By Elena Voropay

If one morning you woke up feeling like your head has sunk in the shoulders and your neck has turned into an oak pole, check your pillow. Or your training routine from yesterday. Since your major preoccupation with mass directs your mind to big parts of the body, neck is probably the last thing on your training list – unless you are trying to transform your nerdy pencil into a sturdy stump.

In any regard, everybody, I repeat, everybody should think of neck protection for the sake of the entire body function. It's great that your amazing neck is so small, but strong enough to carry almost 10% of your bodyweight coming from your head. Its flexibility lets you turn turn anywhere you want, but this manly thick and womanly gracious structure is extremely vulnerable to injury.

If you haven't heard much about neck pain doesn't mean that it's uncommon. Around 10% of the adult population at any one time is suffering from a stiff neck, and as much as 50% of those over 50 have osteoarthritis of the neck. Disc problems are present in as many as 40% of males, and 28% of females between the ages of 55 and 64.

If one morning you woke up feeling like your head has sunk in the shoulders and your neck has turned into an oak pole, check your pillow. Or your training routine from yesterday. Since your major preoccupation with mass directs your mind to big parts of the body, neck is probably the last thing on your training list – unless you are trying to transform your nerdy pencil into a sturdy stump. In any regard, everybody, I repeat, everybody should think of neck protection for the sake of the entire body function.

If you haven't heard much about neck pain doesn't mean that it's uncommon. Around 10% of the adult population at any one time is suffering from a stiff neck, and as much as 50% of those over 50 have osteoarthritis of the neck. Disc problems are present in as many as 40% of males, and 28% of females between the ages of 55 and 64.

What's more, you don't have to damage it directly to have an injury. Any part of your entire body - muscles, bones, joints, tendons, ligaments or nerves - can cause it. In addition, other structures like the trachea (wind pipe), blood vessels, thyroid gland, and lymph nodes are also found in the neck and can be a source of pain. Pain may also come from your shoulder, jaw, head or upper arms. Surprised? No wonder.

The Spine Factor

When you think of spinal injuries, you most certainly think of lumbar and anything close to it. But neck problems are just as bad, and many of them don't even come from injuring the neck itself. If any link in the back spins out of balance, your neck will let you know. This is because neck takes the top of the spinal column, reflecting everything that goes on down under it. The spine (or vertebral column) has three natural curves: Lumber (lower back). Thoracic (mid back) and Cervical (neck.). A weakness in any one of these curves will flash in all of the corresponding structures to compensate for it by changing their function and ultimately structure.

Your neck is not an isolated region, but just one small part of the spine which, along with the ribs and sternum, constitutes the skeleton of the trunk of the body. The spine itself is made up of 33 bones called vertebrae. These, in turn, are distributed in three curvatures of the spine: Cervical has 7 vertebrae, Thoracic 12, Lumbar 5.

I bet you master math science with your daily calculations of sets, reps, weights, calories and grams, so you figured that the above counts don't add up to 33. This is because there are additional 5 sacral vertebrae which are fused into one bone called the sacrum and 4 coccygeal vertebrae fused into two bones called the coccyx.

Intervertebral Disks

To make the spine structure even more complicated, besides bones, muscles, tendons and ligaments found in every part of the body you've got intervertebral disks situated between adjacent vertebrae from the first Cervical to the Sacrum. Their main job is to absorb the tremendous shock you put on your poor spine when you train and to cushion the vertebrae during your stretching and turning.

Made of dense fibrous collagen tissue, these structures look just like your weight plates, except instead of an epmpy handle hole in the middle they have a nutritious gelly-like core, called Nucleus Pulposus (NP). It is this core that tells your spine how much weight to load on your plates so you can withstand the pressure without any damage. Due to the abundance of molecules called glycosaminoglucans in the core, Mr NP is able to attract and hold water molecules and is responsible for the function, strength, flexibility and endurance of your interverbals disks.

Treat your neck as a very special structure not because it connects your thinking head with its gray matter to the rest of the body, but because there is far less disc material and substantially less force in the cervical spine. Another thing which makes cervical vertebrae so special is their unique anatomy. The oval shaped vertebral bodies have large spinal canals, articular facets and foramina in their transverse which contain the vertebral artery and vein.

The first cervical vertebra is known as the atlas, and it is remarkable for having no body, but a tubercle in the front instead. This is why you can move your head forward and backwards. But when your buddy calls your name somewhere from the back, it's not a smart idea to tilt your head back in response. You would rather turn your head to the side, right? Well, thank your second cervical vertebra for being able to do that.

Interestingly, your disks are stronger stronger in the morning than in the evening. Reason? Hydration. As the day progresses, forces of gravity lead to loss of water and subsequently loss of disk height, almost 2 centimeters – but you regain the balance back when you sleep at night. Another reason to get your full deep eight of shut-eye therapy.

Neck Bulk

Ever noticed which parts of your body get tense when you are under stress? Exactly, your Traps. Even though these huge chunks of bulk lying right on top of shoulders in the upper back attach only to the the 7th Cervical Vertebra, their tension can pull on the scull and all thoracic vertebrae where they originate causing jolting neck and back pain paralyzing your upper body.

Did you know that anatomically your Trapezius actually occupies more land on your back than your aiplane wings, or Latissimus Dorsi? That's right, their grand size can tell you that the pull on your upper spinal tissues is strong enough to disrupt any body function. And if you thrive on jaw-quinching shrugs for pencil-neck metamorphosis, you may over-tax your most important spinal link.

And this is just one tip of the ice-burg, but you get the idea. When it comes to Neck movement, there are 11 muscles involved, and Trapezius is just one of four extensors (splenius capitis, semispinalis capitis, suboccipitals). Plus, there are three flexors (longus colli & capitis, infra hyoids), four rotators (splenius capitis, sternocleidomastoid, levator scapula, suboccipitals) and one lateral flexor (scalenes). I wonder why these miniscular muscles have such long names – probably to sound important, and for a good reason. Because these muscles are small and unprotected, they weep for special care.

Pain in the Neck

Remember feeling dizzy after drilling iron on deadlifts and squats? You could have damaged your disks, ligaments, tendons or muscles – it doesn't matter. What's important is that disturbed the natural balance of your back. The pain receptors will get the message quickly and first you will have to endure the tightness or inflammation just in that region. So, the damaged part of the spine, say it's lower back, will loose its full function and you may not be able to lift as much next time. Not only that, the response will travel up your spine and the thoracic and cervical regions will have to work twice as hard just to compensate for the disfunctional lumbar.

If you want to progress with your workouts, by all means try to care for your neck. If you don't, you may as well forget your shoulders, chest, back, even legs or abs – it is all related. Just because your neck looks like it sits up high above your mass in complete loneliness, doesn't mean it's should be left out. In fact, it's high position means that it governs your entire system.

When the cervical spine is contracted, the Pectoralis Major muscles in the upper chest fatigue and draw the shoulder forward, causing the upper back to struggle just to maintain upright posture and function. Then Trapezius and Rhomboid muscles in the upper back get into spasmatic action and force all muscles in the upper chest and upper back to fight for protection with rigidity. The tighter the front, the tighter the back, and vica versa. Causes of Neck Pain Ok, let's get it straight – most of your injuries follow the same course. You want it all fast – bigger guns and leaner abs. You capitalize on elecrifying energy by outsmarting your body in the gym, your workouts become consistently frequent, and you seem to add loads of mass on your weight stacks.

But this is just the beginning of a never-ending cycle of overtraining and overusing your volnurable body tissues when the all-mighty spinal structure sits there in silence waiting for the perfect moment to break down. And the neck may come first. As the saying goes, a neck pain can be a real 'Pain in the Neck (or other parts of the body)'.

As the name suggests, the frustrations it may cause are a handful. It is tough not only to find causes, reasons and treatments for it, but even figuring out that that your neck has a problem is harder than finding the magic pill that burns fat and builds muscle while you sleep!

1. Muscle strain, sprain or tension are the most common causes of neck pain. A sprain is a stretch or tear in the ligament which connects bones. A sprain comes from injuries to the tendons connecting muscles to bones. Whether you work out with screaming power in the gym, or decided to escape in a stretching yoga class forgeting that your body tissues have limits, you may be up for some neck trouble.

Straining your neck is quite common and occurs mostly from muscle overuse, such as from too many hours hunched over a steering wheel or a computer, from sleeping in an awkward position or overdoing it during exercise. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.

Sprains may also come from a sudden movement that causes the neck to extend to an extreme position. If you train, you increase your chances of getting your neck strained AND sprained, especially when your face becomes way too familiar to both, morning and evening gym attendants, or you jump into a new exercise with an ambitions drive to show class to your buddies and add more weight than your new unacquanted muscles can handle. Then, with a spinning head you rush to the water fountain and trip over the weights in the over-crowded rubber-smelling heaven – Bam, you fall and your neck is the first to get hurt. Why? Because the forces of gravity naturally pull your head down to earth shaking you up. Get a wake-up call – time to stop!

Hopefully that didn't happen, but there are other natural causes of neck pain. If you forget to use the safety belt while racing in your car to the gym, and stop suddenly on a slippery road, you will get a whiplash, most famous injury of car accidents in a "rear end" automobile collision. This may trow your neck too far forward or back – here goes hyperflexion and hyperextension, and sprain guaranteed.

Usually, impingement of one nerve root on one side of the spine causes most of the symptoms.

2. Cervical disk degeneration also can cause neck pain. As a shock absorber between the bones in the neck, gelatin-like nourishing disc cores deteriorate with age narrowing the space between the vertebrae. The facet joints are designed to move against smooth surfaces, but as the cartilage degenerates it develops a lot of friction stiffening the neck. This adds stress to the joints of the spine causing further wear and degenerative disease. While cervical disc degeneration is virtually ubiquitous in humans, symptoms from this “gray hair of the spine” are less common and often short-lived. However, even a small twist in the spine changes disc space and starts the onset of symptoms may lead to chronic Neck Pain. Symptoms are often proportional to the the level of activity- the more you train, the more the shoulders, arms and neck are used, the more they hurt.

3. Other reasons for Neck Pain are degenerative diseases, such as Osteoarthritis from worn-out vertebrae, and Rheumatoid arthritis from joint destruction. The cervical disk may also protrude and cause pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.

In rare cases Neck Pain may come from infections, tumors, or internal organ disfunction (lungs, heart, etc.)which makes it a 'referred' instead of direct pain. While most common injuries involving soft tissues, i.e., muscles and ligaments, remain local, severe injury with fracture or dislocation of the neck may damage the spinal cord and cause paralysis (quadriplegia).

Locked neck seen in a stiff contraction or spasm on either side of the spine is one of the most typical concerns. This may also cause one shoulder to cock up, “freeze” and make any neck or arm movements impossible. It won't take long before your head starts throbbing. The pain in the upper back and drawn together shoulder blades are not the result of your Traps or Back workout, but rather your frozen shoulder which started from stiffness in the neck.

Pay attention to any of these symptoms as they may be a sign of Neck Injury:

• Pain and muscle spasms , especially in the back of the neck and in the upper regions of the shoulders, that worsens with movement.
  
• Pain usually peaks a day or so after the injury, instead of immediately.
  
• Headache in the rear of the head.
  
• Sore throat.
  
• Increased irritability, fatigue, difficulty sleeping and difficulty concentrating.
  
• Numbness in the arm or hand.
  
• Stiffness or decrease in range of motion (side to side, up and down, circular).
  
• Tingling or weakness in the arms.
  

The initial treatment comes from Dr. R.I.C.E.R. - Rest, Ice, Compression, Elevation and Referral to the specialist. The earlier you take action, the better. Here, ''action' means no physical action at all after the first signs of pain. The first 48 to 72 hours of rest are crucial to a complete and speedy recovery. This is your short golden window of opportunity to avoid future complications and get back to the gym sooner.

Unless you want to see your neck cut, bones cracked or discs replaced ending up with a foreign metal object next to your brain, you have to accurately determine the source of the pain in the neck. Make sure that you go to a specialist or an orthopaedic surgeon for a comprehensive examination and complete history of the difficulties you are having with your neck.

Your orthopaedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. He or she may ask you about other illnesses, injuries or complains that occurred prior to your neck pain.

After a physical examination which evaluates neck motion, tenderness, and the function of the nerves and muscles in your arms and legs, you may need to take an X-ray to see the bones in your neck closely. These simple diagnostic techniques often help orthopaedists to determine the cause of neck pain and to prescribe effective treatment.

In case further evaluation is needed, you may have to undergo one or more of the following examinations:

- MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.

- CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.

- Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.

- EMG (electromyogram). This test evaluates nerve and muscle function.

Your orthopaedist may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists. Most commonly, the symptoms are temporary and can be treated successfully with conservative care (such as rest, medication, immobilization, physical therapy, exercise, activity modifications or a combination of these methods).

When neck pain persists or is chronic, a rehabilitation program with exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back may be useful. If your neck is inflammed, your orthopaedist may prescribe rest and a neck collar for a some time, as well as medication to reduce inflammation.

Remember that if your orthopaedist prescribes rest, it is vital that you follow instructions carefully. If the pain does not respond within 6 to 12 weeks of conservative treatments, then surgery may be recommended.

Let's say you injured your neck, followed the guidelines of your carer, the pain still persists and the last thing you want is see your neck cut, but it is highly recommended by your specialist. What do you do? First, get a second opinion. But if you hear the same thing from different docs, you may want to comply and get your spine stabilized once and for all, or there is a great risk of paralysis in the long term.

In case of herniated disk or bony narrowing of the spinal canal, surgery may reduce pressure on the spinal cord or a nerve root. After all that is done and dangerous conditions are outrulled, you may start rehabilitation. The types of exercises that will help you recover faster are specific to the site of injury. Your physiotherapist is the best person to prescribe these. Supporting your neck with a pillow, rolled towel or special neck roll in certain positions as suggested by your therapist can take pressure off sore or injured areas.

You know how wonderful, free and easy it feels when someone massages your neck muscles, regardless of whether they are tense or not. This may give you an immediate sense of relief, but if you want to prevent further damage and progressively go further, you may want to slow down your training, take a good look at your routine and try the following tips:

• Take a deep, diaphragmatic breathing slowly – not to calm you down, but to help air to reach even the lower lobes of your lungs bringing much needed oxygen to sore tissues and relieve tension. Breath fully and freely at all times. If you get inspired, there are books and even schools on proper breathing promoting to help lose weight, improve health and vitality, and who knows, maybe even give your muscles a boost.
  
• Using healthy posture is like holding a defense shield against future neck problems. When your joints are positioned in their safe--or neutral posture--the body works like an elegant machine- safely and more productively.
  
• Exercises for strength, flexibility, coordination are important during all stages of recovery from neck pain. Movement of joints and muscles can safely ease pain by providing nutrition and lubrication to injured and sore areas and signal the nervous system to block incoming pain.
  But don't go in the pain zone as you know it. Torturing your muscles in the gym may be your growth mantra, but trying to overcome nauseating drill to strengthen your injured neck is nonsense.
  
  
  Neck Exercises
  
  
  

• Chin tucks
  Place your fingertips on your chin and gently push your head straight back as if you are trying to make a double chin. Keep looking forward as your head moves back. Hold 5 seconds and repeat 5 times.
  
  
• Upper trapezius stretch
  The upper trapezius muscle connects your shoulder to your head. Sitting in an upright position, put your right arm behind your back and gently grasp the right side of your head with your left hand to help tilt your head toward the left. You will feel a gentle stretch on your right side. Hold for 15 to 30 seconds. Repeat 3 times on each side.
  
  
• Neck rotation
  Rotate your neck by looking over your right shoulder, place your right palm on the left side of your chin and push your chin toward your right shoulder. Hold for a count of 10 and repeat on the left side. Do this 3 times. Scapular squeezes: While sitting or standing with your arms by your sides, squeeze your shoulder blades together and hold for 5 seconds. Do 3 sets of 10.
  
  
• Thoracic extension
  While sitting in a chair, clasp both arms behind your head. Gently arch backward and look up toward the ceiling. Repeat 10 times. Do this several times per day.
  
  
• Neck Extension
  Start by looking straight ahead. Slowly lean your head to the left. Hold for five seconds, then return to starting position. Then, slowly lean your head to the other side. Hold for five seconds. Return to starting position. Do ten repetitions.

References

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Bronfort G, Evans R, Nelson B, Aker P, Goldsmith CH, Vernon H 2001. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 26:788-799.

Bush K, Chaudhuri R, Hillier S, Penny J 1997. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. Spine 22:183-187.

Jull G, Barret C, Magee R, Ho P 1999. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalgia 19: 179-185 Jull GA 2000.

Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 8:143-154.

Liebenson C, DeFranca C, Lefebvre R 1998. Rehabilitation of the Spine: Functional Evaluation of the Cervical Spine - videotape, Lippincott/Williams & Wilkins, Baltimore. Main CJ, Watson PJ 1999. Psychological aspects of pain. Manual Therapy 4:203-215.

Silverman JL, Rodriguez AA, Agre JC 1991. Quantitative cervical flexor strength in healthy subjects and in subjects with mechanical neck pain. Archives of Physical Medicine and Rehabilitation 72:679-81. Teresi LM, Lufkin RB, Reicher MA, et al 1987. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR Imaging. Radiology.;164:83-88.

Torg, J.S. and T.A. Gennarelli. Head and cervical spine injuries in Orthopaedic Sports Medicine: Principles And Practice J.C. DeLeeand and D. Drez,(eds.)Philadelphia: W. B. Saunders Co., 1994., p 417-462.

Treleavan J, Jull G, Atkinson L 1994. Cervical musculoskeletal dysfunction in post-concussion headache. Cephalalgia 14:273-279.

Watson, DH, Trott PH 1993. Cervical Headache: an investigation of natural head posture and cervical flexor muscle performance. Cephalgia 13;272-284.