Pain happens. In my previous article I described the different factors that influence the sensation of pain. For a quick recap, pain is a multi-factorial process influenced by a person’s biology, psychology, and their environment and social context. All of these factors determine whether you will feel pain, not tissue damage itself. Once you understand these concepts that are influencing pain you can start to use this information to manage some of the aches and pains that happen to all of us. Here’s a possible scenario of how to handle pain in your neck.
You wake up in the morning raise your head up off the pillow and, OW! Your neck seems to be a bit annoyed. Yes, you’ve tweaked your neck, the fancy term is torticollis. You turn your head one way, all good, try the other way, NOPE! The intense pain in your neck makes you want to stop all of your movement, baby the area, and hope it goes away. That’s one option, but there are more effective ways to get rid of that pain in your neck. This signal of pain from your neck is a message of possible threat. Whether or not it is a real threat to your system has to be assessed. So first check in and assess the situation. In this case it’s probably not a broken bone and there’s no blood. If there was you would take the next Uber to your closest ER. Next, is there is any numbness, tingling, or radiating pain? If you answer yes, that can suggest nerve involvement, and again it’s a good idea to get checked by a doctor.
ACTIVE RANGES OF MOTION
After your initial assessment you conclude that it’s a familiar tweaked neck involving just some annoyed muscles. Now check what pain free ranges of motion you have. Check rotation by looking side to side, then flexion and extension by looking up and down, and finally lateral flexion by bringing your ear towards your shoulder on both sides.
This covers your basic ranges of motion in the neck. If you’re someone who likes values and measurements you can note how far you were able to go in each of the ranges by picking a place to stand and note how far you can see in each direction. The next time note if you were able to see a bit farther.
PASSIVE RANGES OF MOTION
Next, you can check your passive movement, which is tested by seeing how much movement you have with no muscles contracting, in essence how far do you move if you were a rag doll. If someone is helping you test passive neck rotation you lie down, while a practitioner cradles your head, and then rotates it side to side. This is obviously the best way to test passive movement, but there are still options of how to do this on your own.
PASSIVE RANGES BY YOURSELF
Neck rotation: If you are by yourself, lie down and rest your head on a hand towel. With your left hand start to slowly pull the towel out from under your head, and your head will start to rotate to the right. Your head will be pulled by the towel so keep your neck muscles as relaxed as you can, remember rag doll. Your arms should do all the work.
Neck flexion: To test flexion keep your head on the towel and grab each end of the towel and cradle your head. Now pull the towel up to raise your head off the ground to bring your chin to your chest, again using just your arms to move your head
Neck extension: To get extension you can lie on your back on the end of a bed. Cradle your head with the towel and push yourself to the edge of the bed so that your head will have space to go back towards the floor. Slowly lower your head down using your hands to hold the weight of your head the whole time.
In the last example you’re passively getting neck extension. If you try that same maneuver actively such as standing and looking up at the ceiling, ouch, it’s way too painful. But lying down, and staying passive you can move the area and access that range of motion that you didn’t have actively. This passive movement enables you to keep the area moving which allows tissues and fluid to move back and forth which speeds up recovery.
PLAN OF ACTION
In the morning, pain and stiffness tend to be worse mostly because we don’t move much at night. This fact further proves the point that lack of movement exacerbates pain symptoms. So movement is our key to healing. It’s ideal to use exercise such as walking because it gets the blood flowing, warms the whole body, and is analgesic systemically.
If you do not happen to be a morning person and can’t get out for a walk you can also warm the area externally with a hot shower or heat pack. Once the area is warmed up you can try some of the passive movements above followed by some of these different movement techniques below.
FitTip: Keep moving! Movement is our key to healing. If you have ranges that are painful to move try to find a different position that is less painful that allows you to get the movement. You can also try to use your hands to cradle and support the injured area to very slowly get a few more degrees of movement.The faster that you get back all of your ranges of motion the faster you will heal.
Say you can move your head 45 degrees to the right. Let’s start with that, rotate your head right up to the edge of pain at 45 degrees pushing into the pain just a bit. On the next rotation try to go a bit further, by the tenth rotation you might be at 55 degrees. That’s 10 degrees more rotation, woohoo! A physiotherapist, Cory Blickenstaff, calls this method Edgework. If you move repeatedly and slowly to the edges of pain you can slowly open the area up bit by bit.
When you open up more degrees of pain free movement your brain sends less messages of threat. When the brain senses less danger this equals less guarding and eventually bringing back all your freedom to move.
FitTip: Note in the early stages the increased ranges described above might only last an hour. You may have to repeat the range of movement exercises every hour at first to keep the ranges open as long as you can. Luckily these are fairly easy to do and can usually be done at a desk. For the neck, all you’re doing is moving your neck in all its ranges. For an ankle it might be simply doing toe taps and ankle circles every hour. Use an alarm clock to remind yourself hourly or every half hour to move the joint as much and as often as your can. Also remember the factors that influence pain, the better you take care of your body with sleep, nutrition, and stress the faster the healing process is.
This next technique is simply tricking the system by changing context, no not moving to a different room to stream Netflix, but changing the relative movement. In the above example you tried to turn your head to the right and you just couldn’t bear it. Instead try to fix your eyes on a spot, keep your head still, and rotate your body to the left. Voila! You relatively speaking attained right neck rotation. You simply moved your body relative to your neck to gain the position. It’s like twisting the bottom of a jam jar off a stationary top, instead of twisting the top off the stationary jar.
If you move your neck when it’s highly sensitized your brain might freak out, but if you move your body around your neck the brain is late on the uptake and won’t send out 5 alarm sirens. You can use this technique of changing context with any body part. If you can’t bend your back to reach your toes, lie down and bring your knees towards your chest. In both cases you obtained flexion at the hip you just took a different route to get there.
While you are locally addressing your tweaked neck you simultaneously want to address your body as a whole to optimize your pain tolerance. The physiotherapist and educator, David Butler, advises people to increase their safety in me’s, or SIMs, which are synonymous with the more familiar buzz word self-care. SIMs are all those self-care tactics that benefit the fitness and health of the body and mind.
For an example, think of how your tweaked neck felt the morning after three hours of sleep, having a diet of snickers and coke for two days, having had a fight with a friend, and no exercise all week. Your pain tolerance is suboptimal and your neck is probably killing you. Now think of how your neck might feel if you got a full night sleep, ate well, went for a hike in the forest with your buddy, and got a massage after completing all your deadlines at work.
The second example is chock full of SIM’s. These practices fortify, rejuvenate, bolster, and create an environment in your body that increases your tolerance to pain such that at the end of the day you realize you hardly remembered your neck was bugging you.
These are effective techniques to use in the beginning stages of injury that will enable you to get back in action quicker. After your neck is less sensitive and you feel a bit stronger, this is the stage where you start to increase your exercise, and begin to load and strengthen the specific joint. How you progress with strength training is dependent on age, fitness level, and experience with weightlifting.
We all get hit with injury at different points in our lives and it’s important to figure out the fastest and most effective way to get yourself back on track. Injury can be frustrating so your ability to have a smart plan and sense a feeling of progression can help keep the frustration at a minimum. It’s also important to figure out alternative ways to keep movement in your daily practice even in the face of injury. If you can’t run, try biking, swimming, or walking. Maybe you will go to a local yoga class as an alternative exercise and find it appealing, now you have yet another movement practice you can explore.
Keep on moving!
RECAP OF YOUR PAIN SCIENCE BASICS:
1) Pain is a useful and important function of our body. It serves as a threat detector or an alarm system to make us pay attention, check in, assess the present situation, and elicit action or not.
2) Sensation of pain is the culmination of multiple inputs of information coming from the environment, body, and brain that sends a report of pain, or no pain.
3) Tissue damage is not correlative to pain. In other words, you can have pain with no damage, or damage without pain.
4) Pain with no damage is evidence that the alarm system is too sensitive sending messages of threat when there are none. This hypersensitivity is created by a maladaptive system either at the site of pain, spinal cord, or brain.
5) Pain happens. Try to be a bit more accepting of discomfort every so often. Being fearful and alarmist about pain can increase pain sensation.
Catherine Cowey M.A. is a personal trainer and post-rehabilitation expert working for over twenty years in the Bay Area. She teaches workshops and is a contributing writer for several fitness websites. You can find out more on her website www.fitwizesf.com.
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