Neck & Shoulder pain exercise & treatment

Pain or deep ache of the neck, shoulder or arm(this needs to be differantiated from true shoulder pain, such as tendonitis\bursitis).  There may be burning or tingling of the arm or hand or headaches. It may be continuous, or only occur when you are in a certain position. 

The pain may be aggravated by turning your head, looking up or looking down ( as with reading).limited range of motion (less than normal movement) of the  neck. Stiffness of the neck and shoulder muscles.

Causes:               

1. Postural strain ( improper position when sitting - reading - working at a computer)
2. Severe blow or fall.
3. Car accident
4. Heavy lifting.
5. Sleeping without good neck support/sleeping on your stomach
6. Turning over while you are asleep. Then waking up with a "stiff neck."
7. Degenerated/ ruptured cervical disc.
8. Bone spur.
9. Nerve dysfunction.
10. Osteoporosis, tumors.
11. Spondylosis (hardening and stiffening of the spinal column).
12. Congenital problem.
13. Often there is no obvious cause.

How Are Neck and Shoulder Pain Diagnosed?

• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
• MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.
• Myelography/CT scanning: Sometimes used as an alternative to MRI
• Electrodiagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.

Risk Increases With:

1. Sitting for long periods and bending your head /neck forward.  (desk work, cooking, etc.)
2. Participation in sports without warming up ( stretches).
3. Sharp increase in athletic activity (weekend athlete)
4. Poor posture with sitting - sleeping.
5. Frequent travel on planes.
6. Falling asleep sitting up.(head hanging down)

How to Prevent:

1. Exercises to strengthen /stretch neck and shoulder muscles.
2. Learn how to sit and work without bending your neck.
3. Proper back & neck support for your car/bed/sofa/chair.

For each neck exercise:

1. Move smoothly and slowly, without sudden jerks. The key is precision and control.
2. Keep your mouth and jaw relaxed. Keep lips together, teeth slightly apart and let your tongue rest on the roof of your mouth.
3. Gently hold your shoulders back and down so that they are relaxed while doing all exercises (see posture correction exercise, exercise 4)
4. In movement exercises, try to move the same distance to each side. If one side is stiffer, move gently into the stiffness. Move to that direction a little more often.
5. Expect some discomfort, but remember exercises should not cause severe pain.
6. Neck exercises lying down: Lie down with a soft pillow under your neck, and with your knees bent up.

1) The chin nod neck exercises:

Gently and slowly nod your head forward as if to say ‘yes’. Feel the muscles at the front of your neck. Stop the nodding action just before you feel the front muscles hardening.	Hold the nod position for five seconds and then relax. Gently move your head back to the normal start position. Repeat up to 10 times.

2) Head rotation neck exercises:

Gently turn your head from one side to the other. Look where you are going. Progressively aim to turn your head far enough so your chin is in line with your shoulder and you can see the wall in line with your shoulder. Repeat 10 times to each side.

3) Shoulder blade exercises:

This exercise will relax and ease any tension in the muscles on top of your shoulders. It will help to give you pain relief.
Lie on your right side with your arm resting up on two pillows.	Roll your left shoulder blade back and across your ribs towards the center of your back. Hold the position for 10 seconds. Repeat 5 times.
Repeat lying on the left side for the right shoulder blade.

Neck pain exercises while sitting:

4) Posture position exercise:

Correct your posture regularly by gently straightening up your lower back and pelvis (sit tall). Now gently draw your shoulder blades back and down (women towards their bra clip). Gently tuck your chin in. Hold the position with ease for at least 10 seconds. This position will prevent and ease muscle pain and tension in your neck and shoulder muscles. Repeat the correction regularly, every half hour during the day. You can do this exercise at work, in the car, train or bus and sitting at home.

5) Neck retraction exercises:

Sit in the correct postural position as shown in exercise 4 above.
Gently draw your head back, sliding your chin back horizontally and keeping your nose pointing straight ahead. You should feel the retraction movement at the base of your neck and your neck should stay long. Repeat this 10 times every hour when sitting.

Neck movement exercises: Sit in the correct postural position as described in exercise 4. Repeat all exercises below 10 times to each side.

6) Rotation neck exercises:

Gently turn your head from one side to the other. Look where you are going, progressively aim to see the wall in line with your shoulder. This exercise is similar to the one you did lying down. This time you do it sitting. Your neck should stay long. Repeat this 10 times every hour when sitting.

7) Side bending neck exercises:

Gently tilt your head towards your shoulder and feel the gentle stretch in the muscles on the side of your neck. Perform the movement to both sides.

8) Bending and extension neck exercises:

Gently bend your head towards your chest. Lead the movement with your chin. Moving the chin first, bring your head back to the upright position and gently roll it back to look up towards the ceiling. Leading with your chin, return your head to the upright position.

Neck strengthening exercises (Exercises 9-11) should only be started later in your recovery. If unsure when to begin this, ask your treating health professional.

9) Neck strengthening exercises (isometric, no movement exercise):

Sit in the correct postural position as described in exercise 4. Make sure your chin is relaxed and slightly down. Place your right hand on your right cheek. Gently try to turn your head into your fingers to look over your right shoulder but allow no movement. Hold the contraction for five seconds. Use 10% to 20% effort, no more! Repeat with the left hand on the left cheek. Do five repetitions of the holding exercise to each side.

Neck strengthening exercises with 4-point kneeling:

Firstly, adopt the 4-point kneeling position. Begin by ensuring your knees are directly under your hips, and your hands under your shoulders. Your low back should be in a neutral position that is, with a natural arch. Gently draw your belly button to your spine (10% effort). Push gently through your shoulder blades, so that your upper back is level. Draw your shoulders gently away from your ears, or toward your hips. Lift your head up so that it is level with your shoulders, but maintaining a gentle chin tucked or nod position. Once you can hold the safe 4-point kneeling position, then proceed with the neck movement exercises as described below:

10) Neck bending and extension exercises in 4-point kneeling:

Adopt the safe 4-point kneeling position. Slowly look up toward the ceiling as far as you can go. Hold for 5-10 seconds. Follow this by slowly bending your neck, leading the movement with a chin tuck or nodding action. Continue the neck bending movement as far as possible, aim for your chin to touch your chest. Throughout this movement you should hold the neutral lower back and shoulder blade posture described above. Perform 5-10 repetitions.

11) Neck rotation exercises in 4-point kneeling:

Adopt the safe 4-point kneeling position. Slowly rotate (turn your neck to one side). It is important to maintain the gentle chin tuck or ‘nod’ position throughout the movement. Also, make sure your head stays level with your body, and does not drop down. If you do this exercise correctly, you should be looking over your shoulder at the end of the movement. It helps to do this exercise side on to a mirror so that you can check your head position. Repeat to the other side.Perform 5-10 repetitions.