In this installment of our “injury of the week” series we’re going to be talking about neck strains/sprains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system.
“I woke up and couldn’t move my neck.” Sound familiar?
While a good portion of neck strains and spasms occur following a traumatic injury (i.e. fall, bike crash, car accident, etc), an even larger portion occur after the fact. The muscles get overworked and stiffen up after the actual “injury”. That can occur hours later, at night while watching TV, or even overnight. So what actually causes it when there is no specific “injury”?
The simple answer is postural abnormalities.
Good posture means: shoulders back, neck in neutral position. Most of us do not sit or stand like this. Sure, we do when we think about it but more often than not we fall forward into a more comfortable slouch position. By itself, that isn’t a bad thing, but over time, we can actually get stuck in that position. Ladies? We are even more at risk for obvious reasons.
Here’s a picture showing what I mean. It’s not the exaggerated slouch we all see and ignore because we aren’t that bad, right?
In this picture you’ll see that: 1) the chin and head are forward, 2) the shoulders/upper thoracic spine are a bit rounded, and 3) the humerus/upper arm bone is rotated in ( see how the bone sticks out in the front just above the yellow?). Why is that bad?
- The muscles in the front of the neck get stuck in a short/tight position. Now they can’t move fully or contract fully.
- The muscles in the back of the neck/upper back are now stretched out and have to work hard to hold us upright. Over time, trigger points and increased tension will develop in them. If they get tight enough they can even pull up on your shoulder blades.
- As the the muscles in the back of the neck/shoulder get weaker, we actually stoop forward and the muscles in the chest get stuck in that short/tight position.
- As the front of the shoulder gets tight, the humerus rotates in and the scapular muscles/stabilizers get pulled into the mess.
What do you NEED to know after reading that?
The cervical spine is a dynamic part of the body. It’s stability and muscle balance carries over into how our arms and entire upper body work and vice versa. To function properly the muscles on both the front and back need to be both mobile and strong. More often than not we get tight on the front and the back gets beat up as a result, hence the trigger points and muscle strains we get.
My neck hurts. Now what?
First things first. Like we’ve said all along. This site is not designed to keep you from your doctor and healthcare team. It’s designed to teach you the things that you can do at home to help alleviate symptoms and prevent them from becoming a full blown injury. That being said, the neck is a complex place. If you have any of the following, time to see your doctor. Numbness/tingling anywhere in your neck/shoulder/arm. Burning pain or pain in multiple locations (i.e. into the shoulder blade or into the arm). Weakness in your hand or difficulty lifting your arm over your head. If you aren’t making any progress? See your doctor. Remember, the thing to keep in mind with nagging symptoms in the neck is that the pain/spasm don’t always have to be muscular in nature. It could be because a nerve got pinched in the cervical spine itself or in the muscles that run along it. Numbness/tingling/weakness are a big red flag for this, but so are continued symptoms that don’t improve regardless of treatment.
Be smart when self treating at home. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait weeks and even months before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:
- Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. A tight neck will definitely benefit from some hands on/massage work. When looking for someone on the ART list you’re looking for spine certified. If possible, someone certified with nerve entrapments is also a plus. Might as well cover all of your bases right?
- Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations, others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.
How to treat it.
Step 1- Symptom management
When a new muscle injury occurs, the first and most important goal is always to decrease pain and any inflammation that may be present. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge. Use that to your advantage when working to heal an injury!
Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery. For the neck, avoid overhead activities and heavy lifts. If you can’t pick it up with your elbows glued to your sides, it’s too heavy.
Ice: Typically I firmly recommend ice in the first seven days following an injury. It’s hands down the better option for decreasing pain and an absolute must for swelling reduction. However…in the event of a muscle spasm, I change that advice. Alternate them. Heat the muscles 10-15 minutes before any soft tissue work/stretching and then follow it up with ice 10-15 minutes. Once the acute pain is gone, switch over to ice only following your treatment sessions.
Step 2- Kinesiology taping:
The taping application for a neck strain/spasm is designed to help restore normal alignment.
- Taping application. Click here.
Step 3- Getting mobility back:
The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.
1) Rest/ice/heat + gentle stretching. There should be no pain with stretching.
2) Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> rest/ice/heat.
3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> rest/ice/heat.
4) Begin using the tennis ball/theracane for mobilizations. The order should be foam roll around injury -> over injury -> mobilizations -> stretch -> rest/ice/heat.
5) Begin using the tennis ball for cross friction + trigger point release. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.
How long do you need to rest/ice/heat for??? Until it’s 100% gone.
Here’s what it looks like for a neck strain/sprain. Use the guidelines above.
Step 4: Strengthening
We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.
What you’ll need: 1) To start? Nothing at all. 2) As you add resistance? Ankle weights/little dumbbells.
Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.
Hope that helps, and fire away with any questions in the comments section!
1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.
2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.
5) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.