chronic neck stiffness/pain

I will definately give PT a try, as it seems like the best/safest approach. 

Wishing you a speedy recovery also. 

Hi Myra, 

I've visited two RMTs one of which was also a SMT, and both indicated no real issues with my traps/levator scap although that is where my pain initially started from, later moving to my neck aswell. Although I feel stiff in the area, they are saying I'm relatively loose...I've also taken up foam rolling with a tennis ball to help out. I'll definately stop the chiro treatments and followup with a PT, but I can't get over the fact that my x-rays show a loss in cervical curve.

Moving neck pain is common.  The initial injury to your levator and upper trap may have caused other muscles in your neck to compensate, causing further stiffness.  

Sorry... hit the wrong button! 

Anyway, you may be feeling the reisudual of this compensation, and the original injured muscles still may be weak.  That's why I think strengthening the upper back is important for you, especially the serratus anterior.  It is a major stabilizor of the scapula.  Also have your PT check the muscles on the front of your neck, as tightness here can reduce the curve in your neck.  They should also be able to do some soft tissue release on your suboccipitals to reduce or get rid of the noise you've been hearing.

Any ideas for me myra? I'm battling a injury from 1998 which I had thoracic outlet surgery. Now I'm having pain in my neck front and back, collar bone area and it moves down my back..

Just wondering what the reasoning is  behind any therapy which suggests that the neck muscles need strenghtening when a vulnerability is present due to a condition like C/S.  Under normal circumstances,  with no condition evident,  it would seem that exercising or 'strenghtening' the neck seldom seems necessary for maintaining normal flexibility.  So,  why would it seem right to over-tax an already vulnerable neck ?  Surely the opposite  (relaxing) would be more appropriate !  I think with some 'old-schoolers',  the old adage 'no pain, no gain'  still affects their approach to some conditions.  As I see it,  most C/S sufferers are trying to relieve their symptoms,  not add to them !

Hi Tonya,

I would need some more specifics. What was the injury, and what was the surgery on? Thoracic outlet syndrome is a broad term (like low back pain). Also, what type of pain are you feeling (Burning, aching, sharp etc), and what makes it feel worse and better?

Hi Gerry,

Can you clarify c/s for me? I may use different acronyms. A general answer to your question is that strengthening is used to maintain balanced neck muscles. A lot of us use our bodies in ways that build up strength in only some neck muscles which throws everything 'out of wack.' For example, a lot of us become stronger on the side of our dominant hand. When muscles are out of balance in our neck it can cause a whole slew of symptoms such as general pain, severe headaches, numbness and coolness in the arm and hand as well as nerve impingement. I can try to give a more clear example once I'm sure what condition you are speaking of.

Hi Myra

Thanks for replying.  C/S stands for Cervical Spondylosis,  one of the more common conditions responsible for neurological and muscular reactive symptoms in the neck area.  Hope that clarifies.

With nerve impingement issues due to degeneration,  as with C/S,  there are usually painful muscular reaction adjustments being instigated constantly or intermittently,  whether referred, radiated, or local.  These muscular reactions can lead to various symptoms, including, as you've already correctly pointed out,  cervicogenic headaches at back of head.  Considering that adaptive behaviour is already somewhat overworked, adjusting to the needs of a threatened nerve,  I was wondering what reasoning lies behind any therapies which include manipulations which might exacerbate the already overworked  neck muscles.  My reasoning says that the neck muscles need to relax first,  and only when normal flexibility has been restored,  should there be any consideration given to further strains being applied to the neck.  Without that normal flexibility,  I think any external interference will only further aggravate the vulnerable nerve/s.  I suppose the real question is.....why would anyone assume that applying force to a stiff neck would, in any way,  assist in restoring any normal flexibility.  What if any applied force counteracts, or contradicts, any adaptive processes already occuring.  In my experience of neck issues it seems that there is a continuous attempted corrective process going on,  and any interference in that process should be justified with an explanation of the details of that adaptive process,  so that compatability can be assessed first.

Perhaps we differ in our overviews,  but I think it's worth asking the difficult questions where C/S patients might  be faced with making decisions about best way forward.

Gerry

I had my labrium repaired from a injury. In 98 I had a rib resection caused from thoracic outlet syndrome. I'm having neck and back pain,shoulder pain. Its stiff in morning and I notice it going down to my tailbone area.. It feels like a dull ache everyday..

Icing it then applying heat makes it feel better.. As long as I lay still I'm ok.. Bending hurts turning my head either way is bothersome.

Hi Gerry,

Thank you for clarifying. Best to have the correct information before proceeding -which is what you are looking for. I think it's great. All therapies and treatments should be explained as fully as possible. If you understand the reasoning you are more likely to follow the treatment better.

in this case the general need for strengthening applies, but I will explain it as it pertains to you. As I said before our neck muscles become imbalanced with regular everyday use. Thes muscles, if not strong enough, end up shortening. Its almost as if your body is trying to turn them into something more like ligaments. Other muscles lengthen. As its more difficult for muscles to manage load in a lengthened state they respond by forming adhesions aka knots. This applies a greater or pressure on any joint involved, or causes the joint to move in an unnatural way Hereby causing damage. In your case the facet joints in the vertebrae where the nerves exit the spine. Because you have less play room before you start feeling compression of the nerves, you would start feeling symptoms earlier than anyone else. Therfore it is important to find good treatment to get you on the right track and keep up maintenance.

In terms of strengthening vs relaxing, both are needed. I'm not talking about bulking up like the Hulk or anything. And instead for using the word relaxing I would use lengthening. You need to lengthen the shortened muscles then make sure they are strong enough to carry the load being asked of them plus a little bit more. You also need to make sure the other muscles in your neck stay balanced with the more heavily worked muscles so a new imbalance is not created. Generally I focus on lengthening first. When he muscle is almost at its full length again I slowly introduce a strengthening program that fits the needs of my client. I along apply c-spine traction to similar clients to stretch out rotatores and multifidi muscles that are too small and deep to reach manually. This allows maintenance of space between the facet joints and as a result reducing impingement. As for relaxing YES IT IS IMPORTANT! Stress and anxiety are often carried in the neck and shoulders which is a large barrier to being able to properly lengthen and stretch muscles. Deep diaghragmatic breathing can help with this.

I hope that at least starts to answer your questions. If you need clarification on any hinges please let me know.

Thanks for the explanation.  More or less what I would have expected,  and not surprised to also see a mention for traction, to get at deep lying tissue.  I tend to disagree with that approach because it ignores the adaptive processes already ongoing.  Also,  one more question,  if I may......how does the therapy you recommend guard against the possibility of vascular compression,  possibly leading to stroke ? This is a well known,  if infrequent, outcome where cervical manipulations  are applied...there are current court cases exploring the dangers inherent in osteopathic cervical manipulations for neurological neck issues .   Is there any known way of avoiding such an outcome when applying external forces  ?   

Thank you for the information.  I've never treated anyone with a rib resoction done.  From what you told me about your symptoms, it sounds like your body is notadjusting well to less support from the labrum issue and possibly the resection depending on the extent of the bone removal.  Initially I would suggest strenthening the rotator cuff muscles, deltoid muscles, biceps and triceps.  By providing stronger support for the shoulder joint strain would not be put on your neck and back.  There are likely trigger points throughout the muscles that should be tended to as well. Trigger points can cause something called reffered pain; pain that travels or appears on different areas of the body.  This means that a trigger point in your shoulder could be causeing you back pain even if the muscle is healthy. 

So what should you do?  I can't give specifics as I have not assessed you, but again a physio and massage combo seems best.  If you can find a massage therapist that is knowledeable about strengthening then there is less need for a physio.  

I hope this helps!  Again, the permanence of your injury will require maintenance once you are well on the path to feeling better.  Don't wait until you really hurt to go in, take care of it early!

Hi Gerry, 

The treatment actually directly interferes with the adaptive process.  Except for surgical intervention a lot of adaptive processes can never be stopped.  Even then, the resulting rods or scars of the surgery have to be adapted to.  By reversing or reducing the adaptive process and maintaining the final result you are actually teaching the body not to participate in that adaptive behavior or creating an environment for your body to not need to adapt.  Also, on top of treatment you can have the PT or RMT discuss your daily activities with you to see if there are things you do that can be modified to reduce the amount of adaptation happening.  Speaking to an occupational therapist would probably be the most expert person for this information, though.

As for vascular compression in the neck, this type of treatment can't guarantee it will not happen (no treatment for anything can make that statement) but can reduce the chances of it.  Blood vessels wind through the body up and around muscles.  If muscles shorten they compress the vessels either themselves or pushing a bony structure onto them.  If they are strengthened they do not.  Think of shortened muscles as ropes, and lengthened but strong muscles as elastics. Elastics allow movement, ropes cut off movement.  

Thank you so much Myra.. I just started exercises at therapy to help straighten my shoulder. Not intense yet but once my pain level is lower it will be increased.. any suggestions on at home exercises? Your very knowledgeable.. Xxx

I'm glad to hear you have started treatment! Just remember, slow and steady. Since you've been having difficulty for such a long time it will take a while to get there. I don't think I should suggest exercises for you as I haven't assessed you personally, but perhaps speak to your therapist about eventually trying yoga once or twice a week. Because it includes strengthening and stretching as well as emphasising working within your limits it would likely be beneficus for you. I usually say following a video is OK only if you have taken at least 7 classes. This way you learn proper posing and how to guage where your limits are. Please kept me up to speed on how you're progressing!

Hi Myra

Thanks for that...very informative.  We might disagree on appropriate methods, and reasons,  but I appreciate you aren't 'dodging the issues',  and I'd have no problems with experimental approaches to treatments as long as there is good understanding of the peculiarities of 'threatened nerve' behaviour.  Seems to me that, unlike with more straightforward injuries,  a 'threatrened ' nerve creates its own rules,  thus manifesting as referred or radiated issues,  rather than as 'pain at source'.  We'd probably both agree that somehow the nerve needs to be 'unthreatened'  for any symptom relief to occur.

My own experience suggests that the easiest and quickest ways to ease symptoms is to identify the most relaxed postures for the neck,  particularly when sleeping.  During 'awake' hours it seems the neck is in defensive, or protective mode,  and it resists any attempts to externally influence its vulnerabilities.  Also,  it can be difficult to read the effects of external manipulation because it sometimes takes days for any reaction, whether good or bad,  to take effect.  Adjusting sleep postures is the only way I know for achieving an almost instant change of intensity of symptoms,  or even a change of symptoms.  I'm not sure there is any evidence out there which confirms that manipulations or traction are any more reliable than a simple 'wait and see' approach....and,  if both methods have an equal value in terms of results,  then, to me,  the obvious choice is 'wait and see',  because of its lesser potential for worsening the problem.  I believe the appropriate term is  'Less Wrong',  and that makes sense where neither approach is particularly supported by the research.  I think that if all treatments for cervical 'nerve' issues were laid out on a chart,  and their successes/failures statistically analysed,  then a 'Wait and See' approach might well ciome out top of the list,  or at least share equal success statistics with the best of the many other treatments to choose from......'success'  meaning,  not a cure,  but an acquired manageability.