Why does my neck hurt? Is it due to lack of strength or lack of stability?


Let’s air out a dirty little secret. Being strong and being stable are two different and important concepts to understand. I get this question and/or comment a lot, particularly in relation to neck pain. 

So what is the difference, and why the heck are they so important anyway?

Let’s talk about strength first. I often will group muscle activation and strength in the same category. Strength, or activation is the ability for the muscle to contract and hold against resistance. The more strength, the more you can fight resistance (and move heavier things). Strength, however, does not guarantee that the muscles fire in the right order to move things efficiently and effectively.  Picture a car, and the cylinders that fire in the right order to make the engine work. Now, say the timing belt gets thrown off. The cylinders still fire, and likely the car can still run, but you will have some back-fires and hiccups. The pistons can be full of fuel and ready to fire (lots of strength) but lack effectiveness due to firing in the wrong order. You can be the strongest person in the world, but lacking the right order makes the muscles ineffective at their job.

 

This firing in the correct order and time is the function of stability. This is the ability to control motion through a range with correct timing and force. You don’t have to be extremely strong if you use the right coordination and right timing. The coordination is built through practice of working through range of motion focusing on body position and control (and often breathing).  

 

Often, in a rehab situation, both the strength and the stability are altered and need attention. When someone lacks strength, they cannot support the load of their body and will often use alternative methods to ensure physical success. Two major options that come to mind are:

  1. Using a different muscle group.
  2. Limiting the amount of motion to limit the overall load needing to be controlled.

 

The first option bypasses the muscle group completely. Let’s talk about the neck. If we are weak through our neck stabilizers, rather than challenge that group we completely bypass it and opt to use another muscle group entirely (our bodies choose this, we don’t make a conscious decision).

The second simply increases the neck stabilizers tone to prevent the head and neck from moving so much therefore decreasing the strength needed to function. This often ends in the muscle simply getting tighter and tighter.

 

More often than not we also see overall motion get limited in the area. This is because with option 1, we avoid using the area at all, and option 2, we tense the area so no motion can occur.

The main thing I hear with folks like this when they walk through my door is this: I stretch and stretch and stretch and nothing ever changes.

This is a stability problem and stretching won’t fix it!  If you’re interested in learning more about potential stability exercises to help the neck and shoulders.