Falla D, Gizzi L, Parsa H, Dieterich A, Petzke F. People with chronic neck pain walk with a stiffer spine. J Orthop Sports Phys Ther. 2017;47(4):268-277. http://dx.doi.org/10.2519/jospt.2017.6768
Many people fall into the cycle of chronic neck pain. They may not realize that not only are the effects of neck pain local, but they may also be remote. Local changes include but are not limited to reduced neck range of motion in all directions, reduced smoothness of neck rotation, and reduced speed of neck motions (Falla et al.). It has also been found that individuals with neck pain have decreased proprioception (the body’s awareness in space) and increased swaying of the body during balance tasks (Falla et al.).
The aim of the study listed above was to assess spine kinematics (studying an object in motion) and walking characteristics in people with chronic neck pain. The researchers hypothesized that changes in walking pattern would be present in those with chronic neck pain. They believed this because it is thought that motor adaptations occur in response to pain. They body attempts to protect itself from additional painful experiences once it has already experienced pain. Therefore, it adapts to altered patterns of moving.
The study compared individuals with episodic chronic neck pain greater than 3 months with a pain-free control group. Participants were asked to walk on a treadmill at 3 different speeds (two preselected by researchers and one self-selected by the participant) with the neck in three different positions (neutral and rotated to the right and left). A custom-made helmet with markers and two laser pointers was worn by participants. They were instructed to project the lasers to specific targets during the rotational portions of the experiment to verify each participant had the same amount of rotation. Markers were also placed over the participant’s body to track motion throughout the body while walking.
It was found that the group with neck pain demonstrated a shorter stride length and less trunk rotation than the control group. The trunk rotation was decreased in the neck pain group versus the control group during slower speeds and the difference was even more pronounced at higher walking speeds and with the head rotated. This is an interesting finding because at higher speeds of walking trunk rotation should increase in order to optimally transfer energy through the body. If there is limited trunk rotation, this can cause increased stress to other areas of the body that are absorbing this energy or working harder to compensate for the lack of energy storage. It can then lead to premature breakdown of certain areas of the body creating unnecessary injuries.
Additionally, the researchers hypothesize that a further reduction in trunk rotation is seen with the head rotated to the right or left possibly because of psychological factors. They believe that because the head rotation is a more demanding situation that places the patient in disequilibrium, the patients have less trunk rotation as a guarding mechanism due to fear of movement or anxiety.
What can patients with chronic neck pain do to avoid this? In the simplest way, patients can work on rotating their trunk and swinging their arms during walking. They can also work with a physical therapist to improve the mobility of their trunk through hands-on techniques as well as through stretching and exercise. Performing neck range of motion exercises in pain-free ranges can build up confidence in the patient that they can move in pain-free patterns. This will reduce overall guarding from movement patterns in the neck and elsewhere in the body. This article reinforces the effects that a chronically dysfunctional area of the body can have elsewhere and the importance of addressing pain before it becomes chronic.