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Relieving the Discomfort-Spasm-Discomfort Cycle in the Neck


By Kate Zanoni, LPTA

A neck spasm, neck pain and general discomfort are common complaints in the orthopedic rehab world, and we’ve certainly treated our share of patients who suffer from various conditions related to neck pain at LSTC. With the high prevalence of desk jobs, the influx of cell phone use, computer use and video gaming, as well as time spent relaxing in front of the TV, our posture certainly suffers more often than we realize. Over time, these repetitive tasks put us into a position called forward head posture, in which our heads and necks protrude forward into a flexed position. Although poor posture and sedentary lifestyles are big contributions to neck pain, there are several other conditions that can cause that big pain in the neck.

Osteoporosis and Forward Head Lifestyle

Forward head posture is also caused by age-related degeneration and muscular weakness. Over time, our bones can become more brittle and porous, leading to a condition known as osteoporosis. Weakened, fragile bones increase the risk for falls or broken bones. As the bones become more brittle, the spine compresses and begins to change shape, creating a stooped posture known as a Dowager’s Hump in the upper thoracic spine, in addition to forward head posture. The best treatment for age-related spinal degeneration and porous bones is weight-bearing exercise to slow bone loss and stimulate the growth of new bone.

As we age, the discs that create cushioning between the vertebrae in our spines begin to dry out and lose their height. You may have heard your grandmother complain of “shrinking” or losing inches. Degeneration of the spine, bone loss and deterioration of the discs cushioning the vertebrae is the root cause of height loss.

In general, as we age, we become more sedentary, less active and our muscles weaken as a result of inactivity and disuse. As we lose our strength, it becomes much more difficult for our weak neck muscles and “shortened” necks to support the weight of our heads, leading to an increase in forward head posture.

Forward head posture causes strain on our neck muscles and can lead to headaches due to pain referring from those tight neck muscles. When the muscles at the base of the skull, called suboccipitals, become chronically tight, trigger points can form, increasing tension in the already tightened musculature, thereby causing tension headaches. Trigger points occur when a muscle is so tight that a “knot” forms as a chemical neurotransmitter known as acetylcholine builds up along the muscle wall and inhibits the neurotransmitter’s signal to the brain that allows the muscle to relax. Therefore, the muscle continuously contracts in a vicious pain-spasm-pain cycle, leading to increased tension and exacerbated pain.


Contrary to popular belief, whiplash does not only occur during a car accident. Whiplash can be caused by any sudden jolt of the head in a forward or backward motion and can take place during any sport. The structures injured during whiplash can vary but include muscles in the head, neck, trunk and back, ligaments, nerve roots, discs and joints. Symptoms will also vary depending upon the mechanism of injury as well as the severity of the body’s inflammatory response. Whiplash is characterized by tightness, stiffness and muscle spasms in the neck and back; headaches; neck, shoulder and/or back pain; radiating pain or numbness down the arm; and difficulty concentrating or sleeping.

Herniated Disc

Herniated discs are more common than you think. As previously mentioned, our intervertebral discs lose their hydration and suppleness and begin to “dry out” as we age, losing height and causing the vertebrae to approximate. As the spine degenerates and the vertebrae compress, the discs between each vertebrae further compress, leading to increased pressure. This wear and tear on the spine coupled with increased pressure can cause one or more discs to protrude from their natural position and begin pressing on nerves. This is called a herniated disc. Symptoms of disc herniation include neck pain that may radiate down into your arm or hands, tingling or numbness down your arm, and associated muscle weakness caused by nerve compression.

Oftentimes, people with herniated discs are asymptomatic and do not know there is an underlying problem in their spines because they are symptom-free. MRIs will often show disc herniations in asymptomatic, healthy people and were likely caused by the natural degeneration of the spine. It’s important to remember not to define yourself by your imaging results. Unless you are in pain, there should be no cause for alarm.

However, if you are experiencing neck pain of any kind, call LSTC at 703-450-4300 to schedule an hour-long one-on-one evaluation with one of our orthopedic physical therapists. Through specific tests and measurements, we will create an individualized plan of care to combat your pain, increase your mobility and strength, and show you how to safely return to your daily activities while avoiding those added stresses that contribute to that “pain in the neck.”     

PT’s Role in Alleviating Neck Pain

Although each underlying cause of neck pain may present differently and each patient’s presentation differs, all of the aforementioned conditions will benefit from manual hands-on therapy, including manual stretching to increase flexibility of tight muscles; joint mobilization to increase joint nutrition and mobility; manual traction to relieve disc compression and muscle tension; and soft tissue mobilization to reduce muscle tightness and relieve trigger points. Furthermore, each physical therapy plan of care includes targeted stretches for tight muscles and individualized weight-bearing and resistance strengthening exercises to reduce postural weakness and improve overall daily function.

CLICK HERE for more information on how physical therapy can address neck pain.