Sunday, January 9, 2011


Many people, myself included, suffer from chronic neck and shoulder pain, often with accompanying headache. Some experience what is known as cervicogenic headache, the latter being a syndrome characterized by chronic hemicranial (that is, restricted to one side of the head) pain - often of a throbbing, pulsating kind - that is referred to the head from either bony structures or soft tissues of the neck. Others experience head pain, and headache, as if someone had hit them on the back of the head with a baseball bat. Either way, it’s debilitating.

I now realize that much of this pain is due to bad habits of poor posture that have been built up over many years. In response to bad posture, and stress, muscles tend to contract involuntarily and tighten. The tightened muscles squeeze blood vessels and reduce circulation. The result? Headaches, muscle spasms, cortisol-induced hypertension ... and even nausea and vomiting.

Further, once severe pain manifests itself more often than not the result is more pain as a result of the workings and dynamics of what is known as the pain cycle.

Those who suffer from chronic joint and muscular pain are all too aware of how pain tends to be followed by further muscle tension, unbalanced forces, altered joint movements and positions, leading to abnormal movement patterns, compensation ... and more pain!

In almost all such cases, there is laziness in the form of a lack of self-awareness. We can get so involved, even fixated, in what we are doing (eg writing or typing a letter or surfing the net) that we cease to be aware of the position of our body. Over time, bad muscular habits develop, many of which tighten and stiffen the muscles of the neck, shoulders and back while at the same time leading to muscle weakness. The result? Pain ... with a capital “P”.

All too many of us lead sedentary lives and have sedentary jobs. Prolonged sitting, and inactivity, makes muscles and joints feel tight, stiff and tense. Further, unexercised muscles grow lax and lazy and lose strength. However, the real laziness relates, not to our muscles and bodies generally, but to our lack of self-awareness and alertness. That is the real problem.

In at least one previous blog I have made mention of the fact that Mindfulness and Mindfulness Meditation have been proven to assist in the management of both acute and chronic pain conditions.

Mindfulness takes meditation and applies it to one’s entire life. Mindful stretching takes Mindfulness and applies it to one’s body and the consciousness of one's body parts and bodily sensations.

Mindful stretching consists of various gentle stretching procedures - not exercises - done very slowly and mindfully, that is, with a moment to moment level of awareness of breathing, posture, and the
various sensations that arise in your body, mind and consciousness ... from one moment to the next. The procedures consist of various actions and motions that are mindfully slow and relaxed.

In the past I derived some benefit from regular sessions of chiropractic, osteopathy and massage, as well as from exercises recommended by those practitioners, but, over time, my chronic neck and shoulder pain condition got so bad that the above mentioned therapeutic modalities were of little or no assistance to me. (Physiotherapy was of no help to me at all, but that doesn't necessarily mean it can't help others.)

In more recent years I underwent surgical procedures to my cervical spine including facet joint injections and percutaneous facet joint denervation. Again, no relief from pain.

Eventually I came to understand that, despite having quite severe cervical spondylosismy particular problem was largely biomechanical and anatomical in nature, and that the "answer" lay elsewhere ... but where?!

Today, Mindfulness is the only natural modality that gives me any real assistance in managing my condition. Why? Because when I practise Mindfulness I become more self-aware of what is happening in my body, mind and consciousness. Over time, I have learned to overcome poor habits of breathing and posture ... simply by being aware of my bad habits in that regard and by making appropriate changes before things turn ugly.
Mindful stretching is a specific application of Mindfulness in order to gain insight and understanding into how our bodies are working. With a better understanding of how are bodies are functioning - appropriately or inappropriately - we are then able to allow our muscles and other parts of our anatomy to make their own adjustments pursuant to certain inbuilt postural reflexes that are still latent within our bodies ... no matter how lax or tense our muscles may be.
The important thing to bear in mind is this ... let, don’t try. In particular, don’t try to deliberately override your existing posture. Also, don’t do any of these procedures forcefully or vigorously. They are NOT physical fitness exercises ... at least not when done in the spirit of Mindfulness. Rather let the outworking of these procedures happen by themselves as much as possible.
Sure, at first you will have to think of certain actions during the procedures, but even at that early stage try to let the actions unfold as naturally and as effortlessly as possible, being aware at each stage of the procedure of what is unfolding in your body, mind and consciousness. Enquire, with curiosity, as to the nature of your experience ... for example, are you experiencing tightness, rigidity, spasm? If so, say, interiorly, to yourself, “Tightness”, “Rigidity” or “Spasm” as the case may be.
When performing the procedures be aware of any holding of your breath or tightening of the jaw, neck, shoulders or back. Breathe easily and naturally throughout the procedures and, at the risk of repeating myself, pay attention ... moment to moment ... to the areas of your body that are or remain tense.
Now, here are the two mindful stretching procedures which I have found to be the most helpful ones for me with respect to the management of my condition. However, please read both the "SPECIAL NOTE" and the "IMPORTANT NOTICE" at the end of this blog before doing either of the procedures.

Head circles
This procedure, which involves gently but purposefully moving only your head, can assist in relieving neck tension.

Sit upright and relaxed in an office-type chair with your feet placed squarely and evenly on the floor. Rest your hands on your upper legs or directly over your knees. Gently let your head drop forward until your chin gently touches your chest. Let your shoulders be relaxed and still, but not rigid. Notice any tightness, rigidity or spasm in your neck or shoulders. Don't fight against it or try to get rid of it. Let it be.

Keep your mouth closed (unless you have to breathe through your mouth) but allow a small gap between your teeth as any undue tesnion in the muscles of the jaw will pull the head off balance or otherwise affect its smooth, easy movement throughout this procedure.
Now, with your eyes open and looking without strain in the direction of your movement (as your head will tend to move with and in the direction of where your eyes are pointing), slowly and as effortlessly as possible move your head around to the right in a large, easy circle. You may well hear some crepitus (that is, a crackling or grating feeling or sound). That is not uncommon, but easy does it at all times. Let your head move at a comfortable pace without any strain.

Once you have completed your circle to the right, reverse the movement and now slowly and as effortlessly as possible move your head around to the left in a large, easy circle.

Again, easy does it, and let your head move at a comfortable pace without any strain.
Continue your mindful stretching, alternating directions, until you have done, say, 6 movements to each side.

Go slow with, and throughout, this procedure, and be careful with your range of motion (which can be affected by factors such as age, osteoarthritis, degenerative disc disease, etc). Stop if you experience any pain or unusual discomfort. If the procedure hurts, don't do it.

Shoulder shrugs
This procedure, which involves gently but purposefully straightening your arms and shrugging your shoulders, can assist in relieving both neck and shoulder tension.
As in the first procedure, sit upright in an office-type chair with your feet placed squarely and evenly on the floor. Rest your hands on your upper legs or directly over your knees. Let your head tilt ever so slightly backward. Notice any tightness, rigidity or spasm in your neck or shoulders. Again, don't fight against it or try to get rid of it. Just let it be.

Now inhale, while at the same time and straightening your arms and shrugging your shoulders high toward your ears. Maintain this position for some 3-5 seconds, being aware of and alert to what should be no more than moderate tension in the cervical region. Now exhale in one long, easy sigh, letting your shoulders sag, your head drop forward, and your arms go relaxed and loose. Feel the tension dissipating.
Remain in what you notice to be a relaxed slump for some 3-5 seconds. Then repeat the procedure some 5 more times.
Remember, gently does it, at all times, even when shrugging the shoulders and maintaining them in a somewhat tensed position. Be aware of both the tension and the progressive release of tension as you carry out the procedure.
Once again, stop if you experience any pain or unusual discomfort. If the procedure hurts, don't do it.

With each procedure, be mindful of whatever arises from moment to moment. You cannot fail at Mindfulness if you remain mindfully aware of whatever happens. Oh, yes, when doing each procedure there should be no holding or stopping of the breath (except, if you really must, with the shoulder shrugs, when holding the shrugs for the 3-5 second period). Breathe normally (for you) in rhythm with your movements, and if you want to go deeper into a stretch don't force it but breathe and relax gently into it.

Perhaps the most importat thing of all is this ... apply Mindfulness each moment of the day, from moment to moment. Do not allow yourself to, for example, sit in a "bad" position in front of the computer for hours, or even minutes, on end without becoming aware of what you are doing to yourself. Mindfulness means being self-aware and alert to what is happening to your body. Observe, notice, and take corrective action before pain sets in.

I hope one day to be able to rely entirely upon Mindfulness for the management of my chronic pain condition. At present, I still need the help of anti-inflammatory and pain medications, but the practice of Mindfulness now plays an increasingly more important role in the management of my condition.

(This blog sets out a simple form of mindfulness sitting meditation.)

SPECIAL NOTE. The information in this blog is not designed to replace a health care professional’s independent judgment about the appropriateness or risks of either of the above procedures for you. Always consult your health care professional about your medical conditions including neck and back problems.
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