This past week I got to experience head heavy neck pain and it wasn’t pretty. What’s that? This is when you feel like you can’t support your head. Your neck may be tight, stiff, and painful. A common recommendation by many physicians and physical therapists is that when you have this problem, it’s due to weak neck muscles and all you need to do is to strengthen your neck. However, does this really work when your neck hurts? The answer according to a recent study seems to be a resounding NOPE.
The concept that strengthening could solve all spinal problems began in the 1980s with a concept called “work hardening”. The idea was that patients with back and neck pain were weak, so all they needed was aggressive strengthening. The problem was that in reality this didn’t work. I can’t tell you how many patients I saw in the 80s and 90s who were made miserable by strengthening. Intuitively, smart physicians and therapists figured out that these poor patients were dealing with “pain inhibition”. Early studies in the shoulder for example showed that patients with bursitis couldn’t strengthen their shoulder muscles in the same way as someone without pain. Why? There were protective mechanisms which developed through the eons to protect the body and to give it time to heal. What we didn’t have were sophisticated and well done studies to absolutely prove the point, until now.
This most recent study took patients and randomized them into three groups of 10-one with neck pain who strengthened, one without neck pain who also strengthened, and one with neck pain who didn’t perform exercises. They then looked at how well the brain’s motor cortex (the part involved in sending signals to neck muscles) was working as well as how efficiently these signals made the neck muscles fire. What did they find? Patients with neck pain who tried to strengthen shut down their brain’s ability to activate the muscles for up to a week! In essence, if you take a patient with neck pain and force him to strength train his muscles, no matter how hard he tries, the signals that cause muscles to fire and strengthen will be shut down for long periods of time.
What should these patients do to get stronger? Their physicians must first find a way to eliminate their pain. We commonly do this by identifying what’s causing the pain and then promoting healing in the area using various biologics like platelets and stem cells.
The upshot? In this study, pain equals no gain. It’s personally gratifying to see that the no pain-no gain mantra of 1980s work hardening programs has finally been put to rest along with VCRs and the Sony Walkman!