The 20-second test for Neck Pain

Many people with chronic pain can point to a specific event after which their pain began, such as a car accident or fall. Still others point out that stress leads to their pain. Finally others report their pain just gradually came on and wouldn’t go away. Why do chronic neck pain or headaches happen and what can we do to not only prevent it but fix it? The answer lies in simply knowing a little about the anatomy and biomechanics of the neck and shoulder.

Know Your Anatomy

Looking at a skeleton, you’ll see that at almost every joint the bones are stacked on top of each other. Joint compression due to gravity is one factor that helps our body stay in alignment. But look more closely at the shoulder and you’ll see that its only connection to the rest of the skeleton is via a horizontal collar bone (clavicle) at the front of the rib cage.

How can that tiny clavicle hold up the shoulder? It can’t. What holds the shoulder in position is not joint compression but instead, muscles (Figure 1.1). Two of these muscles, levator scapula and trapezius also attach to the neck bones and/or base of the skull.

Now think of how heavy your arm is, including the shoulder blade. Think of all those muscles, bones, nerves, blood, tendons, and ligaments. How heavy—10, 15… 20+ pounds? If the muscles holding the arm in place aren’t functioning properly, suddenly you’ve got a big pendulum hanging from your neck, dragging it around by virtue of the levator scapula and trapezius muscles’ connections to the head and neck.

This can contribute to compression, rotation, and extension of the cervical vertebrae as well as disk problems. This also causes thoracic outlet syndrome, nerve pain, carpal tunnel syndrome, migraines—you name it. Any musculoskeletal or neurological issue associated with the upper arm or head can stem from this problem.

One of the biggest keys to neck function is a shoulder blade (scapula) that works as it should. This bone needs to rest and move in a fairly precise way in order to unload the neck and shoulder joints. If that isn’t happening, they are in for some real work and, therefore, pain.

This is also why pain from accidents never heals. Because prior to the accident, many of these problems were already in place but had not quite reached the threshold of pain. If treatment doesn’t correct the root problems, pain or dysfunction will never resolve.

It’s similar to going to a doctor for a broken left thumb and having him cast it without realizing that the right hand is hitting it with a hammer. Yes the left thumb may heal temporarily but pain will always return because the underlying problem of the right hand was never resolved. It’s the same with chronic pain everywhere in the body.

The 20-second Test

Here’s a little test you can try on yourself. Let’s say you have right-sided neck pain or a headache. Raise your right hand and let it rest on top of your head as in the picture below (Figure 1.2). When your hand is resting up there, slightly shrug the right shoulder up toward your right ear, just a little bit is all you need. Hold it there for about 20 seconds and then lower the arm back to your side while keeping the right shoulder slightly shrugged upward. Make sure your neck isn’t craning sideways to help! Once the arm is back to your side, slowly allow the right shoulder to relax downward but don’t push it down. Has your pain diminished? If it has, it is likely you have a poorly functioning shoulder at the root of your chronic neck pain or headaches.

This explains all three causes of neck pain mentioned at the beginning of this article. Accidents expose an existing vulnerability in the body. Without proper restoration of the scapula, stress to the cervical spine will not be alleviated. Stress contributes to neck pain and headaches due to the fact we pay less attention to our mechanics or perform more activities which exacerbate the poorly functioning shoulder during stressful situations. Gradual onset of neck pain is simply our bodies losing to gravity. In all cases, restoring the scapular mechanics and improving muscle function of scapular muscles alleviates most if not all stress to vulnerable cervical tissues and therefore pain.

Rick Olderman is a sports and orthopedic physical therapist, personal trainer, Pilates instructor and speaker. He is the author of Fixing You: Back Pain, available at www.FixingYou.net. Email Rick at Rick@FixingYou.net or call 303-477-4212.