AND THE RELATIONSHIP TO
CHRONIC NECK PAIN
“Headaches and tension in the shoulders and back are often created by chronic bad posture. If you’re slouching, you may also have gastrointestinal reflux or feel fatigued because you’re unable to breathe deeply.” Spokesperson for the American Physical Therapy Association (APTA); New York City Physical Therapist, Peggy W. Brill
Your body is designed for good posture. What I mean by this is that your spine is specifically designed with a number of curves in it (see animation). No; these are not the side-to-side curves that are known as 'Scoliosis'. These are the curves that can be seen from front-to-back when looking at people in profile. Your neck and low back should have what are known as lordotic curves (lordosis), while your mid back and sacral areas should have an opposite curve --- a kyphotic curve (kyphosis). All too often and for a whole host of reasons, this is not the case. Note that in the animated skeleton to the left, the neck actually has a degree of FHP or "FORWARD HEAD POSTURE".
Despite the fact that medical radiology reports will usually mention loss of normal lordotic curve in the c-spine if it is present (more often than not, it is), your doctor will never mention this to you as a potential source of your neck pain (NECK PAIN, RADICULOPATHY, HEADACHES, etc). About the best you can hope for is to be given a few stretches to help loosen things up a bit. At worst (this is more typically the case), you'll be prescribed PAIN KILLERS, NSAIDS, MUSCLE RELAXERS, and CORTICOSTEROID INJECTIONS --- and when those don't work, ANTIDEPRESSANTS. My goal with this post is to help keep you off of drugs and out of the surgeon's office. In other words, I want you to leave my clinic with an EXIT STRATEGY in hand.
A FEW COMMON CAUSES OF POOR POSTURE
- BORN THAT WAY: Although this is used as an excuse far too often, there is some degree of truth to it. All you have to do is look at family pics to figure this out. However, whatever sort of spine / posture you were born with; there are things you can do to improve and maintain it. EPIGENETICS rule over genetics.
- PAIN: I hear it all the time; "If I sit up straight, I hurt worse. Slouching and slumping helps relieve some of the pain in my neck and between my shoulders". If this is in fact true, it merely means you have to deal with the underlying cause(s) of your pain. See next bullet point.
- OLD INJURIES: I cannot tell you how many people I see on a day-to-day basis whose pain started with some sort of injury. One of the most common is WHIPLASH (whether caused by a CAR WRECK, ABUSE, or something else). Another is SPORTS INJURIES. Muscle Guarding / Splinting and SCAR TISSUE (often referred to by the medical community as "FIBROSIS") are commonly found together after these sorts of injuries --- often years or even decades after the fact. Injuries also tend to lead to muscle imbalances, which work in tandem to create poor posture. The poor posture causes further muscle imbalances, which can lead to more Scar Tissue, Fibrosis, and Adhesion. Repeat. The end result is always degeneration of all affected tissues (HERE). If you want to see a real-life example of this phenomenon in action, HERE it is.
- BAD HABIT(S): When I was in school, if you slumped or slouched, a teacher was going to say something to you (I had a shop teacher who would actually throw a chalk eraser at you if you slumped in your chair). Now it seems like the worse you can slouch, the cooler you are --- sort of like wearing pants so low that half your boxers show. Thus, poor posture causes more of the same. Your body will eventually recalibrate its PROPRIOCEPTION / MECHANORECEPTION so that slouching seems normal. Trust me; good posture does not get easier as you get older.
- STRESS: How many people do you know who are under serious stress that are able to maintain great posture? Not many. Stress tends to fold you up into a ball (HERE). I realize it's far too easy for me to simply tell you to de-stress your life. But truthfully; figure out what it will take to have less stress in your life and do it.
- AGE: As we age, we tend to slump forward (HERE). Simple as that. Read the next bullet point to understand this phenomenon better.
- POOR NUTRITION / OSTEOPOROSIS: Despite what you have been told, there are some things that you can do to help your cause when it comes to OSTEOPOROSIS. As an osteoporotic spine is pulled forward, the fronts of the vertebrae start to 'compress' into a wedge shape. This pulls the body forward even more. Can you see a viscous cycle forming? Click on the link above to learn how to defeat Osteoporosis.
- POOR FOOT MECHANICS / POOR FOOTWEAR: Unfortunately, I learned about this one firsthand. If you constantly wear flip flops or crappy shoes; or if you have poor biomechanics of the feet, it can cause postural abnormalities that can literally affect your entire body ---- including your neck.
HOW TO COMBAT POOR POSTURE
HOW TO MAINTAIN GOOD POSTURE
- GET RID OF UNDERLYING SCAR TISSUE AND FASCIAL ADHESIONS: These were covered at length in my post called GETTING RID OF CHRONIC NECK PAIN: PHASE I. Be aware that this is not where this bullet ends --- not by a long shot, as now you'll have to RESTORE NORMAL NECK CURVES in order to restore normal posture. I covered restoration of normal cervical curve in PART II.
- GOOD NUTRITION / PROPER HYDRATION: It stands to reason that if poor posture can, at the very least, be related to poor nutrition, it might be beneficial to work on that area. I have written about this extensively. HERE is where you can start to learn about real nutrition. And seriously; if you are one of those people who struggles with Chronic Neck Pain and are drinking anything other than good old H20 --- shame on you! INFLAMMATION is at the root of nearly every problem imaginable, including neck pain. It is not a reach to come up with a couple dozen ways that increased levels of Inflammation could affect your posture (much of it revolving around the fact that OVERWEIGHT / OBESITY are both considered to be "inflammatory".
- EXERCISE / STRETCH / CORE STRENGTH: While it is not universally true, for the most part, if you are doing these three things, your posture will be better than those who are not ---- usually much better. HERE, HERE, and HERE are some links to get you started in this area. You will have to spend some time studying this one on your own.
- FOCUS: In order to create good posture, you are going to have to think about what you do, as well as pay attention to the way that you sit and stand. Whether sitting or standing, use a mirror (or better yet, have someone take a picture of you when you least expect it) to monitor your progress.
- PROPER ERGONOMICS: I once had a UPS driver who would not get better. He would do OK for a few days and then start hurting in his upper back again. I could not figure it out until he showed me his truck. As crazy as it sounds, the seat was off-set from the steering column by nearly a foot. They gave him a different truck; problem solved. A couple things I will mention here is using an Exercise Ball as a work chair, as well as using a 'Stand Up Desk'. After reading the article, "Sitting is the New Smoking," I am going to start standing much more.