Ouch, I've got a crick! Neck pain 101

Have you ever woken up with a crick in your neck after a bad night's sleep? Or feel like you can't rotate your head? Many people will experience neck pain at some point in life. Luckily, there are science-backed treatments and exercises to ease those nagging aches. This episode, a spine surgeon, sports medicine doctor, sleep expert and physical therapist give tips on working through neck pain. Follow us on Instagram: @nprlifekitSign up for our newsletter here. Have an episode idea or feedback you want to share? Email us at [email protected] the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekitLearn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

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• 0:17Marielle Segarra?

  You're listening to Life Kit from NPR.

• 0:22Marielle Segarra?

  Hey, it's Marielle. You ever wake up with a stiff neck that just ruins your day? Maybe you slept on it wrong, or you carried around way too much stuff in that messenger bag yesterday. Either way, now you can only turn your head to the right and you feel a headache building. Soon enough, you start feeling pain in your shoulder, too, and your back, and on it goes.

• 0:44Speaker 02

  Because, you know, the song, "The Headbones Connected to the Thigh."

• 0:56Marielle Segarra?

  This is Sharla Fisher, an orthopedic spine surgeon at the NYU Langone Spine Center.

• 1:01Speaker 02

  The pain can not only radiate to other parts of the body, but then you can start to have compensation for that pain. So, for example, if you're, if it hurts to lean forward with your neck, maybe you're going to start to lean forward with your lower back, just slightly. The other thing is that the muscles in the, in the neck connect to the head. And so they can, if they're spasming, you can start to get headaches that way.

• 1:30Marielle Segarra?

  And those are just two examples. The bones in your neck, or cervical spine, are part of your axial skeleton. 80 bones that form and protect the central core of the human body, the skull, the spine, and the rib cage. And the muscles, by the way, in our axial skeleton, don't get to rest a lot. After all, they have to hold us up all the time. Our neck muscles specifically have a big job. They help to support our heavy heads, to keep us erect when we walk. And they're constantly fighting the pull of gravity. It makes sense that they'd get tired, mixed up, overworked.

• 2:05Speaker 02

  I would guess almost everyone has neck pain at some point in their life, just like everyone experiences low back pain at some point in their life.

• 2:14Marielle Segarra?

  But there are a lot of different types of neck pain that can have a lot of different causes. So how do you know when to worry or how to feel better?

• 2:24Marielle Segarra?

  That's what we'll cover in this episode. Life Kit reporter Andy Tagle is going to walk us through some common causes for neck pain and give us exercises to prevent it and help us deal with it when it crops up.

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• 4:18Speaker 04

  So did just the title of this podcast make you a little achy? I'm with you. Get this. In a 2016 study, neck and low back pain were clocked as the biggest drivers of healthcare spending in the US from a list of 154 conditions. An estimated $134.5 billion.

• 4:41Speaker 05

  But it's very important to know that it's very preventable. Okay?

• 4:45Speaker 04

  Dr. Fabian Morales is a sports medicine physician and an entrepreneur. Currently, he's based in Georgia, but in the past, he's spent a lot of time traveling for work.

• 4:53Speaker 05

  I actually was the medical director of the National Basketball Association for 10 years. And to me, that was probably the best time in my career.

• 5:05Speaker 04

  He's also worked with Major League Baseball and ringside for USA Boxing.

• 5:08Speaker 05

  Whether you're a professional athlete or not, I think prevention is the best way to go about anything with neck pain. Because once you have it, I mean, treatment is a little more difficult.

• 5:19Speaker 04

  Or a lot more difficult, depending on your type of pain and how long you've had it. But let's not get ahead of ourselves. Let's position our heads right where they should be instead.

• 5:29Speaker 05

  Have your shoulders in line with your ears. Whether you're sitting or standing, that is very, very important for your posture support.

• 5:39Speaker 04

  Takeaway one. Strong posture is pain prevention. Ears over shoulders is a good starting point because, well, physics. Take it from Ellen Wormter. She's a sleep expert we'll spend more time with in just a bit.

• 5:53Speaker 06

  When you're carrying something heavy, you keep it close to your body. It's easier. So if you think about serving a plate, when you reach out to serve that plate and your hand is extended, it feels much heavier in that extended position.

• 6:08Speaker 04

  The same thing can happen to our necks as they hold up our heads, which are 11 pounds on average. But beyond this general truth, it's important to note, there is no one perfect posture. Different tasks require different movements and different angles. That's why ergonomics, you know, functional design, often plays a big role in creating safe, strong postures.

• 6:30Speaker 05

  Those are foundational in preventing neck pain, especially in today's digital world, that everyone's in front of the computers, everyone's on their phone, everyone's texting. So small adjustments in desk height, chair support, or even monitoring position, that can make a huge difference.

• 6:47Speaker 04

  Now, we should say you can get really detailed with all of these things. And we have, for the record. We've got a whole episode dedicated to ergonomics and another excellent interview specifically on improving your posture, if you want more after this. But for now, we're just going to cover the biggies for a happy neck. For example,

• 7:06Speaker 05

  Using a chair with lumbar and neck support?

• 7:08Speaker 04

  Supportive chairs, whether at work or home, should allow you to put both feet flat on the floor. Or, for fellow shorties, a footrest works too. These are important for proper circulation and to reduce pressure on the thigh muscles, which also help keep you upright. If you sit at a desk for long stretches of time, aim for an adjustable one, if possible, because the stretch and strain on your arms, neck, and shoulders can vary depending on the work you're doing and the tools you're using. And of course, screen height is a big deal, too.

• 7:40Speaker 05

  Keep your monitor at, basically, eye level. That way, you're not going forward and putting strain on your neck.

• 7:47Speaker 04

  And this advice applies for all your other screens, too.

• 7:51Speaker 05

  I don't know if you've heard of text neck.

• 7:52Speaker 04

  Text neck, or tech neck, is a uniquely modern-day malady. It's neck pain brought on by, yep, you guessed it, prolonged forward head posture from looking at phones or similar screens for too long. But you can also use your technology to improve your posture and decrease your pain. Maybe wear headphones and have your phone read notifications for you so you don't have to constantly crane your neck, for instance. Or try using that very helpful, very analog feature, a timer.

• 8:24Speaker 05

  Taking mini breaks is so, so important because you're constantly under pressure with your neck.

• 8:28Speaker 04

  The best posture is your neck's posture. So you could aim for a little bit of movement every time you switch a task at the office. Do some cat-cow stretches every 50 miles of your road trip. Or simply set a quick timer at the top of every work hour.

• 8:41Speaker 05

  Take a three- to five-minute break, you know, move your neck around, do some range-of-motion exercises, and that'll help at least relax some of that tension around your neck muscles.

• 8:50Speaker 04

  Now, once you've got some good daytime habits down, don't stop there. Because good posture, ergonomics, they don't just apply to your waking hours. Takeaway two: sleep the way you stand. For me, neck pain visits most frequently first thing in the morning, even or especially after I've gotten the rare full eight hours of sleep. And then sticks around for most of the day, giving me headaches and generally making me a very cranky camper. Can anyone else relate?

• 9:20Speaker 06

  You know, it's funny because when you're young, you have to have an incident to create injury, right? But once you get older, you can get into a perfectly comfortable bed for six, seven, eight hours and wake up with an injury.

• 9:32Speaker 04

  Ellen Wormter is a nurse practitioner and behavioral sleep medicine specialist. She says age can play a role in sleep-related neck pain, but the more complete answer likely has to do with posture. Because when you sleep, just like when you're sitting at a desk or running around doing errands, you want to aim for ideal spinal alignment.

• 9:52Speaker 06

  You want your neck to be aligned with the upper back. You want your chin and neck aligned to the center of your shoulders, and you want your shoulders in line with your hips. And then you want your head looking forward, not bent up and not bent down.

• 10:08Speaker 04

  In case you couldn't quite picture that, all Ellen's saying is, aim to sleep the way you stand, as in a straight line from the top of your head to your tailbone. You wouldn't go walking around all day long with your head tilted down to one shoulder. And you wouldn't sit at your desk for an eight-hour shift, turning your hips one way and your shoulders another if you could help it, right? And yet, those are the exact kinds of awkward positions we put ourselves in when we sleep. Of course, your body is going to react.

• 10:36Speaker 06

  Your brain thinks that there might be an injury. And so to prevent further injury, it's going to tense the muscles up to sort of protect it. That's when you get that crick or that muscle spasm. All of that stiffness is there from usually being in a position overnight, especially if it's for an extended period of time where you're not getting the proper support.

• 10:58Speaker 04

  And that's what makes sleep posture so important. There are three main types: back, side, and stomach.

• 11:05Speaker 06

  And each position sort of has pros and cons.

• 11:09Speaker 04

  No matter your preference, you can optimize your sleeping posture to guard against pain by being intentional about your pillow, mattress, and general sleep space. Back sleepers, for instance, are already starting out ahead, since it's generally easier to keep your spine in that straight line. But pillow choice can be a bit tricky, because you don't want to elevate the neck too much and crane it in your sleep technic style. So Ellen says...

• 11:33Speaker 06

  Generally a thinner pillow.

• 11:35Speaker 04

  Or something ergonomic, like with curves for your neck. Be mindful of any gaps at the small of your back or under your knees. Maybe add smaller pillows in those spots.

• 11:45Speaker 06

  Because whenever there's a gap, your soft tissue is going to want to sag into the gap, and when it does that, the muscles are going to want to tense up to kind of make up for that, and then you're going to have these aches and pains.

• 11:58Speaker 04

  This position is also most prone to snoring. If that's you, the Sleep Foundation recommends elevating the head of your bed if possible, or training yourself to side sleep. You can do that with yet another type of pillow.

• 12:10Speaker 06

  You can use wedges. There are various products that have sort of a bulge in the back, sort of like a pool noodle, or a tennis ball, or something where if you roll on your back, it will wake you up.

• 12:23Speaker 04

  Side sleeping is the most common position for adults. And according to some strains of research, also probably the healthiest when done in correct alignment. Lying on your left side increases circulation, for example. That's why doctors often recommend it for pregnant women. It can also help minimize sleep apnea, and even reduce symptoms of heartburn and acid reflux. But side sleepers can also be prone to shoulder and neck pain. If, for example, they have the wrong mattress, or if your pillow doesn't have the right amount of loft.

• 12:54Speaker 06

  And that's sort of the height of the pillow, right? The loft? And so if you measure from the bend of your neck to the edge of your shoulder, that's about the loft that you're going to want. So if you're a side sleeper, for instance, and you have very broad shoulders, you're going to need a thicker pillow.

• 13:13Speaker 04

  So the ideal head pillow should fit right in between that space to keep your spine in alignment without pushing your head and neck further up. Lots of side sleepers also prefer placing a small pillow in between their knees, which can help reduce pressure in your hips and lower back. Last, and also kind of least, is stomach sleeping. This posture can help open up airways for struggling snores, but it's more often associated with its potential downsides, like neck, back, and shoulder aches, and more fragmented sleep from switching positions more often throughout the night.

• 13:46Speaker 06

  Really avoiding stomach sleeping is the biggest posture recommendation. The main issue is it's really hard to keep your head looking forward because it naturally bends up. Or you turn it to the side, you're getting some tension there with the rotating.

• 14:02Speaker 04

  So in terms of pillow choice?

• 14:04Speaker 06

  Stomach is usually the thinnest pillow of all. When I used to stomach sleep, I just would sleep flat on the mattress because that helped to align the back of my neck a little bit better.

• 14:16Speaker 04

  If you're absolutely stuck on stomach sleeping and you need a pillow, an ergonomic one might be well worth the investment. And more generally, Ellen says finding the exact right pillow type or types for you, loft, length, material, firmness, will take some trial and error.

• 14:32Speaker 06

  You do have to just try out a few. The good news is that we are supposed to be replacing our pillows fairly often anyway.

• 14:41Speaker 04

  The Better Sleep Council suggests replacing your pillows every two to three years to account for dust, oils, allergens, and because pillows lose their structure over time. And the same goes for your mattress, by the way. Best practice there is to find a new one every seven years at most because that's generally how long you can depend on one for proper support.

• 15:03Speaker 04

  Now, maybe by this point, you've done about 15 neck rotations while listening, and you're saying to yourself, "Okay, okay, I'll add pillow shopping to my to-do list." But this is a story about neck pain. So would you mind, like, actually explaining this pain in my neck a little? I woke up with a giant knot. I still can't turn my head to the right. Help me.

• 15:22Speaker 07

  If your problem is rotating, it could be the upper area of the cervical spine where a lot of our rotation happens. You could have a joint restriction in that capsule. Every one of our joints, including in our spine, have a bit of a capsule around them, a connective tissue capsule. Sometimes muscle tension from being in one position takes a little bit to work out. So if we can move our neck around gently at first, slowly it will get better.

• 15:46Speaker 04

  This is Michael Woodard, a physical therapist and clinic director of Spine and Sport Physical Therapy in Mission Valley, San Diego. He's going to help us deal with neck pain through movement. Because, takeaway three, all necks need strength and mobility training. Yes, even the achy ones. Does it feel better stepping up to the side than stepping forward? Actually, I feel it more to the side. Feel it more? Yeah. I interviewed Michael in his clinic bright and early at the start of his workday, which is why you might hear the whir or clunk of sports equipment or sounds of gentle encouragement in the background, just FYI. He says neck pain is very common in his line of work. The key is going to be how do you feel, how do you feel after, how do you feel tomorrow? Whiplash from car accidents, work injuries, day-to-day neck pain from sleep or screen

• 16:31Speaker 04

  time. So there's a big range, and every achy neck is unique. Now, let's note, we're assuming if you were, say, just in a car crash or suffered a similar major accident or injury, you're not coming to a podcast about everyday neck pain for advice first. But if you have, you definitely want to head to a healthcare professional to get checked out. And in case you didn't know, physical therapists like Michael can provide that care to you directly, without a doctor's note, in all 50 states. Often covered by insurance for at least the first few visits.

• 17:04Speaker 07

  We can do the screening and make sure to tell you, is this something serious going on? Or do you just have a joint mobility, muscle problem, a musculoskeletal issue? Because neck pain can, you know, be a sign of other more serious things.

• 17:17Speaker 04

  We can't parse through every potentially serious neck problem here. That would be a real pain and that would take far too long. But I am going to tap in Spine Surgeon Charlotte to delineate a few hotspots for us. For one, musculoskeletal pain can sometimes be confused with nerve pain. So how do you know the difference? Muscle pain in your neck is often localized, accompanied by tightness, dull aches, and swelling in the affected area.

• 17:45Speaker 04

  Nerve pain is more often sharp, might have a burning sensation.

• 17:49Speaker 02

  Pain going down the arm or numbness and tingling in the arm or hands or weakness in the arms or hands. That is a sign that maybe there's a pinched nerve in the neck, either from a disc herniation or degeneration and arthritis.

• 18:06Speaker 04

  You might also want to consult a doctor sooner than later if you have neck pain as well as balance issues like trouble walking.

• 18:14Speaker 02

  Feeling like you're dropping things, like just an overall sense of clumsiness. That may be a good time to see someone about that.

• 18:23Speaker 04

  Or maybe nothing about your condition is sounding any serious alarms, but it just doesn't feel good and it's getting in the way of your day to day.

• 18:32Speaker 02

  Anytime your pain is like on a scale of one to 10, maybe consistently five to 10 for, you know, more than a week, then it's good to seek some sort of guidance on that.

• 18:46Speaker 04

  But the absolute most common neck pain, according to Sharla, is muscle injury due to repetitive stress, the type of thing that crops up as a result of what we were just talking about, poor posture, weird sleep angles. And while that type of strain stiffness can get real uncomfortable, it's not something to stress over or freeze up about.

• 19:06Speaker 07

  The real danger is when we get into the point where we say, my neck must be out of alignment, therefore I need to rest this, I can't move. That's what can lead to this little crick in your neck from this benign thing turning into a longer term recovery.

• 19:22Speaker 04

  Now, the idea of addressing neck pain with movement might feel a little counterintuitive. If you've ever sprained a wrist or an ankle, you might be familiar with the RICE method for extremity injuries. It stands for rest, ice, compression, elevation. Basically, don't move, don't use it. But Michael says that just doesn't really apply for the neck.

• 19:44Speaker 07

  We use them every day. So mild issues of the neck and the back, we can't just quote unquote, not use them. We're finding more and more that things like bed rest, things like inactivity only exacerbate, especially mobility issues. If you don't move, you can get, you know, less mobility, you can get less strength, you can lead to worsening of those symptoms.

• 20:10Speaker 04

  And the reverse is true as well. The more you move and strengthen those neck muscles, the better off you'll likely be against pain in the future. That's whether or not you're actively in pain or just an active person.

• 20:23Speaker 07

  We really need to work on strength training as a big aspect of this because it can, especially in your postural muscles, keep you more upright for longer throughout your life and will prevent issues down the road.

• 20:36Speaker 04

  And it's easy to start. If you're currently dealing with a stiff or sore neck, you can ease in with some gentle stretches and mobility exercises. You could use a door frame to do some pec stretches, for example, or you could try a thoracic extension.

• 20:51Speaker 07

  So you can do it over a chair like this. You're going to put your hands interlocked behind your neck and extend your body over the chair. You should feel a nice light stretch in the middle of your back. And oftentimes, if you improve the mobility of the middle of your spine, it requires you to move your neck less, which will lead to less overuse injuries of the neck.

• 21:15Speaker 04

  Fabian gave me another great one you can try. It's called a levator scapulae stretch. Hard to pronounce, easy to practice.

• 21:24Speaker 05

  You turn your head about 45 degrees to one side, and then you bring your chin down to your chest and you pull down slowly on your head and you hold for about 20 to 30 seconds. You do that two to three times on each side. That's going to help stretching those neck muscles and hopefully helping with the stiffness and helping with the range of motion.

• 21:48Speaker 04

  Now for strength. The next time you're driving or sitting at a desk, try a retraction exercise. It's a chin tuck, essentially. You just want to be careful to keep your gaze on the horizon and your head straight, not tilting up or tilting down.

• 22:06Speaker 07

  Like a double chin if you've done that before. So that's exactly what...

• 22:11Speaker 04

  To work the back of the neck?

• 22:12Speaker 07

  That's to lengthen the muscles in the back of the neck and work on the muscles called the deep neck flexors. So they're in the front of your neck and they actually are important stabilizers of your neck. And that can help you to maintain positions for longer and just overall strengthen and stabilize your neck to deal with daily life.

• 22:32Speaker 04

  You can practice this daily or even a few times a day if it feels good. And if you want to step it up a notch, try the same thing lying down, then lift your head. That's a chin tuck and lift.

• 22:42Speaker 07

  That works to stabilize your neck and keep you out of that tech neck position we talk about.

• 22:47Speaker 04

  And you can and should try the same exercise for the back and sides of your neck. When you do that, you just use your hands as resistance. Other than that, Michael says to just keep it moving. Because like your posture overall, dynamic movement is best. There's no one perfect position for your neck.

• 23:06Speaker 07

  It's less fragile than we think. It's designed to handle loads of 12 pounds or more for our entire lives. So it is, it can handle that. And especially if you train it to handle it, it can get better and better at that.

• 23:19Speaker 04

  All right, we've covered best practices for the office, the bedroom, the gym, and traveling in between all three. But I'm afraid I still can't promise you'll always be neck pain free. So Sharla has a few final thoughts for us. Takeaway four, still twisted up about neck pain? Stay safe, stay flexible.

• 23:41Speaker 04

  There are a lot of different remedies out there to deal with ongoing neck pain. If you prevent what you can, work out what you can't, and still find yourself sore and stiff, you might be seeking a multi-pronged approach to help with pain management. Some options may feel better than others, and some may carry more risk.

• 24:01Speaker 04

  Chiropractic work is a common inquiry for neck, back, shoulder pain. Our expert said, if you're interested in this route, you want to make sure to be aware of potential risks and consider doing so in conjunction with other care providers, like a physical therapist or primary care doctor. There are lots of mind-body practices you could try.

• 24:21Speaker 02

  Like meditation or keeping a pain journal.

• 24:25Speaker 04

  Or massages, or cupping, or yoga. Research has shown both acupressure and acupuncture can be effective treatments for chronic pain. Sharla and Fabian also mentioned doing what you can to prevent and avoid inflammation.

• 24:40Speaker 02

  There's nothing you can do to prevent the normal wear and tear of the spine, but you can keep everything else as healthy as possible, right? So you can not smoke, because that always makes everything worse. You can maintain a healthy diet and healthy weight.

• 24:57Speaker 04

  When your neck pain flares, Sharla says you can reach for good old Advil or Relief. You know, over the counter anti-inflammatory meds. Or try something topical, like Icy Hot or Tiger Bomb.

• 25:10Speaker 04

  Charlotte says she's often asked what's best for neck pain? Hot or cold? Ice or heat packs?

• 25:16Speaker 02

  It's whatever makes you feel better at that time. There's no science behind it. And sometimes ice feels better, sometimes heat feels better. And you can switch it up. It's just important to not do more than like 20 to 30 minutes at a time, three times a day.

• 25:32Speaker 04

  And speaking of heat, don't mind if I do.

• 25:35Speaker 02

  So if you have chronic pain or you have like a new pain, I've had patients say, well, I went on vacation to Arizona where it's a dry heat. Or I went on vacation to Costa Rica where it's more humidity and that really helped. So just keeping in mind that sometimes a change of scenery can do a lot of good, both mentally and physically.

• 26:00Speaker 04

  So you're saying that I should go to Hawaii is what I'm hearing? That I should take a trip to Hawaii immediately?

• 26:06Speaker 02

  Yeah. Yes, you need to take a trip to Hawaii.

• 26:08Speaker 04

  Well, doctor's orders.

• 26:09Speaker 02

  I'm writing it on a script pad right now.

• 26:18Speaker 04

  Okay, let's take a quick, controlled look back.

• 26:24Speaker 04

  Takeaway one, strong posture is pain prevention. Remember, there isn't just one. Takeaway two, sleep the way you stand. It's just as important to keep your spine aligned when you're snoozing. Optimize your sleep posture with the right pillow and mattress picks. Takeaway three, the strength and mobility of your neck matters, whether or not you are currently in pain. Take some time to do a chin tuck right now. Yes, you. Takeaway four, stay safe, smart, and flexible about your pain management. Don't discount the power of a warm shower, a fresh ice pack, or your favorite yoga class.

• 27:07Marielle Segarra?

  That was Life Kit reporter Andy Tagle. If you love Life Kit and you want even more, follow us on Instagram at NPR Life Kit. There you will find videos demonstrating some of our favorite tips, as well as exclusive videos of experts answering juicy questions like, "How do I get over my jealousy of my girlfriend's dog?" Or, "How do I tell my friend to stop texting me all the time?" You can find those by following us at NPR Life Kit. This episode of Life Kit was produced by Margaret Serino. Our visuals editor is Beck Harlan, and our digital editor is Malika Gribb. Megan Kane is our senior supervising editor, and Beth Donovan is our executive producer.

• 27:49Marielle Segarra?

  Our production team also includes Claire Marie Schneider and Sylvie Douglas. Engineering support comes from Jimmy Keely. Fact checking by Tyler Jones. Special thanks to Dylan Steinhauer and the rest of the team at Spine and Sport Physical Therapy. I'm Marielle Segarra. Thanks for listening.

• 28:21Speaker 03

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