By Scott Lucett, MS, NASM-CPT, PES, CES
With the advancements in technology and more people having to work on computers, the incidents of neck pain are becoming more prevalent. With some basic assessments and a systematic corrective exercise strategy, neck pain can be a thing of the past.
According to a survey conducted by the National Centers for Health Statistics (NCHS), neck pain is the third most common type of pain for Americans (1). Roughly two thirds of the population will experience neck pain in their lifetime. Its side effects can be mild or severe, and interfere with normal daily functioning such as sitting, turning, and sleeping. Neck pain can be acute (lasting less than three months), or chronic (lasting longer than three months). In the NCHS survey, the majority of respondents (42%) had suffered neck pain for longer than a year. The survey also showed that women are three times more likely to suffer with this health problem than men and that if you are under severe stress your risk of neck pain increases by one and a half times. However, research has shown that exercise, in the form of neck strengthening, stretching, and proprioceptive exercises, can decrease the risk of neck pain and improve the symptoms of neck pain (2–11).
Neck pain can be caused by muscle imbalances associated with the cervical spine, so it will be important to assess for these imbalances to help determine the best course of corrective exercise action. These assessments can come in the form of static and dynamic postural assessments.
Static Postural Assessment for Cervical Imbalances
Neck pain is commonly associated with the upper crossed postural distortion syndrome in which one possesses a forward head and rounded shoulder posture. This posture is commonly seen in those who frequently sit in front of a computer. Spending long periods of time in this position can cause certain muscles to adapt by shortening and becoming tight and others becoming lengthened and weak. Muscles of the cervical spine that are commonly tight and contribute to this distortion pattern include the upper trapezius, levator scapulae, sternocleidomastoid and scalenes while muscles that are commonly weak include the deep cervical flexors. If a forward head posture is identified during a static postural assessment, these key muscles may need to be addressed through corrective exercise to improve cervical postural alignment and decreasing stress to the cervical spine.
Dynamic Postural Assessment for Cervical Imbalances
Assessing for cervical muscle imbalances can also be done through the use of dynamic postural assessments, where an individual performs a functional movement and the professional assesses cervical and shoulder alignment during the movement. A common compensation that may occur and is indicative of cervical imbalances is the head migrating forward and/or the shoulders elevating during the movement being performed. For example, the professional may have their client perform a rowing motion and assess if these compensations occur. If the compensations occur, this may be due to over-activity of the upper trapezius, sternocleidomastoid and scalenes pulling the head and/or shoulders into this compensation and under-activity of the deep cervical flexors allowing for the compensation to occur. Like the static postural assessment, this dynamic assessment provides the professional guidance on corrective strategies to improve movement quality of the cervical spine and shoulder complex leading to a decreased risk of injury.Corrective Exercise Strategies for Neck Pain Prevention
Following NASM’s Corrective Exercise Continuum programming strategy can help address potential muscle imbalances that may be contributing to movement compensations which lead to a forward head posture and neck pain. First, inhibit the muscles that may be tight/overactive via self-myofascial release. Typically, this technique would be performed with a foam roller, but due to the regions being addressed, hand-held devices (such as a Theracane) may work best. Key regions that should be addressed using such a tool would be the upper trapezius and levetor scapulae. If one also possesses rounded shoulders, foam rolling the thoracic spine will also be important to help improve thoracic spine range of motion and decrease stress to the cervical spine.
The next step is to lengthen the tight muscles via static stretching. Key muscles to stretch to decrease neck pain include the upper trapezius/scalenes, levator scapulae and sternocleidomastoid. Hold each stretch for a minimum of 30 seconds perform 1-2 sets of each stretch.
Once the overactive muscles have been addressed, activate the underactive muscles. Key areas to target with isolated strengthening are the deep cervical flexors, which can be done by performing chin tucks. Perform 1-2 sets of 10-15 repetitions.
Finally, perform an integrated exercise to improve muscle synergy to enhance neuromuscular efficiency and overall movement quality. This can be done by performing a ball cobra while maintaining proper cervical spine alignment. Perform 1-2 sets of 10-15 repetitions.
With individuals becoming more sedentary with the advancements in technology, neck pain is increasingly more common. It will be important for exercise professionals to perform assessments to identify potential muscle imbalances of the cervical spine that may need to be addressed through corrective exercise. By implementing basic flexibility and strengthening techniques to key regions of the cervical spine as well as teaching proper cervical spine posture, one can greatly reduce their risk for neck pain.
- National Centers for Health Statistics, Chartbook on Trends in the Health of Americans 2006, Special Feature: Pain. http://www.cdc.gov/nchs/data/hus/hus06.pdf
- Häkkinen A, Kautiainen H, Hannonen P, Ylinen J. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil 2008;22:592–600.
- Häkkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med 2007;39:575–9.
- Ylinen J, Takala EP, Nykänen M, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA 2003;289:2509–16.
- Cunha AC, Burke TN, França FJ, Marques AP. Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. Clinics (Sao Paulo) 2008;63:763–70.
- Taimela S, Takala EP, Asklöf T, Seppälä K, Parviainen S. Active treatment of chronic neck pain: a prospective randomized intervention. Spine 2000;25:1021–7.
- Nikander R, Mälkiä E, Parkkari J, Heinonen A, Starck H, Ylinen J. Dose-response relationship of specific training to reduce chronic neck pain and disability. Med Sci Sports Exerc 2006;38:2068–74.
- Ylinen JJ, Häkkinen AH, Takala EP, et al. Effects of neck muscle training in women with chronic neck pain: one-year follow-up study. J Strength Cond Res 2006;20:6–13.
- Ylinen J, Häkkinen A, Nykänen M, Kautiainen H, Takala EP. Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study. Eura Medicophys 2007;43:161–9. Epub 2007 May 28.
- Ylinen J, Kautiainen H, Wirén K, Häkkinen A. Stretching exercises vs. manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med 2007;39:126–32.
- Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. J Orthop Res 2007;25:404–12.