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Chronic Neck Pain: What are the Possible Reasons, and How Can Clinical Pilates Help?

“Sok Ching is a registered Physiotherapist and Clinical Pilates specialist working at Body in Common. She shares some of her wisdom in dealing with Chronic Neck Pain.”

Neck pain is one of the most common issues that people experience, ranging from a mild annoyance, to completely debilitating. It affects men and women of any age, fitness level, and health level. Ever since ancient humans took the leap from moving on all-fours to standing up straight, our neck has taken on more and more stress.

Whether you’re in your teens, middle age, or old age, you might have had days where you’ve woken up in the morning with a stiff neck, and feeling like you’ve barely slept at all! With that said, have you ever wondered what exactly is happening within the neck?

The neck, (medically known as the Cervical Spine), is a complex structure which is more than what you think it would be.
The Neck is a Very Complex Structure

While it’s a fairly complex topic, here is a simple breakdown of your neck:
The Cervical Spine is made up of seven pieces of uniquely shaped bones (vertebrae) connected on top of each other. In between these seven bones, there are soft discs that separate them apart. These discs are crucial in supporting your neck, as they provide a cushion-like effect to the bones, as well as allowing a much greater range of movement than you can get if bone was stacked on bone.

At the top of the Cervical Spine, the top segment connects directly to the skull; and at the bottom it connects to the next section of the spine, which has a different curve and different bone shapes (called the Thoracic Spine).
Just like the Thoracic (Upper) and Lumbar (Lower) spine sections below, the Cervical Spine also has joint “holes” (Foramen) where the spinal cord can pass through smoothly. The spinal cord runs along the spine right from the base of the skull down to the base of the Lumbar spine above your tailbone. Along this spinal cord, there are spinal nerves that emerge from it. These spinal nerves come out between each level of the vertebrae, and are in-charge of giving us our complex motor-sensory control. They are the central ‘phone-line’ between our brain and the rest of our body.
With such a complex structure that not only moves, but also signals the rest of the body, it is easy to see how even the slightest imbalance can cause major discomfort and issues throughout the body!

Neck Pain Affects Everybody

Why Most of us Don't Fix Our Neck Pain

It’s common to hear people say: “No, I’ve never had neck injuries before – it’s just painful!”

This is where the Chronic pain usually comes in. People feel that because they’ve never done any neck injuries, they don’t need to seek medical help. Slowly, over time, the pain and stiffness gets worse. Sometimes it even gets temporarily better too. You learn to live with the pain instead of fixing it, and soon enough, it’s just the way you’ve always felt.

You don’t need to have serious injuries to seek medical help. Pain or discomfort in any parts of your body might might mean that something small is out of balance, and you should find out the reason as soon as possible before it worsens. Living a pain-free life is one of the most important things you can do!

When it comes to Chronic muscular-skeletal pain (such as neck pain), Physiotherapists are the right specialists for the job. All Physiotherapists are registered professionals with University degrees and countless hours of hospital and private-practice training. Consulting a physio will be a good idea here, because not only do you get your pains assessed, we also go through a thorough physical assessment based on your condition to pin-point the underlying issues so that we can work on a plan to address the problems.

Chronic Pain vs Acute Pain - Who to See?

There are three categories of pain, and each type is usually seen by a different specialist.

Acute pain is the ‘immediate’ type that has been caused by a recent injury, followed by Sub-Acute pain after the first week as things heal. This type includes things such as car accidents, sports injuries, and falls. This type is focused on healing, repair, and rest. Acute pain usually lasts between 3 to 7 days. When you have acute pain, the right person to see is a Sport-type or Injury Rehabilitation Physiotherapist, and this is the type of Physio where you see the electro-therapy machines and ultrasound.

The other type of pain is Chronic Pain. This is the type of pain that may be caused by any range of reasons, and can stick around for weeks, months, and years. It might be that nagging knee, annoying shoulder, or stiff neck. It’s also our Specialty here at Body in Common. This type of pain is the type that you think you can just put-off for another day, because you don’t know who to see about it anyway. Well now you know: You can come to see us!

Common Causes of Chronic Neck Pain

Here are some of the possible reasons of chronic neck pain:

1 - Postural Neck Pain

Postural pain is usually caused by long-term adaptations of our muscles in an improper way, commonly caused by bad postures. The most amazing thing about our bodies is the ability to adapt and compensate when things go wrong. If you hurt your dominant hand, you’ll eventually learn to use the other one. If you hurt your back, you will start walking in ways to avoid the issue.

Unfortunately, this fantastic adaptability can also cause major imbalances in our body over time. If left uncorrected, we develop all sorts of aches and pains as a result. Some muscles eventually become tighter on the overworked side, while muscles on the other side can become weaker and longer.

Eventually, poor or unnatural posture will lead to neck tension as the muscles get over-worked and out-of-position. This tension can extend up into the skul (causing headaches), as well as down the shoulders and upper back.

I’m pretty sure everyone of us has been reminded since young to “sit up straight”, “don’t slouch”, “don’t spend too much time on your phones”, and offices giving advice on “proper sitting ergonomics while working on desks”. It’s all sounds quite easy, however ‘sitting tall’ is just one small part of the posture puzzle.

The two very common postural changes causing neck tensions are the head protruding forward (forward head poke) and slouching/ rounded shoulders. When you sit in a slouched position, your shoulders naturally round forward. Over time, the front of your chest (pectoralis muscles) become very tight. At the same time, the opposite muscles (antagonists) on your upper back and shoulder blades will gradually become weaker.

From here, if your neck is protruding forward, it forces your upper shoulders (the upper trapezius) to be put under stress all the time because they have to work extra hard to hold onto the head, which is constantly falling forward.

Imagine holding onto a heavy box for hours with your arms extended forward in front of you. Your muscles will ache, cramp, and cause all sorts of problems! The same concept applies to the upper shoulders/ upper trapezius. Our head on average weighs about 4 to 5 kilograms, which is quite heavy. If it’s falling forward for such a long time, think of how much stress the upper trapezius has to take on. Aside from the upper trapezius, the smaller ‘accessory’ muscles surrounding the neck such as Scalenes, Sternocledomastoid, and Levator Scaps also become overworked unnecessarily. Not only that, it also causes weakness in the deep neck flexors located in the front of your throat. These muscles have to be strong for your neck to be retracted back to sit in alignment.

Long Story short: when your head is out of position, some muscles become too strong and tight, while others become weak, causing permanent pain.

2 - Chronic Neck Pain from Structural Issues

Unlike postural pain that is usually caused by muscular involvement only, pain caused by a structural factor is due to changes in the physical structure of the vertebrae itself.

Some of us may just naturally have a differently aligned cervical spine that is flatter in the curvature, causing the neck to be stiffer than the rest. A stiff neck may limit the movements in the neck, and overtime causes tension to build up as well. A stiff neck will cause the surrounding muscles in the neck to stiffen up, thus making them tighten. However, if the condition worsens, it may lead to more than just muscle tensions. For instance, it may cause the tips of your vertebrae to come in contact with each other more vulnerably compared to a neck that has more joint spaces in between.

Other structural changes in the neck may include degeneration in the vertebrae or discs. Worst cases may lead to growth of bony spurs, narrowing of spaces in the vertebral foramen, or also known as the “holes” for spinal cord to pass through, or sometimes locking in one of the segments of the vertebrae. These kinds of changes usually disrupt the neural structures in the spine, causing symptoms like numbness, pins and needles, reduced or loss of sensation in your arms, or weakness in the arms. These will be discussed below.

3 - Chronic Neck Pain from Neural Issues

Our neck consists of neural structures that supply motor and sensory functions to our arms, all the way to the fingers. Sometimes the nerves may be slightly irritated, or even compressed in severe cases. Depending on how bad the nerves are affected, the severity of the symptoms will defer. Not only that, the area of symptoms will usually guide us to determine the affected areas in your cervical spine. Different levels of your spinal and peripheral nerves supply different parts of your arms, forearms, hands, and fingers.

Oftentimes, these kinds of problems can be solved if accurate intervention is done by your healthcare practitioner. Always seek medical advice for the best guidance.

How Can Clinical Pilates Help Chronic Neck Pain?

Time for the good news! Chronic Neck Pain can usually be improved, and in many cases, can be completely solved.

Depending on the severity of your condition, your practitioner will decide on the plan of your recovery. If your condition is at the irritable and sensitive stage, your Physiotherapist will first need to address the immediate pain with some short-term treatments, so that you can get back some quality of life. To do that, several techniques can be done, either to release the tension in the overworked muscles, mobilizing your spine for better mobility, or reducing the compression on the nerves.

Once the immediate pain is under control, the next and most important step is to fix the underlying causes of the pain. A short-term solution is no good if it means you’ll be unwell again next week!
This is where Physiotherapy-driven Clinical Pilates is a fantastic tool for solving the underlying cause of your Chronic Neck Pain.
Clinical Pilates’ role is for you to start working on the imbalances of your muscles, as well as getting more mobility through the spine. After getting a proper assessment with your Clinical Pilates Instructor, you’ll then find out which part of your body that you have to work on.
Our bodies are complex, with muscles overlapping each other, and hundreds of bones making up the structure. Oftentimes when you have neck pain, you may find that causes may be in different parts of the body. For example, a small issue in your knee may cause spinal misalignment – ultimately leading to neck pain! Because of how complex our spine and body is, a full-body assessment is important for any case. If one problem arises, something else will also appear, either it is a compensated response, or a pre-existing issue that was never addressed until the current problem has appeared.
For instance, you will need to work on stretching out the tight overworked muscles such as upper trapezius, scalenes, and pectoralis. You will be taught on the correct method of stretching them out to get the maximal effect. Along this, you will also need to build strength to your deep neck flexors, and also rhomboids. All of these may seem overwhelming, but with proper guidance, you will work your way step by step.
What is the Clinical Pilates Process?

The first step is to do a Full Body Assessment. This involves analyzing posture, gait (walking type), where the pain is, range of motion, and many other factors. Once this analysis is done, we have usually found the majority of the underlying causes of the Chronic Neck Pain. We then design a personalized programme to suit those causes.

We then teach this programme to you over a series of 3 weeks – usually with 2-3 sessions per week. Every exercise is targeted to strengthen weak muscles, and also to lengthen and even weaken muscles that may be over-acting. We also need to teach behavioural and postural changes to truly fix the issues.

Real Pain Relief without Drugs or Surgery

After six sessions, most clients have already found significant relief and are living with a higher quality of life.
If you have Chronic Neck Pain (or other Chronic pain), we hope that this article gives you the courage to contact your Physiotherapist and start to solve issues that you’ve been living with for too long.

“Body in Common is an Australian-Style Physiotherapy Studio in Bangsar, Malaysia. We provide Physiotherapy and Clinical Pilates services in our studio, as well as online Telehealth services. Feel free to get in touch and look after yourself.”