Dear Readers,

Welcome to this week’s edition of The Overhead Athlete’s Edge, as we dive into the importance of the neck in the overhead athlete, how stiffness can affect mechanics, and why addressing neck dysfunction is crucial for optimizing performance and longevity. Let’s take a closer look into why stiff necks happen and how improving neck mobility can enhance efficiency, reduce strain, and keep you competing at your best.

In Focus: Breaking Down a Stiff Neck and What it Means for the Athlete

We’ve all woken up at some point in our live’s with a stiff neck. You rub it, stretch it, maybe put a heating pad on it and go about your day. By afternoon, you are feeling okay and the stiff neck is behind you. Your stiff neck is probably from a suboptimal sleeping position over the course of a few hours, or the result of an activity you did the day before causing muscle soreness.

In the overhead athlete, we also contribute many cases of neck stiffness to poor posturing and overuse. Muscle strain or tension in the upper back and neck region are often the result of repetitive motions, such as throwing and batting, which at high volumes place significant stress on the stabilizers and rotators of the cervical spine. Poor posture and head position during practice or games, as well as off the field, can exacerbate injury caused by overuse. Think about the time spent hunching over while analyzing game footage, sitting in the dugout, or even looking down at your phone.

In the competitive athlete, we have to consider trauma as well. For example, the center fielder sprinting 20 miles per hour to catch a fly ball on the warning track and slamming into the wall. Or the QB who gets pummeled to the ground for a sack. Any sudden jolt or collision on the field can lead to whiplash (as most people know it), if the force of the action is greater than the impact the neck stabilizers can endure.

Can I Play Through the Neck Stiffness? Is it Really That Big of a Deal?

You can usually play through neck stiffness depending on your sport and position, but don’t be surprised if your performance isn’t at the level you are used to.

Neck stiffness effects:

1. Head Rotation and Vision: Neck stiffness makes it more challenging to track a ball, such as hitting off of a pitcher throwing a 95mph fastball. Or when catching a fly ball, having to make adjustments with the sun in your eyes. Or think about a quarterback trying to scan quickly through his progressions, having to quickly look to the left and right, back and forth.

2. Throwing mechanics and velocity: Limited motion at the neck will cause the body to compensate by finding more motion at the upper back or shoulder. This will change movement patterns and force production for throwing, affecting pitch speed and accuracy, and can result in serious injury to the throwing arm such as rotator cuff tears

3. Increased fatigue and tension headaches

4. Psychological Affects: The distraction of a stiff neck affects performance. Think of the pitcher who is having a hard time getting his neck to relax and can’t get into a good rhythm. Or a QB in the pocket who has decreased peripheral vision because of poor neck mobility, and is now afraid to get hit.

Don’t neglect the increased risk of injury that comes with playing with neck stiffness:

Rotator Cuff Injury - Optimal shoulder function relies on proper cervical and thoracic alignment. Neck stiffness can disrupt scapular positioning and control, leading to impingements or rotator cuff stress with overhead throwing motions.

Checkout this article that showed the correlation between decreased neck motion in preseason with shoulder and elbow injuries during season in college baseball players:

Thoracic Outlet Syndrome - Dysfunctional “tight” neck muscles along with poor posturing can contribute to compression of nerves/vessels that run from the neck to the arm, leading to weakness or numbness in the throwing arm.

Here’s an article discussing how throwing affects stiffness of the scalene muscles of the neck in collegiate baseball players, and how this correlates with thoracic outlet syndrome:

Concussions - A stiff, weak neck absorbs less force during collisions or falls, increasing vulnerability to hitting your head. This study found that for every one-pound increase in neck strength, the odds of sustaining a concussion decreased by 5%. This systematic review concluded that dynamic neck strength training might reduce the risk of concussions and other head–neck injuries, while this one indicates that athletes with higher neck strength experience lower magnitudes of head impacts across various sports.

Chronic Tension Headaches - Often related to imbalances in the neck muscles

Just a quick note, that while the majority of the time neck pain/stiffness is typically orthopedic in nature, we have to be aware of red flags that may indicate a further look by a healthcare professional:

• Symptoms of Meningitis: Nausea, vomiting, light sensitivity, confusion, lack of appetite, extreme sleepiness, small round spots that look like a rash. Go to the emergency room if you have a stiff neck and these associated symptoms.

• Severe neck pain following trauma

• Neurologic Symptoms such as weakness, tingling, numbness in the neck, arms, and/or or hands

• Fever and Headache, Loss of Bowel & Bladder Control, Changes in Vision, Night sweats or unexplained weight loss

Expert Insights: Strategies for Managing Neck Pain

The single best way to address a stiff neck is to strengthen and optimize mobility while your athlete is healthy! I get it, neck strengthening is weird. If you saw someone at the gym doing it, you would think that it is strange. But the truth is, we strengthen and train other parts of our bodies, so why not our neck?

The neck is often overlooked in strength training routines, yet it's crucial for overall body stability, spatial awareness, injury prevention, and performance. Just like with knees or other joints, regularly training the neck can provide greater resilience, helping to reduce the severity of any injuries and reducing recovery times if an injury does occur.

First and foremost, prioritize proper warm-ups and cool-downs that include neck mobility exercises. Simple active stretches, such as gentle neck rotations and tilts, and simple neck stabilization exercises can help maintain flexibility, increase blood flow, and reduce tension before hitting the field. Building off of that, incorporating strength training for your neck and upper back muscles into your strength and conditioning program is equally important, as this creates a stable base and posture during repetitive overhead shoulder movements.

Check out this article showing how including neck exercises in the warm up of 18-30 year old athletes improved performance and reduced both incidence and severity of minor TBIs such as concussions.

Postural awareness is another key factor. Make a conscious effort to sit and stand upright, avoiding slouching with your head and neck forward for long periods, such as when driving or sitting at a desk. When sitting, keep your back supported and your head aligned with your shoulders. If you’re spending extended time on your phone or laptop, take frequent breaks to stretch and reset your posture.

So How Do I Deal With My Stiff Neck?

Stretching your neck may seem like the logical response to tightness or stiffness, but it’s important to understand the body’s protective mechanisms. In many cases, tightness, stiffness, or spasms in the neck occur because your body is trying to protect and stabilize the area, much like a natural neck brace. These symptoms often signal underlying imbalances, such as restricted mobility in certain segments of the spine. When you stretch your neck, you’re likely targeting areas that are already too mobile while not addressing the areas that are typically restricted. This can then perpetuate dysfunction, instability, and pain. While it is okay to use gentle passive stretching for pain relief in the beginning, using more active stretching will help your athlete regain function quicker.

What I recommend from day 1:

Pain relief and calming of the sympathetic nervous system. This may look like relaxation, gentle massage, meditation, laying flat on the ground in a dark room, NSAIDS, hot/cold therapy.

Isometric activation of the neck muscles in all directions. Start with small contractions if it hurts, then build up to pushing harder.

Active stretching of the neck. I like Functional Range Conditioning for hitting all directions of neck mobility, using pain as your guide. I also really like active-assisted neck motion such as this exercise below.

Mobility of the thoracic spine, using a foam roller or other mobility device to focus on extension and rotation.

Continue with your lower body programming as long as it doesn’t exacerbate symptoms.

Gradually Return to Activity using your symptoms as your guide. Add a neck strengthening and mobility program into your weekly training regimen.

It’s wise to consult a sports physical therapist specializing in your sport who can assess your condition and create a personalized treatment plan. Techniques such as manual therapy, dry needling, or guided rehabilitation exercises may be necessary to resolve the issue fully.

Technique Spotlight: Eliminating Neck Pain by challenging your posterior chain

Here is what I love about this exercise: A wall sit with a chin tuck is an excellent exercise to alleviate neck pain and strengthen the deep spinal muscles that run from the base of the skull to the back of the hips. Begin by standing with your back against a wall and slowly sliding down into a wall sit position, keeping your spine in a neutral position. Place a yoga block, pillow, or similar support between the back of your head and the wall. Perform a gentle chin tuck by drawing your chin straight back toward the wall without tilting your head. This exercise strengthens the deep neck and spinal stabilizers while promoting proper alignment and posture.

Want to take this exercise one step further? Try it with a ball behind your head instead and add in very slow and controlled head rotations without losing that neutral spine position.

The Iron Neck (as silly as it looks) is a highly effective tool for alleviating neck pain by strengthening the muscles that stabilize the cervical spine. By providing controlled resistance in multiple directions, it challenges strength, mobility, and posture, teaching athletes how to control forces and reduce strain on the neck, thus decreasing the likelihood of injury during competition. This tool is particularly useful for athletes engaging in impact sports or sports that require quick changes in neck motion such as baseball, football, and soccer. I often incorporate the Iron Neck into treatment plans for my clients, as it promotes long-term relief and resilience by addressing the root causes of neck pain (usually muscle imbalances, weakness, or soft tissue trauma) through targeted strengthening exercises.

Success Story: Overcoming Adversity - Matt A.

For athletes, injuries often feel like a pause button on their passion, but for Matt A., it was nearly a full stop. A basketball player with an unstoppable drive, Matt’s journey took an unexpected turn after a car accident left him with debilitating neck pain. Initially, Matt feared his athletic career might be over. However, after consulting with a specialist, he was introduced to a tailored physical therapy program. This marked the beginning of his path to recovery.

Matt’s therapy incorporated a lot of manual therapy, targeted movement patterns, and stabilization exercises, with goals of restoring neck range of motion, regaining full spinal mobility, and strengthening his neck and upper body. Over several months, Matt committed to his program with the same tenacity he brought to the basketball court. By combining therapeutic exercises with a personalized mobility routine, he gradually reduced the pain and regained his full functionality.

Today, Matt is not only back on the court but playing better than ever. His story serves as a powerful reminder that setbacks can lead to comebacks. With determination, the right treatment, and a positive mindset, challenges can transform into opportunities for growth.

Ask the Expert: Your Burning Questions Answered - “What Do You Think About Traction?”

I love traction for a stiff neck in athletes, but only when it is appropriate. Its effectiveness depends on the underlying cause of the stiffness and how it's applied. You have to be careful though, because in the wrong scenario, traction can actually do more harm than good.

When I recommend and use traction:

• Nerve-related stiffness such as disc issues or nerve root compression

• Postural-related stiffness with upper trap dominance, or excessive cervical compression from forward head posture

• Facet Joint Stiffness

• Mild whiplash; controlled light traction may relieve protective tightness/tension

When I DON’T recommend traction:

• Acute muscle strains such as from an overuse injury

• Athlete’s with significant hypermobility or ligament laxity

• Unstable Disc Injuries

• Concussion-Related Symptoms

• Possible signs of cervical instability after a collision

How to get traction:

1. Manual traction from a trained sports PT, athletic trainer, or chiropractor

2. Traction devices such as the Neck Hammock or in-clinic mechanical traction devices

3. The Iron Neck under the supervision of a sports physical therapist

4. Hanging upside down such as inversion tables

5. Self-traction using a towel

Traction can be a useful tool, especially for athletes dealing with nerve-related or joint-based neck stiffness, but it should be combined with active strengthening and mobility work for long-term results.

Stay Connected: Join Our Community

Connect with our vibrant online community of fellow overhead athletes, coaches, and sports enthusiasts by giving us a follow on Instagram @TheTrainingRoomOC. Share your experiences, seek advice, and stay updated on the latest developments in sports performance physical therapy for overhead athletes. Together, we can elevate our performance and achieve new heights in our respective sports.

Closing Note:

Thank you for embarking on this journey with us through the world of sports performance physical therapy for overhead athletes. We hope you found this issue of "The Overhead Athlete's Edge" insightful and empowering. Stay tuned for more valuable information and inspiration in our next edition. Until then, keep honing your skills, pushing your limits, and trusting the process!

Best regards,

Dr. Sam