Having Neck Pain? Could it be your posture?
Each tissue has a loading tolerance, which when exceeded will cause pain and ultimately tissue damage. This explains the nuances of the term “bad posture” – why some people appear to have bad posture but feel fine but others find themselves quite sore when they find themselves in the same position. Their anatomy and physiology have not adapted to be able to function in that position without discomfort.
Posture affects the load on the anatomical structures supporting the position. For example, the forward head posture – also known as the chin poke in layman terms has a profound effect on the loads placed upon the tissues of the neck. The head represents 6% of an individual’s bodyweight so the way it is stacked on top of your spine changes how much your body works to allow it to function.
Postural neck pain can be attributed to several causes:
- myofascial pain,
- disc irritation,
- osteophyte formation,
- nucleus protrusion,
- compressive loading on facet joints
- ligament sprains,
- tendonopathy etc.
Any conditions that may be related to postural Neck Pain?
Postural issues may influence other functions of the body. For example, forward head posture may contribute to:
- Compressive loading on joints and ligaments of the cervical spine and exiting nerves
- Decreasing respiratory function by decreasing the mobility of the lower thorax (
- Shoulder pain with altered biomechanics – upper traps and lower traps appeared to significantly increase activity
Tension type headaches with associated trigger points in cervical and pericranial musculature (Fernández-de-las-Peñas et al., 2006).
Other serious pathologies that may masquerade as neck pain (Blanpied et al., 2017):
- Myocardial Infarction
- Arterial Insufficiency
- Upper Cervical Ligamentous Insufficiency
- Unexplained Cranial Nerve Dysfunction
Common symptoms/signs of Neck Pain
- Myofascial pain – Pain associated with inflammation or irritation of muscle or the surrounding fascia particularly in the posterior cervical extensor muscles
- Tension-type Headaches
- Associated shoulder girdle pain or upper extremity pain from referred pain from overworked muscles or nerve root irritation.
- Limited cervical mobility
- Neck pain with movement
What Causes Neck Pain?
Neck pain is significantly associated with holding the neck in a forward head posture for a prolonged time and with repetitive movements in the workplace. With this type of load, there may be the development of myofascial trigger points from overuse with associated tension-type headaches and upper limb pain. Prolonged tight band of muscle fiber constricts local blood vessels which leads to tissue distress and release of local inflammatory and sensitizing substances.
How does Physiotherapy treat Neck Pain?
This type of condition is usually treated with conservative physiotherapy. This is split into 3 broad phases depending upon the stage of rehab the patient is in: Acute, Subacute and Chronic. This may differ on the individual.
Acute (Less than 6 weeks) – Manage pain and regain range of movement of the neck.
- Cervical and thoracic manual therapy mobilizations by a physiotherapist which has been found to benefit recovery in the 2-3 days after but tends to make the patient feel more sore on the day of treatment (Blanpied et al., 2017).
- Soft tissue massage through overworked muscles
- Home exercise program with neck range of movement exercises
- May begin deep neck flexor, scapulothoracic and upper extremity strengthening with endurance focus.
Subacute (6-12 weeks) – Progress neck and shoulder girdle endurance exercises with or without therapist thoracic and cervical mobilizations.
Chronic (more than 12 weeks) – Progress neck and shoulder girdle exercises. Incorporate neuromuscular exercises that improve posture, coordination and proprioception.
Risk factors of this Neck Pain?
Risk Factors for new-onset neck pain according to a systematic review that sampled across a range of different populations according to McLean et al. (2010).
Moderate to high-level evidence supporting these risk factors:
– Female Sex
– Previous History of neck or low back disorders.
Low to moderate evidence risk factors:
– Older Age
– High Job Demands
– Low Social or Work Support
Risk factors for the development of Chronic Neck Pain (Blanpied et al., 2017):
– Age greater than 40
– Coexisting LBP
– Long History of Neck Pain
– Cycling as regular activity
– Loss of strength in hands
– Worrisome attitude
– Poor quality of life
– Less vitality
Other Possible causes?
Congenital spinal or muscular deformities may contribute to neck pain and require more long term treatment.
Neck pain with radiating arm pain‐ radiculopathy
- Can occur due to spondylosis resulting in a narrowing of the intervertebral foramen (lateral stenosis)
- Can also result from a disc protrusion
- Radiculopathy resulting in upper limb
Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., Robertson, E. K., Altman, R. D., & Beattie, P. (2017). Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1-A83.
Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2006). Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension-Type Headache [https://doi.org/10.1111/j.1526-4610.2006.00288.x]. Headache: The Journal of Head and Face Pain, 46(3), 454-460. https://doi.org/https://doi.org/10.1111/j.1526-4610.2006.00288.x
Jafri, M. S. (2014). Mechanisms of Myofascial Pain. International scholarly research notices, 2014, 523924. https://doi.org/10.1155/2014/523924
Koseki, T., Kakizaki, F., Hayashi, S., Nishida, N., & Itoh, M. (2019). Effect of forward head posture on thoracic shape and respiratory function. J Phys Ther Sci, 31(1), 63-68. https://doi.org/10.1589/jpts.31.63
Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine, 12(4), 562-577. https://doi.org/10.1007/s12178-019-09594-y
McGill, S. (2007). Designing back exercise: From rehabilitation to enhancing performance. Guide to training the flexion-intolerant back.
McLean, S. M., May, S., Klaber-Moffett, J., Sharp, D. M., & Gardiner, E. (2010). Risk factors for the onset of non-specific neck pain: a systematic review. Journal of Epidemiology & Community Health, 64(7), 565-572.
Szczygieł, E., Węglarz, K., Piotrowski, K., Mazur, T., Mętel, S., & Golec, J. (2015). Biomechanical influences on head posture and the respiratory movements of the chest. Acta of Bioengineering and Biomechanics, 17, 143-148. https://doi.org/10.5277/ABB-00118-2014-02
Weon, J.-H., Oh, J.-S., Cynn, H.-S., Kim, Y.-W., Kwon, O.-Y., & Yi, C.-H. (2010). Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and Movement Therapies, 14(4), 367-374. https://doi.org/https://doi.org/10.1016/j.jbmt.2009.06.006