Neck pain normally after surfing or prolonged periods of laying prone (on your belly) with head lifted.
A blog by Osteopath Belinda Clark.
Surfing is a popular sport enjoyed by many, myself included. From beginner to advanced, no matter what level you’re at, surfing involves laying on your belly with your head looking forward for a long period of time.
Paddle technique and efficiency, as well as frequency and force of getting wiped out (and if you’re anything like me, being held down in the washing machine not knowing which way is up), both come into play with how quickly your neck fatigues and therefore likelihood of experiencing pain in the neck during or after surfing. And of course, classic comment coming from me, it can all be related back to how well you can maintain diaphragmatic breathing and the appropriate use of the accessory muscles of respiration around your neck.
This blog will discuss some basic anatomy, mechanism of injury, clinical presentation and a few tips for prevention of such neck pain, and osteopathic treatment.
Relevant Anatomy /mechanism of injury –
There is a facet joint on both sides of the neck at each vertebral level, between these joints there is a space (intervertebral foramen) where the nerves and blood supply exit the spinal column. The orientation of these joints and the sliding of the joint surfaces on one another allow for movement of the spine from side to side, into rotation and up and down. The muscles that control extension (and deep flexion) of the neck, the fascia which connects around the neck into the jaw and the base of the skull, as well as the connecting muscles into the chest and thoracic region, all help to move and stabilise the region along with the core, diaphragm and lower limbs.
As we know, in an osteopathic approach, everything is connected!
We cannot efficiently lift and stabilise the head (to look forward while laying belly down) if we do not have sufficient thoracic extension and core control to maintain balance and stability on the board. As we paddle, either with poor technique to begin with or as we start to fatigue after a while on the water, the thoracic spine and chest drop down toward the board and as a consequence the degree of extension required through the upper cervical spine increases. In this position the efficient use of the shoulder complex becomes disadvantaged and we rely on the upper traps and levator scapulae muscles to lift your arms to paddle, further increasing the compression of facet joints in the cervical spine, and tension in the muscles around the top of your neck.
We also need good rib cage function and proper diaphragm contraction so that even against the pressure of contracting your core to stabilise on the board and the board itself pressing on your belly, you are still able to breathe into your lower rib cage and back body with ease. If this is dysfunctional, or not as efficient as you need, you will use the smaller accessory muscles of respiration (which are in your neck) to help lift your rib cage. This is an extremely inefficient way to take a breath and adds greatly to the tension profile developing in your neck. Furthermore, the diaphragm crura connect into the front of your lumbar spine and add to your core stability to help prevent lower back pain in this extended position.
Clinical presentation –
Normally the pain will begin as a sense of fatigue while you’re out on the water. Then a few hours after the surf session surfers will often notice tightness and reduced range of motion in the neck, along with stiffness in the mid and lower back.
Headaches are very common with the tightness and congestion in the upper neck region.
Normally with some stretches and gentle movements these symptoms ease within a few days. However if surfing often or without sufficient rest and strength and mobility training, these issues may become recurrent and headaches and jaw pain will become more frequent and take longer to resolve.
Osteopathic approach to treatment and some tips for prevention –
An Osteopathic approach to treating surfer’s neck will include a range of techniques aiming to improve the range of motion of the joints of the entire spine and shoulder girdle. As well as improve the circulation and blood flow to and from the muscles of the neck and back. An Osteopath should look at your breathing mechanics and help to improve the 360 degree function of the rib cage.
We use a range of soft tissue massage techniques, as well as articulation and mobilisation.
We might also suggest a surf lesson with a coach who can further assist you in the water with your paddle technique.
Exercises an osteopath may suggest for self management and prevention may include things such as:
Thoracic mobility*: thread the needle (rotation into flexion), open books (rotation into extension), cat/cow (flexion and extension), cat/cow with lateral twist (flexion and extension with side-bending).
Diaphragm breathing*: (see my other blog post about diaphragm breathing and how osteopathic treatment can help).
Deep neck flexor exercises*: chin tucks (seated/supine/prone with lift/with breath).
Stretches/mobilisations*: pecs, traps, levator scapulae, anterior scalenes. Self-mobilisations into rotation, side bending, flexion and extension.
Back strength and stability*: prone head lifts, prone cobra, WY’s, bird dogs, back extensions with breath and pelvic floor control.
*These are an idea only, please speak with your Osteopath for more information or if you have an active injury.
Conclusion –
Surfing is an amazingly fun whole body workout which requires a great deal of strength and coordination through many systems of your body. If you’re just starting out and experiencing ‘surfer’s neck’ book in for a session with an osteopath and we will look at how together we can best prepare your body so you can continue enjoying the stoke day after day!
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