If you are experiencing neck pain, you probably feel like a good neck and shoulder massage would be a good help towards recovery, along with some decent horizontal rest to relieve your pain. In fact, recent evidence shows that staying physically active is much more effective and that specific neck exercises actually reduce neck pain and improve function. (1-3)
In a previous blog post, we introduced the Hierarchy of Recovery where we placed staying active, doing regular physio-prescribed exercises and training around pain as the top three things to prioritise when setting out a plan to recover from neck pain.
In this, the first of a two-part blog, we will elaborate on how you can continue to exercise when you have neck pain, followed by showing you how to use specific neck exercises as part of your recovery.
Resuming activities while you are still in pain can be an important part of recovery and although it might seem odd, keep in mind that the human body responds well to load and stress, even when part of it is painful or injured.
Let’s, for example, take a hip or knee replacement surgery where the patient is up and walking on the same day. Even though there is still plenty of damage around the joint, gentle movement helps with both pain and healing the affected tissue. The same is true for an acute injury like an ankle sprain, where putting an early load on the ankle is helpful in recovery (4), compared to simply resting and icing it. In the same way, being physically active, or resuming the physical activity that you were participating in prior to your neck pain, can assist your recovery - just be aware that your activity or training must be with the correct intensity and with an adequate recovery period between sessions - obviously, you shouldn’t just smash into pain and continue to train through it.
You may need to modify training variables such as exercise selection, session duration and training intensity, to suit your new load tolerance. All can be altered for a certain period of time so that they meet the level that your injured or painful body part can tolerate without experiencing a flare up. The guidelines for this adjustment can be found in our Load Threshold Barometer which shows that if you’re able to manage your training load and activity level correctly, your pain can reduce over time, your load threshold should increase and you will be able to gradually get back to your preferred level of sporting or physical activity.
Different people show very different behaviours when experiencing pain, and some people are better than others at finding the right training load catered to their pain or injury.
Finding your own threshold and capacity to tolerate load and stress on the body can be quite tricky with neck pain as the pain itself can fluctuate a lot from day to day. Keep in mind that pain is multifactorial and not only affected by physiological stressors but also psychological and emotional factors, beliefs and expectations about pain, along with lots of other things.
Some people have a tendency to ignore pain and just push through it when they exercise. World renowned physiotherapist, Greg Lehman, calls these people “Pain Persistence Copers”. They tend to do a little too much, too soon, which irritates the tissue or body part that is sensitive and as a result, they experience stagnation or setbacks in their recovery. If you can relate to this type of person, you should look to modify your training activities during recovery - have a read of our example “Persistence Coper” below:
In this example, we have a female (let’s call her Gabriella) who exercises to get in better shape and to lose weight. Gabriella does quite a lot of cardio training like running and plyometric workouts including box jumps, squats and skipping. For the past two months she has experienced knee pain while doing her normal training, but has always just pushed through it - her mindset being “pain is just weakness leaving the body”. Her pain often gets better once her body temperature is elevated after about 15 minutes of training, but it always comes back towards the end of the session and hurts afterwards as well. Overall, the pain hasn’t improved in the last two months.
Gabriella has consulted with her physician and all serious injuries and other conditions have been ruled out, so given that Gabriella’s knee problem is overuse-related, there is no reason for her to stop cardio training altogether, but she probably needs to modify her exercise selection a bit. Exercises like running, squats and skipping, all put a considerable amount of stress on the knee. This isn’t inherently bad, but when it continues to cause pain and there’s no sign of improvement, it’s an indication that she is training above the threshold that her knee can currently tolerate. As an alternative to running, Gabriella could instead select some ‘knee friendly’ cardio exercises like working on a cross trainer, rower, or walking with an incline on a treadmill. Similarly, she could swap squats (which is a very knee-dominant exercise) for kettlebell swings or deadlifts, which would decrease the stress on her knees considerably. Remember, it’s okay for Gabriella to experience some mild pain because it’s not that all pain is bad, just as long as that pain gradually decreases over time. Like Greg Lehman says: “you can poke the bear... but don’t hump the shit out of it.”. When the pain level eventually goes down, she can gradually come back to her preferred exercises and activities like running and squatting.
If you are an active gym goer suffering with neck or shoulder pain, you might find it challenging to find upper-body exercises that don’t provoke your pain. As we mentioned, some people might push through it with a “no pain, no gain” mentality, while others will cope with the pain by avoiding upper-body exercises completely. Neither of these scenarios is optimal, but more often than not, it is possible to find some effective upper-body strength training exercises that work around your pain.
Common exercises like overhead presses, heavy lateral raises, heavy barbell bench presses and some pull-up variations, might aggravate symptoms. Instead, try different rowing- or horizontal pulling- variations as these are very neck and shoulder friendly and can usually be executed without pain. Evidence shows that thoracic or upper-back exercises like the rowing variations, can be beneficial for people with neck pain.
To balance out your program, pressing exercises can be fine if they are done using the correct load. For instance, try to do bench presses with dumbbells (if heavy barbell bench presses are causing pain). If they still hurt, lower the weight and focus on more reps at a lower tempo in order to fatigue the muscles… Muscles not only grow and get stronger with the use of heavy weights, but fatiguing the muscles is also effective.
So there you have it. Remember that when you are suffering from neck pain, you should try to stay active and continue to do the normal activities and training that motivate you, just with the necessary modifications if something is painful and not improving over time. Seek to find your load threshold and stay within its boundaries - with patience, you’ll feel your threshold increase and gradually you’ll be able to do the things you love without pain.
If you're interested in reading more on the benefits of strength training and keeping active for neck pain, take a look at the references below. If you’re suffering from neck pain and want help with getting your threshold back to where it was, and even higher, then check our Reach Online Physio app.
Here’s to your active best!