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Long-Term Pain Relief

You’ve tried everything, but why hasn’t it worked? 

You may have experienced 1 or all of the following:

  • They told you to stretch because you had “tight muscles”
  • They gave you exercises because you had “weak muscles” 
  • You went and got adjusted because there was some “misalignment”
  • You received surgery because they found a “tear” 

These methods only give temporary relief because they are just fighting the symptoms and not connecting the dots from the deepest root. The body is too complex for such a basic approach. 

You need a specialized solution that will treat the body as a whole and get to the root cause of your pain. 

Conditions Treated

  • Broken/Fractured Bone
  • Bulging Disc
  • Degenerative Disc Disease
  • Forward-Head Posture
  • Headaches
  • Herniated Disc
  • Muscle Pain & Tightness
  • Muscle Pulls & Strains
  • Post-Surgical Rehab
  • Upper Trap Pain & Tightness
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The 5 Best Exercises For Improving Neck Mobility & Relieving Pain
Do you find yourself turning your entire body to try to look over your shoulder while driving? Or maybe you only feel your neck working even though you’re doing an ab workout. If so, you’re probably dealing with a restricted and overactive neck.  This is not so uncommon in a society that is stress driven and spends hours a day on computers and cell phones. Unfortunately, many proposed solutions fail to eliminate the problem at the source and instead offer boring stretches that slap a band- aid on the symptoms. Maybe, you’ve been lucky enough to avoid the stretching craze but have been told you need to improve your posture and strengthening exercises such as face pulls are the solution. Neither of these options offers a viable solution to the culprit of restricted neck mobility and may even make matters worse.  Below are 5 exercises meant to target the culprit of restricted neck mobility which tends to be faulty breathing patterns, restricted rib cage mobility and being stuck in repetitive patterns of movement.  Note that these exercises are meant to be performed in the sequence laid out for maximal effectiveness.  #1. Zercher band Breathing  [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] You may be wondering why the first step in restoring neck mobility involves expanding your upper back and breathing. Two important reasons. Firstly, your cervical (neck) extensor muscles, the muscles that help you look up at the ceiling and will resist your ability to look down and turn your head attach all the way down to the middle of your back. If you’re not attenuating to upper back mobility you will likely fall short. Secondly, that muscles that attach to the front and back of your neck as what are called “accessory breathing muscles.” Meaning the assist in moving your rib cage to allow your lungs to expand. If your rib cage is stiff and you can’t expand your rib cage in certain places your accessory breathing muscles will work even harder leading to overactivity of your neck muscles.  Start with the Zercher Band Breathing to improve rib cage mobility and allow expansion of the mid back musculature.  Perform 3-5 sets x 5 breaths  #2. Staggered Stance DB Curls [embed]https://www.youtube.com/watch?v=o16wXhnkCs4[/embed] We’re doing biceps curls to get my neck moving? Hell yeah we are! In reality, the biceps curl is just a façade for what’s really being accomplished with this exercise. The arm position mimics that of the previous exercise, the act of curling the weight forces your to pull the shoulder down away from your ears and the slight rotation of the neck gives your neck some much needed movement. Those goal with this exercise it to maintain expansion of the rib cage and upper muscles. The rotation of the neck put the Upper Trap muscle (a common culprit in neck tightness) in a lengthened position. Breathe as instructed I the video to reinforce the position.  Perform 2-3 sets x 10 reps on the side that’s restricted (can perform both sides) #3. Lower Body Rolling [embed]https://www.youtube.com/watch?v=ZeugF67eiFw[/embed] The human spine is made up of 33 segments (26 moveable segments). To maintain healthy movement in any portion of your spine, you need to ensure that you retain segmental motion. This is the ability of each spinal segment to move independently of the next segment.  When the spine begins to move as a unit versus segmentally is when your movement begins to look robotic and lacks fluidity (turning your entire body to look over your shoulder).  Lower body rolling is a great way to teach your body to segment spinal movement from the bottom up; initiating the movement through the hips and pelvis and finishing with the neck. Again, upper back and neck rotation are reinforced by the inhale at the end of the movement.  Perform 2-3 sets x 6 rolls on the side that’s restricted (can perform both sides) #4. Rolling Arm Bar  [embed]https://www.youtube.com/watch?v=rfuEzHjiGro[/embed] Once you’ve built comfort and confidence moving your neck in more static or passive ways, it’s time to get things moving more actively. That is where kettlebell-based movements become an excellent tool. The rolling arm bar is must- do exercise for anyone looking to restore and maintain good neck movement.  In this movement, the kettlebell forces you to reach with the shoulder, thereby, maintaining expansion of the upper back. We used the same bottoms-up approach of restoring segmental spinal movement as the lower body rolling, but, this time we maintain gaze on the kettlebell to teach your body to active turn your neck through a full range.  Fatigue in the neck is a common result as you’re retraining your body how to move properly but ultimately you should feel improvement in baseline movement after performing this exercise.  Perform 2-3 sets x 6 rolls on the side that’s restricted (can perform both sides) #5. Turkish Get Up  [embed]https://www.youtube.com/watch?v=vPUD-Lqh6w0[/embed] Overhead movement of the shoulder is intimately related to movement of the lower cervical spine. That is why you’ll frequently see weightlifters jut their head forward when they press a barbell overhead...it allows them to maintain the relationship between the mechanics of the shoulder and the neck. The Turkish Get Up is a movement that will allow you to couple these two areas of your body for optimal mechanics. The kettlebell will force you to reach the shoulder to maintain back expansion and those upper back muscles loose. Keeping your gaze on the kettlebell will allow you to match the normal mechanics of the shoulder and neck. Because you are looking in the upward direction you will maintain a lengthening position of the musculature in the front of your neck. This movement is great reinforcement of all the mechanics you worked to restore in the previous 4 exercises.  Perform 2-3 sets x 3 reps on the side that’s restricted (can perform both sides) Give this 5-exercise routine a try to get your neck moving again! If pain is a limiting factor to performing these movements, it’s time you get checked out by a professional. Reach out to Next Level Physical Therapy to get set up with a free in-person or virtual Discovery session! 
To Chin Tuck Or Not (Part 1/2): When Does This Help Neck Pain?
Chin tucks, the nickname for a motion moving the upper part of your neck and lower part of your neck like you’re making a double chin, are a frequently prescribed activity for folks with a variety of symptoms around the neck. Video 1 gives a demonstration of one of our physical therapists performing one. Video 1: The “Chin Tuck” exercise. They can be effective for symptom relief with individuals having pain in the region of their neck and accompanying arm pain. For individuals having headaches, or even those having general aches in the back of their neck.  Some people get positive changes in their ability to move their neck and can decrease or even eliminate their neck pain with an activity like this. Meanwhile, some patients I have talked to have been doing chin tucks for several years and are still coming to see me for help with their neck discomfort.  I want to make sure the time folks spend working on a solution to whatever movement or pain related impairment they have is spent effectively, so let’s jump into the point of this article:  When is doing chin tucks useful?  There’s a couple heuristics that I use to decide when someone might get a positive return on time investment with the chin tuck.  1. You have a directional preference for your neck and/or arm pain.  Often individuals with neck discomfort may have symptoms down their arm or into their hand. A “directional preference” means that moving your neck in one direction, say forwards, seems to make your neck and arm pain worse, while moving your neck backwards seems to reduce it.  If performing some chin tucks held at the end of the range of movement for a few seconds improves your symptoms, great! Keep performing them and see if you continue to get reductions in discomfort and if the movement of your neck improves.  Even if performing the chin tuck doesn’t improve your neck discomfort but reduces the tension or discomfort into your arm or hand, keep performing them. That’s an occurrence called “centralization” that is strongly associated with improvements in neck discomfort.  2. Your neck endurance could use improvement.  When people have neck discomfort for a long time, it is a common reaction for folks to move their neck less. Just like if we stopped moving our bodies or exercising, our body would adapt to this and we would have less capacity for performing movement before fatigue sets in.  The Neck Flexor Endurance Test, pictured below in Video 2, is something I’ll occasionally use to measure the capacity of someone to hold their neck in this position.  [embed]https://www.youtube.com/watch?v=0JEWM_McBmM[/embed] Video 2: The Neck Flexor Endurance Test  If my patient is shaking and struggling to maintain the position of the test for <30s, or especially less than 10s, then it is probably worthwhile for us to spend some time filling the bucket of neck force production over durations of time.  However, if someone doesn’t have a directional preference, and they ace the neck flexor and neck extensor endurance tests, spending time working on chin tucks won’t likely move someone towards their goals. Now, for the next part:  When is doing chin tucks not useful?  I see a lot of individuals whom present like they are already doing a chin tuck with their cervical position when they are standing or doing many upright activities. They look similar to this person below:  [caption id="" align="aligncenter" width="681"] Graphic 1: Doing more chin tucks won’t be useful here.[/caption] This lifter above is already doing a chin tuck because of the demands of the exercise he is doing. If when this person is not bench pressing, his neck and head already gravitate towards this position, AND he happens to have neck pain, would reinforcing the positions his body already wants to be in result in a change in outcome?  I would tend to say that the probability of that changing would be low.  A better question is: “Why do high force production activities like the bench press drive this neck position?”. We’ll dive into that topic on the next post in this series.  To sum it up: chin tucks aren’t special, they are an exercise that moves our body towards a specific position.  They can be useful if you have a directional preference that improves your neck or arm symptoms by moving towards the “chin tucked” position.  If you’ve become deconditioned locally at your deep neck flexors, working on being able to hold the chin tuck in different positions can be useful at building up your local muscle endurance.  The important takeaway is to recognize what your unique starting conditions are, and then match the intervention to those conditions. Next time, we’ll talk about what I consider when I believe that chin tucks won’t be the answer! 
To Chin Tuck Or Not (Part 2/2): If Not, What Else?
We’re going to discuss what other movements you should consider doing if you’re having movement related neck discomfort and the chin tuck exercise hasn’t helped.  Not sure what a chin tuck is or if it could be useful? Check out the previous article in this series here to see if your neck pain solution might be that simple! At the end of the first blog post, we talked about how chin tucks are an exercise that extend your lower cervical spine and expand the back of your upper cervical spine. That looks like this in Picture 1. [caption id="attachment_1580" align="aligncenter" width="790"] Picture 1: The orientations of the two regions of the neck in a chin tuck position, live in action.[/caption] A concept that was also introduced is that this position is not harmful. This position is frequently used by people who are strong, when they are using their strength to move heavy objects, which involves producing a lot of force.  When the goal is being able to be strong or when you want to produce force, the body will produce the most force by reducing total movement available.  Think about the last time you helped a friend move their couch. If you squeeze your body tight before picking it up, and move it straight up and down, that feels easier than when you start to drop your end of it and must twist to grab it again but lose your grip and end up dropping it.  By moving away from the body positions that were limiting the amount your body was able to rotate or turn, you didn’t have as much leverage to be as strong.  Individuals like the powerlifter performing a bench press above will compress other regions in their body, like their middle back space by pinching their shoulder blades together, and compressing their lower back to extend it (read, increase the distance between it and the bench) to further limit the ability for their body to turn so they can be as strong as possible in a straight line.  For them, this is a performance adaptation! This adaptation overtime can contribute to a loss of the ability to turn your head, however. To be able to move your body into an area, you must be able to expand it in that direction.  The chin tuck position extends (synonymous with “straightens”) or compresses the lower neck. To be able to turn your head to the right, you must be able to expand the right side of your lower neck AND compress the left side, and the opposite for turning to the left.  So, if you already have a head and neck that look like you’re performing a heavy bench press when you aren’t performing a bench press, and have issues turning your head to either direction, doing chin tucks has a low chance of improving your ability to move your neck.  In this case, exercises that will expand your lower neck will start to improve the ability for your neck to turn side to side.  A great activity to start learning how to do this is the Alternating Frog Crawl, shown below!  A video of the alternating frog crawl exercise. There are a couple benefits to this exercise for people who struggle to turn their neck, or whom have had neck pain for a while.  First, you learn to create pressure through the ground to expand the area between your shoulder blades and the base of your neck.  Secondly, you’re learning to maintain this position against the downward force of gravity, so you’ll build your endurance in your neck muscles to hold your head up.  As you step one arm and leg forward, you start to create compression on one side and more expansion on the other, which are the biomechanical results you need to be able to turn your head back and forth!  To summarize, there’s nothing bad with the chin tuck position. It has certain benefits for movement, but it’s not a magical cure-all for neck pain.  The goal is to have a neck that can get into positions to resist movement, and getting into positions to create movement from, so it is adaptable for you to move in many ways!  If you’ve tried chin tucking all your problems away and you’ve still got neck stiffness limiting you, try a different solution to address how you’re able to get your neck to move and get an adaptable neck! 
Why Your Neck Pain Is Being Caused By More Than Just “Bad Posture”
It seems like in today’s world filled with technology and working from home, “posture” is a buzzword with a negative connotation. We are filled with messages and images about what makes a “good” or “bad” posture, and why it’s the end all be all culprit for all your aches and pains. We are bombarded by “Pull your shoulders back, stand up tall!” and “Stop looking down and hunching over!” Or my personal favorite, the as-seen-on-TV posture correctors that literally do the work of your muscles for you (which is ultimately going to make your problems worse, by the way!). Have neck or back pain? It must be your posture, fix your posture! With all of  this information out there, it can be hard to interpret what’s right and what’s not. You can spend hours researching your neck pain without actually finding a solution. The truth is, the body is a lot more complicated than just finding one perfect posture to solve all of your aches and pains. We are built to be dynamic, built to move, and everything in our body is designed to move together. So the answer to solving your neck pain isn’t just “have better posture”, it goes so much deeper than that!  Take a look at picture 1 above. Everytime you move your shoulder, your shoulder blade, or scapula, must move as well. If we look at the muscles that surround the scapula, particularly the levator scapulae and upper trapezius muscles, you can see that they attach on one end at the scapula, and on the other end at the cervical spine. Basically, this means that every time you move your shoulders and use these two muscles, this can have an impact on your neck as well. So, if you have neck pain take a second to think. Are you really stressed out and feel yourself holding tension by keeping your shoulders shrugged? Do you type all day long at a keyboard that is too high, which would also keep your shoulders shrugged all day long? Do you ever feel like you just don’t have the motion required to reach overhead or behind your back? If this sounds like you, then the culprit to your neck pain might actually be the position your shoulders are in and the tension in those muscles!  The second picture above shows your neck muscles from the front. You can see your SCM muscles, scalene muscles, and again, the upper trap muscles. In addition to moving your neck, these muscles also assist with breathing. Before we dive into this further, I want to go over what we *should* normally see when we breathe.  Ideally, we want to see the ribcage move out and up as we inhale, and down and in as we exhale. We should get a fair amount of rib cage movement with each breath if we are breathing with our diaphragms. However, sometimes this breathing pattern can become faulty. The rib cage no longer moves the way that it should, and the diaphragm is not utilized to its full potential. Instead, we end up relying on these neck accessory muscles to drive our breathing. Clearly these muscles are not that big, thus are not meant for such high demands! You can imagine if you are asking these guys to take on the task of 22,000 breaths per day, they may not quite be up for the job. They are not capable of meeting such demands, which ultimately would lead to increased tension in that area and you guessed it; pain.  While “bad posture” is the easy explanation for your neck pain, it’s a pretty empty explanation if you ask me. The body is so much more complex than that and a lot of our muscles attach different body parts to each other. With this knowledge, it is easy to see why neck pain is not as simple as it’s made out to be. If you are suffering from chronic neck pain, it’s important to zoom out and take a deeper look than just your posture. Because you may listen to mom and “pull those shoulders back”, but if it’s your ribcage and your breathing that is causing your pain, you will find no relief with that solution. If this sounds like you, definitely get checked out by a licensed professional who will be able to connect all the dots with how your body is moving and get to the root cause of your neck pain!
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Michael W.
College Football Player

About three years ago I had a neck injury during one of my football games and went to numerous doctors and specialists who could not diagnose my problem. I was desperate to get back on the field but was discouraged after having no success with traditional medicine. Then I was introduced to Dr. Mike and my life was changed. His methods are unorthodox but extremely effective and after only a few sessions with him my neck pain was gone. After only a few sessions you can tell he is a very knowledgable person who is willing to go the extra mile to accommodate his clients. I can’t thank him enough for helping me get back on the field.

Mark A.
Volleyball Player

I can not say enough about the therapy I received from Dr Elyse Dinan and the staff at Next Level. I am a 65 years old and I came in for treatment of a pinched nerve in my neck which was causing radiating pain down my arm. The pain was preventing me from sleeping, dong daily activities, and playing volleyball. I had a goal that in 7 weeks I needed to be able to participate in the National Senior Games in Fort Lauderdale in the volleyball tournament. Within one week of treatment I was able to sleep through the night and in 3 weeks the pain had decreased dramatically. By the end of the 7th week of treatment I was confident that my body had healed well enough to participate in the Sr Games. I went to Florida knowing I was I was going to be able to play at a level I hadn’t for quite a long time. With Next Levels help I not only got to play in the games but our team won the gold medal! Thank you Elyse and Next Level!!!

Dan B.
Active Adult

Next Level Physical Therapy did wonders for me. I had a chronic pain on my right side of my back. It went to the neck down to the bottom of the back. It did not prevent me from doing things like working out but it inhibited me quite a bit. It also caused many headaches. Dr. Ben worked with me to create stability where I was lacking. My strength and flexibility were always there. I just needed to learn how to stabilize my body in areas to create more balance and harmony with the muscles. This was done with many breathing exercises where we hold a position and tighten up the muscle area. Then by achieving full breaths into the chest and releasing it, the oxygen getting to the areas allowed for the pain to disappear. Repeating these exercises each day allowed me to achieve a huge level of success. I now have very little pain, fewer headaches and more range of motion. My stability has become much greater allowing my intense workouts to be even better. Thank you Dr. Ben and Next Level Physical Therapy! You guys are #1 to me!

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