Friday Q A Neck Pain and Fear

Q: I read of yoga for back pain, but little about neck pain. I've been in PT for months, with good ideas about posture/extension/alignment, etc. And now I'm in a series of skillful massage targeted to the neck muscles...but such stiffness in spite of it all! Did yoga for years, but not lately (still active!) I'm wary of yoga that my pain might be exacerbated. I'm 52. My work is varied, with some hours at a desk but broken up with people interaction. Thanks for your counsel!

 A: I understand why you might be afraid of doing yoga again but I want to reassure you that starting to practice again will be beneficial for you in so many ways. I currently have a student with a lot of physical challenges and chronic pain from prior surgeries. She has told me so many times that even though her body may not be able to move the way she wants it to, when she wants it to do something, she finds that “yoga is good for my mind. It makes me tune in and just listen to myself.” This individual needs a lot of modifications when she practices, but because she trusts both me and my co-teacher Bonnie, she is willing to try new things, "even when they are scary,” specifically because she knows she can stop WHENEVER she needs or wants to and we respect her decisions. We have a “circle of trust” in our class that is very valuable to both the teachers, the students and our assistants.

The great thing about yoga in my mind is the ability to stop whenever necessary. The practice is an internal dialogue not an external show. Sometimes we need to be reassured we can still do an activity but are afraid because it might hurt. Well, if something or an activity causes an increase in pain, then we have the ability to stop the action. Sometimes although our minds fear something when there really isn't a physical correlation between the fear and the action, we have to teach our mind not to fear the action. It is kind of like relearning to ride a bike when we have fallen off in the past and done some serious damage but now have the desire to get back on the bike. But where to start? With all activities it is helpful to imagine the activity first before attempting it. So, if you had some yoga poses that you used to do that gave you pleasure, start with those. I would set myself up in a position of comfort where I was warm and felt safe, and then I might mentally begin the practice using only my memory. After a while of envisioning the pose, I would try it just a little bit. If I felt scared that I was going to hurt myself, then I would stop and leave it and try again tomorrow.

If this type of mental re-entry into yoga doesn't work for you, then you might re-contact your teacher (if you had one) and ask to talk about your concerns about returning to a class. If you don’t have a teacher anymore, look for someone in your local area who has experience with working with individuals with neck injuries and discuss your concerns about re-entering a class. If that isn’t possible, look for a class either for people recovering from injuries or with a gentle focus, and, again, approach the teacher with your concerns. Going back to a class has to feel safe for you, and in order to feel safe you have to be able to trust the teacher to not make you do more than you are comfortable with. Don’t be afraid to be frank about your needs and to have the ability to keep yourself safe. If you still can't find a teacher who fits this profile, contact the International Association of Yoga Therapists and ask for a teacher in your area or near to you that you can work with. They keep a registry on file for all members.

And finally when you do begin to practice I would follow the motto of “less is better” because more than that might spiral you back into a flare-up cycle and put you off of yoga for quite a while. Poses that I particularly like when my own neck is feeling fragile are more passive poses like Viparita Karani (Legs Up the Wall pose) or a passive backbend over bolster with neck and head support. Active practice like standing poses with arm motions often make my own neck feel worse, so go easy on those. Learning to twist again without using arms for leverage also is important. I also like Chair Shoulderstand with a bolster under my upper back and no weight on my neck.

You mention only the physical aspect of asana but as you can see on many of the posts on our blog, that is only one small part of the practice of yoga. I might use this opportunity to re-visit some of the other limbs of yoga, especially some pranayama or basic breathing practices. The ability to fully breathe is a gift in learning to manage chronic pain and stiffness because it's like doing a massage from the inside out. I suffer from major neck issues myself, and I find that my neck will often let me know when I am overworked or overly stressed because the littlest things can set off my own pain cycles. There is no quick fix, but there are many pieces to the puzzle in learning how to manage ourselves in life.

—Shari

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PDF Eye flashes neck pain

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Information On How A Dallas GA Chiropractic Office Helps Keep Your Neck Healthy

By Bob Albert Lewis

Headaches, shoulder cramps and eyesight issues are all additional problems that can stem from a stiff or troublesome neck. Dealing with such pain often means taking a fair amount of medications. However, individuals who would like to find an alternative form of relief may wish to consult with a Dallas GA chiropractor to assess the situation.

Chiropractic medicine is a field that studies the alignment of the skeletal system and how it affects the body. Through adjustments of the spine, many pain related issues and neuromuscular disorders may be addressed without resorting to medication or surgery. Generally speaking, these methods fall under the category of alternative health care.

Before any type of adjustment is performed, the doctor will first administer a thorough examination and order the necessary blood work and diagnostic imaging. All of this data will be used in an effort to make the most informed decisions. Should it turn out that the issue requires a more traditional approach, the patient will immediately be referred to an appropriate physician for further care.

A leading factor in constant neck pain is often misaligned vertebrae. Just the slightest twist might be enough to squeeze a nerve or pinch muscle or sensitive tissue. There are multiple chiropractic methods that may be applied to obtain relief.

The doctor will carefully apply calculated and precise force along the vertebrae to realign the spine properly. Correct positioning restores regular blood flow and relieves the pressure that may have been put on the surrounding muscles. Deep tissue massages might be administered to help reduce built up tension.

The necessity of follow up sessions are left to the doctor's discretion after they have thoroughly assessed the situation and the likelihood of recurrence. There are exercises, activities and ergonomic techniques that can be utilized at home between visits to keep pain under control. Health care without pharmaceuticals just may be the way to handle certain discomforts.

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How To Ease Yourself From Neck Pain Worries

By Sarah Robinson

Body aches can cause anguish and frustration. In most cases, patients have experience delays at their daily routines and activities. Serious signs and symptoms might show in the later years as well. Pain, notwithstanding of its type, has always been a huge dilemma of many.

Agony might radiates from the different parts of the body that brings discomfort to anyone. Due to certain complications and for other reasons, some people are enduring the effects caused by a neck pain Conroe. This might seem a normal daily thing, but this should not be taken too lightly. Good thing that there are steps and strategies you can do to prevent the pain from coming back. Below are key tips and tricks that might come in handy one day.

Change of pillows. Most of us believe that our pillows changes our position and could in fact cause inconvenience rather than comfort sometimes. Should you are suspecting that one reason for pain to occur is because of pillows, change it. Then, see the changes and difference for yourself. If your condition persistently lingers and shows no sign of stopping, consider the next option.

Sleep on your back. Sleeping on best possible position calms and helps spine to have a comfortable rest. Since the neck and spine is somehow interconnected, this is one ideal position. Try placing pillow on every arm to takes off strain. If ever you are suffering from a serious condition, its highly advisable to talk to a doctor to address your needs.

Avoid texting too much. Looking down or texting on the phone develops an excessive strain which will sooner or later cause anguish. Over time, an increase of stress on joints affect the neck regions. Consider raising the phone higher or simply maintain an eye level view. Have some frequent breaks too. When using cellular device for hours, avoid tilting head.

Eye level computer monitor. Sit comfortably straight when facing the computer and then slowly close your eyes. After that, open them and see if your sight is focus on the middle of the computer screen or not. Laptops are different, however. Since they can be move in a downward and upward position, it might be best to use big monitors and screens for your own convenience.

Stay hydrated. Drinking lots of water hydrate your discs and give you a comfortable sleep at night. The discs are those spongy structures that mostly lie on between the vertebrae. They are made mostly of water, so being well hydrated might solve the situation. Ideally, a suggested amount which is eight glasses of water might provide you the best kind of result.

Balance your weight evenly. Carrying a heavy item on one side of body can be dangerous. Yet many fail to realize this. Aside from lightening the load of your materials, make an effort to keep your shoulders even. In that way, there might be less problem in the long run.

Perform regular neck exercise. This is practically viewed by many people as one essential solution. Stretching together with proper exercise introduce benefits someday.

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Neck Position in Camel Pose Ustrasana and Other Backbends

by Baxter and Janet Rae Humphrey

Margann Green, Age 77

We received this excellent set of safety recommendations for Camel pose for older adults from Janet Rae Humphrey, E-RYT, of YogaForStability.com in Scottsdale, Arizona, and wanted to share it with you all: 

Dear Nina and Baxter, 

As a yoga teacher who specializes in older adults ages 70 to 95, I would like to comment on your post Are Backbends Stimulating or Relaxing?

The photograph of Margann Green doing Camel inspires me to write about precautions that are necessary when teaching people over 70. At age 77 Margann’s ability to do a full Camel pose is remarkable and certainly shows the advantages practicing yoga as one ages. I see a distinct difference between the residents of senior living centers who have exercised all their lives and those who have not. The first group is far stronger, more flexible, and is less likely to use assistive devices. Those that begin a yoga practice in their later years also benefit greatly by the increased mobility that yoga offers. 

Camel is frequently performed and photographed with the chin up to the ceiling or the head tilting back even further. In yoga we follow the principle of doing no harm. Camel, therefore, as well as other poses, needs to be modified as we age. 

Baxter has identified how aging affects the cardiovascular system as follows:

• Baroreceptors (see Why You Should Love Your Baroreceptors) become less sensitive with aging, which can contribute to sudden drops in blood pressure when you move from reclining to sitting or standing, and general dizziness. 
• The walls of the smallest blood vessels, the capillaries, can get thicker with aging, which could contribute to slower exchange of fuel and waste into and out of our body’s tissues. 
• Both the main artery leaving the left heart, the aorta, and other arteries in the body start to have changes in their connective tissue layers. This can lead to the vessels becoming stiff and less flexible, which in turn can make the heart work harder. 
• Arteriosclerosis (hardening of the arteries) gradually narrows the blood vessels that lead to the brain and over time can completely block them.
• Strokes or mini strokes can result if normal blood flow to the brain is temporarily or permanently dramatically decreased  or stopped altogether, due to arteriosclerosis, arrhythmias, and other factors.

These types of changes may affect the ability to do and/or the safety of a person assuming certain physical positions or yoga poses. 

I worked in the neurology department at several teaching hospitals and have seen the damage done by someone over 70 tilting their head back. Think stretching a piece of rubber tubing with fluid running through it. The shape changes from round to flat and the opening is greatly restricted. When the stretching stops, the fluid gushes through with increased pressure. 

When the head is tilted back, the carotid arteries in the neck become flat and the flow of blood to the brain is restricted. This can lead to a stroke or transient ischemic attack. Furthermore, when the head is lifted, blood rushes to the head, increasing the blood pressure. This becomes more problematic with aging because the baroreceptors are less sensitive to changes in blood pressure, the walls of the blood vessels are thicker, fatty deposits in the vessels further restrict the blood flow, and the capillaries in the brain are more likely to burst when they are under high pressure. 

One of the more common places for older women to have a stroke is in the beauty parlor when their hair is being washed. I mentioned this in a class I taught and one of my older students said that was where she had a stroke. 

I encourage your readers who teach people 65 and above to remind students to keep their chins tucked and not allow their head to fall back during back bends. One way to do this is to put one hand behind the head to support the head during a backbend. 

A second reason for older adults not to tilt their head back is the changes in the discs between the vertebrae as we age. Baxter discuss these changes in his post Degenerative Disc Disease and Yoga: 

"Degenerative disc disease is a process of change to the cushion-like discs found between the vertebrae or spinal bones. It most commonly affects the discs in the neck/cervical region and the lumber/lower back region. There is some ongoing debate on whether the deterioration of the discs is a natural part of the aging process (since it is seen in people without symptoms of back or neck pain in gradually increasing percentages as we age) or whether it is directly related to an abnormal condition of change in the discs. It is really part of the general wear and tear arthritic changes we see in other joints, as the discs represent a unique kind of cushion structure that is similar to the cartilage caps found on the ends of other bones in major joints of movement. But it is different from the regular cartilage in other joints in that it is a larger structure, not adherent to the vertebrae above and below it, as well as having a unique structure that distributes the intense force of gravity that travels down the spine in a specialized way. 

Not only do the discs degenerate, but they also lose moisture and become thinner and denser. Their cushioning ability decreases. A sponge fresh from the package is tall, soft and pliable. An old sponge that has been sitting on the counter is thin, dense and hard. The same is true for the discs as we age. The thinning of the vertebral discs is the major reason why we become shorter as we age. The natural padding in the spine degenerates with age and the cervical vertebrae can be crushed together when the head is tilted back. Older adults, both men and women, have a much higher risk of osteoporosis and can easily get compression fractures of the spine. Forward bends and twists can be hazardous for someone with osteoporosis because these postures can cause painful compression fractures of the spine. "

Poses performed in a supine position can also cause neck problems in older adults. If the student has hyperkyphosis or a tight front chest, their shoulders will not reach the floor in the same way that the shoulders of a younger students do. Because of the excessive curving of the thoracic area, the student will be lying on their spine and just the tips of their shoulder blades. In this position the neck is elevated off the floor and the chin is higher than the forehead because the entire back of the head does not reach the floor. One end of a folded blanked can be rolled to go under the neck and the other side folded to support the head so the forehead and chin are at the same level thus maintaining the correct cervical curve. 

These precautions are most important for people over 70, but they are good to consider in regards to younger students who have neck injuries, arthritis of the spine, tight shoulders, over developed musculature of the shoulders, arterial sclerosis, high blood pressure or other medical conditions that could cause changes in the arteries and the shape of the upper back. 

I remind my students, “Keep your neck in a normal cervical curve and in line with your spine. Being safe is more important than looking like the picture in the yoga book.” 

—Janet Rae Humphrey, E-RYT

Thoughts on Janet’s advice: 

First off, I am grateful to Janet for sharing her wisdom and experience with us regarding safety precautions specifically for Camel pose (Ustrasana), in which the head and neck are often taken into extension along with the rest of the spine. And I generally agree with her recommendations for modifications for those over 70 and even for younger adults who may have skeletal issues like cervical problems, pronounced thoracic kyphosis (rounding of the upper back), or osteoporosis. 

Keep in mind, however, that these are not hard and fast rules, and that those who older and are healthy and without risk factors for such problems (no diabetes, hypertension, hardening of the arteries, history of past heart attacks or strokes, arthritis, osteoporosis, etc.) and have good flexibility and strength may still be able to approach the full pose, under expert guidance. 

One key factor to consider is how long you are in such poses. It seems the risks of serious adverse events rise the longer you are in such an extended position, for example, longer than 5-10 minutes. I’d recommend, if you choose to try Camel with some head and neck extension, that you do it for very brief timings, say 10-20 seconds, and use support to start with. Or, as I do now, do it with the chin tucked to the chest and enjoy the backbend in the rest of your spine! 

Also, please note that Janet is referring mostly to neck awareness and cautions for Camel pose, which involves dropping the head back in space into the pull of gravity. I don’t have the same concerns for backbends like Cobra (Bhujanghasana) and Locust (Salabasana), where you are lifting your neck up and so have different forces acting on the neck. Taking the head and neck into extension in these backbends is generally not going to put you at risk for strokes and compression fractures of the cervical area. 

—Baxter

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