Dear HEALTHbeat subscriber,

Neck pain is no stranger to many of us. Doctors estimate that seven out of 10 people will be troubled by neck pain at some point in their lives. For one in 20 sufferers, the discomfort can significantly limit the ability to work and play. This issue of HEALTHbeat explains why, surprisingly, movement may be the key to relieving neck pain. Also in this issue, Dr. Kenneth Arndt, member of the Harvard Health Letter editorial board, discusses why skin gets “pruney” when immersed in water.

Wishing you good health,


Nancy Ferrari
Managing Editor
Harvard Health Publications
HEALTHbeat@hms.harvard.edu

The study

Danish scientists at the National Research Center for the Working Environment in Copenhagen recruited women engaged in repetitive work, mostly at computer keyboards, at banks, post offices, administrative offices, and an industrial facility. All complained of neck pain lasting more than a month during the previous year. They were eligible for the study if physical examinations showed they had trapezius myalgia — chronic pain and tightness in the muscles that run down the back of the neck and fan out toward the shoulders.

Participants were divided randomly into three groups. One group received strength training focused on neck and shoulder muscles. The second group received general fitness training, which consisted of riding an exercise bike without holding onto the handlebars. The third group was given only health counseling. The two exercise groups worked out for 20 minutes three times a week for 10 weeks.

The women rated pain intensity in the trapezius muscles immediately before and immediately after each training session and two hours after each workout. The strength training group experienced a 75% decrease in pain, on average, during the intervention as well as during a 10-week follow-up period involving no workouts. General fitness training resulted in only a short-term decrease in pain that was too small to be considered clinically important, although the researchers did suggest that even a little reduction in pain severity could encourage people to give exercise a try. There was no improvement in the health counseling group.

This study isn’t the final word on relieving chronic neck pain. The number of participants (48) was small, and most of the women were under age 60. The results may not apply to women who are older or have conditions that limit their ability to strength train. Still, the findings suggest that performing specific muscle-strengthening exercises may be a helpful strategy for many women with chronic neck pain. (The researchers have investigated the effectiveness of each exercise with electromyography, which measures muscle-generated electrical activity. Results will be published in the journal Physical Therapy.)

The exercises

Strength training in the Danish study consisted of five exercises that involved the use of hand weights to strengthen neck and shoulder muscles. Three times a week (Mondays, Wednesdays, and Fridays), for 20 minutes per session, participants performed three of the five exercises, doing three sets of eight to 12 repetitions (each set lasting 25 to 35 seconds) for each exercise. The exercises changed from session to session but always included dumbbell shrugs. The weight load was gradually increased during the study, roughly doubling in 10 weeks.

This was an intensive program and study participants were carefully supervised. So before you embark on a similar regimen, consult a physical therapist or exercise specialist who can help design a program for your needs and make sure that you’re doing the exercises correctly. In the exercises pictured here, the starting weights in parentheses are those used in the study. For each exercise, you should start with a weight that allows a maximum of eight to 12 repetitions.

Dumbbell shrug Stand straight with your feet shoulder-width apart and your knees slightly bent. Hold a weight in each hand, and allow your arms to hang down at your sides, with your palms facing your body. Shrug your shoulders upward, contracting the upper trapezius muscle, hold for one count, and lower. Repeat eight to 12 times per set. (Starting weight: 17 to 26 pounds.)

One-arm row Stand with your left knee on a flat bench and your right foot on the floor. Hold a weight in your right hand. Bend your torso forward, placing your left hand on the bench for support. Allow the weighted hand to hang down toward the floor. Pull the weight up until your upper arm is parallel with your back, pause, and then lower it. Repeat eight to 12 times per set. Switch to the left side, and repeat. (Starting weight: 13 to 22 pounds.)

Upright row Stand straight with your feet shoulder-width apart. Hold the weights down in front of your thighs, with your palms facing your body. Slowly bring the weights straight up, as if you were zipping up a jacket. Slowly lower the weights to their original position. Repeat eight to 12 times per set. (Starting weight: 4 to 11 pounds.)

Reverse fly Lie on a bench at a 45-degree angle. Hold a weight in each hand and allow your arms to extend down toward the floor. Keeping your elbows slightly bent, lift the weights up and out to the side to about shoulder level. Slowly lower the weights. Repeat eight to 12 times per set. (Starting weight: 2 to 6 pounds.)

Lateral raise Stand straight with your feet shoulder-width apart and your knees slightly bent. Lift your arms up to the sides until they are parallel with the floor. Your elbows should be slightly bent. Slowly lower your arms. Repeat eight to 12 times per set. (Starting weight: 4 to 9 pounds.)

For more information on strength training, order our Special Health Report, Strength and Power Training, at www.health.harvard.edu/SPT.

Q:  Why do our hands and feet wrinkle up when immersed in water? Your article about moisturizers said they work by trapping water in the skin, so why don’t we wrinkle up after applying moisturizer?

A.The top layer of our skin, the stratum corneum, is like a sponge that absorbs water when it’s immersed. And when it’s filled with water, it expands and gets softer and more pliable. And, as you’ve noted, only the undersides of the hands and the feet prune up, especially the fingertips and the toes. That’s because the stratum corneum is thick there.

Some people think that the wrinkles occur because of osmosis — water flowing out from the skin into a less “salty” environment. This mistakenly suggests that the wrinkles from the bath are like the tiny depressions and folds of dry skin. In reality, bathtub wrinkles are raised areas of skin puffed up by water absorption. One explanation that’s been offered for pruney skin is that the absorbed water affects nerves, which leads to constricted blood vessels that pull the skin downward, creating furrows.

Exposing your skin to water will dry it out because the water absorbed by the stratum corneum tends to evaporate out of it relatively quickly. And your skin will become drier and drier after each cycle of getting wet and drying out again. But it would stay soft and hydrated if you were to wear something — say, a rubber glove — that blocks evaporation.

In fact, most moisturizers work in just that way. They have occlusive ingredients that keep water from evaporating from your skin. And you don’t prune up, even with a water-based moisturizer, because there isn’t enough water there to make the skin swell up and fold: there’s just enough to temporarily soften and smooth out the skin.

— Kenneth A. Arndt, M.D.
SkinCare Physicians, Chestnut Hill, MA

This Question and Answer first appeared in the May 2008 Harvard Health Letter, available at www.health.harvard.edu/health.

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