Hello and welcome back again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy related. The last blog post looked at my 5 top tips as a physiotherapist to avoid back pain, so I thought it might be a good idea to continue on the preventative theme and look at my top tips for avoiding neck pain.

Neck Anatomy 

As ever with physiotherapy before we can look at what to do about something we need to have an idea of the anatomy of the area and some of the structures involved. The neck is a complex area and we could spend a long time just looking at the specifics of the structures of the neck and how they work but in this article we shall aim to keep it straightforward. 

The neck is made up of 7 vertebrae (bones) which are labelled C1 to C7 with the C standing for Cervical. C1 & 2  are underneath the skull and you can't feel these but as you come down from the large bump on the back of your skull (called the occiput) you will feel C3. C7 is also fairly easy to find and will be the reasonably large bump as you descend down the spine. Each vertebrae has a disk and a nerve root leaving at both sides. The nerves then intertwine and mingle and join at the brachial plexus which is found either side of the neck and underneath your trapezius muscles. This "plexus" is where the nerves of the neck become the nerves of the arm such as the radial nerve, ulnar nerve and median nerve. There are also a large number of ligaments and tendons around each of the joints of the neck. Muscles connect into the neck allowing the neck to move through a large range of motion. Some of the more important neck muscles are trapezius - this is easy to find and is the two large bumps either side of where your neck joins your back. The scalenes and sternocleidomastoid are also very important for neck movement and stability and attach to the collar bone and first rib.

What Structures Cause Neck Pain?

Having looked at some of the structures in and around the neck, we can now think about what might be causing pain:

• Muscles: the neck has a lot of muscles which move the head and neck and also keep the head, neck and shoulders stable. Sometimes muscles such as trapezius, sternocleidomastoid and the scalenes get overloaded and they can become fatigued and cause pain.
• Spinal Joints: the neck has 7 bones (vertebrae) each of which articulates (forms a joint) with the bone above and below. Sometimes (often due to age) these joints can become irritated - a common reason for this being that the cartilage between the joints has become worn. This can then lead to neck pain and also commonly pain in the muscles supporting the neck.
• Intervertebral Disks: in between each of the vertebrae (bones) of the neck is a disk and as we age these tend to get thinner and more worn. This can in turn lead to the disk becoming irritated and causing pain which also commonly leads to muscular tightness and pain in an effort to compensate.

So, as we can see there are a lot of structures in the neck that can cause pain, next we need to look at some of the reasons that these structures can become irritated.

Why Does The Neck Become Painful?

We could clearly do an entire article simply on the causes of neck pain but below I have tried to give a short summary of the ways in which the neck can become painful:

1. Poor Work Posture/Positioning: many people these days work in an office and at a desk and often work long hours in a very static position. Now, when you are younger and have only just started your working career being in a constant poor posture may not cause you any problems but as you grow a bit older the structures in your neck such as your joints and the muscles start to protest and get irritated. 

2. Poor Sleeping Position: everybody (well almost everybody) will have gone to bed fine and then woken up the next day with a stiff and very sore neck. What has happened is that in the night you have moved and your head and neck have ended up in an unusual position and you ahve stayed like this for several hours and this has irritated the joints of your neck. Sometimes though we see patients who have too many pillows and are sleeping with their head and neck in an extreme angle and this is causing them to have a bad neck.

3. Trauma: any kind of impact or jarring around the head or neck can irritate one of the joints or ligaments in the neck and cause neck pain. Sports that involve physical cotact such as boxing or rugby can often cause neck pain. Another common cause of neck pain is whiplash from a road traffic accident although there is a large amount of dispute around this. 

4. Age: as with most conditions affecting the human body, age does unfortunately play a role in neck pain. As we age the structures in our neck get more worn and the disks and cartilage between the joints gets thinner and this means they can get irritated and become painful.

What to do to Avoid Neck Pain:

1. Look At Your Posture At Work

More so than for back pain, having a good posture whil;st at your desk at work is the real key to avoiding having neck and upper shoulder pain.

Now, there is a lot of debate about if there is even such a thing as a bad posture but I think we can all agree that the photo to the right hardly represents a great position and that it is reasonable to think that anyone sitting like that for extended periods might have some issues! It is important for anyone that sits at a desk for long periods as part of their work to have an office set up that promotes them having good posture. As a physio seeing people at home I always look at their home office set-up if they work from home and commonly it is not great. It is important to have a full DSE (Display Screen Equipment) assessment at work so that you can have a good work office set up that promotes good posture. In the meantime, for your home office these basic guidelines should help: 

• The top of your screen should be at eyelevel when sitting in the most upright position you can achieve.
• If on a laptop, you need a separate keyboard and mouse and you may need a laptop stand.
• You should be able to reach and use your keyboard and mouse with your arms hanging down and should not have to reach forward.
• Your desk should be at the same height as your elbows when you are sat upright (this stops then need to lift your shoulders to get your arms on the desk)
• You need a supportive and comfy office chair with arm rests that is height adjustable (a dining room chair is no good!)

2. Stretch and Move Your Neck

Throughout the day, give your neck a stretch and move it through its full range. You would be amazed at the number of people I see as a physiotherapist who almost immediately benefit from this simple piece of advice. Lots of people work at a fixed position and forget that they should be moving their neck and then wonder why it has gone stiff after being in the same position for 4 hours! Neck stretches are very simple to do and take very little time, the simple routine below will help keep problems at bay:

• Move your neck so that you are looking at the ceiling and now move it so that you are looking down to the floor and return to a neutral position.
• Turn your head to the left and to to the right.
• Roll your head around 
• Roll your shoulders a couple of time

I would generally recommend that this is done every couple of hours and by doing this you will feel if any stiffness is building up and you can address it.

3. Deep Tissue Massage

Get a regular deep tissue massage on your neck and upper back. This works wonders to relieve tension, reduce any build up of pain and generally keep your neck and shoulders feeling loose. Personally I would recommend that you see one our amazing physiotherapists for this!

I hope that you have enjoyed reading this blog post. For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk