While there are a variety of reasons somebody can develop neck pain, the majority of cases are “mechanical” in nature. This usually means that body tissues like muscles, tendons, or joint surfaces become irritated in a way that limits their ability to move — leading to limited movement ability (restricted range of motion), muscle tightness, and pain.
When this is the reason people are having neck pain, re-establishing normal movement of the neck as soon as possible is an important step in achieving recovery.
The simplest way to begin improving the neck’s movement ability when it’s feeling stuck or limited is to remove some of the tightness surrounding it and regain control of the full movement potential. Put more simply, stretching and active movement.
Stretching for Neck Pain
Neck pain frequently creates a lot of muscular tightness throughout the neck and shoulders. This tightness is important to reduce in order to efficiently improve movement ability. Usually this can be achieved through treatments delivered by others (massage, joint manipulation) or with self-interventions like stretching. Once you have the tightness diminished, it becomes a lot easier to move the neck in a more normal manner.
Stretching comes in a variety of forms — some types involve contraction of muscle before or after a stretch, others are quick, dynamic movements that spring into new movement ranges, and others still have no movement component at all. For early stages of neck pain, static stretching (where movement is minimal) is likely the most prudent since it carries the lowest injury risk, and gives you more personal control over the stretch to avoid re-aggravation of your issue.
All of which is a long way of say static stretching is easy to do, has low injury risk, and you know when you might be overdoing it because it becomes uncomfortable.
For complaints of neck pain, I find there tend to be four key stretches that govern range of motion improvements: stretches of the Upper Neck, Lower Neck, Levator Scapula, and Upper Trapezius.
General stretching rules:
- All of these stretches begin in a “stacked” position — sitting tall with the head centred over the shoulders (see 1B for reference).
- Never force your head into a position with your hand — use the hand to hold a stretching position only.
- Do not push into or through painful ranges — if you try to stretch something and you begin feeling more than a little discomfort (like something sharp, throbbing, or would otherwise make you say “ouch”), back off that position so that you have a less aggressive stretched position. Or, avoid this position at the moment and return to it stretch later.
- Some noises (crunches, clicks, pops) are commonly reportedly with neck pain, especially when tightness is present. As long as these noises are not associated with sudden pain they are rarely serious. However, work around these sensations with caution. Intentionally recreating these sensations can eventually create more irritation, but doing stretches properly will help these sensations improve as well.
- Perform these movements slowly, hold the stretch for 15-20 seconds, and repeat for 2-4 repetitions.
Upper Neck Stretch
Any movement of the head where the chin moves towards the chest will stretch the muscles at the back of the neck primarily. However, it is sometimes helpful to separate these posterior neck muscles into two sections — an Upper Neck (where the head meets the neck) and a Lower Neck (where the neck meets the shoulders).
To get a more specific stretch of the Upper Neck, the main movement from your stacked starting position is a ‘chin-tuck’, rather than a full chin-to-chest action. This places a more specific stretch on the muscles that attach the base of skull to the neck proper.
This movement is subtle — most people can only achieve 20-25º of movement when done correctly — so it is helpful in this position to use a hand on top of your head to apply gentle pressure to hold your tucked position.
Please do not force your head into that position with your hand though! This is much more effective if you chin tuck actively (you move it there intentionally) and simply use your hand to hold your head in place for the duration of the stretch.
Lower Neck Stretch
This will feel like a more conventional stretch than the Upper Neck did. From your starting “stacked” position, simply draw a line straight down with the tip of your nose until you bring your chin as close to your chest as possible.
You will feel this stretch along the back of the neck to the top of the shoulders/mid-back. Once again, use a free hand to apply gentle pressure to hold your head in the chin-to-chest position for the duration of the stretch. But do not force your head into that position with your hand.
Levator Scapula Stretch
The Levator Scapula is a muscle that connects your shoulder blade to your neck. One of the ways we tend to find natural support for an irritated neck is by recruiting muscles in the shoulders as well — so stretching a muscle like this can be very helpful with re-establishing neck movement when pain is present.
Make one small change to the starting position here — whichever side you are stretching, take the hand on that side and either hold the seat of the chair you are sitting on with it, or tuck it under your thigh. For example, if it is the left neck and shoulder being stretched, use the left hand. This will keep that side from moving so you get a more effective stretch.
From there, draw a line straight down with the tip of your nose like you are doing the lower neck stretch again. When you begin to feel a small stretch, stop. There is no need to create a large stretch yet.
Next, roll your head halfway to the opposite shoulder (in this example, to the right). Take the free hand (right hand) and apply gentle pressure to hold your head in the stretch position. At the end of the stretch duration, release the pressure, let your head roll back to centre (chin-to-chest position), and then return to a starting position.
Upper Trapezius Stretch
Finally, the Trapezius is another muscle frequently involved in neck pain. This large muscle span from the tip of the shoulder blade, to the base of the skull, and all the way down to the junction of the mid- and lower back. The section of muscle we are focused on relaxing here is just the upper portion though — from the base of the head to the tip of the shoulder.
Use the same starting position as the Levator Scapula stretch — “stacked” position with the stretch side hand holding the chair or pinned under the thigh. Follow the same directions so that the tip of the nose draws a line down towards a chin-to-chest position. Again, stop with a small stretch here.
This time, however, roll the head towards the opposite side (in this example, the right side) all to way until the head is on top of the shoulder (an ear-to-shoulder position). Take the free hand (right hand) and apply gentle pressure to hold your head in the stretch position. At the end of the stretch duration, release the pressure, let your head roll back to centre (chin-to-chest position), and then return to a starting position.
Controlling Neck Range of Motion
Now that you have the muscles stretched and tension diminished, it will be more possible to actually achieve freedom of neck movement. Unfortunately, improvements in range of motion tend to be short-lived without repeated stretching (several times daily, several daily consecutively).
To make improved movement more lasting, however, you simply need to USE this movement in a safe way after stretching. Your body responds and adapts to the demands you place on it — so as long as there isn’t pain present, it is much more likely you will be able to maintain range of motion improvements if you continue to ask your muscles and joints to work in ways that use your movement ability.
Do these movements SLOWLY AND WITH CONTROL — do not quickly ‘bounce’ at the end of movement in hopes of achieving just a couple more centimetres, and perform single directions of movement at a time. There are no combined ranges to start — that will come later.
As always, work up to or around discomfort, but not through painful ranges.
There are six fundamental movement directions for the neck. I strongly recommend completing all six, since daily activities require combinations of each — so even if one direction is painful and off-limits at a particular time, still complete the others as best as possible because healthy movement in that range of motion will help the painful range improve faster as well.
Use the tip of your nose as a guide consistent movement. I also recommend looking in the direction of movement with your eyes too — this helps, trust me! Complete 8-10 repetitions in each direction, consecutively, and then repeat for two sets of all six movements.
Six Directions for Neck Active Range of Motion:
- Neck Flexion
- Neck Extension
- Neck Lateral Flexion Left
- Neck Lateral Flexion Right
- Neck Rotation Left
- Neck Rotation Right
Keys to remember for Range of Motion exercises:
- Perform these movements slowly and in a controlled manner.
- Don’t push through painful ranges — work around, or up to a painful barrier, or return to the movement later.
- Use your nose as a guide for consistent movement (eg. draw a line with the tip of your nose).
- Complete 2 sets of 8-10 repetitions for each direction of movement.
These activities should do an excellent job of loosening tight muscles in the neck and shoulders, improving range of motion in the essential movements of the neck, and makes general movements with the head and neck less painful overall.
The next aspect of dealing with neck pain is to develop more tissue resilience so that neck pain is less recurrent. That will be covered in the next blog.