It’s not a coincidence that I write a website about stubborn pain problems: I have always had more than my fair share of them. While not cursed with the grinding, life-eroding pain of the serious chronic pain patient, I am peppered with a never-ending series of minor to moderate annoyances, perhaps due to bad genes, a sadistic poltergeist, or an excess of black bile.
Lately I have had a persistent, moderate and super annoying neck pain in the junction of my shoulder and neck — what I call the “sheck.” Despite everything I know, I have been unable to put a dent in this problem. It’s been growing for six months, and it has become really quite serious in the last few weeks (wherein by “serious” I mean “bad enough to ruin my mood on lots of days that would have been otherwise perfectly good days”). It is completely predictable. It always hurts when I tip my head forward or to the left. Without fail.
Except in the water.
I discovered this by accident. I was in the pool cooling off and floating and splashing exhaustedly around after a good hot soak in my sauna. (Heat eases the intensity of the pain reliably, but not much and not for long.) I sank to the bottom of the pool to drift meditatively for a minute while holding my breath, because I’m funny that way. I tested my neck movement experimentally and found it to be … completely painless.
I quickly experimented and confirmed: a simple dunking stops pain in its tracks (for as long as I can hold my breath). I repeated the experiment every day for several days, and it was the same every time. My neck pain disappears completely and instantly when I am underwater. It resumes within seconds after getting out of the water, so it does not seem to constitute a “treatment.” It does appear to be a completely reliable mechanism of relief. But the totality of the temporary relief is fascinating. I had discovered aquatic therapy.
If only I could hold my breath longer!
Your brain on water
This is just an educated guess, but I suspect that modern pain science has a pretty good explanation for this curious phenomenon: water feels safe, supportive and cushiony. Floating is directly and profoundly reassuring … and it goes right to my head (brain), and that has surprisingly potent pain-killing effects.
We know that “pain is an opinion” and that nothing hurts unless the brain believes there is danger. It probably doesn’t seem to you like pain and danger go together in lockstep, but that’s because it’s not strictly you that decides what’s dangerous — it’s your brain, acting quite independently of conscious you, and so there’s usually a puzzling disconnect between what we consciously think of a situation and the pain we actually experience. You may reckon a situation is “safe,” but your brain does no more than take that under advisement, and perhaps it does not even take you very seriously — it’s paying attention to many factors and inputs, and can easily overrule you.
Consciousness is really only a thin scum on top of the deep pond of the brain-mind.
Usually we experience that disconnect in a negative way: things are surprisingly painful. I think my pool experience is a rare, vivid, pleasant opposite example of my brain ruling in my favour: deciding that a situation is much safer than I thought. Certainly I think floating underwater is soothing, and I sought it out for that reason. But I would not normally expect a maddeningly persistent pain to vanish like a magician’s rabbit simply because I felt “soothed”!
My brain, however, apparently thinks that floating is the bomb. Floating seems to persuade my brain that my neck is totally safe. There may be something fairly primal at work. Floating is womb-like?
More questions than answers
Assuming my reasoning about this is sound, there are many interesting and unanswered clinical questions about this. Above all: is it therapy in some sense? Could there be any kind of lasting value to brief blasts of total relief? Could repeated exposure to this experience gradually persuade my brain that my neck is fine in or out of the water? Even if my brain remains committed to the pain outside of the water, could repeated demonstrations of painless neck prevent my brain from settling into permanent paranoia about my neck — that is, prevention of chronic pain? And if it did, isn’t prevention of chronic pain more or less equivalent with therapy in this context?
I can’t answer any of those questions confidently. I do know there’s certainly no harm in trying, and I’ll be seeking out that relief regularly!
If my neck pain finally goes away in the next few weeks, however, I already know how tempting and wrong it would be to attribute it to a water cure: pains like this are infamously erratic, and I’ve had many unpleasant and long-lasting neck cricks in the past that eventually went away for no clear reason. The clinical importance of the pool time is likely to remain unknown.
Better than nothing
As any pain patient knows, chronic pain lowers your standards. It makes you more open-minded. Sometimes much too open-minded: you’ll take anything, try anything. Even mostly ineffective treatments start to seem attractive, as long as they have any upside at all. This is why pain patients often cheerfully claim that they’ve got a therapist who is a “life saver” or a “miracle worker” even when their main problem is clearly anything but solved. They will heap praise on a chiropractor or massage therapist for producing even erratic, minor and fleeting benefits — because even those are a lot better than nothing, value that can be measured in cold hard cash eagerly spent from a shred of relief.
That’s how I’m feeling about the pool at the moment. It doesn’t really seem like a “treatment.” I’d be very cautious about recommending it as a pain-busting tip. And yet … I’ll certainly be doing it myself today.
And yet more data would be nice. It would be pleasant and informative to stay in this pain-relieving situation with the aid of a snorkel! I went shopping …
I was disappointed by my unfriendly neighbourhood gigantic sporting goods store with surly, clueless teenaged employees. They had snorkelling kits only, each one including flippers, goggles and about three kilograms of heavy plastic packaging — to protect them from what? Moisture? I could have overpaid for a crappy kid’s kit, or really overpaid for a decent one, and it occurred to me that they wouldn’t really do the job anyway: the relatively short barrel of a snorkel wouldn’t work very well with me sitting underwater and moving my neck around. Likely I’d just end up with a mouthful of water.
Then I got a storm in my brain: I decided to buy a piece of vinyl tubing at the hardware instead. $0.45 per foot! Perfect!
I chose a ¼-inch diameter, which proved to be too narrow. But it did at least provide me an odd tangent to a story that was already odd …
Breathing tube physics
Simply deep breathing while submerged to your chin is an easy way to challenge your respiratory musculature. Why you might want to exercise this way is another topic (addressed briefly below), but for now let’s just say it’s an interesting option, if a bit eccentric. And if you’re really a bit of an odd duck? The exercise challenge can be made more acute — with surprising physics on display — if you add a narrow breathing tube to the equation and sink just a little further into the water.
As I discovered, it’s super difficult to breathe through a narrow tube while submerged, and the hardship spikes impressively with every inch of depth. Even modest water pressure provides substantial resistance to inhalation. The weight of the water presses relentlessly inwards on every square inch of rib cage and belly.
The narrow diameter of the tube becomes the sole pressure outlet for the weight of all that water. Air whooshes out of your lungs and through the tube, unless you stop it. Put your tongue over the tube end, and you will notice a formidable suction. When you try to inhale through that tube, you have to first match the suction and then exceed it to get any air! It becomes well nigh impossible as you descend.
Water pressure resists expansion of the rib cage & abdomen uniformly on all sides — & therefore it resists diaphragm contraction. When all of that pressure can only escape through a narrow breathing tube, the effect is startling.
This pressure differential happens with a snorkel too, and snorkelling would be indeed good respiratory exercise in itself, but there are two differences that make all the difference:
- you’re floating horizontally and therefore much shallower
- the tube is a fairly large diameter
So both sides of the pressure equation are smaller, resulting in a much more modest force to overcome.
(Blazingly obvious, disclaimery safety warnings: I am not responsible for you being foolish in the water. Don’t do this alone. Don’t do this in deep water. Don’t use too long/wide a tube for too long.Why?Old friend, reader, and experienced diver Jason T. explains why you shouldn’t use too big a tube: “CO2 buildup in the breathing tube. Shallow breaths won't flush the tube of CO2, and you wind up pushing spent breath a bit backwards and a bit forwards. Your lungs get that burning feeling, you get dizzy and headachy, then you pass out from the reduced oxygen if you keep it up too long. With normal snorkels, it’s really hard to get to ‘too long.’ With long snorkels, the breaths must get deeper to sweep the CO2 from the tube, and because you chest is deeper, your breaths get shallower. Whoops. The good news is that this kinda takes care of itself: most people get tired and fed up with the effort and get out of the pool before hypoxia has a chance to set in.” Don’t keep going if you feel dizzy or nauseous. Don’t inhale water. Don’t chew gum while you’re doing this. Etc.)
A helmet full of body — ewwwwww!
The breathing tube physics described above were a matter of life and death in early diving suits — the old-timey kind with a big metal helmet and a long breathing tube to the surface. The same physics were at work, but at hyperbolic extremes, due to the depth.
The tube had to be pressurized from the surface to match the water pressure. If it wasn’t, something really horrible happened. Not only was the diver crushed, but — if the depth was great enough — he would literally be sucked into the helmet and tube, reduced to a paste of meat and bone chips. That’s the power of water pressure multiplied both by area and depth! Pressure math is spooky.
The MythBusters quite reasonably wondered if such a thing is really possible. It is. And they demonstrated it. See MythBusters: A Helmet Full of Body. Tip: don’t eat first. It’s one of the most disgusting tests they’ve ever performed.
Water yoga for the lungs?
So why do this weird thing? Well, there are people who actually need inspiratory muscle training (IMT), and good evidence that it works. But that’s mostly for people with a real medical problem to solve (i.e. chronic obstructive pulmonary disease).
I have no great interest in doing respiratory exercise for its own sake, but that’s just me (I have other exercise goals). Many people will do almost any kind of exercise it for its own sake, and will do this — water yoga for your lungs, basically — just to be the proud owner of a stronger diaphragm and a greater respiratory capacity. Good for you, if you’re keen on it. And, just possibly, a stronger diaphram might be a way of relieving strain on the other (accessory) muscles of respiration … which may be overused and irritable thanks to a chronic failure to breathe “properly” with the belly … which may in turn be a common source of neck and shoulder pain (see The Respiration Connection).
This setup clearly involves a much more sharply defined and obvious challenge, for those who want that.
What an odd, interesting little detour!
I’ll continue the neck pain story once I’ve had a chance to buy and mess around with a larger breathing tube.
See also: Get in the Pool for Pain: Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and injury rehab options
A (good news) update on my weird exploration of submersion therapy for a stubborn neck pain
To recap: first I discovered that submerging myself strangely provided complete relief — as long as I stayed down, anyway. Then, trying to stay submerged, I discovered that it’s actually very difficult to breathe through a narrow tube while submerged — an odd detour. Finally, I’m back on track with a bigger tube — about 1cm diameter, double the bore of the first tube — and I have an update.
I was not hopeful. Things have changed with my neck over the last couple weeks.
While I was taking my sweet time getting around to buying a bigger tube, I was also experimenting more with my neck movements. I nailed down exactly which movements cause pain. I can cause the pain with precision and total consistency: pull chin back, and tip chin down. That really hurts. Every. Single. Time. I will call it “the chin method” for the rest of this article.
No other movement hurts, except full neck flexion. The chin method hurts about twice as much as full neck flexion, and it doesn’t take much. The chin method is kind of brutal. I have to be careful with it.
With such hair-trigger sensitivity, I began to doubt that the weird pain-relieving effect of the water was going to be any match for the mighty chin method! It was just too much pain, too predictable and intense. Surely it would hurt above water and below? My earlier results must have been an illusion — perhaps being underwater had never really relieved the pain. Even though I had tested as carefully as I could the first time, something about being underwater must have simply limited my movements to the painless ones (as opposed to somehow making painful movements painless).
I could have tested this before getting a bigger breathing tube, but I decided to wait and do the best possible test.
Testing the chin method underwater
I was eager to do this test! I got in the pool as quick as I could. Standing neck deep in the water, breathing through the tube already, trying to make everything as much like the underwwater test as possible — everything but being underwater — I re-tested the chin method several times: tilt—ow! … tilt—ow! … tilt—ow! Yep, that sure does still hurt. And I felt more certain than ever that it would still hurt when I sank beneath the surface. It’s an easy movement to perform.
I sank beneath the surface.
I spent a little time getting comfortable with the slightly tricky tube breathing. The larger bore was certainly a big improvement — but it was still a bit of a struggle to draw breath. Air wants to leave, and you have to fight a little to keep it from leaving. It took a little practice to get breathing smoothly, but I more or less had it down after a couple minutes. It was finally time for the test.
I surfaced and re-checked the chin method one final time. Tilt—ow! Yep, all systems go.
I submerged my whole head, took three deep breaths, and tried it.
Tilt … nothing.
Tilt … nothing.
Tilt … nothing.
I tested this for several minutes and determined to my satisfaction that I am roughly 95% pain-free underwater. If I apply the chin method vigorously, I can just kinda barely sorta feel a ghostly echo of the pain. It barely counts.
Stranger yet, remarkably little submersion is required. Basically, the pain fades rapidly as the water level passes my shoulders, and the chin method is nearly painless by the time the water is at my ears. This suggests that the effect is unlikely to be mechanical and related to head flotation (because the head isn’t floating yet). It gives some more support to the notion that the effect is neurological: the water “reassures” my brain, and there is a pre-conscious certainty that I’m safe in the water.
I also had a reduction of pain for several minutes after emerging — the glimmerings of an actual therapeutic effect. It was too brief to get excited about. But it was certainly enough to inspire me to spend a fair amount of time underwater with Mr. Breathing Tube.
Fast forward several months …
A good-news-bad-news update on my “immersion therapy” experiment, several months later
This section is about the long term. What happened?
It seemed like my weird treatment worked. I had been suffering for about six months at that point, and it all came to an end over the course of a two-week period immediately following several daily sessions of “immersion therapy,” and the relief was lasting. So this is where I am supposed to recommend immersion therapy because “it worked for me.” Right?
I’ve got good news & bad news
I failed to follow-up because my pain went away and I stopped thinking about it. But then I was reminded to tell the end of the story when the pain came back — and I am in pain again now, as I write this. (Ow.) And even if I had remained pain-free, I certainly would not try to take credit for discovering a weirdly wonderful treatment for neck pain because:
- The discovery was an accident at best.
- I was actively self-treating in other ways and I simply don’t know which of them actually made the difference. It could have been any, all or none.
Like most people, even though I’d been in pain for months, I really hadn’t done all that much to help myself up to that point. Despite my substantial knowledge of neck pain and related topics, I had simply put up with it for at least four months. I finally started some self-treatment efforts a couple months before the immersion discovery. They were ineffective, but that’s hardly a surprise, because they were also half-hearted. In spite of the severity of my symptoms — and it really was quite bad — I was only trying the low-hanging fruit, the easiest options. But by the time I started with the water thing, I was also getting desperate and serious and trying other things.
And this is exactly what tends to happen, and it makes it really hard to figure out what gets credit for healing: people don’t get really serious about treatment until they feel desperate, and then they tend to start throwing a lot of resources and experiments at the problem all at once, which makes it awfully hard to tell what worked, or maybe the flurry of effort just coincides with natural recovery, which usually tends to happen right around the same time that you’re getting really frustrated and desperate. Or maybe it’s all of the above. I suspect “natural” recovery often happens a little more suddenly and decisively with a little desperate help — a facilitated coincidence.
So the problem went away for some reason, finally, right after the dunking therapy. And it stayed away for about three months. Which seemed like a great achievement at the time.
And then, about three months later in the fall, it came back. I’d enjoyed two or three months pain free, resisting the temptation to attribute it to the water, and then another episode began. I’ve had episodes of neck pain my whole adult life, generally getting worse over the years. They always come, they always go, and it’s never really clear why they come, or why they go. That’s why I call them episodes. And this one has now persisted for some time and become Officially the Most Miserable Body Pain I’ve Ever Had. I definitely hit an 8 on Allie Brosh’s hilarious pain scale:
No. 8 on the Brosh pain scale.
- I am experiencing a disturbing amount of pain. I might actually be dying. Please help.
Can neck pain be lethal? It feels like it. So that’s the bad news: whatever immersion therapy did or didn’t do last year, it definitely didn’t stick.
Immersion therapy fails!
The immersion method has had exactly no effect whatsoever on this episode of neck pain. Zip. Zero. Zilch.
I was hoping for at least a decent placebo effect thanks to a little unjustified optimism! But no such luck. Last year I experienced a dramatic effect with no expectations: it was a strange, cool surprise in the pool that I wasn’t even looking for. So this time I went into the pool all hopeful … and just ended up splashing around and dunking and breathing through a tube like an ninny. Even though my symptoms are similar, clearly something is different.
So far, only two approaches to this episode have “worked” temporarily:
- Getting thoroughly drunk worked great, and here’s the weird part: it didn’t work just for an evening, but actually knocked a multi-day hole in my symptoms. I felt almost completely better for much of a week. I cannot explain this. I am deeply annoyed by its mysteriousness.
- Massage. Muscle rubbing has been it’s usual self: amazingly effective, temporarily. I can always get some relief. And it always rapidly fades. Yay massage?
I won’t delve deeply and publicly into what is actually a current health crisis for me — it feels too personal, too complex. But I’m sharing it to emphasize that this is why I write about pain. I know all about it. Clearly I’m prone to this kind of suffering for some infernal reason.
And I’m sharing it to conclude that strange story about “immersion therapy,” which does have a meaningful lesson in it. At the time it seemed near miraculous, and it would have convinced a lot of health care professionals that they had discovered a new neck pain cure. Unfortunately, it’s actually hopelessly unclear what was really going on: “something interesting” was all I could really get out of it.
The happy ending
This was, without a doubt, my own toughest experience with chronic pain. But, not long after that final update, my pain finally simmered down and then disappeared, over the course of a couple weeks, and it has remained gone for many months until this update in late 2013. Although I was applying a complex stew of self-treatment options, mostly it seems like massage was the main source of relief in the end. I definitely cannot attribute my ultimate success to the submersion, but I can’t rule it out as a helpful contribution either.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.