About That Pain in Your Neck

Sometimes ordinary, every day¬†tension in your neck and shoulders suddenly descends¬†into neck pain. Maybe you can’t turn your head because of stabbing pain in your shoulder. Your neck is painfully stiff. Maybe you have pain shooting down your shoulder and arm. Is your sleep affected?

You’ve decided¬†it’s time¬†to get help and want to know more about it, including who can help.¬†In New York City and New York State you can see a Physical Therapist directly without going to a doctor¬†for a referral. Or you might prefer to¬†see your doctor first to get his advice and impression. Common diagnoses¬†for neck pain are cervical pain, cervical spondylosis, cervical arthritis and cervical radiculopathy.

I’ve made some notes below which I hope will help you on your journey of healing.

The Physical

  • You are getting older and your¬†disks and joints may be injured from misuse, overuse or just stiffness which can come with age. (NB this can be helped.)
  • You have a family history of neck pain and/or back pain. Does anyone¬†in your family have degenerative disk disease (DDD) also called Degenerative Joint Disease (DJD)? (Don’t worry: these are awful and unfortunate¬†medical names which basically just mean that your body is aging.) Likewise with a family history of cervical radiculopathy, cervical spondylosis and cervical osteoarthritis, you might be at a greater risk of developing neck pain. Genetics.
  • It’s possible you sleep in a way that irritates your neck muscles and joints. Is your pillow too hard, too soft, too high or too low? ¬†Did you sleep on your belly?
  • Overwork or strain from sitting hours at the computer.
  • Slouching.
  • From exercising – too much or too little.
  • You pulled a muscle in your shoulder or neck – not likely.
  • You were in a car accident or you fell and injured your neck. Do you have whiplash?
  • Your have a habit of holding tension in your neck and shoulders – not just a little but a lot. (Do you have¬†a super stressful job or life or both?) Do you hold your shoulders up around your ears?

 The Psychological

  • You hold psychological tension and stress in your neck. See above.
  • You are stressed / angry / sad / mad / anxious / depressed.¬† John Sarno, MD wrote extensively about the psychological influences, even causes, of our unacknowledged, unconscious, emotions and thoughts on our bodies – that these thoughts and feelings may be causing your neck pain and low back pain.
  • You are sticking your neck out, engaging in some new and uncomfortable activities which may be causing you stress.
  • You’re a parent
  • A student
  • You work at a stressful job
  • You don’t have a job
  • You have financial stresses
  • You get the picture.

What to do About It?

 

Tips and Help for Surviving Neck Pain in NYC

Did you just wake up one morning with neck stiffness, neck pain? Or did you have a stabbing sensation around your shoulder blade and you can’t turn your head? Do you feel pain radiating to your shoulder, deltoid, wrist or hand? Chances are that these symptoms start in your neck.

Here are strategies to get through it and back to feeling great.

First, try to identify the cause of your neck pain. Did you sleep in an awkward position? Did you overexert yourself the day before? Spend too many hours at the computer leaning into the screen slumping in your chair?

Next, reach out to someone in your network to help you — a good massage therapist, acupuncturist, physical therapist, doctor or physiatrist.

Rest lying down on your back with head on a low pillow. Apply a moist heating pad for 20-30 minutes. Longer if you have the time. Constructive Rest, breathing and meditation can be extremely helpful. It is amazing how much mindful  breathing in a supported position can melt away overall body soreness and tension.

Feldenkrais arm movements. Make the arms into a shelf by holding onto the forearm/wrists perpendicular to the torso. Keep a loose hold on both wrists and let the arms fall to the side. Breathe. Breathe deeply. Alternate sides 3x. These are my favorite neck exercises, which really help with neck pain.

Exercise Balls. I have nubby balls, and balls made with spikes to dig into the trigger points. Get some small balls to place under your shoulders, neck or back to dig into the painful or tight spots, wherever they help with the pain. You will want to use balls smaller than tennis balls. Golf balls are the perfect size but much too hard. You can probably find¬†a rubber sports ball that’s the perfect¬†size in your the¬†gym section of big box stores or in a local sports store. Rubz for instance should be perfect.

Heat or Ice for at least 15-20 minutes. Different people respond differently to ice and heat. If you have an electric heating pad with a sponge for moist heat, or a microwavable heating pad, lie on it for 15-20 minutes, longer if you have the time. If you prefer ice and have gel packs, great. If not, many use a large bag of frozen peas or corn as an ice pack. You can also make your own by throwing 8-12 cubes of ice into a drip free plastic bag. If using ice, be sure protect your skin with a moistened towel.

Finally, don’t forget to take an anti-inflammatory medication, depending on your beliefs about medication. Your doctor may recommend something – use¬†what¬†works best for you. Many people swear by ibuprofen (Advil, Motrin and store brands). Or you might prefer Naproxen, aspirin or Tylenol. There are any number of topical creams or patches from the drugstore that may help. A homeopathic cream with arnica used by many people is¬†Traumeel.¬†If you live near Chinatown, you can find some great remedies there. Take something that works for you that will take the edge off the pain so you can begin to work your way through it. Tumeric is known to be good for pain. Lavender and chamomile teas before bed are relaxing.

Another tip. Paradoxically, I have found hip stretches to be great relievers of neck pain — secretary stretch, hip stirs, knee-to-chest stretch and the wonderfully relieving figure-4 stretch (sometimes called thread-the-needle).

The Best Way to Relax

When you are suffering from neck, back, hip or shoulder pain, even if you’re just plain tired, Constructive Rest, practiced just 10 minutes a day, is the way to go.

Constructive Rest, pictured below, is a resting position of the body, in which the arms and legs are supported rather than held by the muscles of the neck and spine. By relieving the spine of the weight of the legs at their articulation with the trunk, the pelvis, trunk muscles, fascia and internal organs are also given a chance to rest. As the weight of the arms across the chest presses into the articulation of the shoulders where they meet the trunk, chronically tight and overworked neck, shoulder and back muscles are given an opportunity to reset, too.

Basic Position: open your feet hip-width apart with the heels outside the toes in a slightly pigeon-toed position. Let your knees fall together so your legs support one another. Cross and drape your arms one over the other, resting them on your chest like empty coat sleeves. Your hands should be relaxed and open, falling off the arms.*

In The Thinking Body, Mabel Todd, who originated Constructive Rest, recommends it for “relieving the spine from strain of leg weights and favoring a return of blood to heart.”¬≤ She describes how, throughout nature, cycles of work are always followed by a dynamic pause, or rest. Different from sleep, these dynamic rest periods are intrinsic to life — from the tiniest cells to the heart, lungs, digestive and neuromuscular systems. The moment of rest and silence in the lub dub of the heart is when the heart’s atrial chambers fill with oxygenated blood in preparation for the next squeeze of the heart, which then sends newly oxygenated blood out to each and every cell in the body. It is a dynamic pause.

Lulu Sweigard, a student of Todd’s, wrote in the Human Movement Potential that “the distribution of its structural weight should balance the body so that no muscle work need be added to maintain equilibrium in the position.”¬≥ What we are seeking to accomplish with Constructive Rest, then, is to bring the body into effortless mechanical equilibrium.

Constructive Rest creates an opportunity for the spinal curves, from head to tailbone, from left to right, to relax and lengthen onto the even surface of a supportive ground. Tense muscles, tissues, joints and organs throughout the body can relax and literally unwind from the demands of maintaining an upright position against gravity.

Remember, the point is to be absolutely comfortable and use as little muscular effort as possible to maintain the position. If you don’t find this position comfortable, perhaps another variation on Constructive Rest might work better for you.

Practicing Constructive Rest only 10 minutes a day has delicious effects. By supporting your body in dynamic relaxation, you can unwind from pain and fatigue while you tune into your breath and your body, relax and let go.**

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NOTES AND REFERENCES

* Try not to forcefully bend your arms or hold your arms in place by gripping with your hands.

** Other benefits may be similar to those of meditation and yoga where lowered stress levels, decreased anxiety, lower blood pressure, decreased heart rate, improved mood and energy levels are well documented. However, to discuss these bonus effects is beyond the scope of this article.

¬Ļ Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.

² Todd, Mabel Elsworth, The Thinking Body: A Study of the Balancing Forces of Dynamic Man,  Dance Horizons, Incorporated, 1937, p.290.

³ Sweigard, Lulu E., Human Movement Potential: Its Ideokinetic Facilitation, Harper & Row, Publishers, Inc., 1974, p. 216

Variations on Constructive Rest

In a previous blog post, The Best Way to Relax, I described the many benefits of Constructive Rest. Here, I wish to offer a few variations on the basic position, pictured at left. At different times, or because of your body type, you might find one of these variations more comfortable. And comfort is what we’re looking for here.

  • Try placing a small pillow under the head if you have a deep chest (thoracic kyphosis) or forward head. If you notice your chin is pointing towards the ceiling and your head is cocked back, you need a pillow. If you simply feel strain in your neck or back, try a pillow. It should be as small as possible to comfortably support your head and neck. The goal is to support your body’s neutral alignment in a comfortable, balanced way so that you can let go of all muscular holding.
  • If the backs of the hips are tight (this is true for many men), try lining up your knees with your hips and ankles rather than trying to force the knees together. Then cross the arms over your chest. If your legs stay in place on their own without drifting to the sides or falling open, this may be the optimal position for your body.
  • If you have a large chest, or if for any reason you are simply uncomfortable crossing your arms over the chest, try resting your arms about 45 degrees away from the trunk of your body with your palms facing up. Allow the weight of the arms to release into gravity.
  • You can loosely tie your thighs together with a scarf or theraband to keep legs from falling open.
  • If the floor feels hard or uncomfortable, try putting more padding down.
  • Sometimes a small pillow placed under the pelvis or low back may feel good.
  • Another approach to Constructive Rest is to prop the legs, bent 90 degrees at the hips and knees, onto a chair seat or sofa. Open the arms out to the sides, palms up, or cross your arms across your chest as in the basic position.

Whichever adaptation you choose, try lying in the same position for 10 minutes a day for a few days. Notice the difference in how you feel.

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* Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.

How Yoga Physical Therapy Works With Pain

Day 2. I started this blog because I want to get the word out about NY Yoga Physical Therapy. Sometimes I come home after working with a patient who has chronic pain with a great idea that we discovered during our session, and I want to share it. So this is a way to get me started writing about the work, to explain what it is that we do in Yoga Physical Therapy.

First and foremost, I look at the body with the eyes of a Physical Therapist. The training was the best I could find for understanding the components of the human body and how it moves in space. From my background in dance and yoga, I became a Physical Therapist because I was hungry to know about muscles, joints, the nervous system, and how it all fits together. Then, by studying the pathology of injury and disease, I learned what happens when something goes wrong. My job as a Physical Therapist is to find a way to help the injured body in pain recover. These 20 plus years of working with injuries and disease have only increased my understanding and intuitive approach.

Yet as great as the Physical Therapy training was, it didn’t give me a way to deal with the whole person. Often I would find people were tense, upset and holding tension in their bodies, especially those with low back pain, upper back pain, neck pain and those with frozen and painful shoulders. (I also see people holding tension in their feet, knees and hips.) At first, I didn’t know what to do with this growing observation. I wasn’t trained in how to deal with stress and the psychological components of pain, disease and injury.

Once I consciously started practicing holistically, incorporating Yoga, mindful breath work and other holistic practices into the sessions, I began to be able to help people help themselves with the effects of stress held in their bodies Рphysically, emotionally and psychologically. The introduction of the breath, not only into the exercises, but as a separate activity in itself, began to transform the effectiveness of the therapy sessions, especially in those with chronic neck pain, upper back pain, middle back pain and low back pain.

By helping you learn how to breathe into area injury and pain, you become aware of your own experience of feelings, holding, tension and tightness in that area of the body. On a physical level, getting breath into a tight or tense area literally begins to open up the area. As the muscles relax, they loosen their hold on the bones. The affected bone(s), pulled out of line by an overactive muscle, can begin to relax back into place. When the muscle, then the bone(s), release back into a relaxed state, then the affected joint can begin to realign itself. Yes, you can learn to breathe into targeted areas of the body. As the body relaxes, or disinhibits from tension and pain, then the breath can freely move the trunk.

Secondly, blood does not flow freely through tense muscles. So another result of using a mindful breath is that it helps muscles to relax. Relaxed muscles allow blood to freely circulate through these affected muscles. With more blood flow, more oxygen gets into the area. More oxygen equals more healing. The molecules and chemicals for healing can now get to get to the injured, painful area. Not only that, but the byproducts and waste molecules from cellular respiration Рor cleaning up the debris from the injury Р is now able to move out of the area more quickly. This aids in decreased swelling, inflammation and therefore improved healing.

On the psychological level, mindful, meditative breathing is documented to lessen the effects of stress, including lowering blood pressure and decreasing heart rate. It lessens¬†the effects of cortisol, the stress hormone of the fight-or-flight reaction. As a person becomes more aware of ¬†bodily tension and learns to breathe into it, often the emotions or thinking that contributes to that tension begin to loosen their hold as well. As the mind begins to relax, so too does the body. Once the body begins to relax, so do the mind and emotions. It’s a dynamic, interactive process.

I’ve had patients thank me for helping them to identify and learn to work with the stress that is contributing to their pain and injury. Once they developed an awareness that they were holding tension in their backs, necks, feet or hips, they were able to begin working with, and begin lessening, that tension. Their pain started to go down, too.

For one patient with chronic back pain and neck pain, a sudden¬†awareness and acceptance¬†of how he held¬†tension in these areas was the turning point in his treatment. He said, “I thought about what you said last week about accepting the discomfort. And over the weekend, I got it. It was weird, but my experience of the pain changed.” He stopped therapy shortly after.

Awareness is key. So is acceptance. With aware breathing into an injury, combined with specifically targeted positioning or stretching of the body, the healing process is powerfully supported. Using a gentle and mindful breath also gives us an effective tool to support the entire healing process, body and mind. Paradoxically, acceptance of pain can reduce the anxiety and fear surrounding it, which then contributes to the relaxation of the tension that we hold because these feelings.

Sharon Gary of Yoga Physical Therapy in mid-town Manhattan can help you with this holistic, integrative approach to healing.