Sticking your Neck Out 

I am a literature major in my final semester and I have to read about four novels and write two to three papers per week. So much time spent reading and writing often leaves me in severe back, neck and shoulder pain.

I try to do at least 20 minutes of yoga a day, if I can. Also, I break things up by cleaning or watching television or going outside between homework since I can't sit in one position for more than 15 minutes. But no matter what I do, I usually just hurt from my shoulders up. What can I do? I ask not just for me, but for all studentkind.

—Jenny R., Boise

Finally. A chiropractic question. After dozens and dozens of articles, you would think I would have been given an opening for a self-serving column about neck pain before now. Apparently, though, topics like irrigating your colon, dieting with tapeworms and drinking your own urine are somehow more interesting than adjusting spinal fixations. OK, I have to admit, those subjects actually are more interesting. So maybe I'm in the wrong business. Does anybody know if DeVry still offers the Careers in Kooky Medicine degree program?

But before I change careers, Jenny, I must tell you that your pain is very likely due to the position of your head when you study. Unless you're at The Flicks watching Wuthering Heights instead of actually reading the novel, your head is probably in a forward, bowed position. While this is normal for short periods of studying, if you lead with your head when you're, say, walking to class, it could mean trouble. Called "forward head posture," this awkward position puts stress on the muscles at the back of the neck. To illustrate, imagine keeping a bowling ball balanced upright by holding one end of a foot-long stick placed in one of the fingerholes. Holding it straight up is easy, but tilt it slightly forward and your forearm muscles will quickly burn hotter than Heathcliff on the moors. In that same way, carrying your head forward can make your neck and shoulder muscles ache.

Unfortunately, the fix is not as easy as simply standing up straight. That forward head position is often a result of losing the normal curve in the neck. This curve is a natural shock absorber and can be lost for many reasons—injuries or accidents, habitually sleeping on your stomach or even a few seemingly minor "stiff necks." Whichever the cause, the usual result is a muscle spasm that will tightly lock down the vertebrae and their joints. Eventually, the spasm relaxes and those vertebrae usually pop loose and begin moving freely again. Sometimes, though, one or more joints don't release, and those bones stay somewhat stuck together.

Chiropractors call this fixation or subluxation. After months or years, the surrounding muscles and ligaments become accustomed to the lack of motion and can shorten or become less flexible. So simply standing straight and pulling your head backward won't just be uncomfortable, it'll be as fruitless as the farm in The Grapes of Wrath. All your good intentions and all those aspirin, creams and massages won't free those joints—only some form of mobilization can release them properly. On this, and very little else, chiropractors seem to agree (if you haven't noticed, we are mostly contrary misfits, otherwise we'd have gone to medical school).

My advice to first and foremost get your spine checked is not simply self-indulgent practice-building (that's just a bonus); there is significant evidence behind it. In 2003, the medical journal Spine published a paper describing a clinical trial involving 115 patients with neck pain similar to yours. Up against medication and acupuncture, spinal manipulation resolved the pain in the highest proportion of patients. More importantly, however, the following year, a review article looked at 33 previously published, randomized clinical trials involving neck pain. The conclusion was that mobilization techniques definitely work, but they must be combined with exercise to maintain any lasting benefit.

Which brings me to your yoga. Without regard to its ancient spiritual history, the core of yoga is slow, ergonomically perfect stretching—which I highly recommend continuing. Focus on positions that open your chest and shoulders, and extend your head up and back. As for reading, reclining on a bed or couch will make things worse by forcing your head and neck into flexion. Do your reading and writing at a desk or table, or sit erect in a comfortable chair with armrests. Finally, be careful not to judge my profession by the neck mobilizations described in A Tale of Two Cities: Guillotines were never part of the curriculum—not even at DeVry.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send the Book-of-the-Month and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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