Neck Posture a Key to Pain Relief

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

By Joanne Brayden

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SEATTLE, February 13, 1997 --   Head and neck posture may be a major factor in the pain experienced by many fibromyalgia (FMS) and chronic fatigue and immune dysfunction syndrome(CFIDS) patients. Case studies presented last week showed that successful treatment of neck and jaw pain made significant improvements in FMS and CFIDS patients. Herbert P. Gordon, D.D.S., Ph.D., P.S., attributed a major portion of head, neck, jaw, and shoulder pain to the posture of the sufferer. Dr. Gordon, an assistant professor of oral medicine at the University of Washington, Seattle, presented his theories and techniques for pain relief to the conference, which was attended by 200 FMS and CFIDS survivors.

Dr. Gordon explained that the pressure placed on other muscle groups in the head and neck accounts for a significant portion of referred head and neck pain in FMS and CFIDS survivors. The head is balanced on a very small group of layered muscles that are clustered at the top of the spine and hold the head erect. Dr. Gordon said that these muscles are so small that some of them can literally begin to atrophy in as little as 20 minutes if unused.

If these muscles are fatigued or atrophied, the head is held up by the major muscles of the head, specifically those that control the jaw and the neck, but in an awkward forward position. With the head forward, the neck muscles hyperextend, and the total load on all the muscles supporting the head increases. For every inch the head goes forward, the pressure put on the muscles of the head increases twofold.

Fatigue or disuse of these muscles causes the characteristic poor posture of fibromyalgia patients. Dr. Gordon quoted from a 1985 study by Friction et al that found these abnormal postures common in patients with FMS, Myofascial Pain Syndrome, and Temporomandibular Joint Dysfunction: poor standing and sitting position (96 percent), forward head posture (85 percent), and forward and rounded shoulders (82 percent). Dr. Gordon said that these are all at least partially due to the fatigue of the small muscles that hold up the head.

The head and neck muscles are the source of several trigger points that refer pain to other areas, Dr. Gordon said. He gave a few examples from his case studies. The temporalis muscles, in the temple area, can refer pain to the teeth, and the top and back of the head. The lateral neck muscles, stretching from the back of the head to the front of the neck, can cause pain on the side of the face and the back and top of the head. This radiating pain can cross over from one side to the other. The trapezius muscles, from the back of the head to the shoulders, can cause pain in the neck, under the jaw, in the temple area, and behind the ear. The deep neck muscles of the cervical spine can cause pain in front of and behind the ear.

"If your head hurts, work on your neck," Dr. Gordon said. In his work with FMS and CFIDS patients, Dr. Gordon has found that the combination of jaw and neck headaches can trigger migraines. Among his patients, he has detected three types of FMS related headaches: jaw headaches, neck headaches, and migraines. By controlling the first two, at least one trigger for migraines can be eliminated, Dr. Gordon said. A combination of good posture, physical therapy, stretching, moist heat, exercise, and trigger point injections where necessary can help relieve headache pain.

"If you have any jaw problems, address them. They can be solved, almost always without surgery," advised Dr. Gordon. Jaw problems are far more prevalent than has been previously recognized. Dr. Gordon provided figures on the prevalence of jaw injuries resulting from trauma: in whiplash-type injuries, 90 percent of the time the jaw is injured and 70 percent of the time the disc in the jaw joint is pushed out of place. Either of these events can cause extreme jaw and head pain.

Dr. Gordon demonstrated a simple self exam technique for the discovery of jaw displacement problems. Place fingers over both jaw joints just in front of the ears and slowly open the mouth. The jaw should move freely and evenly. Both sides of the jaw should open at the same time and there should not be a lot of clicking and popping. Individuals should be able to place the span of four fingers in their opened mouth. If patients suspect problems, Dr. Gordon suggests being examined by a professional. Something as simple as a guard or a splint worn at night could greatly reduce the amount of jaw related pain.

Addressing neck posture is significant for FMS and CFIDS survivors because symptom severity is directly related to a patient's total pain load, Dr. Gordon said.

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Source: Exclusive SHN Report from the Seattle Fibromyalgia International Team Conference
Copyright 1997 by Sapient Health Network, Inc. All rights reserved.

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