Neck and Shoulder Pain

Neck and
Shoulder Pain

Easy to Keep at Bay

You sit in front of a computer for hours every day, barely moving your head. You sleep in a bed for hours every night, barely moving anything.

Oh, sure, you moved around at work and even a little afterward. You talked to your colleagues, went for a soda, leaned over some files.

But much of the past 24 hours was spent with your neck and shoulders in a single position. And now--surprise--you've got a royal pain in the neck and a shoulder that's as stiff as an old piece of leather.

We've all known someone who has complained of neck and shoulder pain, and most of us have gone a round or two with it ourselves.

It's not known whether this type of pain is more common in men or women. But doctors do know what causes it. So, starting with the neck, let's take a look at these two troublesome body parts and see if we can figure out how to keep them from being such a pain.

A Delicate Balancing Act

Poor posture, tight muscles, muscle tension and back and other injuries can cause neck pain. In fact, about 50 percent of people with back pain--and that's 80 percent of the population--also have neck pain. Diseases including rheumatoid arthritis, fibromyalgia, which causes muscle pain throughout the body, and degenerated or herniated disks can also lead to neck pain.

What to do about it? Practice good posture, for one thing, says Baltimore physical therapist Z. Annette Iglarsh, Ph.D., vice president of Theraphysics, a rehabilitation managed-care corporation, and president of the Orthopedic Section of the American Physical Therapy Association. That's because poor posture takes the spine and neck out of alignment.

A common problem is sitting or standing with your head too far forward, which makes the small muscles at the back of your neck work twice as hard as they normally would, says Dr. Iglarsh. With your head in the wrong place, the neck muscles lose the support of the spine and end up having to do all the work of holding up your head by themselves. The muscles are overworked and pain is the result.

Driving, sitting for long periods, working at a computer and lifting objects are tough on posture. So is tension, since overwrought muscles get tired and don't perform the way they should.

Physical changes that come with aging can also cause neck pain. As time passes, the disks between the spinal vertebrae start to dry up, which causes them to shrink and the vertebrae above and below them to shift.

When this happens, nerves passing from the spinal cord through holes in the vertebrae can become pinched. This is called degenerative disk disease and can lead not only to pain but to a decrease in the range of neck motion. While everyone gets degenerative disk disease to some extent as they age, good posture and limber neck muscles can reduce the chances of a pinched nerve.

The disks between the bones of the spinal column can also crack, or herniate. When this happens, the jellylike substance inside the disk leaks out and presses on the nerves leading to the neck, causing pain.

Every year there are roughly one million cases of whiplash, a well-known cause of pain in which the ligaments are strained when the neck is "whipped" forward and back--or slammed backward, then forward--during an automobile accident. Women are twice as likely as men to have pain after a whiplash, possibly because a woman's neck is smaller and usually weaker than a man's.

Being Nice to Your Neck

Although necks are vulnerable to disease and injury, preventing pain is frequently simply a matter of common sense. Here's how to apply it.

Keep it in neutral. Having your neck in a neutral position can prevent excessive strain, says Dr. Iglarsh. To see if your neck is in the right position, place two fingers on your upper lip and push your head back until your ears are in line with your shoulders.

Use a good pillow. Your head should be in the neutral position when you sleep, says Dr. Iglarsh. That is, when you lie on your back, your pillow should be low enough so that your chin is not on your chest. And it should be fat enough so that when you roll onto your side, the pillow fills the space between your shoulder and the bed, she says.

Make your own. An orthopedic pillow can keep your neck in neutral, and while there are lots of these pillows on the market, it's easy to make your own, says Dr. Iglarsh. To increase neck support, fold a thick bath towel lengthwise into quarters. Using safety pins, fasten the folded towel to the lower long edge of your pillow and slip your pillowcase over it. Sleep with the folded-towel portion of the pillow under your neck.

For a pillow shaped like a bow-tie, fold the towel in quarters again, says Dr. Iglarsh, and pin the towel tightly around the center of the pillow, pinching the pillow into the "bow-tie" shape. Then slip the pillowcase over it. This shape can support your neck in neutral when you're lying on your side. Give these pillows a try before spending money on a commercial model, and use these pillow-making techniques when you travel, says Dr. Iglarsh.

Try a neck roll. If you prefer to sleep without a pillow, try a neck roll instead, says Dr. Iglarsh. Just fashion a towel into a small roll that fits into the curve of your neck.

Take care on the road. Sleeping with your neck in awkward positions while you travel in a plane, bus, car or train can lead to neck pain, says Edward Hanley, M.D., chairman of orthopedic surgery at the Carolinas Medical Center in Charlotte, North Carolina. Try one of the cervical pillows designed for travel.

Stretch your neck muscles. Preventing muscles from getting too tight can forestall pain and relieve aches caused by tension and fatigue, says Dr. Iglarsh. Stretches that involve trying to touch one ear to the shoulder beneath it and alternately turning your chin toward each shoulder are effective.

Don't crack your neck. Cracking the neck to relieve pain isn't good, says Dr. Iglarsh. It can loosen up the neck joints, which will make them less stable and more prone to injury, she says.

Lighten your load. Carrying a heavy handbag, briefcase, gym bag or other bag on one shoulder is dangerous, says Dr. Iglarsh. Must you really carry all that stuff around? For must-haves, like lipsticks or hairbrushes, keep one in your office, one in the car or gym and one at home, she says. Also, put travel bags on wheels, she says.

Use the headrest. Sixty-two percent of people in car accidents report to the emergency room complaining of neck pain. To avoid this problem--and the whiplash that generally causes it--adjust the headrest on your seat so that the top of the headrest is in line with the top of your ear.

Strain, Then Pain

Shoulder pain in women is frequently caused by muscle strain, tendinitis, arthritis or a condition called frozen shoulder, where the shoulder gets stiff and can't move freely. Fibromyagia, which occurs more often in women than men, can also cause pain.

The shoulder is a ball-and-socket joint that is held together by muscles, tendons and ligaments that allow the shoulder a wide range of motion but also keep it stable. The central stabilizing force in the shoulder are the four muscles of the rotator cuff. Lifting too heavy an object or overdoing it with exercise can strain the muscles and cause pain.

The fact that most women have less shoulder power than men doesn't make them more prone to shoulder injuries, says John M. Fenlin, Jr., M.D., clinical professor of orthopedic surgery at Thomas Jefferson University in Philadelphia. He says most women's shoulders are actually strong relative to their body size.

What can make women more susceptible to shoulder pain and injury, however, is that their shoulders are naturally more lax, or loose, than men's. This can make women candidates for dislocation and impingement, in which tendons in the shoulder become pinched against a bone. According to Dr. Fenlin, some people are more predisposed to this because the bone at the top of their shoulder has a little beak on it that is more likely to rub on the tendon. Others can develop it when tired muscles don't function as they should and the tendon gets pinched as a result.

Women who play tennis, work as baggers in grocery stores or work at a computer keyboard are most likely to get shoulder pain, says Dr. Fenlin.

Another common problem for women is frozen shoulder. For some reason, the ligaments that go around the ball-and-socket joint become inflamed, says Dr. Fenlin. The pain causes a reduction in use of the shoulder. As a result, the ligaments don't get stretched and the shoulder starts to tighten up.

Saving Your Shoulders

You may be able to carry the world on your shoulders, but only if you keep them in good shape. Here's how to do it.

Stretch out. Before engaging in exercise or strenuous chores, warm up and stretch your shoulders to get them ready for exertion, says Dr. Fenlin. Simple forward and backward arm circles can help limber them up.

Take breaks. When you use your muscles for a sustained period of time to do things like clip the hedge, paint a room or turn over the garden, muscle fatigue and pain can result, says Dr. Iglarsh. "Take breaks," she says. And divide the task into segments instead of trying to do it all at once. Work for half an hour or so, do something else that does not use the same muscles for a while, then come back to your original task for another short period of time. Do this until the task is done.

Watch your work surface. Whether you're working in the office or in the kitchen, make sure your work surface is at a height that's comfortable for you, says Dr. Iglarsh. A surface that's too low will cause you to hunch your shoulders and upper back, and one that's too high will cause you to arch your back too much.

Lift it right. When you lift something, pay attention to the position of your head, says Dr. Iglarsh. Bend at the knees to pick something up, and hold the item close to your body. (If your head moves forward, the weight is too heavy: don't lift it at all.) If you're lifting a child, have her climb onto a chair so you can pick her up from there, says, Dr. Iglarsh.

Strengthen yourself. The stronger the muscles in your shoulder, the more stable--and less prone to injury--it will be. Ask a physical therapist to put you on a shoulder-strengthening program. But make sure your therapist helps you adjust any weight machines to your particular size. Since weight machines designed for men are too big for a woman's frame, you may need to customize the machine by adding extra seat cushions and back pads.

See a doctor. If you develop shoulder pain, check with a physician if it lasts longer than a month, says Dr. Fenlin.