Discover the ‘core’ muscles of your neck – the deep neck flexors

We are all aware of the role of the deep abdominals, pelvic floor and diaphragm as postural support muscles for the lower trunk and pelvis. These act together and in balance to support and stabilise the gentle curves of the lumbar spine and the alignments of pelvic joints.

Just as we have this deep and balanced support in our lower trunk, we have a similar set up and about the neck. The neck or cervical spine, like the lumbar spine, has a gentle concave curve to it and there are many muscles attaching to these vertebrae. It is again the relative activity or balance between these muscles that can help support our curve well and release tension from the larger superficial muscles at the back of our neck. We probably all know of these after too much time spent in a poor posture at the computer or after a long drive.

The neck flexors sit at the front of your neck (near your throat) and the extensors behind our neck from the base of the skull to across the upper shoulders. Postures with our chin poked forward or with a head that tilts back too much (such as reading though bifocals at the computer screen), cause a relative imbalance between these 2 sets of muscles with too much activity, tiredness and tension in the extensors and not enough activity from the front at the flexors. How often have you had the painful tense neck and shoulder region, possibly stretching to the shoulder blade region, or up to the head as a headache?

Gentle lengthening through the back of your neck from the base of your skull and remembering to hold your mango gently under your chin is a great start to achieve muscular balance around the neck. Try this when you next sit at your desk, drive or read the newspaper at the breakfast table.

Here is another deep neck strengthening exercise to try on your mat on the floor. All movements here are extremely subtle, so learn to take it easy and feel for slight contractions in your neck muscles near your throat.

The Starting Position:

The focus:

• Lie on your back in the basic relaxed position, pelvis neutral and with your head resting on a folded towel of approximately 9 layers.

• Make sure your towel is pulled to the base of your neck for support.

• Focus on your wide shoulder blade placement and feel their heaviness on the mat.

• Allow your neck to melt, release your jaw and feel your shoulder melting away from your ears. Imagine a mango held delicately under your chin.

• You could picture the clowns with wide open mouths for pingpong balls here at the Easter show – turn with a lovely long neck on a pure central axis.

• Keep breathing

• Focus on subtle contractions and slow movements

• Try to maintain a soft length to the back of your neck.

The Movement:

• Gently lengthen the back of your neck as if your skull is moving away from your shoulders.
• Now gently push your tongue to the roof of your mouth. Become aware of the subtle muscle activity at the front of your neck near your ‘voice box’.
• While keeping this tongue position, gently roll your head to one side. Imagine the front of the neck melting, shoulder melting away from the ears and the neck feeling long at the back. Repeat rolling side to side 8-10 times.
• Finish by gently pushing the back of your head down into the towel. Focus on your long neck, soft jaw, tongue pushing upwards and not squashing your mango

Tip: Try this every night before you go to bed. It will take you 2 minutes and will help alleviate neck tension from the day and support your neck in the balanced way as it were meant.

Ion channels, receptors and action potentials

Last month we began to explore the role of nerves in the pain experience. We talked about ‘nociception’ – danger messages that a nerve or nerves will send to the brain. You may recall that these electrical impulses themselves are not a ‘pain message’ and that the pain experience is a brain based construct using all relevant information for that time, place and experience.

Let’s look at nerves in more detail. Nerves from the tissues (muscles, skin etc) to the brain will only send quantitative data and not qualitative. The nerves do this via receptors or ion channels which are positioned at the end of the nerve and ‘open and shut’ in response to stimuli. They are made of proteins and respond to 3 differing stimuli:

• Temperature changes, such as hot and cold
• Mechanical changes or stresses, such as stretching and vibration
• Chemical changes in the tissues, such as inflammatory by-products, histamine, adrenalin, stress hormones like cortisol.

Opening ion channels allow for enough positive charges to flow into the nerve, thereby ‘exciting it’. At a critical level of ‘excitement’, the nerve will ‘fire off’ an electrical impulse to the brain via the spinal cord. This is called an action potential. It is this message (and the intensity of it) that the brain uses to decide whether a pain experience will result from it. Can you see that the ion channels and therefore the messages to the brain will revolve around the stimuli of temperature, chemical or mechanical?

Another amazing fact about receptors is that they are in a constant state of change or remodelling (like the rest of our body eg skin cells). Receptors close, move and open every few days and will do so in response to these 3 stimuli. When a nerve is under greater levels of stimulation, more receptors will form and open. We can call this an ‘over-excited’ or ‘over-sensitive’ nerve. Here are some common examples we see all of the time:

• poor postures of the neck and upper back, increasing the pulling stresses in shoulder and upper back nerves
• anxiety and stress can increase the number of open chemical ion channels in all nerves
• inflammatory products such as histamine in a newly sprained ankle will increase the opening of the chemical ion channels.

An ‘over-sensitive’ nerve will send increased intensities of danger messages and your brain will need to sit up and take more notice of this. The brain is more than likely to say “hey, this is enough of a danger message to decide I am in pain.”

And there is always a more hopeful and positive side to these facts! Receptors and ion channels can close by decreasing the levels of these 3 stimuli. And less ion channels opening will mean less danger messages to the brain. Sound great?

How do we do this? By reducing the chemical and mechanical loads on the nerves. There are many many ways, but here are a few:

• unload the nerve mechanically such as through movement, changes in posture, better muscle strength and endurance to get you through your days, better work place ergonomics
• improve the health of your nerve tissues such as through nerve gliding exercises to improve the blood flow to the nerves and their protective sheaths
• de-stressing and reducing anxieties, such as through education, psychology, relaxation techniques, drugs such as anti-depressants.

So as you continue to work on your good postures, build ‘core’ and trunk strength and slide your nerves in all those fancy ways, remember that you are not only having a positive impact on your muscles and joints, but also your nerves. You are helping to ‘dampen them’, making them less sensitive and reducing the levels of nociceptive danger messages to your brain.

Pelvic Floor and Pelvic Wall Overactivity

We know that the pelvic floor muscles are a hammock-like group of muscles within our pelvis that extend from our tailbone to our pubic bone and fan out to our sit bones. These pelvic floor muscles exist to support our pelvic organs as well as to provide pelvic stability and support for our spine.

Another group of muscles exist within the pelvis and are referred to as the pelvic wall muscles. These include muscles named coccygeus and obturator internus. The pelvic floor muscles stick onto these two pelvic wall muscles.

• Coccygeus attaches from the tailbone and spreads out towards the sit bones. It is one of the muscles that tightens in those of us called ‘butt grippers’. It is the muscle we are trying to relax when we say “widen your sit bones”.
• Obturator internus attaches from within the pelvis (inside the base of your pelvic bowl) and heads down toward the top of the leg bone at the hip. This makes it an outward rotator of the hip. This muscle switches on when we are rolling the leg out in exercises like the ‘Leg roll out and in’ and ‘the clam’.

If someone has pelvic pain or a long-standing hip pain, there is often a dysfunction within the pelvic floor muscles and/or the pelvic wall muscles. Sometimes the strength of these muscles is not the main issue, but rather that they are already switched on or are contracting even when we are relaxed or at rest. If these muscles stay switched on for long periods of time and especially during episodes of pain, they can start to spasm and develop trigger points and tightness, which can continue the cycle of pain.

Because the obturator internus muscle has nerves that pass by it, you may develop pain or numbness in the front thigh when the muscle is in spasm. Some people may have bladder pain or strong urges to empty their bladder. Increased frequency to empty their bladder is another common side effect of this muscle over-activity. It can often produce a burning sensation in the inner areas of your pelvis if it is in spasm.

Sometimes if these pelvic wall muscles spasm, the pelvic floor muscles can also spasm because all these muscles are joined together. So even though you may have weakness in your pelvic floor muscles, you can also have spasm and trigger points along them. This is no different to muscle ‘knots’ or trigger points in the large neck and shoulder muscles that we can all feel after long bouts sitting at the computer.

Managing this type of pain and over activity is therefore no different to seeking treatment from your physio or masseur for your neck pain and tightness. Just like having treatment to release tight muscles in the neck, these pelvic floor and pelvic wall muscles need to be released.

This is best done by seeing a Women’s Health or Men’s Health Physiotherapist.