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Neck, upper back and upper extremity problems have become a worldwide pandemic because of our time spent seated and our head-forward postures. The good news is that there is an antidote and we will cover it in this article. Neck and upper back problems represent a massive socio-economic and public health burden as recent studies have shown them to be the third leading cause of disability worldwide.
An understanding of basic anatomy is essential to grasping the impact that repetitive postures can have on pain, function, health and spinal longevity. The average human head, which weighs approximately 10-15 pounds or 4.5 -6.8 kilograms, sits on top of seven cervical (neck) vertebra (spine bones). The spine protects our vital and delicate spinal cord and spinal nerves and these bones are separated by discs that allow space for nerves to exit as well as being shock absorbers and necessary from normal range of motion. The spine, when viewed from the side, also has curvatures, similar to engineers creating curves in bridges, dams and other structures, for strength and flexibility. The spine is at it’s strongest when it has normal curves and appears straight when viewed from the front or back. However these curvatures and the position of the head in relation to the body can be altered from repetitive poor postures. This is commonly referred to as head forward posture or anterior head carriage (AHC). Forward translation of the head over the body by as little as 25 millimeters (2.5 centimeters) has been shown to add 10 pounds of strain to ligaments, muscles
and spinal discs and joints in the neck and upper back (thoracic spine). Craning your neck forward for brief periods of time is of little consequence but when done repetitively over time it can lead to degenerative musculoskeletal conditions associated with this area. This is similar to a car with a frame misalignment creating uneven wear in the tires.
Over the short-term people may experience neck, shoulder and upper back (between the shoulder-blade) tension. As months turn into years these postures cause spinal nerves to become irritated, compressed and dysfunctional while spinal bones and joints can degenerate from osteoarthritis (most common form of arthritis by far). The nerves that exit the cervical and upper thoracic spines can become dysfunctional causing problems with balance, vision, hearing, hormones, the jaw (TMJ), face, shoulders, arms, elbows, wrists, heart, lungs, gallbladder and more.
Many devices and therapies are available but I will discuss what I feel the most effective strategies are. Let me start by saying that there are ways of taping or bracing the neck and shoulder blades to improve posture but these are not optimal in my opinion. The reason for this is that your body becomes dependant on them and it’s not sustainable to wear tape or braces for longer periods of time. Typically these postures have been habitually developed over years and the solution is not a quick fix but a gradual improvement over time. Fortunately most people can gain pain relief quickly even if the cause of the problem (biomechanics and posture) is yet to be fixed. Some of the solutions I detail below are ways to incorporate new habits while others are ways to treat fibrotic
muscles and stiff misaligned joints.
- Awareness: I recommend setting a timer for every 20 minutes spent sitting at work or while studying. When the timer goes off, get up and move for 20 seconds, this is known as the 20/20 rule. Recall that when viewing the human body from the side that a plum (gravity) line drawn through the hip, should intersect with the knee, ankle, shoulder and ear. Be aware of the ear and shoulder line especially. It other words, keep your head over body and not craned forward or looking down at a mobile device such as a tablet or cell phone. This step is crucial to make progress.
- Head retraction exercises: My favorite exercise I call the ‘Angel’ because it is like doing a snow angel. I recommend doing it against a wall if possible as this is the most difficult. Here is a link to watch a video of it being performed. Stand against a wall or lie flat on your back. Retract your head (bring your head towards the wall or floor and if done correctly it should create double chins as your face moves evenly backwards) and slide your arms as low as you can then as high above your head as possible. The goal is to keep your wrists, elbows and shoulders against the wall or floor throughout the movement while keeping your spine in a non-arched posture. For best result perform this daily for approximately 10 repetitions.
- Massage therapy: Getting tough, leathery, fibrotic tissues broken-up will help increase motion allowing for exercises and stretches to be more effective.
- Stretching: Movement is life and stretching will help hydrate joints, let nerves slide and keep tissues supple. Following our featured video for a game changing stretch routine in this link.
- Chiropractic: Once spinal misalignments become entrenched chiropractic care is needed to restore alignment, motion and proper nerve functioning. Chiropractic is a performance enhancer and will allow stretches, massage and exercise to be more effective. Plus chiropractic helps connect you to your deepest self, allowing for increased clarity and inner awareness.
- Foam Rolling: Using a foam roller can help break up global adhesions in the upper back. This is not a replacement for a skilled massage therapist.
- Work place ergonomics: Adjust the chair, desk, monitor, phone, mouse or reading material so that you can perform your work in an optimal biomechanical position.