Neck exercises for Long Covid-- Part Deux

 

Image created with Midjourney by D. Troy Roach (Feb 18th, 2023)

Neck Exercises for Long Covid-- Part Deux

This is my 8-month update from the neck exercises (TMJ exercises, Throat exercises, Posture, etc). 

January 2024 update: See the "Mewing" section below for a new "Tongue Circle" exercise which I think will be a game changer.

March 2024 update: I have now added tongue circles. The tongue is a huge muscle that can help strengthen the neck as a whole.
https://youtu.be/B3dF5TDkgiY?si=ZInmhrtoLbYW4VpA

May 2024 update: I tried to stop my tine dose (10 mg) of amitriptyline. One month taper down to 5 mg...then off it for a few weeks. Bad idea to stop. My sleep got worse and neck tension came back. So I am now back on 5mg. The stop was because my head was feeling "too loose and bobbly", so a half dose of 5mg seems to be a good half-way point.
Amitriptyline didn't start working until after nicotine patches... so I wonder what will happen when I take a long NP break this summer? More anatomy I find useful. The Vagus (Nerve 10)  share the same foramen as the tongue (9) and neck nerves (11) and major arteries. The recent brainstem/vagusnerve/immune response research brought me back to this rabbit hole.
https://www.youtube.com/watch?v=oTyO2XlmlEI 

August 2024 update: This video explains the connection between the throat, vagus nerve, neck fascia and tongue strength + swallowing issues, voice issues, CCI and maybe even SGB (stellate ganglian block).
https://www.youtube.com/watch?v=Aevqu6mI9PQ&t=255s

These vestibular exercises...done correctly should help many neck issues, but also POTS issues:

https://youtu.be/5fDkVtMM3oI?si=qEk6FQVuI0ZIuiz2

Vestibular Occular Reflex exercises. Deceptively simple yet powerful exercises! Start with only one or two rounds! Don't forget to breath!
https://youtu.be/5fDkVtMM3oI?si=Nf8jpJKpWeOqN_6O

September 2024:
Understanding this key junction point around your collar bone will help a lot with lymphatic drainage, bloodflow and nerve issues. Be gentle! Don't forget to breath!
https://www.youtube.com/watch?v=cUBv4YyCsHA

October 2024 update:
More deceptively easy, yet powerful exercises from the "Stop chasing pain" YT channel. And the Vestibular Occular Reflex exercises are helping. I can crack my neck sometimes now...before it was impossible. Don't forget to breath!
1. Take time to learn the science.
2. Go slow, "More is not better, Better is better."
https://youtu.be/Di_8IQDwCjI?si=Wjt3V5rGMXPs0L0n

It has been a long journey since March 2020! 

Since my second SARS2 infection in April of 2021, my main physical symptom (not counting fatigue, PEM, etc...) has been neck pain. Nothing I did seemed to help improve neck issues; stretching, weekly PT, Chiropractor, different pillows, muscle relaxers, etc. were all a bust!

Luckily, in June 2022 I found some isometric exercises which have made a big difference!

Notes/Disclaimer:
My N=1, not medical advice. Don't do anything that causes acute pain!

Before these exercises, I took Gabapentin for 5 weeks and then Pregabalin for three weeks. Both seemed to help my neck, Pregabalin more than Gabapentin. Three weeks seems to be a good amount of time. Taking it at night helped me sleep the first week. And it was easy to wean off it during the 3rd week. Pregabalin seems to reduce neurological pain and calm down the hypersensitive ANS.

Lymphatic/Glymphatic Massage: 
Lymphatic massage could be beneficial for anyone with Long Covid, whether they have neck pain or not! Here is a link to the routine and tips which I do regularly (Especially at night, right before going to bed, and in the morning):

https://youtu.be/_4yvyWkFQiA

This is the science behind why Lymph/glymph massage is beneficial for Post-Covid.

https://youtu.be/9CzIhMDzJRU

Isometric Exercises and stretching:

Start Slow: You might want to experiment with a couple videos (browse)and learn from the comments without pushing yourself. Useful comments often come in the middle and at the end of videos!

I have done sports my entire life and recovered from many minor injuries. I know my body pretty well. I know when I can "push" and when to back off. I am not a Physio, but I teach Technical English to 2nd-year Physio and Nursing students at a university. I have more knowledge about rehabilitation than the average person and I have lots of colleagues who I can consult. You might benefit from guidance from an experienced/specialized Physio. At least to help get started and make sure you are doing the exercises correctly with personalized guidance.

Tiny differences in posture, angle, tension & position can completely change a neck exercise and recruit different muscles, tendons, and joints. Therefore, a millimetre change in posture might work the wrong part of the body! However, you might want to experiment with slight changes in an exercise to attack slightly different muscles. And things like posture, breathing technique, stress, chewing technique, swallowing technique, speaking technique, infections, swollen lymph nodes, etc can all have an effect. Try to look at it holistically. There are many tiny parts but they are all connected.

A normal Physio might not be as useful as a Physio who is specialized in TMJ or Cervical Rehab. It is a very complex bit of anatomy.

Anatomy: 

Spend some time learning about the neck (C1-Atlas, occipitals, SCM, scalene), throat (tongue, muscle tension dysphonia), TMJ, the complex web of nerves, and blood flow and tongue anatomy. Be clear about what specific muscles, joints, and nerves are affected. Understanding fascia and how it can "stick" to muscles helps too.

(This section is an edit, added 05-03-2023)
Understanding the complex anatomy and a theory of how occipital movement/posture/exercises affect the flow of cerebral spinal fluid. The TLDR of the video:

1. In my opinion, this Youtuber is well-intentioned, but you have to take his advice with a grain of salt!

2. The occipitals are connected to the eyes. Movement of the eyes can be felt in the occipitals.

3. The occipitals are attached to the cranium, the C1, and C2... however, they are also attached to the dura mater of the spinal cord/brain!

4. Correct posture and Movement of the occipitals affect the flow of Cerebral Spinal Fluid, glymph, Lymph, etc...

5. This movement can be compounded by eye movement.

 

My Notes:

A. The occipitals are an important part of my issues. However, there are other issues (TMJ, bloodflow, lymph flow, etc...).

B. Posture while doing this simple exercise is important.

C. This is deceptively easy. However, if you decide to try it; start with one rep!

D. Doing any and all neck exercises with a specialized PT will give you very valuable feedback on posture, rhythm, breathing, relaxation, etc...

E. Do slowly, with slow, diaphragmic breaths, at about 70% effort, while focusing on relaxation! (Thoughts have an affect on the muscle tension! It should be meditative, relaxing!)

 A link to the video (for information -- the anatomy and theory): 

Hypermobility:

I do not think that I have Hypermobility/EDS. However, many others do. You might want to consult this channel and take her recommendations into account before trying the videos that helped me:

https://www.youtube.com/@JeannieDiBonHypermobility

Her video on Neck pain.

https://youtu.be/pk56QC51OkM

My diagnosis/symptoms:

A specialist Physio:  "probably neuromuscular". 

Symptoms: Tension, rigidity, and pain in the Occipitals, SCM, TMJ (jaw and skull tension, inflamed nodules, etc...), throat (muscles tension dysphonia), tinnitus, etc. It seems to be a kind of CCI (Cranial Cervical instability) that was caused by the Spring 2021 flavor of SARS2. I do not have any formal diagnosis of CCI, Chiari, or Tethered Cord, but my symptoms seem to fit these.

I spent six months with a voice coach to improve my speaking technique before doing this routine. The things I learned helped me improve my technique to get me through the workday, but the exercises themselves -- especially the straw/occlusion/vibration exercises -- made me feel worse. I would "crash" after each 30-minute lesson. My voice is "OK", but the MTD tension is still there.

MTD (muscles tension dysphonia):

This channel has a lot of information and exercises related to MTD. Relaxation and stretching are useful for me. Any voice exercise that causes "vibration" in the head makes me feel worse.

Do you have MTD?

https://www.youtube.com/watch?v=qab7zGHnKDc

My problem seems to be a kind of subconscious tension from the ANS (self-diagnosis). Made worse by poor technique and being a teacher (straining my voice for years with poor technique and even while sick!). This is an interesting video about doctors that mis-diagnose MTD as "being in your head." Sound familiar?

https://youtu.be/BFjCMcUqwf4

My theory/diagnosis/pathology:
(based on extensive research and my N=1 experiments in this #LongCovid journey. I may be completely wrong 😜...)

1. SARS2 clogs up the lymphatic system (hyperinflammation, inflamed nodules in the neck, reduced Glymph flow from the brain, and even reversed glymph/lymph flow up into the cranium). 

2. AND Endothelial damage (probably from the spike) that affects blood flow. Thus muscles, ligaments, and nerves (PNS and CNS) do not get oxygen and nutrients. This includes damage to musculature controlling blood vessels which is controlled by the ANS. And damage to the brain/ANS. Thus POTS, microclots, etc.

3. The ANS (limbic/subcortical brain) is also affected by a lack of blood flow and inflammation. Thus the benefits of brain training. Basically, an mTBI (minor Traumatic Brain Injury) is caused by the virus and/or the body's immune response to the virus.

4. These problems lead to muscles that are weakened and under hypertension 24/7. Muscles then give out and the neck is only supported by the tendons. However, tendons are too weak. Thus the bobblehead, TMJ, MTD, throat issues, etc.

5. The cure? In most cases, it would be rest, time, exercise (strengthening), mobility (blood flow and lymph flow), and various therapies (NIR, IR, heat, cold, vibration, TENS, improved posture, HBOT??, anticoagulants??, etc...).

6. The daily recovery goals...

 IF ... 

You can get the blood flowing to muscles,

& You can strengthen the muscles,

& You can improve posture, speaking technique, etc that exacerbates the issues,

& You do brain training to reduce the amount of ammunition the damaged, negatively biased, ANS has to use against you...

& Take care of your diet so you reduce inflammation, acid reflux, etc...

Then it seems possible to heal! I am at about 85 or 90% recovered from all neck issues (about 70% in general recovery).

 7. The problems...

Healing is slow. 

Most people (even specialized physios) will not understand the complexity of this issue and many don't understand PEM... even when explained. To many physios, understanding PEM is almost impossible since movement+pain within tolerable limits is their bread and butter.

Exercise can lead to reperfusion injury (PEM). Each person has to adapt the exercises (I prefer the term "movement") to their abilities. Stay within your envelope. I stopped my daily breathing exercises to have time and energy to work on my neck problems. 

Healing requires blood flow/lymph flow. However, this causes reperfusion injury which can lead to PEM and or Pain. 

So how can we heal with the catch-22 of PEM?

1. We have to stay within our personal energy envelope. This might be different each day.

2. I like the 80% pacing rule. Do enough physical and mental movement daily to be "tired" enough to get good sleep, but leave 20% for the body to heal. Going near 100% might avoid a crash but it will not let the body heal. Going over 100% will lead to a crash (Boom-bust cycle).

3. Sleep and diet are key to recovery.

4. Monitoring data trends sleep quality, HRV, Step count, Heart rate, etc. can help tell you if you are on the right track. But listen to your body first and only pay attention to the data when it shows positive trends. Otherwise, ignore it. Even the best devices' data are too inaccurate to overrule what your body is telling you each moment. (I tried a muscle relaxant for a few weeks. I felt bad and the data was negative so I stopped taking it.)

5. Start small. Do one rep or three-second holds to start. Then slowly add reps and length of holds. I call this Pacing-dependent, micro-GET (TM) 😜. Normal GET can be dangerous for people with PEM, but the "micro" version that is led by the patient and staying inside the pacing "spoon allowance" is a way to slowly build strength, and energy, improve sleep, etc.

6. Self-compassion was key for my healing journey. I am only at about 70% now (Feb 2023), but I have come a long way. I am working, walking as much as 10,000 steps, doing some socializing (not much), etc... without overdoing it. My inner voice laughs at me when I start off an exercise routine with 1 to 3 reps: 

Inner voice: "Come on you weakling! Push yourself more! You bench pressed 100kgs when you were 15 years old! You ran a marathon in the mountains in your forties! Just a bit more!"

Me: Laughing outloud. "You have kept me in the boom-bust cycle too long! You don't understand ANS dysregulation, the physical dammage that is slow to heal, and PEM! I am finally pacing and getting stronger without crashing!" 

Am I crazy? Maybe, but I am slowly getting better. And each bit makes the next bit easier. 

 

General Tips:

1. I got the best results when doing these exercises twice a day. Sometimes only once a day.

2. I see the most benefits when doing it right before going to sleep. The difference in deep sleep amount and quality was huge! I still see a drop in sleep quality on the nights I do not do anything! 

3. Be mindful and completely evaluate your posture, pillow, sleeping comfort, posture while using a computer or mobile phone, speaking technique, emotional state, needed regular rest breaks, etc... To attack the problem holistically. Anything that will help your body relax, strengthen and heal.

4. Improvements in deep sleep are vital for all stages of healing.

5. If you are lucky enough to have a proper diagnosis for your problem (CCI, Chiarri, etc) from an expert, then listen to them. However, make sure to listen to your body. If they don't understand PEM, don't push yourself just because they said to. And don't believe them when they say it is all in your head.

6. Breathing is key. Coordinate each movement with your exhale. Follow your speed, not the speed of a trainer or video.

7. According to the Adam Fields videos, the "crunching" sound you hear in the neck (not acute pain) when rotating your head or doing occipital lifts is a good sign of blood flow getting to areas that don't get enough blood. Sounds good to me... movement and blood flow are good things.

8. Theoretically, Isometric exercises are "safe." You might feel tightness after some exercises that go away after 10 minutes. There should not be any sharp/Acute pain. And most of the tightness after the exercise should go away after a few minutes of massage with your hands and or a massage ball (roller) etc.

9, You are doing this to gain strength and improve mobility and blood flow. It is normal to notice an effect, but not pain.

10. Lastly, try to smile and relax while doing the exercises. Adam Fields always says "Healthcare is Selfcare" If you are tense while doing them it can be counterproductive. Listen to calming music in the background. Aim to think positive thoughts while doing the exercises to avoid anything negative that will cause tension.

My Routine:

For strengthening. I suggest starting slowly with the videos from this Physio:  

CERVICAL SPINE STABILIZATION 1: https://youtu.be/Ya9q-uN6y0A

CERVICAL SPINE STABILIZATION 2: https://youtu.be/Hjpcyx4rJ1Q 

My favorite videos that do both stretching and some stabilization/strengthening are from the DR Adam Fields' channel:

https://www.youtube.com/@dradamfields

He has a lot of videos/playlists for the neck, TMJ, throat, tinnitus, sinus, headaches, etc. It helps explore different regions and find specific exercises that work for you. There is some repetition and some unique exercises in each video.

This is one of my favorites to help with my neck:

Mewing:

The concept seems strange. It is deceptively simple and ... odd. I have only been "mewing" for about a month, but it is surprisingly helpful!

I don't do it as a "routine". I just try to be mindful of tongue position, and posture and I randomly do tongue strengthening & swallowing exercises throughout the day. It supposedly has lots of benefits for the face structure, etc... but I do it because it seems to help with tension in the throat, TMJ tension, etc.

Tongue position: https://youtu.be/eh9OqEd5z1k 

Swallowing exercises: https://youtu.be/gcI8CvoFxfQ 

There are other sources, but these have been the most helpful.

January 2024 update: I found these "easy" tongue exercises which are a fantastic addition to the Mewing routine.
Tongue circles: https://www.youtube.com/watch?v=B3dF5TDkgiY

Bonus Bits:

Scalp massage: 

During my research, I came across the concept of scalp massage to reverse balding. Maybe there was something to the whole story about Sampson losing his strength when he lost his hair🤣? 

I have incorporated this into my routines to attack the tension from different angles. It gets to the upper part of the head not covered in the other exercises. If it reverses balding, it will be a bonus! Some people get Botox on the scalp to help relax those muscles. This procedure is already used for TMJ. Maybe that would help some people with similar symptoms in Long Covid? 

A video interview about scalp tension massage/baldness connection:

https://www.youtube.com/watch?v=sZmRZRPtULI

Red-Light therapy/NIR:
I bought a small red-light therapy panel last October. The main goal was to avoid the winter slump. So far, it seems to have helped with that.

It also appears to help with the neck stiffness, killing off germs, "feeding" mitochondria to have more energy and it is shown to help with brain damage in preliminary Parkinson's trials. It appears to help my neck issues. And an extra bonus, some studies show benefits for balding!

Tips: Where eye protection, start slow (one minute per surface) and build up to 5 to 10 minutes per surface. Stay about 15 cm from the device. Stop when you start feeling inner warmth. Doing too much can be harmful. My sweet spot for the neck or back is about 7 or 8 minutes. The scalp seems to need only about 3 minutes. Doing too much is bad! Especially at the beginning! And the NIR light can destroy digital cameras! No selfies 😉!

Keep on Keeping on! One day at a time!

Comments and critiques are welcome! This second part is better in part due to comments from others!

How Long Covid symptoms might be caused by CCI or CCI-like damage: 

Take care of yourself, and if you can, someone else too! --Stephen Dubner