smart phone, or go online to https://tomato-timer.com/ to keep track of your sessions. No excuses. 2. Avoid text neck. Texting or looking down at your cell phone or mobile device for long stretches of time puts excessive strain on your neck. Over time, the added stress on the joints, ligaments, and discs in your neck can lead to premature degenerative changes in your neck. Tips to avoid neck damage from texting include raising the phone or mobile device to eye level, minimizing texting time, resting your hands and device on a pillow, and taking frequent breaks. Laptops are similarly risky and often require you to angle your head downward to see the screen, so connecting your laptop to a separate monitor, or screen, is often very helpful. 3. Scoot your tailbone back. When sitting in a chair, just remember to continually scoot your tailbone to the back of the chair. When you do this 1 thing, most of the other spinal curves will fall into place.
3 . Address the stress. While this is important for any painful condition, it is especially important for neck and shoulder pain. There are 2 major problems with stress and neck / shoulder pain. The first is that gravity is always pushing down on us. In a relaxed state (andwith good posture), our bodies canmanage the pressure that gravity exerts on us and utilize the proper muscle firing patterns to perform our daily tasks without adding undue strain on our neck and shoulder muscles. When we are too tense, stressed or constantly in a hurry, we tend to push back against gravity by holding our shoulders up towards our ears, creating an excessive amount of tension and overworking our neck and shoulder muscles. Many of these are muscles that are designed to contract, then relax (phasic muscles). When we keep them contracted for extended periods of time (acting like tonic muscles), they become overworked, inflamed and the muscle fibers can develop “knots” called trigger points. Trigger points are well-known contributors to chronic pain. We need to be aware of not carrying constant tension in our neck and shoulders that create these trigger points. Secondly, stress can put our bodies in a state called sympathetic mode where we remain in a heightened state of tension and stress. Sympathetic mode is the fight or flight response intended to preserve us from mortal danger and puts our bodies in tense state where muscles are overactivated and make it very difficult to relax. Most of our daily lives are not filled with mortal threats, so we must strive not to live in a state that creates that unnecessary tension in our muscles. One quick assessment you can do is measure your resting heart when you are in a relaxed, resting position. Then, as you are working, (preferably still seated and not moving around) measure your heart rate again and see how much higher it is. If it is more than 10 – 20 beats per minute higher, you are possibly working in a sympathetic mode and need to learn to breathe more deeply, release tension from your body and activate your parasympathetic system which slows your heart rate closer to your resting level.
4 . Keep your neck warm and don’t be scared of the cold. Sounds simple, right? But think about it, what do you do when you walk out into the cold, especially when you are not dressed appropriately for the cold? The ears go up to the shoulders, we curl our arms in and hold tension in the neck and shoulders. This is a simple solution. Dress appropriately for the weather or overdress to make certain you don’t carry that tension of being cold in your neck and shoulders. Scarves, hats and layersyou’re your friends. Also, don’t anticipate the cold and tense up as a habit in response to walking outside. Dress right and relax and enjoy the weather.
The heat or ice debate.
I get this question quite a bit. Often people gravitate to whatever they generally prefer, but here are a few tips to guide your use of heat or ice. Any new injury that you would consider a sprain or strain from overusing your muscles, will probably respond best to ice or a cold pack for the first 48-72 hours. You will also lean towards ice for anything you would consider to be a tendinitis or bursitis condition to help reduce the inflammation. 10-12 minutes with a thin layer between your skin and the ice is sufficient. One final pearl of wisdom, if you are experiencing tension headaches, try a cold pack directly at the base of your skull while lying on your back and relaxing. Even if the head hurts more to the sides or front, icing at the base of your skull can help tremendously. I know it’s cold, but it’s for your own good and usually it feels better after enduring the first minute or two. Heat is best used for stiff joints and sore / stiff muscles. Morning neck stiffness, and stiff achy muscles in the top of your shoulder are a great excuse to treat yourself to some heat around the neck and shoulders for 10-15 minutes. Heat is best followed by some gentle range of motion or stretching exercises to maximize the benefit.
Stretching is your friend.
A few simple stretches, done throughout the day, can help keep your muscles from accumulating stiffness and knots that lead to pain. Some of the best and easiest are to simply tilt your head side to side slowly, squeeze your shoulder blades back like you are cracking an egg in between them for 5 seconds, and stand in a doorframe with one arm on each side and lead through the door with one foot and your chest (not your chin), until you feel a stretch in your chest. Hold the door stretch 30 seconds and perform twice. These are great stretches to perform while taking your break from sitting!
12 7 . See a physical therapist. While I hope you have success using the tips I have provided you here, you may need a little extra help. Many are under the false impression that Physical Therapy is simply a bunch of exercises and being rushed through a session while the therapist juggles 2-3 other patients. While this may be true elsewhere, Synergy is altogether a different experience. After an hour evaluation process to determine the true cause of your pain and agreeing on a plan, our therapists spend one on one time with our patients each session and are manual therapy experts. This means we may perform a variety of techniques including various muscle release and massage approaches, mobilization or manipulation similar to what others think only Chiropractors can perform (yes, we do that, too), osteopathic techniques, dry needling, muscle re-education and postural training -just to name a few of our approaches. The bottom line is that we can get to the root cause of your pain and work with you to fix it for good! Imagine life without the pain that limits the activities you love. It is possible, and we can help.
I hope the above tips will help you in your efforts to reduce your neck and shoulder pain and we are always here to help if you need us. If youneedhelprightaway, remember thatmost insurances do not require a physician referral to see us in the state of Virginia, you can call us directly at 540-416-0530. If you have more questions, we’d love to help answer them. You can email us at firstname.lastname@example.org or call 540-416-0530 to set up a free phone consultation or a free 15 minute discovery session to meet us and find out if we can help with your particular issues.
Tobin Forbus, PT, DPT, MS Doctor of Physical Therapy
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