Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (15 page)

INTRODUCING THE NECK

There’s a reason they call it a “pain in the neck.” The bones, ligaments, and muscles that make up the neck have the crucial job of supporting the heavy human head, not only keeping it upright but also allowing it to flex forward, extend backward, and twist from side to side. (Humans evolved as hunters and as the hunted; it pays

THE SPINE

The spine is a vertical stack of twenty-six movable segments that we think of as five distinct sections. Starting from the top, there is the neck or cervical spine, the midback or thoracic spine, the lower back or lumbar spine, and, providing a stabilizing anchor just above the waist, the sacrum. The fifth section, the coccyx or tailbone, is generally not considered structurally important.

The spine evolved to handle two essential jobs: to support the body and to protect the spinal cord. As we move, the spinal column keeps us upright, connecting the upper and lower body in a flexible way so that we can bend and flex and rotate from side to side. That same structure of linked bones or vertebrae doubles as a protective housing for the spinal cord, which passes through it. The spinal cord is a rubbery bundle of millions of nerve fibers—think of a dense fiber-optic cable—that transmits information back and forth between headquarters (the brain) and the branch offices (the peripheral nervous system, which wires the rest of the body). For virtually everything you feel (that would be your sensory neurons firing) and every move you make (your motor neurons firing), data travels up and down the spinal cord as part of an ongoing circular conversation between brain and body.

A lot of craftsmanship has gone into the spinal column. Each vertebra is a cylinder of bone with generally three bony prominences. The side prominences join each vertebra with the one above and below, forming two sets of facet joints, which help guide movement. In between the center of each vertebra are the disks—firm cartilage on the outside, gelatinous on the inside—which act as shock absorbers, contributing to the flexibility of the spine and preventing the bony vertebrae from grinding into each other. Like any hardware, the spine wears down over time. Of all the areas of the spine, the disks can be the most vulnerable pieces.

to have a wide field of vision.) All that movement can cause wear and tear. For that matter, holding your head and neck in a fixed position while staring at a computer screen for hours on end can fatigue the system and invite its own set of pains.

In every “hot-spot” chapter, we want to lay out how the three elements of the system—bone, joint, and muscle—come together to support and drive the human

IMMEDIATE TREATMENT/WHEN TO SEE A DOCTOR

When it comes to possible spinal cord injury, caution rules. If you’ve suff ered a serious blow to the head or neck, see a doctor immediately. You need to rule out damage to the nerves or to the structures of the spinal column, including the vertebrae, the spinal cord, the spinal ligaments, and the disks. Even if there is no obvious trauma, debilitating neck pain or numbness in any part of your body, or shooting pains down your arm, require medical attention right away. If there’s any change in bowel or bladder function, get to the emergency room. Any loss of consciousness associated with a neck injury also requires immediate attention. At the least, you may have a concussion. As with any joint problem, look for any signs of infection such as redness and fever or heat. If there are any, see a doctor immediately.

body, and how, when there is pain and dysfunction, they fall out of sync. But the neck (cervical spine) and lower back (lumbar spine) are somewhat special cases. Medical science is good at spotting damage to the bones, ligaments, and disks of the spine on an X-ray and MRI, but so far it doesn’t always show the exact connection between damage and actual symptoms.

In fact, the best spine specialists will tell you they don’t always know what causes most pain in the cervical and lumbar spine, or why one person has no symptoms and another is in agony when their MRIs show similar amounts of joint damage. Research and experience indicate that this difference can be attributed to muscle. But still we approach the spine with diagnostic humility. In most of the other hot spots we’ll be talking about, for instance the hip or the shoulder, we try to be as specific as possible, identifying the individual muscles that act on the joints to cause particular problems. With the neck and the lower back, we’re happy to take a “big picture” approach, focusing on a few muscle groups that yield excellent treatment (and self-treatment) results no matter what the textbook definition of the injury is. Those labels (scalene anticus syndrome, for example) are long on anatomical precision and short on clues as to how best to treat the problem. As we’ll explain, surgery for cervical and lumbar spine problems is in most cases an option of last resort.

COMMON PROBLEMS AND CULPRITS

The scalene muscles and the sternocleidomastoid muscle in the front of the neck fire to flex the head forward. When they relax, the erector spinae and the suboccipital muscles in the back of the neck engage and extend the head backward. When the neck is flexed forward too far or for too long, the suboccipitals at the base of the skull can tense up, entrapping nerves, which can trigger a tension headache, or “occipital neuralgia.” The scalenes can entrap the nerves in the front of the neck, sending pain and numbness down the arm. These symptoms are similar to a more serious case of nerve impingement: when a disk or some part of a bony vertebra presses down on, or “impinges,” a nerve root exiting the spinal cord.

WHAT GOES WRONG, AND HOW TO FIX IT

Mostly Muscular

Chronic Neck (Cervical) Strain

John, forty-five, is an accountant in Westchester, New York, who spends the better part of every day slumped over his computer screen poring over the tax returns and balance sheets of his corporate clients. During tax season, he’ll stay mostly glued to the spot for eight to twelve hours at a stretch, take-out lunch containers and empty cans of Diet Coke piling up beside his work files. For years, his wife has been after him about his poor posture—his shoulders are rounded and his neck and head project forward instead of being in line with the rest of his spine. He ignored her until he started to be bothered by a laundry list of aches and pains that interfered with his productivity at work. His neck seems perpetually achy and sore, his shoulder throbs in the vicinity of his shoulder blade, and he’s starting to get “tension headaches” that attack the top of his scalp.

Imagine holding a bowling ball, which weighs about as much as a human head, up over your head. Hold it directly overhead, in line with your spine, and it’s not so bad. You can maintain the pose for a while. But let your arms fall forward, and
the effort quickly becomes excruciating as you stress the arm muscles and the supporting muscles of the chest and back. That’s what it’s like for your neck when your head is not in line, and why good posture is important.

As John painfully discovered, the spine can only handle the forces of gravity without irritation when it’s in balance. That doesn’t mean straight up and down, otherwise nature would have equipped us with a solid rod for a backbone (not much flexibility or shock absorption there). Instead our spinal column is a stack of four gently curving C-shaped segments that balance and counterbalance each other: the cervical spine curves forward, the thoracic spine curves backward, the lumbar spine forward, and the sacrum backward. This design functions as a spring. The soft tissues hold this graceful sculpture in place, and a network of ligaments run up and down the spine like supporting ropes. Opposing muscles in front and back of the spine do their part to provide balanced, flexible support.

When John’s shoulders slump forward and his neck and head settle into this forward position, he’s overstretching some of the muscles in the front of his neck and upper back and overworking muscles in the front, sides, and back of the neck, shoulders, and upper back. The result is pain of at least a couple of different kinds. As we described in
chapter 3
, the overworked muscles can contract so forcefully as to cause pain directly. Or muscles in the neck can spasm and entrap nerves running down into the shoulder. John has pain in both areas. (The neck/shoulder connection is a close and often uncomfortable one.) The neck-forward position strains the suboccipital muscles at the base and sides of the skull, which can entrap nerves that run up the back of the head, causing John’s tension headaches. (A couple of John’s colleagues who haven’t made the switch to telephone headsets have one more muscular affliction: achy muscles from cradling a receiver between a hunched shoulder and a sideways-bent neck.)

Skeletally, nothing is seriously wrong with John. Muscularly, he is a mess. And if he does nothing to address his slumpy sitting posture at work, the loss of the normal curve in the cervical spine may finally put enough pressure on the disks to seriously damage them, in which case all the pain and suffering he’s endured to this point will only have been a warm-up act.

The conventional medical approach to John’s problems could be to put him on an over-the-counter anti-inflammatory such as Advil (ibuprofen) and be done
with it. These drugs effectively dull pain, which can help the body to relax and a person to get back to life, but they don’t treat the root of the problem, which still exists when the drugs wear off. More powerful prescription muscle-relaxant drugs are also an option, but they have the same pros and cons. The sensible approach would be to benefit from the anti-inflammatories while pursuing a course of treatment that addresses the underlying issue. John should improve his ergonomics and work habits (see the box on page 86) and go to physical therapy. The therapist will most likely work on bringing his head and neck back in line with the rest of the spine with conditioning exercises that stretch out the tight muscles of the neck and chest, and then strengthen the muscles in his neck and upper back.

But there’s another angle to this story. Slumpers may be born as well as made. John may have a genetic predisposition to age into that rounded-shoulder posture, and it’s certain that the years of working hunched over his keyboard have retrained his brain-muscle connection, his “proprioceptive” sense of where his body should be, so that slumping has come to feel normal. Four or so sessions of insurance-covered PT isn’t going to change that. Moreover, jumping into strength and stretching exercises when his muscles are still contracted and inflamed is likely to do more harm than good.

Timing is everything. The ideal first-line treatment is manual therapy that relieves pain by relaxing muscle tension, especially in the scalenes, which pull the neck forward as they tighten up. When he’s pliable enough, he can get some real benefit from physical therapy, which is necessary for muscular reeducation. In the best of all worlds, John will incorporate some of his PT exercises into his everyday routine, using them to counter the forces of gravity and bad work habits. (You’ll be introduced to muscular self-treatment techniques, stretching, and strength-conditioning exercises at the end of this chapter.) Will John’s commitment to reeducate his body give him perfect posture? Probably not, but it may be enough to keep him out of pain and spare his disks serious damage. Even if all he takes away from PT is the habit of checking in with his body once or twice a day to relax the shoulders and let them drop, that could be enough.