The neck and shoulders take a lot of physcial stress and abuse, turning this way and that, nodding, bobbing, jerking, lifting, hunching and straining all day long. In fact, neck and shoulder problems are among the most common injuries. In addition to physical injury, we carry a lot ot stress and tension in out necks and shoulders.

The following simple exercises can help relieve stiffness and tension, and help strengthen the neck and shoulders against injury.

However, be careful when working with your neck and shoulders. Move slowly and deliberately. Pay attention to which muscles are being used. Never go beyone your edge of comfort. This isn't a workout, test or competition.

1. Chin-to-chest. Inhale and as you exhale slowly lower your chin to your chest, creating a long, gentle stretch along the back of the neck. Take several slow, deep breaths with the chin down. Liftthe head back up on an inhale. Repeat.

2. Ear-to-shoulder. Inhale and then as you exhale slowly lower your right ear toward your right shoulder. It won't reach, but don't worry about it. Breathe into the gentle stretch created along the top of the left shoulder and left side of the neck. Take several slow deep breaths. Inhale and raise your head back up. Repeat on the other side.

3. Neck roll. Follow the instructions for ear-to-shoulder, then roll the chin down toward the chest, across the chest and up the other side. Inhale and as you exhale roll the chin down across the chest and up the other side.

4. Shoulders-to-ears. Inhale and raise your shoulders up to your ears, pulling them up as high as they'll go. Then let go with an "ahhh" and drop your shoulders back down. Repeat several times.

5. Shoulder circles. Raise your shoulders up, rotate them back and down, forward and up again. Repeat several times then go in the opposite direction.

How you do these exercises is most important

• slowly
• with awareness
• ideally synchronised with the breath
• gently
• sensitively focusing inwards trying to detect what you can feel
• a couple of times a day if one wants to remove pain
• even after the pain goes

Shoulder rotation

Moving shoulders forwards and back

Its not rocket science, be creative ;-)

Swimming front crawl

Gradual bend forwards and back up

Neck movement, to side

Neck movement, looking to side over shoulder

Neck movement, head moving forward and back

Neck movement; rotations

Just because these movements are simple, does not mean they are not effective

Awareness improves as time goes on

Recommendation from one person who has benefited from the above movements

And the secret is ...

Summary

Neck pain is a symptom caused by stress to the soft tissues, bones or joints of the the cervical spine or nearby structures. In some cases, neck pain may also result from underlying diseases in the neck or another part of the body.

The neck is the most flexible region of the spine. It also supports the weight of the head. However, the neck is vulnerable to many potential injuries and disorders that produce pain and limit motion.

A variety of factors can contribute to neck pain, including bad posture, trauma and degenerative disorders. Sources of neck pain range from fractures to meningitis to osteoarthritis to polymyalgia rheumatica to whiplash.

In most cases, neck pain can be treated at home using over–the-counter medications, heat therapy, cold therapy and rest. However, pain that does not resolve within two weeks requires the attention of a physician or other healthcare professional. Prescription medicines, physical therapy, manipulation therapy and other treatments can cure the vast majority of cases involving neck pain. In rare cases, surgery may be necessary.

About neck pain

Neck pain is a common medical condition that can result from many types of stresses. Bad posture, accidents, injuries and degenerative disorders may all be responsible for causing pain in a person’s neck. In other cases, underlying disease, such as fibromyalgia, may cause neck pain. Rarely, infection of the covering of the brain can cause neck pain.

The neck is composed of seven bones called vertebrae that begin in the upper torso and end at the base of the skull. Other features of the neck include muscles, tendons, ligaments, facet joints, nerves and shock-absorbing intervertebral discs that separate the vertebrae.

The vertebrae in the neck comprise the cervical spine. The bony vertebrae and ligaments of the neck provide stability to the spine, and the muscles allow for support and motion. The nerves in the neck also spread down into the arms.

The neck allows for a great degree of motion and supports the head, which can weigh up to 10 pounds (4.5 kilograms). However, the neck also is vulnerable to many potential injuries and disorders that produce pain and limit range of motion.

In most cases, neck pain resolves with minimal treatment within a period of weeks. However, some forms of neck pain require professional medical care, including prescription medications, physical therapy and other treatments. In the most extreme cases, surgery may be required to treat neck pain.

A physician should be promptly contacted if neck pain is associated with any of the following:

• Severe pain due to injury. Patients should always seek medical care after head or neck trauma, such as whiplash or a blow to the head. Significant pain over a bone might indicate a fracture or an injury to a ligament.
  
  
• Shooting pain. Pain that radiates from the shoulder and continues through the shoulder blades or down the arm may indicate nerve impingement or irritation. Numbness or tingling in the fingers also may indicate such irritation. Nerve irritation can last from three to six months or longer. Chest pain that radiates to the neck, arm or jaw may be due to a heart attack.
  
  
• Loss of strength. Weakness in an arm or leg (often evident when a person suddenly drops things, or walks with a stiff leg or shuffling feet) indicates the need for immediate evaluation.
  
  
• Change in bladder or bowel habits. Significant changes may indicate a neurological problem. This is particularly true of incontinence (the inability to control the passage of urine or feces).

Other pain areas related to neck pain

In some cases, neck pain may be the result of disease or injury in another part of the body. Areas of the body that can affect the neck include the jaw, head and shoulders.

Conditions that cause pain in the neck and radiate to other parts of the body include:

• Headaches. Tension headaches in particular can cause neck pain. Neck pain may linger after a migraine.
• Radiculopathy. A pinched nerve, often resulting from a herniated disc. In addition to neck pain, the patient may experience pain down the arm that is frequently described as an electrical feeling.

• Spinal stenosis. A narrowing of the nerve openings around the spinal cord or the nerve roots. Symptoms mimic those of a pinched nerve.

• Spinal instability. Increased motion of the vertebrae that can cause tingling in the neck.
  
  
• Facet joint arthropathy. Facet (zygapophyseal) joint Facet joint arthropathy (joint disease) usually happens with whiplash or any other neck injury and can cause pain in neck and associated posterior headaches.

There are also other conditions where pain originates in another part of the body and radiates to the neck, such as TMJ disorder. The temporomandibular joint is where the jaw is hinged to the skull. Disorders that affect this joint can cause neck pain. In some cases, neck pain can also trigger TMJ pain.

In addition to dental pain, headaches and back pain, neck pain can also be related to some types of ear pain (e.g., malignant external otitis), orofacial pain (e.g., carotodynia) or shoulder pain.

Potential causes of neck pain

Neck pain can result from injuries of (or abnormalities within) soft tissues, which include the muscles, ligaments, intervertebral discs and nerves, or the bones and joints of the spine.

The neck is vulnerable to pain for several reasons. The neck is designed to allow a wide range of motion. However, this beneficial aspect of the neck’s design is also its greatest vulnerability as the interconnected structures of the neck are subject to damage from aging-related wear and tear, arthritis and overextension caused by whiplash.

Sources of neck pain include:

• Muscle strains. When neck muscles are overused, it may contribute to muscle strain. Muscles in the back of the neck are particularly vulnerable and can be strained by daily activities such as too many hours of driving or reading in bed. Over time, the repeated strain on these muscles can lead to chronic pain. Lying down in a bad posture for a long period of time is a common cause of neck muscle strains.
  
  
• Trauma. Because the neck is so flexible and supports the head’s weight, it is vulnerable to injury. Some injuries, particularly those sustained in automobile accidents, may result in whiplash, an injury that occurs when the head is jerked forward and backward. This stretches or tears the soft tissues (such as muscles and ligaments) of the neck, resulting in injury and pain. Severe injury can lead to fracture or dislocation of the neck, which may damage the spinal cord and cause paralysis. Also, injury can predispose facet joint arthropathy.
• Arthritis. Neck joints tend to deteriorate with age, leading to arthritis. Patients with a history of whiplash are much more likely to develop arthritis in the neck as they get older. Forms of arthritis in the neck that may cause pain in the neck or elsewhere include:
  

• • Osteoarthritis. Occurs in older people due to wearing of the joints between the bones of the neck. This causes pain to radiate to the shoulder or between the shoulder blades. Pain is generally present at the start of the day, subsides during the day and then returns again at the end of the day.
    
    
  • Rheumatoid arthritis. Chronic disease marked by stiffness and inflammation of the joints, weakness, loss of mobility and deformity. It can cause destruction of the joints of the neck.
    
    
  • Ankylosing spondylitis. Type of arthritis that primarily affects the spine. Typically it begins in the lower back but can progress to the upper back and neck.
    
    
• Disc disorders. Just as problems with the lumbar spine and thoracic spine can cause back pain, problems with the cervical spine can cause neck pain:
  
  
  • Pinched nerve. As a person ages, the intervertebral discs that serve as cushions between the vertebrae of the spine begin to dry out. This narrows the spaces in the spinal column where the nerves come out, and puts pressure on the spinal nerves.
    
    
  • Degenerative disc disease. The discs deteriorate and press upon nerves.
    
    
  • Herniated disc. Intervertebral discs sometimes rupture or herniate, meaning the gelatinous center protrudes through the disc’s tough covering.
    
    
• Cervical stenosis. A narrowing of the spinal canal that pinches the spinal cord. As a person ages, the intervertebral discs begin to dry out, reducing their role as protective “shock absorbers” for the spinal cord. Degenerative changes in the vertebrae can also foster the growth of bone spurs that compress the nerve roots. Finally, bones and ligaments in the spine gradually thicken and become less flexible. All of these changes narrow the spinal canal.
  
  Symptoms associated with cervical stenosis include neck pain, numbness and weakness of the hands, inability to walk quickly, deterioration of fine-motor skills and muscle spasms in the legs.
  
  
• Meningitis. Neck pain associated with headache and fever may be a sign of meningitis, an infection of the membranes surrounding the brain. Extreme stiffness in the neck – such that it is difficult or impossible to touch the chin to the chest – may be a sign of meningitis and demands prompt medical attention.
  
  
• Encephalitis. Inflammation of the brain. Symptoms can include stiffness or pain the back or neck.
  
  
• Fibromyalgia. A chronic disorder marked by musculoskeletal aches, pain and stiffness, tenderness of soft tissues, fatigue and sleep disturbances. Neck pain is among the symptoms commonly associated with fibromyalgia.
  
  
• Myofascial pain syndrome. A chronic musculoskeletal condition that is often associated with trauma, poor posture, sitting at a computer or performing repetitive tasks associated with one’s job. Patients frequently report feeling pain in various parts of the body – including the neck – and may have difficulty sleeping or feeling rested despite sleep.
  
  
• Polymyalgia rheumatica. An inflammatory condition typified by pain and stiffness in the neck, shoulders and hips.
  
  
• Myositis. A group of inflammatory muscle conditions. Myositis typically afflicts areas near the trunk, such as the neck, shoulders and hips.
  
  
• Osteoporosis. A bone-thinning disease most common in women during and after menopause. It lacks symptoms in early stages, but in later stages osteoporosis can cause spinal fractures that may cause back or neck pain.
  
  
• Paget’s disease. A metabolic bone disorder that involves bone destruction and regrowth that causes deformity. The cause of this disease is unknown, but it often results in neck pain.
  
  
• Large, heavy breasts. Women with large breasts often experience pain in the upper neck, which usually is due to increased pressure on the muscles. Some choose to have surgery to reduce the size of the breasts and relieve neck, shoulder and back pain.
  
  
• Other conditions. In rare cases, neck pain is a result of other medical disorders such as cancer, infections or congential abnormalities (birth defects) of the vertebrae. Neck pain can also be a symptom of a heart attack.

Neck pain may also be due to conditions that cause widespread joint pain, such as Lyme disease, lupus, chronic fatigue syndrome, sickle cell anemia or sarcoidosis.

Relief options for neck pain

In most cases, neck pain responds well to a patient’s attempts to treat it at home. Over-the-counter anti-inflammatory drugs such as aspirin, ibuprofen or naproxen can help relieve inflammation and pain. Analgesics such as acetaminophen relieve pain but do not reduce inflammation.

Ice (cryotherapy) can also help reduce inflammation. It should be applied for 15 to 20 minutes, with 40 minutes between applications. The ice should not be applied directly to the skin but should be covered with a towel, ice pack or other barrier. Heat and water treatments (thermotherapy and hydrotherapy) may also be used to relax sore muscles (e.g., hot compress, heating pad or hot shower). However, in some cases heat can aggravate inflammation, so it should be used with caution.

If self treatments do not begin to resolve neck pain within two weeks, prescription drugs or medical pain management interventions may be necessary. These may include:

• Physical therapy. Treatment in which a physical therapist will design and execute a stretching and muscle-strengthening exercise therapy program that enhances the support structures of the cervical spine. In many cases, such therapy is adequate by itself to relieve neck pain. The therapist may also use modalities such as hot packs, therapeutic ultrasound or electrical therapy to ease pain and maximize range of motion. Patients can be instructed to use transcutaneous electrical nerve stimulation (TENS) at home.
  
  
• Manipulation therapy. Professionals such as chiropractors, osteopaths or massage therapists may offer relief.
  
  
• Medications. Prescription pain medicines have many of the same anti-inflammatory and pain–relieving effects as over-the-counter drugs, but offer them in stronger doses. However, some are available only by prescription. Examples of these drugs include:
  
  
  • Opioids. Prescribed to manage severe acute and chronic pain, these medications should be used only under close supervision of a physician, as they can have numerous side effects, including drowsiness, decreased reaction time, impaired judgment, depression and addiction.
    
    
  • Antidepressants. Some antidepressants can relieve pain and assist with sleep.
    
    
• Injection therapy. A number of injections, which include epidurals, facet joint injections and nerve blocks, are available for patients not wanting surgery. These injections are usually performed by pain specialists trained in the neck area.
  
  
• Short-term immobilization. A soft cervical collar can be worn for a period of time. This supports the spine, reduces mobility and lessens pain and irritation while allowing the neck muscles to relax as they heal.
  
  
• Traction. A cervical traction device attaches to the head and uses weights and a pulley to pull up on the head. This is designed to “pull” the neck’s skeletal structure into better alignment. It is especially useful in treating nerve root irritation, and pain relief may last for hours or days. Traction may be used in cases of “unstable spine” or in vertebral fractures but is not commonly employed.

Other treatment methods that a physician may recommend include cognitive behavioral therapy for chronic neck pain or complementary and alternative treatments such as acupuncture, acupressure or biofeedback. If noninvasive methods fail, options may include:

• Cervical spine surgery. In rare cases, surgery may be necessary to treat neck pain. It is most often used to relieve compression of the nerve roots or spinal cord due to a herniated disc or bony narrowing of the spinal canal. Surgery also may be necessary to stabilize the neck and minimize the possibility of paralysis after an injury. Surgical options include:
  
  
  • Anterior cervical discectomy. The most common surgical procedure used to relieve neck pain caused by pressure on one or more nerve roots or on the spinal cord. This procedure enlarges the nerve opening and removes troublesome spinal discs. Bone spurs compressing the spinal sac or nerve roots also are removed.
    
    
  • Cervical corpectomy. A more extensive version of the anterior cervical discectomy, it involves removing vertebrae as well as discs. Risks are slightly higher with this procedure and include damage to nerve roots and the spinal cord, bleeding, infection, damage to the trachea or esophagus and paralysis.
    
    
  • Posterior hemi-laminectomy. Operation performed through a vertical incision in the back of the neck in which bone around the spinal cord or nerve opening is removed. Attached ligaments exerting pressure on the spinal sac and nerve roots also are removed.
    
    
  • Spinal fusion. This procedure will decrease the neck’s range of motion.
    
    
  • Verebroplasty or kyphoplasty. These procedures may be used for compression fractures caused by osteoporosis.

Treatment by a physician or other healthcare professional is likely to proceed in three phases. Initially, treatment will focus on reducing pain and inflammation. The second phase concentrates on promoting increased strength and flexibility of the tissues. The final phase involves exercise and lifestyle techniques that will help the patient maintain this strength and flexibility to minimize the risk of future episodes of neck pain.

Prevention methods for neck pain

The chief source of neck pain – poor posture – can be easily rectified. Proper posture involves keeping the neck in a neutral position with the head back, so that it is centered over the spine. This keeps gravity working with the neck rather than against it. It is also important to avoid gritting teeth, which can place strain on the neck muscles.

Steps that can be taken to improve posture and ergonomics include:

• Take frequent breaks. People who drive long distances or work at a computer for many hours are vulnerable to suffering from strained neck muscles. Taking breaks from these activities can give the neck muscles a chance to relax.
  
  
• Sit properly. Chairs and desks at work should be adjusted so that computer monitors are at eye level and knees are slightly lower than hips. Chairs should also have armrests. People who are sitting for a long period of time in a car or airplane should place a small pillow or rolled-up towel between the neck and the headrest. This maintains the natural curve of the neck.
  
  
• Avoid tucking the phone between the ear and shoulder. People who use the phone frequently should use a headset instead.
  
  
• Stretch frequently and exercise. Neck muscles can be stretched by shrugging the shoulders up and down. It also helps to pull the shoulder blades together and then relax. Pulling the shoulders down while leaning the head to each side can also stretch the neck muscles. Walking causes the spine to rotate, which provides excellent exercise for the neck muscles.
  
  
• Balance the base. Stretching the muscles of the chest wall and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
  
  
• Avoid sleeping on the stomach. Sleeping on the stomach puts stress on the neck. Pillows should be chosen that support the neck’s natural curve.
  
  
• Do not read in bed. This causes neck strain, particularly when propped up on pillow with the neck bent forward and arms held out to support the book. People who cannot give up reading in bed should purchase a wedge pillow or portable “mini-desk” designed for reading in bed.
  
  
• Keep weight evenly distributed. Do not carry items on one shoulder for too long. If possible, carry items in a backpack, which evenly distributes the weight. However, do not overload the backpack.
  
  
• Use proper lifting techniques. Lift from the knees, not the back, to protect both the neck and the lower back. When lifting heavy objects, keep the back straight and the load close to the body. Do not twist the back while lifting. If an object is heavy or awkward, do not lift it without a partner’s help.

In addition, neck injuries can be prevented by taking precautions in situations where the neck is vulnerable to injury. This may include wearing a seat belt when driving or riding in motor vehicles, wearing protective equipment when playing sports, and being careful not to dive in shallow waters when swimming.

Questions for your doctor regarding neck pain

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about neck pain:

1. What could be causing my neck pain?
   
   
2. What tests might be needed to find the source of my neck pain?
   
   
3. What do these tests involve? Do I need to do anything to prepare? Where and when will I have them?
   
   
4. What do my test results show - what is the source of my neck pain?
   
   
5. Is my neck pain likely to be short-lasting or chronic?
   
   
6. Is it possible that a condition in another part of my body is causing the pain in my neck?
   
   
7. What are my treatment options?
   
   
8. If noninvasive treatments aren’t working, will I need surgery to treat my neck pain?
   
   
9. How can I keep my neck pain from recurring?
   
   
10. Are there any particular exercises and activities I should do or avoid?
    
    
11. Is there anything I can do to prevent neck pain?
    

Neck pain can be caused by too much pillowing or not enough. Without the right amount of pillowing it is easy to strain your neck during sleep times. In this position, the head is lower than the neck, which can cause strain. Experiment with pillows to find a neutral position for your neck -- one in which you do not experience neck pain or strain.

Neck Pain and Sleep Position - Neck Strain 2

Sleeping positions that take the spine out of neutral alignment may cause neck pain, as well as back pain, in the morning. The neck and low back are vulnerable to strain from pressure in this sleeping position.

Neck Pain and Sleep Position - How Much Pillowing?