"My neck is always tight"

No matter how much we stretch and pull, things won't likely loosen until we understand what is most likely at the core of chronic stiffness...

As our daily lives are consumed by technology and the postures that come along with it, chronic neck pain and stiffness are all too common. Patients frequently present with low-grade cervical and scapular pain that has seemingly gotten worse with either a new desk job or simply longer hours staring at a screen. Complaints range from overall ‘tightness’ and headaches to even sharper pain and ‘clicking’ sensations during previously non-painful movements. While stretching and the occasional massage seem to improve things for a short while, we’re left with the question of why symptoms return and remain chronic.

Chronic pain is always a complex problem involving sensitization of the central nervous system and an ‘overreaction’ of the body to non-painful stimulus. In this situation specifically, one problem lies with the deeper intrinsic muscles of the spine. The seated postures and flexed neck positions related to desk jobs or phone and tablet use commonly lead to poor postural control and balance. Over time; the deep muscles of the neck can weaken and atrophy, forcing a compensatory bracing or ‘splinting’ of the overlying trapezius muscles. The superficial muscles that aren’t supposed to act as joint stabilizers now take on that responsibility, becoming chronically stiff and tight.

With treatment and rehabilitative exercise we can reduce pain and attempt to restore the proper muscle activity of the deep neck stabilizers (see below for a great exercise aimed at improving deep neck flexor strength and endurance). However, without a change in the workplace ergonomics and reduced home tablet or phone use, the path can be winding and rocky.

1. Elliott, J. M., Pedler, A. R., Jull, G. A., Van Wyk, L., Galloway, G. G., & OʼLeary, S. P. (2014). Differential changes in muscle composition exist in traumatic and nontraumatic neck pain. Spine, 39(1), 39–47.

2. Szeto, G. P. Y., Straker, L. M., & O'Sullivan, P. B. (2009). Neck-shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. Manual Therapy, 14(3), 338–345.

3. Pinsault, N., & Vuillerme, N. (2010). Degradation of cervical joint position sense following muscular fatigue in humans. Spine, 35(3), 294–297.