ACOMS Review, Volume 4, 2022

Tips for Preventing and Relieving Neck Pain

Chronic, intermittent neck pain is a common complaint among health care professionals who spend long periods looking down with intense concentration, especially when paired with flexed shoulder positioning and the required coordination of fine hand-eye-motor skills.

This is not an industry-specific problem; it plagues nearly all groups that mimic similar positioning, from knitters to professional pianists to adolescents pecking away at smartphones. There appears to be a strong correlation between adverse health outcomes and forward displacement of the head (1, 2).

Normal sagittal plane posture minimizes soft tissue loads. In the ideal position, C1, T1, T12, and S1 are vertically stacked. A validated model that describes this arrangement is the Harrison Spine model (3, 4), which was developed and subsequently validated in the late 1990s. Restoring posture to this ideal optimizes function and performance (12).

Using a Lever Analogy

If we think of the spine as a lever, we can see why even mild deviations can have a great effect. Human posture is a 3D first-class lever mechanical system, where the fulcrum is between the load and the effort. Rene Caillet, MD, uses the first-class lever example in his 1996 book “Soft Tissue Pain and Disability” pertaining to the forward head syndrome. If an individual has an unbalanced forward head posture, head weight of 10 pounds, and their head’s center of gravity is displaced three inches, then the required counterbalancing muscle contraction on the opposite side of the fulcrum (the spine) would be 30 pounds (10 pounds times three inches).

The high loads from forward head and shoulder positioning cause more tension on posterior muscle groups of the upper back and neck, as well as inhibition of the anterior cervical musculature. If the musculature doesn’t have enough mass or endurance, fatigue will occur, leading to myofascitis, especially in the smaller musculature, such as the levator scapula, rhomboids, scalene, SCM, terres minor, infraspinatus, and longus colli. The fatigue and inflammatory process has been described in the following way:

Furthermore, anterior positioning with inadequate supporting musculature will increase loads on the spinal discs and facet joints, leading to premature degeneration of these structures, further contributing to chronic pain and dysfunction (6-8).

5 Steps Surgeons Can Take To Relieve Neck Pain

Minimizing the detrimental effects of poor posture requires a multi-pronged approach.

1 - Ergonomic Modification

The most significant strategy is to find ways to decrease the amplitude and duration of forward positioning whenever possible through ergonomic modification. The positive effects of optimizing body mechanics can’t be overstated. This usually necessitates creativity and persistence in trying new ways to improve positioning. Unfortunately, even with the best efforts, the specific demands of many health care activities make this simply untenable. When ergonomics can’t be modified, self-care becomes essential.

2 - Strength and Endurance Exercises

Performing exercises to increase the strength and endurance of posterior musculature that simultaneously reduces anterior head translation, anterior protraction of the shoulders, and hyper kyphosis of the thoracic spine can drastically reduce fatigue and the inflammatory sequelae. Simple exercises that require minimal equipment can fulfill this goal.

Integrating recreational activities that involve strengthening posterior spinal musculature is also highly beneficial. When exercise is perceived as enjoyable and less as a monotonous chore, long-term compliance is much higher. Examples of such activities are rowing, Nordic skiing, and swimming backstroke.

3 - Treat Yourself

When musculature has become overloaded, heat, gentle self-massage, and stretching to increase blood flow and reduce neurologic facilitation of musculature can minimize the annoying soreness of fatigue from spiraling into unrelenting myofascitis, spasm, and even muscle tears. Tennis balls against the wall, massage guns, hot showers, and spa jets on sore muscles are underrated. When done frequently, and before the injury becomes severe, these simple activities help keep musculoskeletal problems at bay.

 

4 - Supplementation

Reducing systemic inflammation also has a significant role in minimizing the effects of overloaded tissues. This is accomplished by reducing consumption of refined carbohydrates and can be enhanced with simple supplementation of bromelain, magnesium, and fish oil high in EPA.

5 - Soft Tissue Spinal Remodeling

Over time, the spine and soft tissues will frequently remodel themselves to adapt to movement patterns and postures that are repetitively ingrained. This can lead to permanent moderate to severe forward head positioning and hyper thoracic kyphosis, which may cause adverse health outcomes independent of the insulting activity, and even long after the activity may cease (9, 10).

In these circumstances, soft tissue spinal remodeling with traction to can help improve posture. It can be difficult if not impossible to return to ideal posture with exercise alone. A Denneroll home traction orthotic is a powerful tool used to reduce anterior head and neck translation, increase cervical lordosis, and reduce the effects of thoracic hyper-kyphosis. The Denneroll is a foam fulcrum with a specialized contoured shape that maximizes spinal bending. It is fitted and monitored through radiographic analysis of the spine using the Harrison Spine Model. This method has been clinically shown to reduce anterior head and neck translation, increase cervical lordosis, improve health outcomes, and optimize functional performance. (11, 12).

Consider New Habits To Prevent Pain

Forward head posture can start early, present asymptomatic, and can progress over time. Being proactive and implementing ergonomic modifications and routine self-care habits before symptoms and injuries occur is worthy of consideration.

References

  1. Moustafa IM, Diab AA, Hegazy F, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskelet Disord. 2018 Nov 12;19(1):396. doi: 10.1186/s12891-018-2317-y. PMID: 30419868; PMCID: PMC6233550.
  2. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia. 2006 Mar;26(3):314-9. doi: 10.1111/j.1468-2982.2005.01042.x. PMID: 16472338.
  3. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2485-92. doi: 10.1097/01.brs.0000144449.90741.7c. PMID: 15543059.
  4. Harrison DD, Janik TJ, Troyanovich SJ, Holland B. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine (Phila Pa 1976). 1996 Mar 15;21(6):667-75. doi: 10.1097/00007632-199603150-00002. PMID: 8882687.
  5. Oakley, Paul & Moustafa, Ibrahim & Harrison, Deed. (2019). Restoration of Cervical and Lumbar Lordosis: CBP® Methods Overview. 10.5772/intechopen.90713.
  6. Harrison DE, Jones EW, Janik TJ, Harrison DD. Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model. J. Manipulative Physiol. Ther. 2002;25:391401.
  7. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J. Neurosurg. Spine. 2009;11:5218.
  8. Takasaki H, Hall T, Kaneko S, Ikemoto Y, Jull G. A radiographic analysis of the influence of initial neck posture on cervical segmental movement at end-range extension in asymptomatic subjects. Man. Ther. 2011;16:749.
  9. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9. doi: 10.1097/01.brs.0000179086.30449.96. PMID: 16166889.
  10. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9. doi: 10.1097/01.brs.0000179086.30449.96. PMID: 16166889.
  11. Mageed SMIA, Abutaleb EEM, Soliman AME, Labib AM. Impact of cervical lordosis rehabilitation on disability and pain in non-specific neck pain. J Medical Sciences 2018; 18(1):20-26.
  12. Moustafa I, Kim M, Harrison DE. Comparison of Sensorimotor Integration and Skill-Related Physical Fitness Components Between College Athletes With and Without Forward Head Posture. J Sport Rehabil. 2022 Jul 22:1-10. doi: 10.1123/jsr.2022-0094. Epub ahead of print. PMID: 35894888.