Joseph M. Horrigan, Soft Tissue Center
Everyone who is serious about exercise and weight training has tried on occasion to train harder, train heavier and get “one more rep.” That extra effort and strain can cause neck injuries if you don’t pay attention to how you do the exercises.
Some trainees are very melodramatic and acrobatic, moving their arms, legs and neck while straining. It’s obvious how this could cause an injury. Other more subtle, neck injuries that trainees experience reveal a few common patterns.
The preacher curl bench is a spot where injuries often take place, especially those related to the cervical spine, or neck. One type of problem occurs when you forcibly flex your neck (bringing your chin to your chest) during the straining portion of the curl. The forced flexion may simply overstretch your upper trapezieus, your erector spinae and your levator scapulae (a muscle that originates on your upper scapula and inserts into the vertebrae of the cervical spine).
The strain to the levator scapulae may be painful and bring about “stiffness,” but it is relatively mild and generally lasts for approximately three days. You may experience a more severe, long lasting problem if the muscle tears. In this case the initial pain lasts for weeks, and the trouble doesn’t stop there. The inflammation and protective muscle spasms cause fibrous adhesions to form in the involved muscles and surrounding tissue, which limits the muscles’ ability to lengthen and contract properly. Consequently, you’ll experience stiffness and pain along with a long-term loss of range of motion.
Another possible injury involves damage to the cervical discs caused by forced flexion during the point of maximum strain. The disc is the fibrocartilage material found between each of your vertebrae. A thick, semi-fluid-like substance in the center of each disc assists in proper weight distribution as well as maintaining the height of the disc. Forced flexion in the preacher curl, compounded by the straining, however, places extreme asymmetric force on the disc.
There are two several stages of possible disc injury and inflammation:
- The disc may have a broad-based bulge;
- A protrusion, which is a more focal injury that may or may not have a crack (fissure) or tear in the outer rings of fibrocartilage material (annulus fibrosus). If the tear is large and the protrusion is very focal and the center material (nucleus pulposus) leaks out of the disc, it is referred to as an extrusion. Sometimes the center material and torn outer portions of the disc break free from the disc. This is called a sequestered disc. Sometimes these disc injuries tear through the overlying ligament and this is then called an uncontained disc extrusion or uncontained sequestered disc.
If these types of injuries occur and it is inflamed, other symptoms may occur. The symptoms may include pain, numbness and tingling that radiates into your shoulder, upper back, arm or hand. You may experience muscle weakness. Inflamed nerves are sensitive and do not withstand pressure very well. Muscle atrophy may occur and is a very important symptom. The duration of the atrophy is important. Atrophy is frequently irreversible. A large disc injury in the neck can also add one more variable and this is spinal cord compression.
The unfortunate trainee who has been correctly diagnosed as having either a large cervical disc extrusion or a sequestered cervical disc frequently needs surgery. For milder cases of protrusion and also muscle strains, various forms of conservative care can reduce inflammation and pain and help to regain range of motion.
Such injuries occur most commonly in flexion, but you can have neck pain from forcefully putting your neck into extension, or tilt it back. In Figure 1 bodybuilder Gary King demonstrates the correct neck position for preacher curls. In Figures 2 and 3 he shows the incorrect flexion and extension positions. The incorrect extension position doesn’t overstretch the levator scapulae and other related muscles as the flexion does. Instead the forceful isometric extension contraction, coupled with the strain of the curls, injures the muscles of the cervical spine, compresses the joint of the spine (facet joints) and may result in the previously described disc pathologies.
Rotating your neck while doing this exercise can also lead to similar injuries. In this case you cause instability in the neck by turning your head while pulling or pushing. To prevent the problem, you must keep your head and neck symmetrical; that is, straight ahead and not twisted to one side or forced up or down.
When you perform an exercise, the muscles of your neck and upper back should pull evenly on your neck. If you turn your neck and head, some of the muscles in your neck and upper back will contract to accomplish the turn, and others will relax somewhat and lengthen. Since there is no longer an even pull on the structures of your neck, the asymmetry and loss of stability leave you ripe for injury.
Figures 4 through 6 show Gary using improper form on preacher curls and pulldowns by turning his head.
Remember that the neck is not an accessory muscle to the action of the lifts; it receives some isometric work from straining. So don’t turn to talk to someone while you’re exercising. Put the weight down first. Also, remember to avoid holding your breath while straining during any exercise; this elevates your blood pressure.
There are two other exercises that can commonly lead to neck injuries: presses behind the neck and leg extensions. In both cases compression forces cause the problem from the direct downward pulling of the neck muscles.
Try to avoid strain caused by excessive tightening of the neck when doing behind-the-neck presses. I have had patients suffer from disc extrusions from doing this exercise improperly, and have required surgery. Unfortunately for some of them, by the time they sought medical help, too much time had passed, and the atrophied muscle did not recover. Other patients, however, have been a little more fortunate.
Many trainees think that their neck is safe during leg training if they simply avoid squats and so avoid placing a heavy bar across their trapezieus. This is not so. In fact, the leg extension machine offers an easy way to hurt your neck.
This can happen if you hold onto the handles by the side of the seat or onto the bottom of the seat itself when you’re forcing weight or extra reps. By pulling on the handles (or the seat) you’re actually performing a maximum isometric shrug — a movement most trainees are not accustomed to or prepared for. Consequently, you strain your scapular muscles. The pain from this strain is sharp, and it shoots from your upper back, or scapula, to one side of your neck.
Many movements can cause an injury if you do them without thinking first. One of my patients claimed that his neck felt stiff when he did bench presses. This stiffness continued, and one day while he was performing pull-ups behind the neck, he rotated his neck around quickly to “loosen” it and felt a sharp, intense pain. The diagnosis was an extruded disc.
Be careful and conscious of what you do in the gym. Most injuries are minor and will pass in a few days. If you experience one of these strains, place ice on the area for 20 minutes, twice a day, for several days. Don’t treat it with heat or stand under a hot shower, as heat will increase the inflammation. (Heat may give you temporary relief for up to four hours, but it will add to the problem.) If the pain hasn’t subsided in three or four days, or if the pain is intolerable, consult your physician.
Author’s note: Gary King has a personal training business, Royal Body Ent., and works out of Gold’s Gym in Hollywood, CA.