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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.
Car accidents are another common cause of a flat neck. When an automobile collides with something, it stops suddenly, and if your seat belt is fastened, so does your body. Your head, however, is unrestrained, free to go flying forward and then back. In those few seconds, the ligaments and muscles on the back of your neck are overstretched violently. That damage, commonly known as whiplash, can contribute to neck pain, spasms, and headaches after the accident.
Reestablish Your Curve
When your posterior neck ligaments and muscles are overstretched, whether suddenly by a one-time violent event, like a car wreck, or more gradually by your spending hours each day with your head forward and chin dropped, the soft tissue at the back of your neck loses its ability to support a normal cervical curve. The neck vertebrae and soft tissue are no longer in their optimal alignment and can cause chronic pain. On a long-term basis, a flat neck can contribute to pinching, bulging, and even rupturing of the cervical disks.
Because a forward head position often accompanies a flat neck, there may also be chronic tension in the neck muscles. Picture your head as a bowling ball sitting atop your neck, two or three inches in front of the center of your shoulders; that’s more or less the situation you’re in when you’re looking at papers flat on your desk. In this position, the muscles at the back of the neck must constantly contract to hold up the weight of your head against the downward pull of gravity.
That constant isometric contraction limits the blood flow into the muscles so that metabolic waste products build up, irritating the muscle to the point of pain. Additionally, the constant pull of the muscles on their attachments to the base of the skull is a common cause of headaches.
Fortunately, both the practice of yoga asanas and the yoga of daily life—using the alignment principles and awareness you gain on the mat elsewhere in your life—can help turn all of these problems around. If you have a flat neck, your first task is to learn to reestablish a normal curve in as many situations as possible: sitting at your desk, standing in line at the grocery store, lying in bed, and—yes—doing yoga.
When you’re lying flat on your back, you can support the cervical curve by using a rolled-up towel or a small cylindrical pillow made for just that purpose. Don’t put the support under your head; instead, place it directly under your neck.
You can also help eliminate habitual flattening by making sure to elevate the surfaces you look at: Place your computer screen up on risers; wean yourself from looking at the keyboard when you’re typing. Rather than placing a book you’re reading flat on a table, lean it against a stack of other books. Use a small inclined desk or other inclined surface to do your paperwork.
It’s a good idea to check the curve of your neck several times a day, simply using your hand to feel whether your neck is curved or flattened. You should also do this while practicing yoga, as a normal cervical curve is desirable in the vast majority of postures.
I’m concerned that I often see yoga students flattening their necks, even in simple upright positions like the home-base standing pose Tadasana (Mountain Pose). It may be that when they learned to lift and open their chests, they simultaneously developed the unnecessary habit of dropping their chins. Although this action is required for a few meditation and pranayama positions, it’s not a good practice in normal sitting and standing poses.
The Flat-Neck Check
To check your habitual neck alignment when you’re doing yoga, sit or stand up tall, lifting your chest, and then check with your hand to see if you have a nice soft curve in your neck. Your chin and gaze should be level. You will notice that if you drop your chin, you look down at the floor. With a normal neck curve, you look straight ahead; if you were at the beach, you’d be looking at the line between the water and the sky.
This is the neutral neck alignment you want to take into most of your yoga poses. It’s especially important that you re-create this Tadasana alignment in Sirsasana (Headstand), a pose in which you bear the weight of your body on your neck. If you have a proper cervical curve in Sirsasana, you’ll be looking straight ahead. If your neck is too flat, your weight will shift toward the back of your head and your gaze will be high up on the wall in front of you. This position is quite stressful for the ligaments, muscles, and disks in your neck, and can lead to injury. Because of this danger, it’s a good idea to have an experienced teacher occasionally check your alignment in Headstand.
If you tend to have a flat neck, Sarvangasana (Shoulderstand) can exacerbate the problem. Since the pose drops your chin toward your chest, it makes it very easy to completely flatten the cervical curve or even curve the neck in the wrong direction. If you have a flat neck that doesn’t cause you pain, practicing Shoulderstand in the Iyengar way—using a few folded blankets to support your shoulders and arms while your head is on the floor—allows you to do the pose without flexing your neck so severely. If you have a fairly recent, still painful, and acute neck injury like whiplash from an auto accident, I recommend that you avoid Shoulderstand. It re-creates the position of your injury, and practicing it too soon can significantly prolong your healing time.
Besides avoiding alignments and poses that overly flatten the neck, you should also work to strengthen the muscles that help support the cervical curve. These include several muscles along the back of the neck, but the best known is probably the upper trapezius, which reaches from the base of the skull down to the upper shoulder blades.
Underneath the trapezius is the levator scapulae, which originates on the upper cervical vertebrae and attaches on the upper scapula. When these muscles contract together, they extend the neck (bend it back). If you have a flat neck, they are likely to be overstretched, so you need to shorten and strengthen them.
When done properly, all the backbends except Setu Bandha Sarvangasana (Bridge Pose) engage the neck extensor muscles. Poses like Salabhasana (Locust Pose) and Bhujangasana (Cobra Pose)—backbends in which the weight of the head is lifted against gravity—offer the most strengthening benefit for the back-of-the-neck muscles. As you practice these poses, however, make sure to pull your shoulder blades away from your ears and not to compress the back of your neck. Try to feel as if the cervical curve is distributed evenly through your whole neck and you’re lengthening your neck even as you bend it back.
If you work to build strength in the back of your neck and break your flattening habits, you can usually restore a normal cervical curve, helping ensure a healthy neck for decades to come.