Sunday, August 17, 2014

Pain in the neck: Some thoughts on how to ensure this does not happen in class or practice

photo from wikipaedia

I will start this by saying that if you feel any discomfort or pain during or after a yoga class, please discuss it with your teacher.  In general, if you move slowly and tense less and stretch less, I hope that you never feel discomfort.   

In this post I will give a few specific cues that work really well to help ease neck discomfort in daily life and certainly while in yoga postures.  However, I advise that you do not practice anything without the guidance of an experienced teacher, especially if you have an injury.  Instead, I hope you might learn or appreciate some of the ways to ensure you do not experience neck pain in yoga and seek to discuss them with a teacher. 

With that said, last week a teacher noted she had advised a student to move from one style of yoga, where poses were held longer, to a more flowing style of yoga.  The advice was given, in part, on the basis that the student’s neck hurt from holding poses to long. 

The student had some form of pre-existing neck issue and it was proposed that the style of yoga (with long held poses) was exacerbating it. 

While this could be true, and other people might draw the same conclusion, I would be cautious to label a particular style of yoga as the reason a neck condition, in and of itself, would be exacerbated (and the teacher would also have had other reasons for recommending a different style for this student as well, including that she genuinely cared for the student and wanted her to continue a yoga practice and so enjoy the benefits of yoga).

Focusing on the questions of whether the style of yoga was to the main contributing factor, the immediate thoughts that came to my mind were:
  • ·      Is the problem holding the pose itself too long or is it the position of the head and neck in that particular pose? 
  • ·      What are the arms and armpits doing in the poses and could the position of the arm/shoulder joint complex be contributing to tension in the neck?
  • ·      What is she doing with her tongue and jaw?
  • ·      How are the mats aligned in the room in the class?

I will talk about each these points in turn below and why they sprung to mind.  They are not necessarily the only things to consider but they are some important ones.

Is the problem holding the pose itself too long or is it the position of the neck in that particular pose? 
This is a really important question to ask. 

Any pose in any style of yoga has the potential to exacerbate neck conditions if you hold the head and neck awkwardly.   The same could be said of lower back conditions and a variety of other health and medical conditions (pregnancy, shoulder injury, knee injury, etc).

For instance, I have compressed and rotated cervical vertebrae.  I know if I hold my head awkwardly any yoga class, whether slow or fast, I will end up uncomfortable and possibly with nerve symptoms such as numbness in my fingers. 

For that matter, I can experience these symptoms if I hold my head awkwardly in daily life.

As an experienced yogi, the risk for me of disturbing my neck is actually heightened in a flowing class if I am unfamiliar with the class or if I do not know what poses to expect or what if coming up and wondering if I am doing the same thing as the teacher. 

All of these things might mean that I keep trying to look at the teacher from the poses while never getting to settle into the pose.  As a result my head and neck would be repeatedly twisting, possibly quickly and awkwardly, to get a view of what the teacher is doing. 

On the other hand, as an experienced yogi in a slower class, with long held postures, at least I have the chance to settle my neck into a comfortable position even if I am unfamiliar with the poses or sequence. 

The key, I think, is to have the appropriate cue about what to do with your head and neck, whether this is a faster or slower moving class. 

Sometimes we assume people know how to hold their head and necks.  And you would certainly think that I, as a teacher, would know how to do so!  But when I am learning something new, sometimes I forget.  There is so much to look at and attend to that you can easily forget how you are holding your head.   

Over time I learned that, as a person with a neck condition, I needed to really attend to neck/head position as a key priority whether or not I am teaching, learning, or just sitting around in daily life.

Again, I re-iterate that this goes for anyone with any condition.  If you had a lower back condition you would probably attend to your needs in the lumbar spine when you were in a pose or learning a pose.  In the same way when I work with pregnant women I think about their needs in constructing a pose and sequence.

Giving clear and appropriate cues to people about how to move and hold their head and neck is vital.  Simon Borg Olivier and Bianca Machliss, in their excellent online courses, talk about the importance of what they call the neck joint complex (consisting of skull and cervical vertebrae and structures). [see for more information on courses and yoga from Simon and Bianca].

High on their agenda with regards to the neck is helping you understand how to create length and stability on all sides of the neck—front, back, and sides—in posture and movement. 

Three important cues they give are:
  • ·      Head down, neck back (chin to the middle of the throat) when taking the head down as though to look downwards or if looking forwards or standing steady.  This creates length at the back of the neck without squashing the front;
  • ·      Throat forward, head up when taking the head up as though to look upwards.  This creates length at the front of the neck without squashing the back;
  • ·      Chin to the middle of the throat, right ear lifting when turning head to right (or left ear lifted when turning head to the left).  This creates length at the side of the neck when turning.

Bianca with throat forward and chin up when looking up so as not to squash the back of the neck.

It is beyond the scope of this blogpost to give further details and I do not advise practicing without an experienced and knowledgeable teacher.  You can learn a lot by either coming to one of my classes or taking Simon and Bianca’s online courses. 

Perhaps the key is to appreciate that there are specific cues you can give with regards to head and neck position in all postures.  If you do not know them then go to an experienced practitioner and learn from them!

When the student with the neck condition came to class I found she was not quite sure how to hold her head and did not realize the position of her head itself might be contributing to or causing tension. 

When I saw her in various poses it seemed she was holding the neck slightly awkwardly (in this case throat back, head up in downward dog), which was contributing to tension at the back of the neck and upper back. 

Certainly, holding the pose for a long time would have exacerbated the neck condition she already had, especially since she was raising her head against gravity.  However, it looked to me that this could have been prevented if she adjusted her head position while in the pose (in this case to look towards her navel or otherwise to bring head down, neck back).

Simon showing looking to navel in downward dog, which helped the student relieve tension in her neck in that pose.

On this note, while I often use the three important cues in class, I will also often just cue people to move their head and neck softly once in a position and instruct them to ‘find a comfortable position for your neck.’  I also advise people to move from the base of the spine and to move their head last.

Having said this, I am always mindful that some people will not be aware that the position they are currently holding has the potential to create tension over time.   This means I will always tell people in poses like trikonasana and parsvakonasana that the most comfortable position for their neck might be looking down rather than up, and that if they need to come out of the pose then they should do so. 

The important point is holding any pose too long can contribute to tension if you are in an awkward position.  A pose as a whole is made up of all parts of the body and you need to look at all parts of the body to make sure they are not being held awkwardly.  Adjust your position, modify the pose, or come out of the pose if it is not comfortable.  

What are the arms and armpits doing in the poses and could the position of the arm/shoulder joint complex be contributing to tension in the neck?
What you do with your shoulders and arms makes a difference to what you feel in your neck. 

If you are tensing muscles above the shoulder, even subtly, you can end up with pain in the neck.  This will be exacerbated if your head and neck are held awkwardly in the first place. 

Armpit awareness is key here.  I have written a few posts on this previously. 

In general, I would advise you cultivate an approach to your practice where you firm the armpits by lightly pressing them in the direction they are facing.  Again, this is a cue I learned from Simon and Bianca.

When the student came to class I found that she had previously been to a physiotherapist and been given exercises to promote scapular movement and stability.  However, these were not generalized to the postures of yoga and indeed, it is beyond the scope of the physio to tell you this.  

In yoga class then we worked a lot on figuring out how use what she had learned in physio with her yoga poses.  It included figuring out what to do with her arms/shoulders/scapula in a variety of common yoga positions such as arms to side in vira II, arms overhead in down dog, arms to the front in kneeling plank etc.  We focused a lot on armpit activity here. 

In this regard, knowing that arm and shoulder position can influence what you experience in your neck, I also often advise people they do not have to take their arms into a particular position.  For example, I advise to move from the base of the spine up in trikonasana and then to choose whether to keep the top arm on the hip or take it up.

What is she doing with her tongue and jaw?
Whether you or a kid or an adult, when you learn something new you often do funny things with your face. 

Even at rest a lot of us hold tension in our face. 

Commonly the tongue and jaw can tense up.  You might feel tension in the throat. 

Tension in these places can also relate to tension in the neck. 

Relaxing the tongue and jaw are key to helping you relax your parasympathetic nervous system (physiological relaxation) but can also help physical relaxation of the muscles around the head and neck. 

In class, I will often cue people to relax the tongue and jaw or relax the face.  I am known for pulling funny faces to remind you of this. It really helps.

How are the mats aligned in the room in the class?
It might sound benign but the first thing I ask people to do in class is to align their mat so they are looking towards me with their whole spine when standing at the top of the mat.

If your mat is aligned to the front wall of the class and not the teacher you will necessarily have to twist your neck in an awkward position to see them even when you are standing straight. 

These days I rarely practice with a mat as I find that you can tend to prioritise aligning yourself on your mat rather than aligning yourself to yourself.  I have found that students naturally align their spines better when they don’t have this mat anxiety, although I appreciate that some people really like them and don’t mean to suggest you shouldn’t use one or that they are not useful.

And then…
Applying cues for head and neck position, cues about shoulder and arm position and armpit activation, cues to relax jaw and tongue, and reminders about aligning your spine to the teacher (or mat position if you use one) can really help to prevent neck tension when teaching/practicing.

It is likely you will find you need to keep giving these cues to yourself/your class as you practice, as it can be easy to forget, especially if you have habitual patterns of tension.

As a teacher teaching a large class it can be difficult to address each student’s unique needs.  I find these cues are helpful for everybody irrespective of whether they have a pre-existing neck condition.  As a student you need to remind yourself to approach your teacher if things do not feel right, as they will always seek to give helpful advice and feedback. 

I am always mindful that our bodies are all different on different days and that sometimes cues that work for most of the population might not work for you in particular.  You need to pay constant attention to what is going on and if a particular instruction or cue does not feel right then do not use it.  I would always recommend asking your teacher about it as they will have given it for a reason and it could be that you are not quite doing what they asked or it is, indeed genuinely the wrong cue for you. 

I know this particular student had come from an Iyengar style class and that this approach is very therapeutic.  With these cues in mind I think she would be able to participate in those classes and just make appropriate modifications that suit her needs.  But it might also be that a flowing style is more conducive to her overall goals and needs at this particular time.  There are so many styles of yoga and even within particular styles the teacher will have their own slant.  I think the sorts of cues I have written about here can go beyond a style though and I hope that, having them on board, you can participate in whatever class is right for you!

I really recommend the online courses by Simon and Bianca to further your learning and approach to practice.   Happy and safe practicing!

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