Neck pain and the Head Righting Reflex

Neck pain is something that I see a lot of coming into the clinic The one common denominator is that more than often, the pain occurs as a result of the neck pulling the head straight because the shoulders are out of position. This leads to my previous blog with relation to the shoulder and shoulder pain.
People will describe achiness going down from the neck to the top outer edge of the shoulder or sharp pain that occurs when rotating or side bending in one direction.
In each ear, deep inside, in the Utricle and Saccule are small gelatinous masses called Otoliths, which have tiny receptor hairs attached to them. If the head is leaned to the side, the Otoliths will move to that side and initiate a response to the receptor hairs going down into the brain to tell the muscles on the other side of the neck to tighten to pull the head back to a level position. This is completely subconscious function so you are unaware that you are doing it. This is where the shoulder comes into play.
Lets say that your right low back is tight and pulls your torso to the right. If you do this, you will notice that your left shoulder is now higher than your right, and your head is now leaned to the right. The Otolith will indicate that your head is in that position and will tell your left neck muscles to tighten to pull your head level. Now the muscles are contracting chronically to keep your head level, which can cause eventual weakness and pain with the muscles that are contracting all the time. What this also causes is a curve in the spine, with the concave on the left side and convex on the right. This will cause pinching of the neck on the left side (especially on turning and side bending your head, like with shoulder checking when driving). There are small lateral joints in the neck called Facet Joints, which are now irritated as they are closer to each other on the concave side. The misposition of the joints vastly affect your neck mobility. Now, there is a little work done to relieve the pain with the neck muscles and to help to take the neck out of that concave/convex curvature but the big long term goal is to level the shoulders so the neck doesn’t have to tighten to relevel the head.
Part of this work is to identify why the shoulders are out of position. Many people are hunched forward so the shoulders are rolled forward, which causes the back neck muscles to tighten on both sides to pull the head straight. Alternatively, it could be a pelvic or (as I described earlier) low back tightness imbalance that leans the upper torso and back to one side or another.
Many people don’t notice the imbalance in the shoulders or back as the Head Righting Reflex will level the head so it is really hard to notice.
I’ve had a lot of success with treating the body as a whole to reduce the need for the neck muscles to tighten to pull the head back to level. Part of it is what I do, but most of the time, what I do is only necessary to make it easier for the patient to do what they need to do, so it is 50% me and 50% them. I’ve seen torso twisted around, pulled to the left or right or leaned forward or backward. Imagine that the head is a house and the shoulders are the foundation. If you want the house level, you need to level the foundation.

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