Making Exercise Healthy Medicine
How To Fix Causes of
Neck Pain, Upper Back Pain and Tightness,
Shoulder Pain, Rotator Cuff, Nerve Compression
Without Drugs or Surgery
This summary covers several musculo-skeletal causes of: Neck Pain, Upper Back Pain, Shoulder Pain, Bad Cervical (Neck) Discs, Nerve Impingement, Pain Down the Arm. Reduced (or Increased) Cervical Lordosis, Forward Head, Poor Posture, Round Shoulders, Rhomboid Pain, Upper Crossed Syndrome, Cervical Spondylolisthesis, Muscular Pain, Rotator Cuff Tears, Numb Fingers, Repetitive Strain, "Stress" Pain, Upper Back and Neck Tightness.
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Copyright © Jolie Bookspan, MEd, PhD, FAWM
Named "The St. Jude of the Joints" by Harvard School of Medicine clinicians
Director Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine - School of Healthy Medicine
Hello. You are on the Fix Neck Pain page of my web site (DrBookspan.com), a no-ad site to make life better, fitter, healthier, smarter, and sometimes funnier. My work is evidence-based primary-source sports medicine that you can use yourself, right away, to fix your neck pain, lower back pain, knee pain, other injuries, learn healthier training, and more. My lab research includes human performance in extreme environments. There are hundreds of articles here for you on my web site about fixing pain, smarter physical training, scuba, going higher, faster, stronger, and more.
Education is crucial to world health. I make my web site available for a better world. There are hundreds of articles here. Find main navigation links (Site Map) at the bottom of each page.
On This page: You can start fixing your own neck and upper body pain yourself, now, today using this Get-Started-Right-Now summary. Don't wait. This article shows you how to understand and stop several major mechanical causes of neck and upper body pain, and learn healthy ways to move so that you do not get the pain in the first place. That is different than doing stretches or exercises to stop symptoms, then returning to the same bad movement that causes or continues the pain. You can enjoy your favorite activities instead of giving them up.
These are summaries, with a wealth of knowledge still to give. Read my books for more. Hope I will get to meet you in my CLASSES or maybe in a rare Private Appointment. Have fun.
Not All Exercise is Good Medicine. I show you how to change daily movement and exercise into Healthy Medicine. It's not health care if it's not healthy. Much cost, time, and worry currently spent in medical treatments are unnecessary, and often unhealthful. Welcome to my Health Care Reform School™- I call it Fixa U™. I have developed information through years of research in the lab, and put it here on my web site for the benefit of the world. Get better and the world will be better.
Answers In A Nutshell
- My work is not alternative medicine. This is evidence-based, tested, sports medicine techniques, applied to real life - where you actually need it. Many call it innovative. I call it simple standard-of-care.
- Neck pain and upper back pain, rotator cuff tears, and most pain in the upper body and shoulder area, are not a disease or "condition" or something that once you have, you have it for life. It can be an injury like a sprained ankle, that with a little common sense and information, can heal and you can be better than before.
- You do not need to have surgery or extended medical treatments or rest to relieve neck and upper body pain, or most disc or rotator cuff tears.
- You do not need to give up impact activities like running or martial arts, give up weights or heavy occupational work, or activities you love.
- Many common exercises and well known stretches, even rehab stretches cause (or don't fix) neck pain because they are not healthy movement. They are found in gyms, yoga, Pilates, and many popular fitness books and videos. They are done out of tradition, and like smoking they may "work" but are not healthy. By changing movement and body habits to healthy ones, you will get the built-in exercise you need for health while you prevent causes of much neck, shoulder, and upper back pain and injury.
- For people with injuries from accidents, poor movement habits can make the areas hurt worse and prevent healing, leading to unnecessary treatments, instead of identifying and stopping the movement habits that make it continue to hurt - long after an injury would ordinarily heal.
- You do not need to give up computer or other desk and sitting work to stop neck and upper body pain. Sitting and working in unhealthy ways can be easily changed to healthful habits. This article will give you the concepts. After understanding them first, use the separate free Sitting Healthy article. This is different from doing sets and reps of exercises, then going back to injurious daily habits.
- It is not true that reaching overhead must impinge the shoulder, or that you need to give up overhead activities, even repetitive overhead activities. The problem most often comes from reaching overhead in faulty positioning. This article covers fixing neck and upper body position to be healthy so that reaching, which is a needed part of real life becomes pain-free, plus a built in stretch.
- Muscle pain, disc, or joint injury are not causes of the problem - they are RESULTs of what you are doing to hurt your neck - things you can fix yourself. Even when inflammation or immune response are identified, they are results, not causes. This article will show you how to understand and fix causes instead of using drugs and surgery for the results. This means you do not fix pain with a bunch of exercises and stretches. We fix the injurious movement habits that cause the problem.
- You may have several causes of pain. If you fix only some of them, you will fix only some of your pain. The answer is not to continue on, missing the rest, saying "it just takes time." Don't allow the other damaging causes to continue. Check for other causes you may have missed and fix them all. Then you will stop all pain, and instead of alternating feeling better from fixing one thing and hurting from other causes, wondering why you have intermittent results, you fix all and heal all and go on stronger and better than before.
- Not all neck pain is from what may show on an x-ray or other test or scan. You are not doomed by scan results.
- Many common medicines and prescription drugs can cause pain. Un-needed treatments and surgeries are done - causing more pain and reduction in physical ability. Easy changes can stop the need for harmful medicines.
- Study of posture rules, exercises, and devices has shown they have made as much or more pain and damage as slouching, and do not create healthy movement. They are also no fun. First, healthy lengths during movement needs to be learned. Then all daily movement builds-in healthy comfortable fun habit.
- This article explains all the above. Make sure you understand the concepts (many highlighted in green). The end of this article (where it says "More fun...") gives many helpful links to pages on this site for more help. Also see the bottom of every page on my web site for main navigation links.
Now go fix your neck!
A Short History of My Work To Develop These Methods (skip this if you prefer to go straight to fix pain with article, below)
My information is not copied from someone else who said it, or something I heard in a gym or in medical school. I am the scientist who researches what really happens. These are my results from years of work and years of schooling in physiology and research design. I started lab research studies in the 1970s to find why standard neck pain, back pain, and other pain exercises and treatments didn't work. I saw that rehab info was not being applied to how people move, sit, and live in their ordinary daily activities. I applied it. People got better. I saw that common treatments and in fact the assumptions about why pain occurs, were not done by real researchers but repeated from myths people liked and bad studies with flawed design and stats. I did painstaking studies and kept careful records (hundreds and hundreds of patients and students) so I would know which things actually worked in real life, and which were due to other things, including just time passing. I worked years on studies answering questions and questioning answers. When I was working on studies of the human body during immersion for combat swimmers, the experimental subjects, the lab physicians, and others in the lab kept saying they had all these aches and pains. Exercises their own physical therapists and docs gave them did not work or made them worse. I fixed them up. Their doctors started calling me (calling the lab actually, as I don't have a phone) asking how I fixed them so well. They (and their physicians) started taking classes with me. In the 1980s, class participants asked me to write everything down for them. I was surprised. I thought they should have taken notes. I typed information sheets for them. More doctors came to me after taking my classes, saying they knew their standard Patient Handouts were ineffective exercises. They asked me to make handouts for their patients. I was surprised. Again. I thought they could do that themselves. I typed Patient Handout sheets for them. I kept collecting data like a good scientist, doing studies to test and retest methods, and develop better ones. When the Internet came out, I sent handouts electronically, instead of photocopies. In the 1990s I typed everything in several training manuals that became books. One is Health & Fitness In Plain English - How To Be Happy, Healthy and Fit for the Rest of Your Life. After two different publishers, the new THIRD edition of How To Be Happy, Healthy and Fit... eliminates wrong things previous publishers added over my objections. Another book is Fix Your Own Pain, with patient stories in every chapter showing why patients get better, or don't, and why. Over the years, for each, I rechecked new data to make sure the work proved tests of time. Several more books of my life's work tell how to make life pain free, stronger, and more fun. Each book is different. I have seen fitness and rehab myths and fads come and go, but these methods remain effective over time. More about me in Adventures. Limited Classes and appointments to train directly with me, and workshop certification by me through AFEM for top students. Get the books for reference while you keep getting better:
To keep this quick and easy, much is shortened.
Use this summary to get better now, and get the books and eBooks for the rest:
Years of poor sitting, standing, and bending habits is enough to injure your neck as badly as from an accident.
- In a "forward head" position, your neck tilts forward, jutting your chin forward. The neck vertebrae shear, and the weight of your head unevenly presses the discs between them. The discs gradually break down (degenerate) and/or bulge in the direction you've been pushing them (herniate), usually toward the back. The disc, and the swelling from the damaged area (and immune response of the body trying to heal the area), can press nerves, sending pain down your arm (and sometimes around your torso, depending which nerves). This is not old age, but bad habits that you can quickly stop.
- Tightness from years of poor positioning - slouching neck forward AND also pulling the neck and head inward thinking that is "standing up straight" can press the same nerves mimicking nerve impingement and disc pain.
- A degenerating disc is not a disease, but a simple, mechanical injury that can heal, if you stop grinding it, shearing your neck bones, and physically pushing the disc out of place with unhealthy habits.
Sitting, standing, and living with your neck and head forward
can eventually shear the cervical (neck) discs on the bone making small tears, and push them out of place
Why Strengthening Does Not Work To Stop This Kind Of Neck Pain
It is not a matter of strengthening muscles to stop pain. Strength does not make you sit or move in healthy ways. Strength does not make you stop bad twisting yoga moves that shear the discs enough to tear them. Many people do strengthening exercises and become stronger people who still slouch. No special chairs or devices make you sit right (although many can encourage worse sitting, so see the article on Healthy Sitting.) Sitting well won't happen automatically from exercises, stretches, special chairs, or devices. Sitting, standing, moving, and living your life with healthy movement mechanics is up to you.
Instead of doing a bunch of artificial rehab exercises, and using stiff, uncomfortable posture drills, then going back to damaging daily life movement, try living and moving in healthy ways - functional movement mechanics. Here is how:
Tilting your head, neck, and upper body forward is called a "Forward Head." See the left-hand drawing below. A "forward head" is the source of much neck, upper back, and shoulder pain. Sufferers are often told they have a condition or disease, or problem that is inherited that they need to live with, and take months of treatments and medicines even surgery. After other injuries, a forward head can make the upper body ache. The forward head causes and adds mechanical pain and injury. The ways to fix it are straightforward and can be quick, depending how much you understand and apply.
The head should be vertically over the body, not forward. Check to see if you let your head and neck tilt forward, shown in the first drawing at left below.
The forward head (#1 left) commonly results in sore shoulder, neck, and upper back.
Many people think it is normal to be so tight that it is not comfortable to stand upright in healthy way for daily use. (right). They also may strain and force to pull to "straight" position, which is as unhealthy and painful as slouching. Use the info on this page to make healthy position comfortable.
A Forward Head Makes Upper Back Muscles Ache
The pull and strain of the weight of a forward head is like the weight of a bowling ball yanking forward on your upper back muscles. A forward head can eventually damage neck and upper back structures, over years of moving and rubbing at angles they were not built for. Chronically holding neck muscles in an overstretched position weakens them. The forward head creates shortened, contracted muscles in front, and a stretched, weakened back. Cervical (neck) discs are pressured posteriorly. This creates a cycle of forward positioning that herniates discs and makes sore aching muscles, and the tightness and habits that keep you tilting forward. The result is that the average person has upper body pain from the poor positioning and at the same time, the chronic poor positioning makes them too tight to stand up straight.
Check Yourself For Forward Head
You may be surprised to find that you do much of your standing, sitting, activity, and exercise with a forward head. No wonder you have pain. Look in any fitness magazine and see all the photos of people doing exercise with their neck tilted forward and chin jutting forward. Look at how people jut their chin and neck forward when they eat. See how they often tilt the neck forward and pinch the back of the neck at a sharp angle when they drink. Instead, get the range of motion from your upper back by gently "unrounding" the upper back and keeping the neck more neutral. Look how people carry backpacks and bags - neck tilting forward against the load instead of using muscles to hold the spine in upright healthy position? Then they do shoulder stands in yoga, which overstretches the posterior ligament, pushes discs outward, and creates forces that generate bone spurs. The average person overstretches and unequally stretches their neck and upper body so much, it is no mystery that they hurt - it is a mystery that they dont hurt more.
Upper Crossed Syndrome
The pain and other problems of the forward head are sometimes referred collectively as "Upper Crossed Syndrome." It is not a disease or "condition" or structural problem, or something to live with. It is mechanical pain from bad posture - slouching. It is easily fixed. Stop holding your neck and head forward. It is simple. Don't "do exercises" for your pain then go back to the forward head. Methods follow below.
Muscular Pain From The Forward Head
Poor standing and sitting ergonomics are a common cause of numb shoulder, upper back pain, and headache. It makes a classic "tension" pain across the shoulders, in a diamond pattern down the middle of the upper back, in the neck, up the neck to the head, and sometimes down the arm. Forward head is a common source of headache. Yet, after mechanically pressuring their neck all day, people call it stress and do not fix the very forward posture that would give them relief and stop the injury process.
Don't Pull The Neck and Head Inward, Tighten, Or Retract with the "Double-Chin" Exercise or Posture
It is common to hear you must pull the head and neck back, or pinch shoulder blades back, and other strains to "stand up straight." Posture rules like this cause as much or more pain than the slouched forward head. This common cause of pain are covered below in #4 below.
The forward head and rounded shoulders are a surprising hidden source of shoulder and rotator cuff pain and impingement. With the head held forward, and/or shoulders rounded, the upper shoulder rotates forward which gets in the way of normal motion when you raise your arm. The upper arm bone squashes the soft structures of the shoulder capsule against the shoulder bones (where the scapula meets the clavicle). This can cause pain, squashing (impingement) and rotator cuff injury. How often does this happen? Every time you wash and comb your hair, pull off a shirt, put away groceries, scratch your head, brush your teeth, and reach for anything you can be causing mechanical injury to the area and / or cutting into rotator cuff tendons a tiny bit at a time, until they fray and eventually tear. In short, a forward head and rounded shoulders can cause shoulder and upper back and neck pain through many dozens of injurious movement mechanics a day. Injury adds up over time.
It is not true that reaching overhead must impinge the shoulder, or that you need to give up overhead activities. When you use healthy position of the upper body and shoulder, there is no more impinging. You will be able to go back to many aspects of daily life that require reaching. Healthy reaching is also a built-in stretch that the shoulder needs for good function. (A small number of people have a damaged or structurally changed shape to the shoulder bones that can, in some instances, rub during arm motion. Good positioning also helps in these instances. In severe cases, for example, dead bone, infection, or a large "acromial hook" the area needs more medical evaluation and possible surgical repair.)Doing standard shoulder exercises does not fix poor positioning.
Check yourself - when you try to stand or sit "straight" or "pull back your shoulders" - do you do it by jutting your chin up (craning the neck), yanking the chin inward (double-chin), tensing the neck muscles, trying to pinch the shoulder blades back? No wonder you hurt.
Craning the Neck
Craning the neck is surprisingly common, and a major source of neck, disc, facet (spine joint), and shoulder pain. "Craning" the neck means folding or pinching the neck backwards, with the chin and face lifted. Craning may be confused for, even the cause of spondylolisthesis in the neck - a sliding of the vertebrae. Check to see if you crane your neck to look up, to drink, eat, to reach overhead, to try to stand straight, to read, to dress yourself, and wash in the shower. Check yourself to see if you jut your chin forward so often in daily life, continuing injurious habits and pain.
People are often told to stand up straight by bringing "ears over shoulders" or "pulling their shoulders back." One common result is to tip head back and crane the neck instead of getting the point - which was to straighten upper body positioning (posture), not make it worse. See the drawing of Backman!™ below demonstrating craning. To stand and sit straighter, don't tip your head back, yank your ear over your shoulder, or merely bring shoulders back, leaving the neck still tilted forward. Get the concept of unrounding the upper spine instead of forcing the neck back to make comfortable healthier upright position.
Are you so tight that you crane your neck to look up, or to try to stand straight?
The forced, pinched neck position hurts and can even create a sliding of vertebrae on the one below it, called spondylysthesis (in general, the top or bottom bone sliding more changes the name to retrolisthesis or anterolisthesis - covered separately). No surgery or pills needed.
Use the two stretches below to become comfortable holding upright position, then stop craning your neck.
Tensing or "Holding" Straight
Other people keep their head and neck wonderfully straight, tightly tensely straight. That hurts, obviously. Forced "straight" position is not healthy and not right either. Relaxed upright position means not tightening the muscles so much they hurt. Overcompensating hurts right at the back of the neck. Pulling the chin in too hard usually hurts at the corners of the side of the neck. Another specific and common place pain will start from doing this wrong is at the back of the head and neck People susceptible to headaches will get pain, and sometimes enough for nausea from tensing the chin inward and backward too tightly and too much as a way of sitting and standing. Many people are mistakenly told to do" the double chin exercise" which misses the whole point of what makes healthy normal positioning. It does not teach healthy relaxed position. Strengthening the muscles is not at all what is needed. Tensing these very muscles like that causes plenty of pain. More about this below.
More bad advice includes "pinching the shoulder blades back." There is no need to pinch anything. PInching brings more pain and tightness.
Often it is not the shoulders that need bringing back, it is the upper spine that is too rounded or forward. What is needed is to "unround" (straighten, extend) the upper spine and leave the shoulders out of it. Other times, the shoulders were fine, but the person applied a party line "fix" of "pinch shoulders back" which moved them back too far (since they weren't wrong in the first place). Blindly trying to do exercises or therapy moves, and never checking cause and effect, wastes time and health.
Another common result of the common instruction to "bring your shoulders back" is that people lean their entire upper body backward. leaning backward is a large hidden cause of lower back ache.
The shoulders and upper back may even stay rounded forward, meaning you caused a new problem as well as kept the old problem. Photo example below shows leaning back instead of stopping slouched and rounded upper body. That is not the point of "bring shoulders back" and it causes lower back and hip pain.
Make sure you are doing what you think you are doing when you think you are straightening. Straighten more from the upper spine, and notice what you are doing with the rest of you. Don't lean back. Your lower back and your shoulders are two different body parts. Pay attention. More on fixing the bad habit of swayback is on the summary page of Fixing Lower Back Pain With Standing.
- Stand near a wall, with your back close to, but not touching the wall.
- Back up toward the wall. See what touches first, and how it feels most habitual for you to stand.
- If your heels, backside, upper back, and back of your head all can easily and comfortably touch the wall (Figure # 5), without trying or straining, then it's a good probability that you can stand healthfully upright and straight. That is the goal.
- Do you like to, or feel most comfortable to stand with only your behind touching, as in figure # 1 in the drawing below? You may stand flexed (bent forward) at the hip.
- Do you like to, or feel most comfortable to stand with your upper back leaning back to touch the wall with the rest of your body forward of the wall (figure # 2)? You may stand with upper body slouched backward.
- Does it feel most "normal" to keep your head forward? Figure # 3
- Do you need to arch your lower back or crane your neck back to line up - figure # 4? Tight, painful, and needs fixing.
If you are too tight to comfortably stand as straight as in figure # 5, then you are too tight to stand up straight. Pain can result from the bad positioning (slouching) your tightness creates all day, every day. Pain also comes from tightly trying to force "straight" position. That is not the point of standing straight. My work shows you how to make healthy positioning comfortable and relaxed.
(Note to large people - if you have a barrel chest and big back, you'd have to have a jug sized head to reach the wall without leaning back In that case, no need to reach the wall. Check if you can comfortably hold in line with midline of the body).
Two Retraining Stretches
Before you do any stretches, see the above to see if you even need them. Stretches do not fix pain. Exercises do not stop sources of pain. They are tools to correct sources of the pain which you are supposed to identify first, then apply the new positioning, as below.
For each stretch to make standing well comfortable and possible, understand and do two things - where do you feel it, and does it hurt or help:
a) Instead of "doing" a stretch, move and adjust until you feel the stretch in the intended place,
b) It does not hurt at all but makes you feel better.If it hurts, you ARE doing it wrong. Use each stretch to identify what you are doing wrong and change what is wrong.
These are not conventional stretches. I designed them to give you instant feedback of what is wrong and what you need to fix.
1. Tight pectoral (chest and front of shoulder) muscles rotate your arms inward. To see if you do this, put your arms at your sides, look in the mirror and note direction of your thumbs. Do they face inward toward each other? To restore the entire front chest area to functional resting length do these two stretches, then *use* the new straight positioning for all you do. It is not the stretches that fix the problem, but the purpose of the stretches - to allow you to hold healthy position the rest of the day:
Chest Stretch (also called Pectoral or "Pec" Stretch, even though it includes other muscles and structures in front / chest)
- Face a wall, left-hand photo below. Lift one hand up, elbow bent out to the side. Shoulder down and relaxed.
- Turn away from the wall, using the wall to gently brace your elbow back as you turn away, shown in the middle and right-hand photos, below. Hold only a few seconds - 3-6 should be enough
- Instead of "doing" a stretch, get the purpose - to feel the stretch in the front of your chest on that side. Then you move accordingly, instead of doing strange rules that you can't feel or understand.
- If you don't feel the stretch in the front chest, you are not doing this stretch right. See if you arm is behind you or merely out to the side. Remember, understand what you want to feel, then you will know how to move.
- Don't ruin the posture of all your other segments. Don't let your lower back arch or your chin jut forward. Stay upright and relaxed without straining any other areas out of line
- If anything hurts, you are doing it wrong. If your fingers or arm goes numb, you are pushing too hard.
- Hold properly only a few seconds, then switch arms.
- Keep good positioning
Avoid the three mistakes pictured in the photo below
Thank you to participants of the Snowmass 2004 Wilderness Medical Society Stretch Workshop for demonstrating in the photo above.
- Avoid hyperlordosis by flexed hip (left), forward head (center), and hyperlordosis by thoracic lean (right).
- Drop your arms and look at your thumbs again. Thumbs should face forward now.
- Try the Wall Test again. It should be easy to stand straight now. If not, see if you have done this stretch correctly.
2. Next - The Top of Upper Back / Shoulder
(Name of this stretch is shortened to Trapezius Stretch, even though it includes Levator Scapulae and MANY other muscles and structures, of course.)
This is not a "neck tilt." Do not use hands to pull the head downward.
I do not recommend neck rolls either.
Use the following for the intended, which means read and understand first. Don't merely"do" it with no understanding. Stretches can't fix you. Use these special movements that I developed to make healthy position comfortable.
Stand against a wall, with your back and the back of your head against the wall, gently
- Put one hand behind you, as if in an opposite pocket, photo above.
- Breathe in. While breathing out, slide your other hand down the side of your body toward your knee, photo at right.
- Tilt your head downward to that same side, gently. Keep it as much against the wall as you comfortably can.
- Don't round or hunch forward, or drop or raise your chin.
- Feel a nice stretch along your entire side.
- Hold a second or two while breathing. Switch sides.
- If your lower back hurts or pinches to do this trapezius stretch, you may be increasing the arch in your lower back. If you don't know how to tuck your hip to reduce overarch, see the free article on hyperlordosis to fix this.
Try the Wall Test again. It should be easy to stand straight now. If not, see if you have done this stretch correctly.Repeat correctly until your Wall Test shows you have fixed the problem. Your wall test should become straighter starting the first day you use this two-stretch method correctly. Your head does not need to touch the wall for your body to be healthy and upright.
How These Two Stretches "Fix" You
Do not do these two retraining methods "as stretches" then go back to forward head. They do not fix the forward head. They fix ability to be comfortable without a forward head - standing straight. Do both stretches many times a day to allow you to stand and move the rest of the day without the forward position that injures and brings on pain. Use the Wall Test to check if you are straight. If not, do the two stretches above (pectoral and trapezius) again, then check if you have accomplished the purpose of the stretches with the Wall Test again until you have corrected the problem right then and there Do not walk away with a tight, forward neck. That would be silly.
More good stretches are also in the Stretching Article on this web site.
Exercises to Strengthen and Retrain Muscles
Neck pain exercises are misunderstood. Do you injure your neck all day then hope to fix it with a few exercises? It will not work if you "do exercises" then walk away with no use of the positioning or strength you just practiced. It is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work." When you stop sitting, standing, and bending wrong and injuring your upper back and neck many dozens of times each day, it can heal.
The key is what you do all day. Try these retraining drills slowly. See how you feel the next day, then increase. Use these movements, not as exercises to do 10 times, but to retrain how to stand, sit and move with straighter healthier positioning all day.
- One of many conventional exercises often misused and misunderstood is the "double chin" (also called "dorsal glide"). It In this not-so-helpful exercise, people are told to pull the chin in 10 times (or 15 or 20...). Often people do this in stiff, painful ways. Then they go back to walking and sitting all day with their head forward, wondering why their neck still hurts. Or they force their chin in, causing more pain. Don't do that. This "exercise" can not strengthen or change posture or pain. Even people who have never had neck pain, can hurt when they do this uncomfortable not-so-helpful exercise.
- Instead, understand that "the double chin" exercise is not something to "do 10 times" then stop. It is something you use in relaxed way to learn the concept of not holding a forward head. Then you can use it to keep healthful relaxed but upright head position all the time. In other words, you do this concept one time. Also you use it to see if you are too tight to stand comfortably straight. You fix that first, then go on to use the straighter positioning..
- Don't overcorrect - not all pain is "Forward Head" often it is "Tense Head." People who think they must keep the chin pulled in stiffly or the head back with effort often notice pain at the bottom of the neck where it joins the shoulder, back of the head, and/ or pain behind the ears. Keep chin from jutting forward, not stiffly or so tightly that it hurts, but easily so that your ear and back of your jaw is above your shoulder, not forward of it. Also don't retract so sharply that the double chin forms. Change the bad "double chin exercise" into a more useful, functional way of standing simply, straight, and healthfully.
- When you try to "straighten up" make sure you can tell if you are straightening from your upper back, not by increasing the inward curve of your lower back, or leaning your upper body backward, or "pulling shoulders back." The move comes from lessening a too-large curve in your upper spine.
- Test your position with your back against a wall often during the day, to see if the back of your head touches, without pain, strain, craning your neck, or arching your lower back (described previously).
- If it is not comfortable, do the two easy stretches (described previously) to restore ability to stand upright - comfortably - and then use that ability all the time, in intelligently applied, relaxed, healthy way.
Strengthening and stretching are important, but do not change posture or lifting habits, and so, do not cure neck pain or posture problems. Use this new Dr. Bookspan method of using your brain and voluntary healthy movement habits to stop the source of pain. I have redesigned back exercises to be used to retrain you how you hold your body all the time.
Doing neck exercise is not like getting a shot of penicillin or going to confession. It does not fix bad habits the rest of the time. Neck exercise is supposed to retrain your thinking and habits *all the time* not merely something to "do 10 times." Strengthening has no effect on posture if you dont apply the strength the rest of the day to control joint angles for all activities.
Neck pain has a large component of bad movement mechanics, not weak muscles. Strength does not make you stand or move in healthy ways. Many people do strengthening exercises and become stronger people who still crane their neck, look upward constantly pinching back from one neck vertebra instead of unrounding their upper back, and slouch their neck and head forward. "Core" exercises are especially misunderstood and repeated and prescribed without any understanding that stronger abdominal muscles have little to do with the most common causes of back pain. Moreover, most conventional core training exercises are done in bent forward ways that reinforce the same bad mechanics you started with. For the research and interesting story on what abdominal muscles really have to do with back pain, see my article on Abdominal Muscles - what they do may surprise you. Bending, standing, moving, and living your life with healthy movement mechanics is up to you. The rest of this article tells more on how.
Where strengthening helps - Someone may use good body mechanics all day, yet ache with fatigue at the end of the day. That is not a back injury or true back pain that needs treatments, and should not be addressed with medications. Another instance is someone who really is so weak that they can't hold up their own body weight or the weight of their shoulder bags and instead, shifts it onto their joints, which wear with time and grind under the weight (slouching).A little strengthening allows you to do more before fatigue pain sets in, and to be more able to use good mechanics instead of slouching. Strengthening will not keep you from slouching, and don't fall prey to unhealthful exercise programs claiming to cure back pain. Almost any movement can make you feel better for the moment. Over the long run, it's better not to use injurious movement techniques for your health. Use good mechanics for all you do and healthier ways to exercise explained in this article, other free articles on this site and the books with more.
If you hurt from excessive forward bending all day over their desk, steering wheel, work, and TV, the last thing you need is more upper back and shoulder rounding. Many exercises, ironically even those commonly (but mistakenly) prescribed for back and neck pain, involve more forward bending - toe touches, knee to chest, crunches, and shoulder stands like "the plow" and "The Frog" (lying backward, raising legs over head so that all weight is on your upper back and neck).
I did studies that found no relation between hamstring flexibility and lower back pain (except for all the people hurting their back by DOING hamstring stretches) - click to see why it is so often mistakenly prescribed for back pain.
Academy student Jessica Lattouf demonstrates fixing neck and upper back position for healthier drinking and eating:
1. Craning the neck and lifting the chin with a rounded upper back (upper left). At upper right: correcting to healthier position.
2. Lower left shows forward head and rounded upper back, fixed to relaxed, healthier neck and upper body (lower right) when eating from plates low on a table:
Healthier body position does not mean to rigidly hold straight and never bend the spine. It means to be aware if you habitually slump your weight on a rounded or angulated spine and use muscular control for healthier mobile positions that move as needed throughout healthy range.Check if you jut your chin forward to eat and drink. Pushing the neck forward while lifting the head (chin forward and up) creates severe forces on the discs, presses the joints together in back, and in general produces unnecessary pain and injury. Instead, keep chin in. When eating and drinking, get more of the lift from your upper back, "unrounding" and straightening the forward curve of the upper back, instead of only pinching back from one spot in the neck.
Easy, fun Neck Saver reminders for drinking and sitting click items.
Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal - if you let it, no differently than a sprained ankle. Stop damaging your discs with bad bending, standing, and sitting habits and the discs can heal. It takes years to herniate a disc, and only days to weeks to heal it by stopping bad habits.
When you over-tighten muscles with hunching and bad habits, they can remain too shortened to let you stand properly. Or they stay tightened in knots or spasm. This changes their muscle chemistry. When you slouch, you keep some muscles overly shortened and others overly stretched, which weakens and strains them. Massage does not stop the cause. Are you paying good money gimmicks and medical devices and massages and treatments and adjustments then go right back to causes? Stop bad movement habits and you will stop causes, and muscle knots and triggers and sore spots will quickly heal.
You may be in great pain from simple damaging mechanics or holding your body tightly. Your X-rays and scans are normal. You may be told nothing is wrong, or that it is "stress" or to give up favorite activities. Your pain persists from bad postural habits. This is no mystery. Change the bad habits to change the pain. You will be able to keep your active life and do more than before.
Other times, the scans show some minor problem like arthritis, herniated disc, or degenerating structures. Like car tires that are mid-life, but perfectly good, some wear may show on exam but this is unrelated to performance or pain. Pain is falsely ascribed to the arthritis or to the disc. Patients feel doomed, and are often told to give up activities. Pain (even the herniation itself) may mostly result from poor mechanics. This is no mystery. Change the bad habits to change the pain. Keep your active life - it's important for your health.
Sometimes, the scans show some major problem, and major surgery is performed to correct it (taking out away from healthy outdoor fun and indoors, sick, eating institutional food, away from fresh air and sunshine - that's not health). When the original problem was from the bad positioning, often pain persists or returns because you never corrected the mechanics that caused it. The defect itself may return from uncorrected mechanics. Surgery can be avoided. Fix the source of the problem and the results of the problem can heal without surgery. Instead of being forced into reduced health and activity, you can do more and have a fun active life.
Common prescription medicines cause much joint and muscle pain. The pain is not a rare effect as previously thought. It is common.
Are you on medicines for lowering cholesterol? Sleeping medicines? Drugs for depression and anxiety? Irritable bowel drugs, stomach acid drugs (a large contributor to osteoporosis and thinning bones, too) drugs to concentrate, to help wake up, to calm you, for allergies. More and more drugs are found to have pain as side effect, even, of all ironies, drugs for pain.
Stretches and exercises will not fix this kind of pain. People with existing pain are often put on new medicines that cause more pain in an expensive, unhealthy cycle of pills, payments and pain, all needless.
In an ever worsening cycle, side effects are "treated" with yet more drugs with effects that lessen and degrade your health. That is not "side effects" and that is not health care. Many of these drugs are not needed. Some, like stomach acid drugs, cause the problem in the first place. Others have even more serious consequences.
A top health priority is to stop the need for these drugs so that you can lessen, then stop the need to take them. If you are in pain and don't exercise or move much because of that, then get cholesterol and other health problems from not moving, can't sleep, then take cholesterol and sleeping medicines that cause dependence and more pain, INSTEAD, start with the healthy principles in my free summary articles and all my books so that you can move again, and be healthfully tired at the end of the day and sleep well at night. Not all exercise is good medicine. Healthy exercise as healthy medicine will stop much pain and need for medicines that cause more problems.
“Doctors are men who prescribe medicines of which they know little,
to cure diseases of which they know less, in human beings of whom they know nothing”
Voltaire (1694–1778), French writer and leading figure of the Enlightenment
Check for large pillows, hard (too firm) pillows, and beds that press or curve you into specific positions. They are a common source of neck and upper body pain and headache. Often they are designed for people with unhealthy tightness to hold them in that same unhealthful position. Save your money and get free preventive medicine and relief - use healthful stretches and movement in the day time so you can straighten out more comfortably while sleeping. If you are too tight to lie down comfortably on your back without with a pillow under your legs and head then it is no mystery that you are too tight to sleep comfortably without being held in shortened tight positions by props and special pillows. Stop the need for them, then you will stop the pain.
Using everything presented above, you should feel the difference as soon as you stop the causes of pain every day, reposition your head and neck during all you do, and use the two easy stretches, as intended, to make healthy position more comfortable. If you're not feeling better right away, check what you are doing compared to what you have learned above and in the other free articles, for example, are you still sitting badly right now reading this?
- Check what you are doing compared to what you THINK you are doing (are you are doing it wrong?).
- Are you doing bad exercises from other sources? It is common to do a few movements from my work, but continue or add injurious moves from other sources that slow recovery and re-injure.
- Are you tightening or clenching any muscles to move? "Tightening" is a common instruction for PT and exercise, however it is not a good instruction. Tight muscles can hurt and impede healthy movement.
- Are you overcompensating? Are you making new bad movement habits that seem opposite of original unhealthy movement thinking that will "undo" or fix?
- Are you going back to bad movement habits during the day? Check my free article on Bad Exercises, this one on bad stretches, and this one showing better health and understanding of healthier ways to sit at a desk and computer and other long sitting.
- Make sure your pain is not from medical conditions (vascular, infection, shingles, Lyme disease, Sickle Cell, allergies and food sensitivities, other) or from many medicines known to have body pain as side effects
It takes years to hurt a disc, or neck muscles, and only days for it to start healing once you no longer are injuring yourself. Make sure there is not something else contributing to your pain. It is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.
(To keep this article quick and easy, much is left out. The books tell more.)
"It is an honor to know you! The best part about all of your work is how you infuse it all with a sense of duty, honor, and commitment to bringing out the best in all of us - I don't know how you do it, but that is what makes you exceptional. I agree with that student of yours who thought you were a superhero."
~ Linda Hsu, Massage Therapist, Academy Certified, Fixing Neck & Back Pain
Neck, upper body, and much shoulder pain is not a mysterious "condition." People spend their day sitting, working, walking, and driving with their upper body rounded forward, they lift and bend with rounded forward bad positioning all day, then exercise rounded forward, physically pressing discs outward and overstretching muscles in back. They do yoga and Pilates moves with their head forward or pinched and craned backward, then do shoulder stands, plows, and other stretches that forcibly push discs outward. They take anti-inflammatory medications for mechanical pain that is not inflammatory, try remedies that do not address the cause of the problem while they continue doing the causes, do physical therapy in bent forward ways that exacerbate the original problem, give up favorite activities, have surgery and then return to previous bent forward habits. After all this obvious cause of pain, everyone is astonished that they "tried everything and nothing seemed to work." It's like overeating all day, waving your hands in the air for five minutes, then saying "I don't understand why I don't lose weight; I do my exercises."
Using muscles to hold healthful positioning would stop the pain at the same time that you burn calories, strengthen, and be a free workout:
- Use healthy positioning to stop the cause of pain and damage. Then no need for pills or surgery, and the injury can heal.
- Pain can be avoided by no longer damaging body structures with poor mechanics.
- It's simple - Dont memorize complicated rules. Simply use muscles easily to reposition for daily life.
How is your body positioning right now? Rounded, bent forward to read this? The whole point of exercise and therapy is missed when you dont learn to consciously use your muscles the rest of the day for standing, sitting, bending, and all you do in daily life. Use your muscles to stand and bend in healthy ways for all daily tasks. Bonus: It burns calories, strengthens, and is a free workout.
- Watch other peoples posture, gait, and movement habits. It will remind you to straighten up.
- Notice injurious "fitness and health" moves featured in fitness and yoga magazines and books.
- Please don't combine other people's injurious stretches and exercises then come back to me and say my work isn't fixing that.
- Make sure your pain is not from medical conditions (vascular, infection, shingles, other) or from many medicines known to have body pain as side effects.
- Send me your success stories and photos showing the principles in action. Prizes for best ones
- Please do not e-mail me saying you are "doing the exercises 10 times" and want me to "tell you how to fix your pain from the forward head, or from straining to do exercise." Here is the answer now: Stop slouching your head and neck forward or forcing and yanking to straighten, and the source of pain can stop. It is not the exercises that fix things, it's you.
- Send success e-mails and photos. First make sure you understand everything in the article above. Success@ DrBookspan DOTcom
- Send typos, ideas to improve this site, funny jokes (clean only) - typos @ DrBookspan DOTcom
- Get the books to get even more.
Henry Louis Mencken said, "Any man who afflicts the human race with ideas must be prepared to see them misunderstood" Even so, please don't change my work back into what you know, or what others say, or what you learned somewhere else, or "doing exercises." Check the concepts in this article again in green type (and let me know if green type doesn't show up on your device). To paraphrase Bertrand Russell, "An untrained man's report of what a knowledgeable man says is never accurate because he unconsciously translates what he hears into something he can understand." My work is primary source, and often, not what we learned in school and the gym. Remember, that is good.
Julie Ballenger had breast cancer, 2 mastectomies, more surgeries to fix complications, infections etc, then a serious car accident that resulted in whiplash, occipital neuralgia, migraines, and scarring. Many years of neck, jaw, head, and upper body pain followed that would not resolve. For years, she saw dentists, oral surgeons, neurologists, chiropractors, myofascial therapists, and others for many expensive and repeated treatments, but, "could not find anyone who has any solutions, options, help other than drugs to mask the pain."
She worked full time, had two young children, and wrote me in 2013, "I drag myself through the days with this constant pain. I found your work online by accident and have become a great fan of your books and am very inspired by your personal history. Thank you for being out there. This has been a very lonely journey. Your books were a lifeline to me and I find you amazing. "
We worked together over mail, then she came to see me for a personal appointment in Philadelphia in 2013. Photo below is the result
Here is her 2015 follow-up:
"I was told in 2000 upon my first breast cancer diagnosis, by a man who was certain he could tell the future, that I would not see 50.
Well- here I remain. Thank you for the Happy Birthday wishes (and remembering) I did indeed have a birthday—49, and planning on 50.
I am doing pretty well. I sometimes still battle neck pain and behind the shoulder blade pain. So- I pull out my very dog-eared Dr Jolie books and my notes from my visit, remind myself, reevaluate, get back to doing some of the stretches and movement I’ve neglected to do for a bit, figure it out and it works. I seem to get amnesia every once in a while and need a gentle Jolie kick in the proverbial pants. You always work, J.
My kids are 13 and 11 now. We are doing a lot of activities as a family this summer—biking, pool, summer evening walks. The job requires computer work, but I do get up and about as much as I can.
You are welcome to post/publish this. I remain one of your biggest fans."
You Dont Have To Live With Pain
What To Do Next
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More Free Summaries on This Web Site.
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The Fitness FixerColumn. My column on Healthline ran from 2006 to 2010. Almost 800 free articles, most archived so you can still use them to change exercise to healthier ways. Check for articles on neck pain, stretches, shoes, sitting, nutrition, and more by alphabetical listing. Click here for an Index of most of the articles. Get updates about healthier ways to be healthy through my Twitter page THEFITNESSFIXER, above.Individual Care. Personal written answers to your questionsLearn In Person. Learn top techniques and fix your pain in class. Group CLASSES and Private Appointments.Earn Certification in the classes above, plus Fellow Advancement. Awards. Better Earth through AFEM -The Academy of Functional Exercise Medicine.Mailing List. I don't send out any mails or keep any lists. For updates, info, articles, fun helpful stuff whenever you want, use my TWITTER page: www.Twitter.com/TheFitnessFixer.Mental & Emotional Training. A page of my short ideas and practices for stronger emotional health.Open our RESORT for healthy life training. Maybe at your campus, studio or cruise ship? Also join fun and instructive Dr. Bookspan projects - help the world, be in my next books, write rhymes about your pain fixes. Click Projects.TYPOS. Are You A Helpful Reader? If you found typos, broken links, or things needing correction on my site, tell me so I can fix them to help everyone, with my thanks: typos @ DrBookspan DOT com.Dr. Bookspan's Adventure Medicine. Higher Faster Stronger Smarter Happier.Bookspan Basics. Here are quick group training drills. Set up healthy movement training programs for schools and groups, all over the world. More on my Academy page.Cool T-Shirts, Mugs, & Fun Stuff. How to fix pain printed right on funny items to learn, remember, and share functional health - Dr. Bookspan's Backsavers UNcommon sense (on cafePress)
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The Ab Revolution Fourth Edition - No More Crunches No More Back Pain Print 4th Edition.
Click here for The Ab Revolution Fourth Edition in Kindle.
The Ab Revolution is core training the way your body actually needs. Two parts: Part 1- Learn neutral spine to stop a major form of lower back pain. Part 2- Functional strengthening from simple moves to the toughest you can get.
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