The Learning Curve

Maintaining a proper cervical curve by strengthening weak muscles can ease many common pains in the neck.

By Julie Gudmestad

In my 26 years of practice as a physical therapist, I have worked with hundreds--perhaps even thousands--of people with varying degrees of neck pain. There are many kinds of neck problems, and there seems to be no end to the creative ways people find to injure their necks. There are tumbles from horses and from the balance beam. There are bicycle crashes and innumerable car wrecks. Large objects fall off store shelves onto people's heads. There are the inevitable incidents in which someone stands up suddenly under a shelf or an open cabinet door. And there are simply the chronic stresses of modern life; many of those with neck pain can't trace it to any specific accident.

But if you experience neck pain and your physician sends you for an X ray, chances are that it will show a loss of the normal slight forward arch of the cervical spine. This "flat neck" syndrome is very common in our society.

An Engineering Marvel

In a normal neck, the spine is in mild extension--the same position the whole spine takes in a gentle backbend. (Extension refers to the position in backbends; flexion is the position in forward bends.) This curve in the neck balances with the curves of the rest of the spine, which include mild extension in the lower back and mild flexion in the middle back, where the ribs attach. These three curves form an engineering marvel: They carry the weight of the head and upper body, absorb shocks, and yet allow movement in all directions. However, the whole spine is thrown off balance—and a host of problems can arise--when any of the curves become either overly flattened or excessively curved.

The best way to gauge the status of your spinal curves is to have a health care provider assess them (perhaps with the aid of an X ray), but you can get a feel for your habitual neck curve with your own hands. Place the palm side of three fingers across the back of your neck. Is it flat or curved? Are the muscles hard or soft? Slowly drop your chin toward your chest: You will feel your neck becoming flatter and the soft tissue--the muscles and ligaments--becoming harder. Now slowly lift your chin until you're looking at the ceiling, then experiment with dropping and lifting your chin until you find a position--it's usually one in which your chin is level--where your neck has a slight forward curve and the muscles and ligaments feel soft under your fingers. That position indicates a neutral cervical spine.

You may wonder what it is about our lifestyle that has created such an epidemic of flat necks in our society. For one thing, working on tasks that require a forward head and downward gaze for long periods of time is very common. As you discovered when you palpated the back of your neck, dropping your chin flattens your neck.

The chin drops when you work in your kitchen, stirring, chopping, or washing dishes. It drops when you look down as you walk, or do handiwork like beading or sewing. And it drops when you look at a computer keyboard, read, or do paperwork. Our natural tendency is to position our eyes in a plane parallel to the surface we're looking at, so if your paperwork or book is flat on a surface in front of you, you will probably drop your chin.

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