Written by Carol Kennedy – Partner, Physiotherapist
Does your head often feel like it weighs a ton, especially after a long day at the office on your computer? Or the muscles between your neck and shoulder are in knots from overworking? Does your chin progressively poke forward as you sit for prolonged periods of time? Or maybe your neck feels fatigued while you are trying to perform your fitness program. Perhaps you have a weak neck ‘core’.
In recent years, ‘core’ exercise programs have gained popular use in the treatment of patients with low back pain. Like the low back, the neck also has a group of ‘core’ muscles that are important for maintaining a healthy neck and specific exercises have been developed to target these muscles. Research suggests that the most effective management of neck pain conditions includes both manual therapy (hand-on mobilization from your physiotherapist) and specific exercises.
The neck requires intricate muscular control to balance the weight of the head in space, move it through the large range of motion available, and position it accurately to allow us to use our senses (sight, smell, hearing, and taste) more easily. Research has suggested that the deep segmental muscles are of paramount importance in preventing the spinal column from buckling when the more superficial (at the surface) muscles move the head through space. These deep, ‘core’, or ‘inner unit’ muscles which attach directly from one vertebra to the next, have been shown to weaken, regardless of the cause of the neck pain. The more superficial or ‘outer unit’ groups, particularly the ones at the front, become overactive trying to guard the neck but unfortunately this creates excessive shear and compression forces on the neck. These are also the muscles that tend to bring the head forward into the poking chin posture. These abnormalities in muscle function are more marked in patients with neck problems related to trauma, and tend to persist even when the pain subsides unless properly retrained. This may explain why so many people experience recurrent episodes of their neck pain.
Several exercises have been developed in an attempt to reactivate these deep segmental muscles. Here is a core neck nod exercise to try:
Lie on the floor with a pillow under your head and a small rolled towel supporting the normal curve in your neck. Put a hand across the front of your neck, just above your collar bone and feel the muscles there.
Now see what happens when you cheat: gently lift your head just off the pillow and you’ll immediately feel muscles tighten or bulge under your fingers. This is what you don’t want.
So, keeping your head on the pillow, nod your chin slowly down toward your throat. You don’t want to feel anything under your hand. Stop just before you feel those muscles kick in and hold 10 seconds. Repeat 10 times.
If you are nodding and the muscles under your hand are relaxed, the only muscles left to nod are the ‘core’ muscles.
If you can’t nod at all without those muscles firing up, don’t worry, a physiotherapist will have other exercises for you. Once you have mastered activation of the ‘core’, there are exercise progressions to improve the balance and overall strength of all the neck muscles.
Patients must also be taught to maintain an optimal neutral neck posture while performing upper extremity tasks. Shoulder blade stability is integral to the stability of the neck, and so exercises to address muscle balance in this region are almost always a component of exercise programs for the neck. It is important to practice this optimal posture throughout your day, and when you are doing other activities such as your yoga or gym program.
We see that ‘core’ exercises are important for the low back and pelvis, as well as the neck. It is becoming apparent that every region of the body has a group of deep ‘core’ muscles that impart the stability required to then allow the larger surface muscles to move that body part in space. For example the shoulder blade muscles set the shoulder so that the other arm muscles can work effectively. The deep muscles in the foot control the small bones so that the larger muscles in the leg can propel the body forward as we walk. So many of the subtle specific exercises that are prescribed by your physiotherapist are targeting these muscles as the base on which to then your strength and function.