What exactly is a "crick"? The word is derived from Middle English cricke, crykke - a bend or twist in the neck. Usually, you wake up with your neck either slightly bent to one side or you avoid moving your neck a certain way because of a sharp pain in your neck or shoulder blade - hence why we use the word "crick". The medical term is "torticollis" which means basically the same thing - a bend or twist in the neck.

There are a number of reasons why you can have a crick in the neck or a very stiff and painful neck and some of them are not musculoskeletal such as spinal meningitis. If you have any other symptoms besides a painful and stiff neck, like a fever or a general feeling of sickness, see your doctor.

As for the musculoskeletal causes, you may have simply over stretched the neck muscles, sprained the joint capsule ligament, torn the annular ligament, herniated an intervertebral disc, overloaded the facet joint surfaces or stretched the spinal nerve that exits the vertebral canal. Any of these conditions can create pain and stiffness which is why some clinicians feel that it is impossible to pin down the exact cause of the problem.

So, without a sense of what is causing the problem, an effective solution is sometimes tough to devise. But, there are some things you can do to reduce the symptoms and improve motion.

1. Avoid stretching your neck. Even though the muscles feel tight, stretching usually does not help and if it does, it's often very transient. Tight muscles get tight mostly in response to another stimulus - inflammation being at the top of the list.
2. If you must sit, support your head and neck. Some office chairs have a high enough back on them to allow you to rest your head on the chair or even use something like a deflated  beach ball behind your head. Doing this allows the tight muscles to relax and lowers the force applied to your disc and joints (and thanks to Lauren Williams - our Director of Operations -  for kindly agreeing to be a model for the image).
3. Try "cervical rock and roll". I explained this here. Gentle oscillations of the joint stimulate anti-pain receptors and other receptors that regulate muscle tension. Cervical rock n' roll relaxes your neck muscles and feels great.
4. Deep pressure over a tender point in the upper trapezius is sometimes helpful. The upper trapezius muscle, also known as the "coat hanger" muscle usually is very tight and will have a "trigger point" or a spot of extreme tenderness. You'll need a trusted friend to help you with this or see a therapist (massage, physical, kinesio) or chiropractor). To perform the technique, lie down on your back. This helps release the tension in the muscle. Have your friend, using his or her index finger, find the tender spot. You don't have to use much pressure either. Once you find the spot, have your friend gently move your head away from the painful direction while delivering some pressure to the spot. Hold the position until you feel less pain and the spot "gives" or feels as if it melts under your finger. This usually takes 30 to 60 seconds. Now, very slowly, return to a neutral position. Repeat this five times. When you get up from lying down, have your friend hold your head to help you. If you don't do this, the weight of your head will kick off a muscle contraction and the pain will come back (and this technique is rarely curative - it will reduce the pain and improve motion but is often short lived).
5. Alternate heat or ice on your neck. The choice is yours. Whatever makes your neck feel better - use it. Apply it in a relaxed, comfortable position. Be careful. You'll want to protect your skin by using appropriate amount of toweling. Leave the heat or ice on for 10 minutes and do this at least three times a day.
6. Use cervical traction. This is a simple and effective technique that can be done at home. You use a special device, an over the door pulley system with attached weights, that is either applied in a sitting position or while lying down. Usually ten minutes a few times a day with 8-10 lbs. of force is enough.

These six things will help you feel better and restore motion however, If you seem to get a crick in your neck often, you may have other biomechanical factors that need attention (a stiff and inflexible thoracic spine is one of them). A therapist with an understanding of spinal biomechanics and tissue healing can help.

"You know, Josh, I think I might have to quit. I'm just not having any fun here at all. I can't hit the ball to save my life," I said to my brother.

Josh and I had rendezvoused in Hilton Head, SC for three days of golf last week. Well, really a golf marathon. Thirty-six holes on Monday, thirty-six holes Tuesday and eighteen holes Wednesday. Of course, I knew better than to tackle that much golf given my spine history and that I had only played one round of golf in the last year. 

But, I was going to give it try.

The first thirty-six holes were fun. I had a few good shots, good puts, good saves from the sand followed by mostly wild and errant shots careening off trees or skidding along the fairway an inch or two off the ground. I didn't care too much as long as I had just a few decent shots. My score was high but it was what I expected.

Tuesday though was another story.

My swing looked like Edward Scissorhands on his best day.  A stiff and sore spine had not eased off by the third or fourth hole and my motions were hurried, jerky. Blend a little Sammie Sosa with the Tin Man and I think you have my swing.

I think my best shot was an 80 yard, 2 inches above the ground screamer that left my hands trembling from the vibration up the shaft.

Stellar.

I tried. I pulled all the tricks I knew, all the positive self-talk, re-framing, freeze-framing, deep breathing and every other technique I had learned or taught.  I felt like a fraud. I had taught clients this; urged them to look for the tiniest improvement and focus on that and what I wanted to do was just drop all my clubs in the lake and go home.

Truthfully, the round of golf was just not any fun. At all. Period.

And then I remembered.

It's not just adopting a positive attitude that gets you out of a funk. It's also doing something different than what you're doing.

So, the next day I suggested that Josh tee-off and I would play from wherever his ball landed. He added, "Why don't we just play best ball? I'll tee off, we both play from there and then play the best shot."

And so we did and we had a blast.

In rainy, windy weather. In conditions that few people were willing to endure, we had the best round of golf of the trip. We had fun. A lot of fun.

My shots improved. My swing was less Scissorhands. I had some good shots. A couple of even great shots.

We had fun by making the round easier; making it match what I could really do.

Positivity is a key element in overcoming a lot of things in life but if you simply marry that to the same behavior, you're probably going to be frustrated. Instead, try changing what you're doing and making it a little easier. You'll get better and have more fun too.

New ebook -FREE!

The Back Pain Tool Box: 27 Things You Can Do to Relieve Back Pain

I'm a physical therapist and performance coach and have helped tens of thousands of people. I've conducted over 20,000 consultations and over 100,000 training sessions. I've worked the extremely weak and de-conditioned to the extremely fit and competitive athlete and I’ve used the very things I teach to help heal and strengthen my own body.



And, I want to help you.

For free.

All you have to do is click here and download the book. The link is valid for one week from the date of this View.

Hope your enjoy it and that it helps you.

This is a guest post by Kim Wright, PT and her husband James (Jay) Butler, MD. Kim is a physical therapist who specializes in orthopedics and her husband is an orthopedic surgeon. They both practice in Houston, Texas. I asked Kim and Jay if they would share their knowledge and experience with knee osteoarthritis and knee replacement and they generously agreed.

The knee joint is composed of three compartments.  They are the inside(medial), outside (lateral) and the kneecap (patellofemoral). Wear and tear on our joint surfaces occurs over time depending on activities we perform and injuries that occur.  Some of us will have more wear and tear due to the alignment or posture of our legs.  Knee alignment refers to the angle of your thigh bone from your hip to your knee and the angle of your shin bone from your knee to your ankle.  Your foot alignment is an angle formed from your heel to your forefoot. Terms such as knockneed, bowlegged and pronation refer to these angles. The angles influence how the force from the weight of your body and activities like running or hiking is distributed through your joints.

If you tend to be knockneed, bowlegged or if you tear a meniscus (shock absorbing pad between the bones) or suffer a fracture, the forces can be increased in one of the compartments. The extra force is transmitted to the bone and the overlying cartilage (articular surface).  Given enough time, this surface wears away and the bone can become exposed and painful.  This wearing away of the articular surface is called chondromalacia (arthritis). It is usually graded I-IV with I being the mildest degree of damage.  When the damage progresses to stages III and IV the bone is actually becoming exposed and this is when pain and swelling occur and simple life activities such as walking, squatting and stairs become difficult.   

When any of the three compartments suffer significant wearing of the articular surface causing Grade IV chondromalacia, the doctor may suggest a partial joint replacement.  Partial joint  replacements are ideal for patients with isolated Grade IV chondromalacia in only one compartment. This usually occurs in younger patients 40-60. Patients with a lot of arthritis in one compartment and some in the others may still have a certain degree of pain and swelling after surgery from the remaining arthritis. This is why a careful examination and selection process is critical for a good outcome.  There are unicompartmental replacements ( ”Uni”) for the medial (inside), lateral (outside) and patellofemoral (kneecap) compartments. In contrast, a total knee replacement replaces all three compartments.

The surgery involves replacing the two sides of the bone of the damaged compartment with metal and plastic components. If you have medial or lateral compartment arthritis, and this has made your leg a little knockneed or bowlegged, the placement of the components will correct the alignment. The surgery involves an incision on the front of the knee.

The recovery is similar to a total knee replacement except it is usually with less pain and is faster. It involves a short stay in the hospital (2-3 days), one-two weeks using crutches or a walker and then 4-6 weeks of physical  therapy. Someone with a unicompartmental replacement should expect to regain full straightening and almost full bend of the knee as compared to their normal knee during the first 4-6 weeks after surgery.

Sports are allowed with a unicompartmental replacement. Sports not involving repetitive high impact activities such as jumping, running and cutting are the best. For example, many patients return to walking, biking, hiking, light doubles tennis, weekly game of softball or baseball, dancing, gym workouts, exercise class. Younger patients may choose to return to running and other more strenuous sports, but this may lead to early deterioration of the plastic (polyethylene) component.  Like all joint replacement and arthritis patients, individuals with a unicompartment replacement should maintain a healthy weight and perform exercises that promote good joint health regularly. This will help prevent wearing of the plastic component and reduce progression of less severe arthritis that may exist in other parts of the joint.

A unicompartment replacement should last about 10-15 years before needing a tune up. Sometimes the unicompartment replacement is just a time grabber for someone who may be destined to a total joint replacement.  For other patients that actually fall into the “isolated” arthritis category it can be the last replacement they need.  All joint replacements have a similar life expectancy before revisions are needed and this is usually stated as 10-15 years on average. There are two reasons the unicompartment replacement may need to be revised over time. Pre-existing arthritis in other parts of the knee can progress and the plastic component can wear out.  If other parts of the knee progress to Grade IV chondromalacia (arthritis) the unicompartment replacement can be converted to a bicompartmental replacement for the onset of kneecap arthritis or a total knee joint for generalized arthritis development in the remaining two compartments.   As with any surgery, but especially one that is performed on an isolated group of patients, ask your doctor why you qualify and ask how many of these procedures they have performed and their specific outcomes.   

For more information on unicompartment replacements you can go to the website for the brand of prosthesis your physician uses or as an example go to www.biomet.com and choose patient and caregiver section, joint replacement, knee pain, knee joint replacement or knee joint products. You will read both good and bad reports from actual patients as well as research articles.  Just remember that there is a very select group of patients that are appropriate for this procedure that will do well over time. Talk with your physician about your qualifications.

For outcome information on custom patellofemoral replacements you can reference the article from James E Butler, MD; Robert Shannon, MD Orthopedics 2009, 32:81 or www.orthosupersite.com.

1. Enhance Your Love Maps. Emotionally intelligent couples know each other's hopes and dreams. They know the history of the other person, significant events, and keep up to date with events.

• Enhance Your Injury Maps. To be successful in beating an illness or injury, you need to know your own history; the actions, choices, attitudes that may have contributed to your current situation.

• Nurture Your Fondness and Admiration of Your Self. When you persist in running on a leg with a stress fracture, or working out despite raging leg pain, you're not honoring and respecting your self. You're only hurting your self. Listen to what your body is telling you and respect it.

• Turn Toward Your Injury or Illness Instead of Away. Denial is a protective emotional mechanism that buys us time while we figure out what to do but prolonged denial can turn an acute problem into a chronic one. When you have symptoms, pay attention to them.

• Let Your Injury / Illness Influence You. Believe it or not, you can learn a lot from an injury - about your self, your body, healing. But, that only happens if you allow it to. You have to find some common ground - something between what you've lost and what you have - to launch something new and great.

• Complain but don’t blame. You can complain about something, although be careful or you may end up with the whine flu, but try not to blame your predicament on someone else even if it is truly not your fault. Blaming blocks you from moving forward. Forgive, let go.
• Make statements that start with “I” instead of “You.” Make your feelings and needs known rather than what someone else must do to fix your situation.
• Describe what is happening, don’t evaluate or judge. One of my favorite stories about accepting, "what is" is here. Injuries carry a certain reality that you must accept to get past. Judging that reality doesn't help.
• Be clear, polite and appreciative. When you hurt or don't feel well, it can be very difficult to remain polite and appreciative. Try remembering that the people around you who want to help you will be more likely to do so if you're not a Grinch.
• Don’t store things up. Tough one for me. Finding a balance between talking about frustrations or lack of progress or recurring symptoms and not feeling like I'm whining is hard. But. not talking or sharing things creates a toxic emotional soup. You can always write things down in a journal if talking makes you too uncomfortable.

• Learn to uncover your partner’s dreams. Well, for an injury it's uncovering your won dreams. Injuries can rob you of your future by seducing you into worrying. The more time you spend worrying, the less time you'll spend working on the very things that will lead you to your dreams.
• Understand why each of you feels so strongly about the gridlocked issue. For an injury, understand why you feel so strongly about the gridlock - the lack of improvement or change you expect. Most clients I've seen have had an injury for years and then expect all to be well in a few weeks. It's not only the unrealistic expectations that are at fault. It's also your reaction to the situation. Why does it upset you so much? Once you can answer that, you'll feel much better.
• Soothe each other to avoid flooding. Use pain relieving techniques, relaxation techniques to ease your discomfort. Be kind to your self.
• End the gridlock by making peace with the issue, accepting the differences between you, talking without hurting each other and compromising. You have to find a way to make peace with your injury or illness without feeling like you've given up. You can still work toward a goal or dream while acknowledging that today you're not there. I'll admit that this is tough to do. I'm about 20 months post-injury and would like to believe I can do what I want, when I want, how I want but I can't. I can't sit in certain chairs or stand in one place too long without symptoms in my hip or leg. Yes, it's mild and temporary and improving, but it's still there.

• Create Shared Meaning About Your Injury. When you can talk about your injury, what it has meant to you both positively and negatively, and still "see" your dream, you create a deeper meaning to the experience. Probably one of the most well known individuals to have done this was Christopher Reeve. He was candid about his injury yet held onto the hope that one day we would find a cure for spinal cord injuries. The injury and his hope created value and meaning in his life.

Overcoming an injury can be a daunting task at times. If you feel this way, try going through this list to make a potentially tough situation more tolerable and rewarding.

Dr. John Gottman from the Relationship Research Institute, also referred to as The Love Lab, in Seattle, Washington claims that within five minutes, he can predict with 91% accuracy whether a married couple will enjoy years of marital bliss or crash and burn.

He and his team, after studying hundreds of couples and scientifically scrutinizing their interactions, have found four negative qualities that predict divorce and seven positive that predict success. 

As I read these, it struck me that these qualities, both positive and negative, are remarkably similar to those of people who overcome an injury and those who don't.

First, the negative:

• Criticism: Global negative statements about your partner’s character or personality.

Global negative statements about your injury or situation; failure to find positive changes no matter how big or small.

• Contempt: Sarcasm, cynicism, name-calling, eye-rolling, sneering, mockery and hostile humor can be poisonous because they convey disgust.

"It won't make any difference anyway...that'll never work..."

• Defensiveness: This is a way of blaming your partner and can escalate the conflict.

Blaming others for your predicament; failure to accept choices you made that either created your problem or sustain it.

• Stonewalling: A partner may disengage from the relationship, signaled by looking away without saying anything and acting as though he/she doesn’t care about what the other is saying.

Ignoring symptoms, refusing to discuss or acknowledge the severity of the problem; "It's not that bad....I'm fine."

According to Gottman, the presence of these four qualities in a relationship predict the end of the relationship with an 82% degree of accuracy. I don't know of any similar research in the injury field but I've said many times that the key to overcoming an injury does not rest primarily in the technical domain. It's not in the head where you win the battle. It's in the heart.

You have to focus your thoughts and energies on a positive frame of mind, be willing to face the issues, take responsibility, and be grateful for the improvements no matter how small to over come an injury or the after effects of surgery. If you don't, you won't fully recover.

And what about the seven qualities that build a great marriage and enhance your chances of recovery from injury?

Coming soon.