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Although the results I've had with this book aren't (so far) as good as his book on back pain, I shall certainly be writing it up here and will continue to try his methods.
I have been struggling with neck pain (a bulging disc) after suffering a fall in January 2024.
Discs are special cartilages that separate the vertebrae. Each disc consists of a soft fluid centre, the nucleus, which is surrounded and held together by a ring (the annulus) . The discs are similar to rubber washers and act as shock absorbers. They are able to alter their shape, thus allowing movement of the vertebrae and neck as a whole. The vertebrae and discs are linked by a series of joints that form the neck (cervical spine). Muscles lie over the joints. Additionally, between each two vertebrae there is a small opening on wither side through which a nerve leaves the spinal canal. The nerves are part of our alarm system. If you have a "pain in the neck" it is a warning that the structure has sustained some damage, or is about to.
Do not use the exercises in the book after a recent, severe accident until you have spoken to your doctor or physiotherapist.
A side view of the human body shows that there is a small inward curve in the neck called the cervical lordosis. Due to bad posture, people can often be seen carrying the head in front of their body and there is no lordosis. Use of smartphones has made this endemic.
Overstretching:
The ligaments and muscles that hold the vertebrae together can be overstretched by an outside force placing a sudden severe strain on the neck, for example due to an accident or during contact sports.
Pain produced by overstretching is common and can also arise when we develop poor postural habits. Whenever we remain in a relaxed position, whether standing, sitting or lying, prolonged overstretching can occur.
Tissue Damage:
It is thought that most neck pain is caused by strained muscles. This is not the case. Muscles, which are the source of power and cause movement, can be overstretched but usually heal rapidly and seldom cause pain lasting for more than a week or two. However, the ligaments that provide support for spinal joints are readily injured from overstretching. When the ligaments and muscles heal they may form scar tissues, become less elastic and shorten. At this stage even normal movements may stretch the scars and produce pain. Unless appropriate exercises are performed to gradually stretch and lengthen these structures and restore their normal flexibility, they may become a continuous source of neck pain.
BULGING DISC:
Complications of another nature arise when the ligaments surrounding the disc are injured to such an extent that the disc loses its ability to absorb shock and its outer wall becomes weakened. This allows the soft inside of the disc to bulge outwards (and, in extreme cases, to burst through the outer ligament, which may cause serious problems). When the disc bulge protrudes far enough backwards it may press painfully on a spinal nerve. This may cause some of the pains to be felt well away from the source of the trouble, for example in the arm or hand.
Due to this bulging the disc may become severely distorted and prevent the vertebrae from lining up properly during movement. In this case some movements may be blocked partially or completely and the forcing of these movements causes severe pain. This is the reason that in some people the head can only be held in an off-centre position. Those of you who experience a sudden onset of pain and following this are unable to move the head normally may have some bulging of the soft disc material. THIS NEED NOT BE A CAUSE FOR ALARM. The movements described in this book are carefully designed to reduce any disturbance of this nature.
Common Causes of Neck Pain
Postural stresses
The poor sitting posture, sitting with the head protruded, is by far the one most often at fault. Poor posture in itself may cause neck pain. Once neck problems have developed however, poor posture will frequently make them worse and always perpetuate them.
Consequences of postural neglect
We seldom increase the lordosis in our neck to the maximum so some of the exercises should focus on that. If you reduce the lordosis for long periods at a time and never properly restore it, you eventually lose the ability completely! THIS IS VERY IMPORTANT!
Sitting for prolonged periods
When we sit and relax in a char, the head and neck muscles slowly protrude because the muscles that support them become tired. We are not designed to sit for six hours daily, seven days a week. But we do.
The position of the lower back strongly influences the posture of the neck. If the low back is allowed to slouch, it is impossible to sit with the head and neck in alignment.
Environmental factors
When driving, the seats may dictate our posture. You may even need to protrude your head and neck in order to peer through the windscreen, especially during adverse weather.
How to manage prolonged sitting situations
In order to prevent the development of neck pain due to prolonged poor sitting, it is necessary to :
Sit correctly, and
Interrupt the protruded head posture or prolonged neck bending at regular intervals.
Correction of sitting posture
It is necessary to first correct the posture of your lower back. Use a cushion or foam support at all times!
Without this support your low back slouches and your head protrudes as soon as you relax or concentrate on anything other than your posture. For example, when talking, reading, writing, working at a computer, watching TV or driving the car.
In order to start everything you must first learn how to retract the head. Become expert at Exercise 1: Head retraction in sitting. Perform this exercises 10 times per session and do three sessions per day. Each backward movement of the head must be performed to the maximum possible degree until you reach the 'retracted head posture' (see page 36).
Correct head posture
The extreme of the retracted head position is not natural and can cause strain so do not overdo it. The pain you have in your beck will readily recur for the first few weeks every time you allow your head to protrude, but eventually you will remain completely pain-free even when you accidentally forget your posture. I recommend that you never again allow yourself to sit slouched with a protruded head.
When first commencing the above procedures to correct your low back and neck posture in sitting, you will experience some new pains. These may be different from your original pain and may be felt in another place.
When working at your desk, sit with the low back supported by a lumbar roll and your head retracted.
New pains are the result of performing new exercises and maintaining new positions. They should be expected and will wear off in a few days, provided postural correction is continued on a regular basis. Once you have become used to sitting correctly you will enjoy it! You soon notice the reduction or absence of pain and an increased comfort. From then on you will automatically choose chairs that allow you to sit correctly.
Regular interruption of prolonged neck bending
When sitting for prolonged period, regular interruption of prolonged neck bending is essential. This can be achieved by retracing the head and extending the neck five or six times on the hour, every hour.
Lying and resting
Correction of sleeping surface
The main function of the pillow is to support both head and neck. Therefore it should fill the natural hollow in the contour of your neck between head and shoulder girdle without tilting your head or lifting it up. On the contrary, the head should be allowed to rest in a dish-shaped hollow, so you must be able to adjust the contents of the pillow easily.
Pillows made of memory foam do not allow their contents to be adjusted. Try a feather down pillow so you can easily adjust the contents to make a hollow for your head and bunch the edge to form a thick support for your neck.
Never lie face down! It's a great strain on the joints of the neck.
UNDERSTANDING THE McKENZIE METHOD
The aim of the exercises
When you are exercising for pain relief, you should move to the edge of the pain or just into the pain, then release the pressure and return to the starting position.
Centralisation
Progression of centralisation of pain indicates is a good sign that the exercises are suitable. If your pain is usually felt further away from your neck and moves towards the middle of the cervical spine that's great.
Pain intensity
If your neck pain is of such intensity that you can only move your head with difficulty and cannot find a position to lie comfortably in bed, please adopt a cautious and unhurried approach to the exercises. Bear in mind that an initial increase in pain on doing the exercises is expected.
If, following an initial pain increase, the pain continues to increase in intensity (especially after exercising) and remains worse the next day; or if, during exercising, symptoms are produced or increased in the arm below the elbow, then stop exercising and seek advice.
If your symptoms have been present rather continuously for many weeks or months, you should not expect to be pain-free in two or three days. The response will be slower, but, if you are doing the correct exercises, it will only be a matter of time before the pain subsides.
THE EXERCISE PROGRAMME
In order to treat present neck problem successfully:
At all times: correct your posture and maintain the correct posture.
When in acute pain: if possible, perform Exercises 1 and 2; if not possible, then do Exercises 3 and 4.
When pain is more to one side and not responding: first Exercise 5, later Exercises 1 and 2.
When acute pain has subsided: Exercises 6 and 7, always followed by Exercises 1 and 2.
In order to prevent future neck problems successfully:
At all times: maintain good postural habits.
When no pain or stiffness: Exercises 6 two times per day, always followed by Exercises 1 and 2.
At first sign of recurrence: postural correction and Exercises 1 and 2 at regular intervals - that is, ten times per session and six sessions per day.
EXERCISE 1 : HEAD RETRACTION IN SITTING (PAGES 52-53)
Sit on a chair or stool and relax. Move your head slowly but steadily backwards until it is pulled back as far as you can manage. It is important to keep your chin tucked down and in as you do this.
Once you have maintained this position for a few seconds, relax, and automatically your head and neck will protrude again. Repeat.
Make sure that the backward movements are performed to the MAXIMUM POSSIBLE DEGREE.
You can even add pressure by placing both hands on the chin and firmly pushing the head back further.
This exercises is used mainly in the treatment of neck pain and when used for this reason, repeat the exercise ten times per session and do six sessions per day.
When used in the prevention of neck pain, repeat six times as often as required.
Should you experience severe pain on attempting this exercise, replace it with Exercise 3.
EXERCISE 2 : NECK EXTENSION IN SITTING (PAGES 53-54)
Reman seated, repeat Exercise 1 a few times and then hold your neck in the retracted position.
Lift your chin up and and tilt your head backwards as if looking up to the sky. Do not allow your neck to move forwards as you do this.
With your head tilted back as far as possible, you must rotate your head from side to side so that your nose moves just 2cm to the right and then to the left, all the time attempting to move head and neck even further backwards. Repeat this movement quite rhythmically and not too slowly.
Once you have done this for a few seconds, return your head to the starting position.
This exercise can be used in both the treatment and prevention of neck pain. Perform it ten times per session, six sessions per day. A LOT! If the pain is too severe, replace it with Exercise 4.
EXERCISE 3 : HEAD RETRACTION IN LYING (PAGES 56-57)
Lie face up on any kind of comfortable flat surface. Push the back of your head into the surface and at the same time pull your chin in.
This exercise is used mainly in the treatment of severe neck pain.
When you have completed ten head retraction, it is important to evaluate the effects of this exercise on the pain. If the pain has centralised or decreased in intensity, you can safely continue this procedure.
EXERCISE 4 : NECK EXTENSION IN LYING (PAGES 58-59)
This exercise should always follow Exercise 3.
Lie down on a fed and move down the bed until the head, neck and the top of your shoulders are extended over the edge.
While supporting your head with one hand lower it slowly down towards the floor.
Now remove your hand, tilt your head and neck as far backwards as you can and try to see as much as possible of the floor directly under you.
In the position repeatedly rotate your head from side to side so that your nose moves just 2cm to the right and then to the left of the middle. After doing this 10 times try to relax in this position for 30 seconds.
In order to return to the resting position, first place one hand behind your head, then assit your head back to the horizontal position and move down along the bed until your head is lying on the bed again.
Following the exercise, it is important that you do not rise immediately but rest for a few minutes with your head flat on the bed.
Once you no longer have pain, replace Exercises 3 and 4 with Exercises 1 and 2.
EXERCISE 5 : SIDEBENDING OF THE NECK (PAGES 60-61)
Sit on a chair, repeat Exercise 1 a few times, and then hold your head in the retracted position.
Bend your neck sideways and move your head towards the side on which you feel most of the pain (my right side). Do not allow your head to turn so that your nose moves towards your shoulder; in other words, keep looking straight ahead and bring your ear down towards your shoulder. Keep your head retracted!
The exercise can be made more effective by placing the hand of your most painful side over the top of your head and gently but firmly pulling your head even further towards the painful side.
Maintain this position for a few seconds and then return to the starting position.
This exercise is used specifically for the treatment of pain felt only to one side of the neck that does not improve with Exercises 1 and 2, or for the treatment of pain felt much more to the one side than the other.
Until the symptoms have centralised, repeat Exercise 5 ten times per session, six sessions per day.
EXERCISE 6 : NECK ROTATION (PAGES 62-63)
Sit on a chair, repeat Exercise 1 a few times, and then hold your head in the retracted position.
While still retracted, turn your head far to the right and then far to the left. Keep the head retracted!!
If you experience pain more on your right side, continue to exercise by rotating to the most painful side.
However, should the pain increase and fail to centralise, continue to exercise by rotating to the least painful side. Once you have the same amount of pain or no pain and only stiffness when turning to either side, continue to exercise by rotating to both sides.
The exercise can be made more effective by using both hands and gently but firmly pushing your head even further into rotation.
Once you have maintained the position of maximum rotation for a few seconds, return your head to the starting position.
Whether centralisation has taken place or not, Exercise 6 must always be followed by Exercises 1 and 2.
Note that in the majority of cases, stiffness on rotation is caused by a blockage at the back of the joint that must be dealt with by performing Exercises 1 and 2. Only do Exercise 6 if your neck pain is not helped by Exercises 1 and 2. I hope that is clear!
EXERCISE 7 : NECK FLEXION IN SITTING (PAGES 64-65)
Flexion means bending forwards. Sit on a chair, look straight ahead and relax.
Drop your head forwards and let it rest with the chin as close as possible to the chest.
Place your hands behind the back of your head and interlock your fingers. Let your arms relax so that the elbows point down towards the floor. In this position the weight of the arms will pull your head down further and bring your chin closer to the chest.
The exercise can be made more effective by using your hands to gently but firmly pull your head onto your chest.
Once you have maintained the position of maximum neck flexion for a few seconds, return your head to the starting position.
This exercise is used specifically for the treatment of headaches, but can also be apples to resolve residual neck pain or stiffness once acute symptoms have subsided.
In both cases it should be repeated only two times (for a total of 3) per session with six sessions per day.
When used in the treatment of neck pain or stiffness, Exercise 7 must always be followed by Exercises 1 and 2.
WHEN TO APPLY THE EXERCISES
When you are in significant pain
Always attempt Exercise 1 : Head retraction in sitting.
As soon as possible, even on the first day, add Exercise 2 : Neck extension in sitting.
If you have performed three or four sessions of Exercise 1 and the pain remains too severe, replace it with Exercise 3 : Head retraction in lying. Add Exercise 4 : Neck extension in lying as soon as you have become well practised in Exercise 3 and your symptoms have improved to some extent. The sooner you can introduce Exercise 4 the better.
When you have improved significantly - usually two or there days after you commence the exercises in lying, you may gradually reduce the number of sessions of Exercises 3 and 4, and as you do this introduce and gradually increases Exercises 1 and 2. The goal is to only be doing Exercises 1 and 2.
No response or benefit
When the pain is felt only to one side of the neck or much more to the one side than to the other, the exercises recommended so far sometimes fail to bring relief. (YES - my pain persists on my right side). If this is the case. commence with Exercise 5: Sidebending of the neck. Whether centralisation or reduction of the pain has taken place or not. Exercise 5 must always be followed by Exercises 1 and 2. After two or three days of practise you may find that the pain is distributed more evenly across the cervical spine or has centralised. Not you may gradually reduce Exercise 5. Now continue below....
When acute pain has subsided
If you have pain on turning the head to the right or the left, practise Exercise 6: Neck rotation, and if you have pain on bending forwards, practise Exercise 7: Neck flexion in sitting. The pain should disappear entirely over a period of two or three weeks. Each session of Exercises 6 and 7 should always be concluded with a few repetitions of Exercises 1 and 2.
If you feel stiffness only on these movements, do the same exercises but apply overpressure with your hands at the end of each movement.
When you have no pain or stiffness
To prevent recurrence of neck problems perform Exercise 6: Neck rotation followed by Exercises 1 and 2: Head retraction in sitting and Neck extension in sitting on a regular basis, preferably in the morning and at night. Furthermore, whenever you feel a minor strain developing during work or while sitting, perform Exercises 1 and 2. It is even more important that you watch your posture at all times and never again let postural stress be the cause of neck pain. These exercises will have very little or no effect if you constantly fall back into poor posture. While it may be necessary to exercises in the manner described for the rest of your left, it is absolutely essential that you develop and maintain good postural habits.
As it only takes one minute to perform one session of Exercise 6 and another minute to combine Exercises 1 and 2 and repeat them 10 times, lack of time should never be used as an excuse for not being able to do these exercises.
Recurrence
At the first sign of recurrence of neck pain immediately perform Exercises 1 and 2: Head retraction in sitting and Neck extension in sitting. If your pain is already too severe to tolerate these exercises or if they fail to reduce the pain, quickly introduce Exercises 3 and 4: Head retraction in lying and Neck extension in lying. If you have one-sided symptoms that do not centralise with any of these exercises, start with Exercise 5: Sidebending of the neck.
KEEP YOUR HEAD UP AT ALL TIMES. DO NOT ROLL YOUR HEAD AROUND AND AVOID QUICK MOVEMENTS, ESPECIALLY TURNING THE HEAD QUICKLY.
FURTHER RESEARCH ON THE BULGING DISC IN MY NECK:
Some people incorrectly use the terms bulging disc and herniated disc interchangeably. A herniated disc is a fully ruptured disc. Bulging discs can eventually become herniated discs.
Causes
Long-term trauma, such as poor posture, can cause a bulging disc in the neck. Aging can also increase the risk of a bulging disc in the neck. Sudden trauma can also be a cause.
Symptoms
It is possible for a bulging disc to occur without any symptoms. In other cases, however, the disc presses on a nerve in the neck. This can cause:
pain in the neck, shoulders, and back
pain when moving
numbness or tingling in the shoulders, arms, or fingers
a reduced range of motion
The severity of the symptoms will depend on how much pressure there is on the nerve. The symptoms often worsen during activity and improve when resting.
Treatment
Doing certain exercises or stretches can ease pressure on the spine and reduce symptoms.
Taking pain medications can also be helpful for reducing discomfort.
If you don't respond you will need a cervical epidural steroidal injection. A series of injections will take place that could leave you pain-free for years. It's not without risks though.
If these treatments are not effective, however, cervical spine surgery is another option. This will involve removing some or all of the disc. The most commonly used procedure is called a microdiscectomy. The surgeon will make a small incision through the skin near the slipped disk. They’ll insert a microscope and small tools in the incision to remove the herniated part of the disk.
Tips & Tricks
Lying on your back with a thinner pillow is the best sleeping position for herniated discs in the neck. It reduces the risk of putting undue pressure on the spinal discs of the neck.
Stretching exercises should be done slowly. They should also be close to pain-free as otherwise you will just keep the inflammation going. Any exercises or movements that don't cause pain are likely to be useful. USE PAIN AS YOUR GUIDE.
Keep the lordosis in the back and neck when you are not doing exercises
Exercises
Neck Retractions : Nurturing Mobility
Neck retractions involve gently sliding your head backward while keeping your chin tucked. This movement encourages cervical spine mobility and helps prevent stiffness that often accompanies a disc bulge.
Cervical Isometrics : Building Stability
Isometric exercises involve contracting muscles without movement. For cervical disc bulge relief, place your hand on your forehead and gently push against it while simultaneously resisting with your neck muscles. This builds stability and strengthens your neck muscles.
Shoulder Blade Squeezes : Improving Posture
Strong upper back muscles contribute to better cervical spine support. To perform shoulder blade squeezes, sit or stand with your arms by your sides. Gently squeeze your shoulder blades together, holding the position for a few seconds. This exercise promotes better posture, reducing strain on the cervical discs
Diagnosis
The good news is that bulging discs get better on their own over time or with nonsurgical physiotherapy for 9 out of 10 people. Your herniated disc can heal on its own, but there is no guarantee that it will completely return to how it was before. Instead, your herniation will go into remission where the disc either shrinks or dries up. With the right treatment, most of your symptoms will go away.
Bulging of C5-C6 (my case)
The C5-C6 disc may be subject to traumatic degeneration following a whiplash injury. Vertebral and disc pain from C5-C6 may occur suddenly following an injury or gradually increase over a period of time. Typically, a dull ache or sharp pain may be felt at the back of the neck. The neck’s range of motion may also decrease. There may be crepitus (a snap, crackle, or pop sound) with neck movements.
If the disc that sits between the C5-C6 vertebrae is bulging, that means its inner nucleus is pushing outwards against its outer annulus. The C5-C6 vertebrae provide support and flexibility to the neck and head above. While supporting the weight of the head might not seem like a challenging task, keep in mind that a shift forward in the head’s posture as little as 1 inch increases the weight of the head on the neck and its muscles by approximately 10 pounds, known as forward head posture.
The cause of C5-C6 disc bulging can be multifactorial, with factors such as age-related wear and tear playing a significant role.
Physical therapy can also be used to treat the symptoms of a bulging disc, but it can be painful and uncomfortable. Any exercise that causes pain should be discontinued immediately.
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