If you have neck pain, you are not alone as it is the 4th leading cause of disability in the U.S. and has an annual prevalence rate exceeding 30% of the population. Effective treatments range from massage, therapeutic exercises, acupuncture, medications and injections and yet for many of us the pain and dysfunction returns. When the pain returns we know that we are merely suppressing the symptoms and not addressing the root cause. I’m not saying we should ignore the pain while we hunt for the cause. Ask anyone that has experienced severe musculoskeletal pain and they will champion the treatment that suppresses that pain. But to be truly effecting at eliminating the root cause of musculoskeletal pain you must look at the extremities, and when in come to neck and shoulder pain we cannot ignore the role of the hands and forearms.
Your neck and shoulder pain is a lagging indicator. That is to say, at some point your central nervous system lost confidence in your upper body’s ability to protect it and now it is letting you know. If you cannot tone down the external physical stress of daily life sufficiently before it gets to your spine, your nervous system will act to protect itself. At first it stiffens your neck and shoulders reflexively and those areas feel tense and irritable. But eventually that stiffening strategy becomes chronic pain. I have many patients that say they used to be able to sit at a computer for hours and feel a bit of shoulder tension, but now they cannot tolerate more than a half-hour without pain. These patients invariable have rounded shoulders, tight chests and a forward head posture. The computer slouching behavior is not a sign of laziness or lack of mindfulness about posture. The body is slouching as it tries to physically organize itself to best handle the physical stress place upon it.
Our musculoskeletal system is self organizing and it’s impetus to self organize is external stress. As you interact with the world, your hands and feet are generally the way your body manipulates the environment. How many bags of groceries, toddlers, boxes did you carry today? How many times did you get up off the floor or push a door open? Does your 90lb pound dog pull you when you go for walks? All of these situations apply stress to your upper body. If your nervous system doesn’t have the confidence in your upper extremities to handle that stress, it will start to stiffen the muscles around the shoulder and neck to help out your hands and arms. In other words, when your hands and arms weaken and do not dampen stress adequately, the problem will manifest itself in the shoulders and/or neck. This stiffening strategy not only begins to limit your motion but also gradually starts to limit the amount of stress your neck and shoulders have the capacity to absorb before you start experiencing pain. Let’s apply this model to my patients who experience neck/shoulder pain when using a computer. Due to wrist and arm weakness, their central nervous system doesn’t trust their upper body to dampen the stress of the environment before it makes its way to the spinal cord. To compensate, their neck and shoulder muscles increase their stiffness and limit shoulder and cervical mobility. The result is that these muscle are already stiff and tired and thus lack that adaptability to tolerate a full work day at the computer, a commute and their teenager’s homework! Cue the sore neck, shoulder and/or headache.
If we apply stress to the upper body in a way that builds a robustness into your hands, forearms, upper arms, we can take the stress level in the neck and shoulders down. Lowering the stress level of the neck and shoulders increases capacity to adapt to stressful positions and prolonged posture. Bearing weight through your hands, specifically with a bias at the base of each finger (metacarpal heads), builds strength through the wrist flexor and elbow extensor muscle groups. During a pushup these muscle groups help slow your descent to the floor, they literally dampen external, physical stress. The goal is to drive load through this muscle group to a improve the variability and adaptability of the neck and shoulders.
Assess the strength of your arms. Begin on your hands and knees, with hands below the shoulders and knees below the hips. Take a slow breath in through your nose and hollow out your back such that your chest and stomach are now closer to the floor. Now exhale through your nose and hollow out your stomach, rounding your back. As you are exhaling, bias the weight in your hands to the base of your fingers (metacarpal heads), slightly unweighting the heel of your palm. Stay in this position for a minute working on long exhales, hollowing out your stomach and pushing through the base of your fingers. Your shoulders should round in this position as this relaxes the rotator cuff and the musculature of your upper back. If this was easy, try unweighting the heels of palm even more. Then progress to doing this with just one hand, holding for a minute or two. If being on your hands and knees is painful for your upper body, start by supporting yourself with your hands while leaning against a wall.
Bearing weight through your wrists and arms is a great way to try and treat your painful neck and shoulders on your own. However, sometimes a skilled clinician’s knowledge and experience will be part of the solution. If your pain is severe or you are experiencing numbness or tingling in you upper extremity consider seeking help from a healthcare professional.