Figuring out the Cause of Your Chronic Neck Pain

Why is neck pain such a pain in the neck to get rid of? First, the muscles in your neck adapt to any postural imbalances you have in the core of your body. If your lumbar or thoracic spine is out of alignment in any way, your neck muscles will have to make up for that misalignment by tilting or turning your head into a straight, upright position.

Second, we instinctively react to negative stress (“threat stress”) by tensing up our neck and shoulder muscles—this is part of the withdrawal response, which I’ll discuss below.

Lastly, the muscles in your neck have to do a great deal of stabilizing as you perform your daily activities. Your neck muscles hold up your heavy head, so as long as you’re sitting or standing upright, they never get a break.

Neck pain can be the result of a structural issue, like a herniated disc, impinged nerve, nerve damage, ligament sprain, or fracture. But in this post I’ll be focusing on the functional causes of neck pain: our posture, stress, and the repetitive activities we do each day that can make neck muscles painfully tight.

When your neck muscles are tight, sore, or painful, your first instinct might be to massage or stretch them. This may give you some short-term relief by temporarily reducing the level of tension in your muscles. However, massage and stretching don’t change the deeply learned messages that your nervous system is sending to your muscles to stay tight, so your muscles will “rebound” and return to their previous level of tension fairly quickly. And if your massage or stretching is deep, it will likely activate your stretch reflex, causing your muscles to tighten up even more. If you have muscular soreness or pain in your neck, I recommend stopping doing any deep massage or stretching immediately. In fact, the more you can simply relax and stop fixating on the tight muscles, the more they will naturally release.

Neck pain caused by tight muscles is functional, coming from the inside—how your nervous system is telling you to stand, move, and react to stress. Manipulative therapies that attempt to fix functional problems from the outside in simply don’t have lasting effect. But by pandiculating your muscles, you can retrain your nervous system, reducing your baseline level of muscle tension and changing damaging posture and movement patterns.

Below, I’ll describe three common postural patterns, how they can cause neck pain, and list the Clinical Somatics exercises (which are pandiculations) that most directly address each postural pattern. Then I’ll discuss some daily habits and activities that often lead to neck pain. Last, I’ll describe an important fact about the muscles involved in head and neck rotation that might be contributing to your tension and pain.

Postural Patterns That Cause Neck Pain

If you think your neck pain is related to your posture in some way, remember this: The goal is to release tightness and regain balanced control of the muscles in your core so that your neck muscles can relax and stop compensating for the imbalances in your posture.

The Withdrawal Response: When we experience negative stress, we instinctively contract our abdominal muscles, raise our shoulders, and pull our head and limbs inward, coming into the fetal position in order to protect the most vulnerable parts of our body. This is the withdrawal response, and it’s hardwired into our nervous system as a means of survival. You may notice yourself slouching forward with raised or rounded shoulders when you feel stressed or fatigued; this is the withdrawal response in action.

When your withdrawal response is triggered repeatedly, your nervous system will start to keep the muscles involved in the response contracted all the time. Gradually, your shoulders will become more raised and rounded, your chest will become concave, and you’ll hold your head farther forward. This is not an inevitable part of aging or a genetic abnormality—it’s simple muscle memory.

This rounded posture often results in neck pain. As your tight abdominal muscles pull your upper body forward, the suboccipital muscles (at the base of your skull) and the extensor muscles of your neck (that pull your head backward) have to work hard to tip your head upright so that you can stay balanced and look straight ahead. These overworked muscles can easily become sore and painful. And over time, the compression of your cervical spine can lead to cervical disc issues and nerve impingement.

In addition, the withdrawal response involves contracting the upper trapezius (the orange section of the trapezius muscle shown in GIF above) and raising the shoulders upward. When people experience neck pain, it’s often because of a chronically tight upper trapezius causing tension and pain in the “shneck” (the area between the neck and shoulder joints).

If you feel that your neck pain may be related to rounded posture, you should do exercises that pandiculate your abdominals, chest, shoulders, and neck. In the Level One Course, the exercises that pandiculate these muscle groups are: Arch & Flatten, Arch & Curl, One-sided Arch & Curl, Diagonal Arch & Curl, Flowering Arch & Curl, and the exercises in both Bonus videos. In Level Two: Head Lifts, Proprioceptive Exercise 1, Scapula Scoops 1 & 2, Diagonal Curl, and Shoulder Directions.

Side-bending Posture: If the muscles in the core of your body are tighter on one side than the other, you may bend to one side slightly. If the imbalance is significant, you could be diagnosed with scoliosis or functional leg length discrepancy.

If your lumbar or thoracic spine bends to one side even a little bit, your cervical spine will have to make up for it. Your neck muscles will automatically tip your head to the opposite side in order to bring your head into a straight position. This can cause tension and pain on one or both sides of the neck, as well as in one or both shoulders.

If you feel that this kind of imbalance could be causing or contributing to your neck pain, you’ll have to release the muscles in your core that are causing the imbalance, in addition to your neck muscles. From the Level One Course, the exercises that will help you most are: Side Curl, Hip Slides, and the upper trapezius release in the Bonus “Ultimate Pandiculation” video. From Level Two: Scapula Scoops 1, Big X, Proprioceptive Exercises 2, 3 & 4, Shoulder Directions, and Hip Directions.

If you have idiopathic scoliosis and that is your only concern, you may instead want to do Clinical Somatics for Scoliosis.

You should also read How to Even out the Imbalances in Your Body.

The Action Response: When we experience positive stress or “challenge stress,” our back muscles contract to make us stand upright, preparing us for action.

The action response is less likely the cause of your neck pain than rounded or side-bending posture. However, if your lower back is tight and arched as a result of the action response, you might balance yourself out by bringing your head and neck forward; this is referred to as kyphosis-lordosis posture. You might also develop this posture if you experience both the withdrawal and action response regularly.

Daily Habits and Activities That Cause Neck Pain

In addition to practicing pandiculation exercises on a regular basis, you need to become aware of what daily habits might be contributing to your neck pain. While these may seem obvious, if you have chronic neck tension and pain it’s likely that one or more activities that you do on a daily basis are helping to keep you in pain. You don’t need to stop doing these activities—you just need to adjust your body use when you do them.

Working at a computer: If your job involves computer work, you likely feel the effects of it in your neck and shoulders. Working at a computer involves inwardly rotating your shoulders and bringing your arms forward, more so on one side when you use a mouse. It’s also very easy to adopt forward head posture or rounded posture if you tend to lean in toward the computer screen. Zoom into what you’re looking at so that you don’t have to lean forward, and adjust your chair, desk, keyboard and screen position so that you can sit in the most neutral position possible.

In addition to practicing Clinical Somatics exercises to release your tight muscles, you should check in with yourself every few minutes and relax your abdominals, chest, and shoulders. Don’t contract your back muscles and force yourself to sit up straight; instead, relax your abdominals and allow yourself to sit up straight. Likewise, don’t pull your shoulders backward; relax your chest and shoulders and allow your chest to open up and your shoulders to relax back.

Using your phone: Looking downward at your phone for hours a day will inevitably lead to forward head posture and neck pain; this is why we see more and more teenagers with forward head posture. The simplest ways to avoid this are: use your phone less, and/or find a way to hold your phone so that you don’t have to look downward. When using your phone, take frequent breaks to lift your head up and relax into a straight, upright posture.

If you talk on the phone a lot, put it on speaker or use a headset or earpiece so that you don’t have to hold the phone to your ear. Holding the phone to your ear for long periods of time will lead to chronic tightness on one side of your neck, and likely in that shoulder as well.

Driving: When you’re driving, notice your posture. Do you lean forward or crane your head and neck forward? Do you lean to one side? Are you tense? Do your best to relax your abdominals, chest, shoulders, and neck as described in the computer work section. Adjust your headrest to the most comfortable position, and try to use both arms evenly to control the steering wheel.

Holding something on one side: We tend to carry things like a purse, a backpack, or a baby on the same side all the time. Not only does this lead to tight neck and shoulder muscles, but these simple habits can even lead to side-bending postural patterns like functional leg length discrepancy. Try holding your bag or your child on the opposite side, and notice how it feels. Alternate sides as much as possible, even if it feels awkward in the beginning.

Sleeping: The position you sleep in has a big impact on your neck muscles. If you sleep on your stomach, you’re spending 6-8 hours per night with your head turned to the side. If you sleep on your side and your spine is out of alignment, your head will be tilted to one side all night. If you sleep on your back with a pillow, you’re spending 6-8 hours per night in forward head posture.

The best sleeping positions to reduce neck pain are:

• On your back with no pillow: If this is not comfortable, do all of the Arch & Curl variations on a regular basis to release your abdominals, and gradually reduce the thickness of your pillow. If your lower back is not comfortable when lying on your back, do the Back Lift on a regular basis, and put a pillow under your knees when you sleep on your back.
• On your side with your spine in alignment: Your mattress should allow your shoulder and hip to sink in enough that your spine remains straight when lying on your side. Too firm or too soft a mattress will move your spine out of alignment. Your pillow should support your head and neck so that your cervical spine is straight.

An Important Fact About Head and Neck Rotation

When a muscle contracts, it shortens and brings the bones it’s attached to on either end closer together. So when you turn your head to the right side, it’s natural to assume that the muscles on the right side of your neck are contracting to do the movement. But this is not true for all of the muscles involved!

The upper trapezius, sternocleidomastoid, and scalene muscles all rotate the head and neck to the opposite side when they contract; this is because of their attachment points.

This is a very important concept to understand if you experience pain when you rotate your head to the side. If you turn your head to the right and feel pain on the right side of your neck, the pain is likely the result of you stretching tight muscles as you turn your head (stretching tight muscles is painful!). You’ll feel this pain even more if you lie on your stomach and turn your head to the side.

Try this: While sitting up, slowly turn your head as far to the right as possible. The farther you go, the more you should notice the muscles on the left side of your neck contract (focus on feeling the location of your upper trapezius; left side of base of neck into the shoulder area). You might notice your left shoulder lifting up because the upper trapezius is contracting. When you’ve rotated as far as you want to go, and felt that contraction, consciously release that contraction as slowly as you possibly can, letting your head and neck very slowly rotate back to center.

Now try this on the other side. Slowly turn your head as far to the left as possible. The farther you go, the more you should notice the muscles on the right side of your neck contract (focus on feeling the location of your upper trapezius; right side of base of neck into the shoulder area). You might notice your right shoulder lifting up because the upper trapezius is contracting. When you’ve rotated as far as you want to go, and felt that contraction, consciously release that contraction as slowly as you possibly can, letting your head and neck very slowly rotate back to center.

Muscular tension and pain in the neck is not something you have to live with! Ninety-nine percent of the time, you’ll be able to completely alleviate it by learning how to pandiculate your muscles, fixing your postural imbalances, and making some changes to your daily habits.

Recommended reading:

The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain by Sarah Warren, CSE

Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health by Thomas Hanna