Pain in the Neck: Fixing the Problem at its Root

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by G. John Mullen, DPT 2011

Neck PainNeck pain: We’ve all had suffered through it at least once in our lives as it is one of most common areas of the body to cause pain.  However, it may be hard to diagnose the primary cause of your neck pain.  Let’s pretend you sit at a desk for 40 hours a week for work/school, and then come home and sit at a desk watching Hulu for a few more hours. Just a hunch, but I think the excessive sitting may be causing some of your neck pain.  Sitting this long is not natural for once nomadic humans.  In addition to sitting for these long hours, most people make it worse by maintaining poor posture while sitting (which is not entirely your fault…humans were not designed to sit for the long durations that our modern lifestyles require).  Despite our societal evolution, our anatomy has not adapted.  As a result, we must actively adapt our bodies to the new societal demands.  Lucky for us, we can make these changes to help improve and possibly prevent most unnecessary neck pain.

Stat Fact: It is estimated that 70% of all muscle injuries that occur without a known accident are sprains or strains.

Neck Anatomy:

The cervical spine is composed of many muscles that are contorted, stretched and shortened with poor posture.  These muscular changes can cause pain in various areas of the spine and in other body parts (shoulders, middle back, etc.).  With sustained poor posture, tiny muscles in the back of your head (suboccipital muscles) tighten or shorten.  Unfortunately, the body compensates by shortening, stretching or elongating the muscles in the front of your neck (your deep neck flexors).

Ways to tell if this is causing your pain…

If you are having neck pain and you think it’s from your poor posture, here are some telltale signs your neck pain is due to your posture:

  • Persistent neck or shoulder blade aching

  • Symptoms worsen with sustained poor posture

  • Muscle imbalances (weak deep neck flexors and weak rhomboids)

Some simple tests you can do to test yourself:

1. Deep neck flexor test:

To perform this test lie down on your back and lift your head off the ground by tucking your chin in tight, as if you’re making a double chin (some people have to try harder to achieve this).  While holding your head 1 inch off the ground, keep your chin tucked as long as humanly possible (shaking and the urge to urinate may be present if one has extreme muscle weakness).  If you unable to hold your neck folds for approximately 30 seconds then you have weak deep neck flexors.

Stat Fact: Patients with neck symptoms (pain, for example) produced 15% less pressure than patients without neck symptoms in the deep neck flexor test.  The bottom line: people with neck pain are usually weak in their deep neck flexors.

2. Neck Rotation Test:

Another simple test to be done at home is a neck rotation test.  Rotate your neck to each side slowly and if your symptoms or pain increases as you rotate more, then your neck pain is probably caused by posture problems.

What to do next?

You have a few of the neck symptoms described above and your neck muscles aren’t as strong as Žydrūnas Savickas…don’t be discouraged there is hope for you!  First and foremost, correcting your posture is the number one cure for this ailment.  I know holding good posture is hard, but so is eating 66 hot dogs in 12 minutes and that didn’t stop Joey Chestnut did it?  A few tips for holding proper posture while at a computer or sitting down:

  • Keep your feet on the floor!  You’re not a six year old kid in elementary school.  Put both feet on the floor and keep them there!

  • Keep your back against the chair, especially your upper back.  If your back is not against the chair there is a high chance you are leaning forward.

  • Keep your chin tucked.  You’re not finishing a 100 meter sprint against Usain Bolt.  Keep that chin tucked.

  • Keep your shoulder blades close, don’t round that back!  I know many people dreamed of being a Teenage Mutant Ninja Turtle growing up, but we hope you’ve outgrown that fantasy.  No need to round out your back as an adult.


Next is a routine of stretches we recommend doing in the shower on a daily basis.  All of these stretches should be done twice for 30-45 seconds each.

1. Armpit Sniffer:

The arm pit sniffer is a favorite of ours for numerous reasons.  While standing, look down towards your armpit as if you were checking to see if that Old Spice has kicked in.  If done correctly, you should feel a slight pull on the neck of the opposite side.  This is stretching the levator scapulae, a muscle that is commonly tight with poor posture.   The picture shows the person pulling their head toward their armpit, but if this muscle is really tight, just looking in the direction will provide a proper stretch.

2. Corner Stretch:

Pectoralis StretchThis stretch is used to stretch the pectoralis muscles that are often tight due to extended periods of time sitting or at a computer.  To complete this stretch, find a doorway and put the inside of your bent arm on the surface of the wall at shoulder height.  To feel the stretch turn your body away from the arm, and you should feel the stretch in chest (amazing ponytail as seen in the photo is optional).

3. Scalene Stretch:

To complete this stretch, hold on to something for support because you will be tipping your head backwards and towards the opposite shoulder.  Tip your head slightly back and to the side, the picture shows the person pulling his head back, this should only be done if you do not feel a stretch in the front of your neck with the initial movement.

4. Upper Trapezius stretch:

This is the simplest of all the stretches.  Without rotating your neck, tip your head, as f you were trying to touch your ear to your shoulder.  If you do not feel a stretch on the  opposite side you can use overpressure with your hand to elicit the desired stretching sensation.


Strengthening exercises should be performed with high repetitions to help build endurance.  We recommend 5 sets of 10 repetitions, 3 times a week for best results.  These exercises may seem simple, but if used properly they can alleviate your nagging neck pain.

1. Chin Tucks:

Similar to the deep neck flexor test done earlier, lie on your back and tuck your chin, lifting your head 1 inch off the ground.  Make sure you hold the double chins in your neck.  Hold for 30 seconds (or as long as you are able to if you cannot hold for 30 seconds) each set and complete 5 sets 3 times each week.  And, yes, this exercise falls into a category of exercises know as “Not sexy but very effective!”

2. Scapular squeezes:

Begin this exercise sitting down and, just as the name suggests, and squeeze your shoulder blades together.  By pinching your shoulder blades together, your chest will stick out slightly.  Make sure not to lift your shoulders towards your ears while holding this position!  Hold this position for 30 seconds each repetition and complete 5 repetitions per day 3 times a week.

3. Upper Cuts:

Upper Cut Exercise

Begin with your knees bent 15 degrees and as you start the upper cut movement, punch towards your opposite shoulder (your bicep should come towards your mouth) and push through your legs.  You can make the exercise more difficult holding a weight in your hand while punching as seen in the photo.  This exercise is used to strengthen the serratus anterior.

Stat Fact: Neck musculature is estimated to contribute 80% to the stability of the cervical spine.

These are some of the exercises and stretches that can be used to help people minimize neck pain.  Next time you’re sitting at your desk, think twice about leaning forward to read the computer screen.  If your neck pain persist or worsens after doing these exercises for a few weeks, talk to your medical doctor about additional treatment options.

Your Future Muscular Neck


Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363–70.

Chiu TT, Law EY, Chiu TH. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005 Sep;35(9):567-71

Ekstrom et al, Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles, J Orthop Sports Phys Ther 2003;33:247–258.

Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.


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