Pain in the Neck

Your ribs are stiff!

Find the area of pain, then look above and below it to find the problem. This axiom is one of the guiding principals I use when restoring proper biomechanics and eliminating musculoskeletal pain. When treating neck pain, it is often quite easy to identify the painful structures and observe the dysfunctional movement. A sore neck presents with irritable musculature and obvious movement compensations in almost all cases. If I focus my treatments on releasing those irritable muscle and restoring healthy neck (cervical spine) movement I can make quick and noticeable improvements, but those benefits are often short-lived. However, when I look below the neck, at the ribs and thoracic spine, the underlying problem becomes painfully obvious. A stiff and immobile mid/upper back (thoracic spine) and ribs forces movement compensations at the neck, that ultimately lead to pain and dysfunction.

It is hard to overstate the importance of rib cage and thoracic spine mobility when considering how to deal with your neck pain. A stiff thoracic spine will necessarily stress the cervical spinal structures in compensation for that loss in thoracic range of motion. Moreover, stiff and immobile ribs force us to alter our breathing patterns leading to overused and irritable neck musculature.

The most common thoracic spine dysfunction is excessive flexion. We slump forward when we sit, run, walk etc. I am a world class slumper myself. Truth be told there is nothing wrong with slumping so long as we maintain our ability to fully extend the thoracic spine and back out of that posture. When we do slump so much that we take on that position as our go to posture and we can’t effectively back out it, our neck suffers. Our brains always want us to maintain the ability to keep our eyes on the horizon. When we slump forward our gaze is down at the ground. To compensate we extend our cervical spine (neck) and hold it there. This posture upsets the length-tension relationship of our neck musculature eventually leading to pain and vertebral disc degradation. To add insult to dysfunction, our slumped posture limits our ability to rotate the thoracic spine. This loss of rotational range of motion has to be compensated for at the neck when turning your head to look laterally, further degrading the vertebral discs and upsetting the cervical musculature.

Daily foam rolling on the thoracic spine is effective at relieving neck pain. Rolling on a foam roller helps neck tension in two ways. One, the pressure from the foam roller releases our thoracic spine musculature. These muscle are often full of tension from supporting the head and shoulder girdle in a slumped position, limiting our cervical spine range of motion. Two, the foam roller gently pushes our thoracic spine out of excessive flexion, and into a functional slightly flexed to neutral posture, allowing us to relax our hyper-extended neck.

Foam Roll - Thoracic Spine

To improve thoracic extension lay on the ground on with the foam roller underneath your upper back, positioned perpendicular to your spine. Cross your arms across your chest as if giving yourself a hug, and lift your hips off the ground. Now use your legs to roll your spine up and down on the foam roller. Spend 2-3 minutes with this. Now position the foam roller at your mid-back, lift your hips off the ground and engage your abdominals. Bend backwards conforming your spine to the shape of the foam roller, holding your lower ribs in place with your abdominals. Reposition the foam roller and inch or two lower on your spine and repeat. Spend another 2-3 minutes playing with this motion.

Deliberately rotating the thoracic spine relieves tension on the neck. Rotating the thoracic spine promotes rotation of the mid/upper back and expansion of the space in between our ribs (elongation and flexibility of intercostal muscles). If we can get more range of motion from the ribs and thoracic spine we require less excessive rotation of the neck.

Threading the Needle

To improve your thoracic rotation position yourself on the ground on your hands and knees. Lift your right hand off the ground and place on the back of your head. Now rotate to the right pointing your right elbow up towards the ceiling. Drive this rotational motion with the muscle of your core, do not reach with the shoulder. Hold the position briefly then rotate to the left, reaching your right hand as far as you can underneath your torso, such that your right shoulder is now pointing towards the ground. Again, drive this motion with your core. Repeat this motion for 1 minute per side.

A daily breathing practice helps prevent and eliminate neck pain by reducing our reliance on secondary respiratory muscles. Secondary respiratory muscle run from our cervical spine to our ribs. When we are exercising or really stressed out, we use these muscles to lift the ribs upward, providing more room for our lungs to inflate. This becomes a problem when our rib cage is tight and we overwork the secondary respiratory muscles even for our breathing at rest. Moreover, a daily breathing practice helps us learn how to use our breath to relax, even during stressful situations, thus reducing our reliance on our neck musculature.

Side Bend Breathing

To reduce your reliance on your secondary respiratory muscles, lay on your left side on the ground across 1-2 two pillows positioned underneath your ribs. Reach up with your right arm positioning it next to your ear. Take a deep nasal inhale for 5-6 seconds. As you inhale, reaching with your right arm and bend over the pillows. Feel the air stretching your right-sided rib cage. Then slowly nasal exhale for 5-6 seconds. Repeat for 1 minute on each side.

As I continue to write these monthly articles about my clinical observations, one on the conclusions I consistently arrive at is that the treatments for pain and dysfunction, anywhere on the body, are often the most beneficial preventive interventions that I recommend to patients. The three exercises I outlined above, while not a completely comprehensive approach to treating existing neck pain, will improve your spinal range of motion and help prevent neck pain.