Could It Be More Than A “Crick” In The Neck?

Posted on May 22, 2007 and filed under Neck and Back

Peggy is a 50-year-old active female who is in relatively good shape. She exercises regularly, isn’t overweight and eats right. But one day while replacing an overhead light bulb, a sharp pain shot through the left side of Peggy’s neck. But the pain didn’t last long, so Peggy wasn’t overly concerned. Within a few hours, however, the pain was back. And this time it was worse than before. Peggy felt her neck muscles cramp, stiffen and tighten. Peggy got on the phone right away with her doctor and scheduled an appointment. At the clinic, Peggy’s doctor revealed that she had a classic case of “cervical pain”. He added that, no, she did not require surgery – the good news was that neck pain such as this responds well to physical therapy. Her doctor then referred her to our clinic. Peggy wanted to know more about “cervical pain”.

What is Cervical Pain?

The cervical spine is located in your neck and supports your head. This structure is both complex and extremely mobile at the same time. It supports a head which weighs as much as a large bowling ball (15lbs. or more) and allows freedom of movement (90 degrees or more) in each direction. The cervical spine includes…

• Seven small bones (called vertebrae),
• Discs between the vertebrae which provide cushioning,
• Several joints which provide stability and mobility,
• Eight nerve roots which send signals to the brain, shoulders, arms and chest,
• Arteries and veins which carry blood to and from the heart,
• More than 30 muscles,
• Tendons and ligaments which create strength in the structure,
• And finally, the spinal cord itself. Because of this amazing complexity, the cervical spine is prone to both pain and injury. In our clinic, we see many different causes for neck pain.

Here are the top ones we see:

Injury and Accidents

If you’ve ever seen someone in a neck brace (cervical collar), many times it’s the result of an injury called “whiplash”. A genuine injury, whiplash normally occurs as the result of auto accidents. Here’s how: Whiplash injury occurs when the head moves either backwards or forwards in a traumatic and violent fashion. When the head is pushed beyond its normal range of motion in this way, the muscles and ligaments in the neck are overstretched and strained, resulting in
“micro-tears”, stiffness and pain.

The Aging Process

Age-associated disorders can also cause neck pain. Some of these include:

• Osteoarthritis – This is a gradual deterioration of joint cartilage. Normally seen in the hands and feet, osteoarthritis can also occur in the neck, causing pain and loss of mobility.
• Spinal Stenosis – Pinched and trapped nerve roots. Stenosis occurs when the “foramen” (small openings for nerves) are squeezed. This “pinching” can cause neck, shoulder and arm pain. Numbness can also be a symptom of stenosis.
• Degenerative Disc Disease (DDD) – DDD occurs when the discs between the bones of the neck (vertebrae) lose water, cushioning and elasticity, resulting in a “drying out” or shrinking of the discs. This can cause severe pain and loss of movement. In the extreme, discs can even bulge or burst. You can imagine how painful this is! Tingling and numbness also result from herniated or bulging discs.

Everyday Wear and Tear

Everyday wear and tear can also cause neck pain. Some of the factors which cause wear and tear on the neck include:

• Stress – causes the neck muscles to become stiff and rigid, which results in pain, numbness and tingling.
• Lack of exercise and /or obesity – Obesity is a contributing factor to many bone and skeletal related disorders. It should be no surprise that obesity and lack of exercise is a factor in neck pain, too. Why? Because excessive weight of the arms, chest and shoulders increases strain on the neck.
• Poor posture – Improper posture changes the normal curvature of the spine, which can result in neck pain.

Trauma

I discussed whiplash a moment ago. Other types of trauma can also cause neck pain, too. Falls, skiing accidents and diving accidents can cause serious neck trauma. These types of accidents result in pain due to compression of the spinal cord itself or fractures of the vertebrae. Tumors and infections of the spine can also cause neck pain. If your pain is excessive or is ongoing, be sure to see your doctor.

Diagnosis

Remember: Pain is your body’s signal that something is wrong . So if you have any type of pain (including neck pain) the first step is always to get it checked out. When you do see your doctor, he or she will take a look at your medical history and probe with questions such as:

1.  “What prompted the pain?”
2. “How long have you experienced this pain?”
3. “Is the pain localized in one area…or does it extend into other areas of the body?”
4. “What makes the pain worse?”

Then your doctor will evaluate your posture, your neck’s range of motion and your overall physical state. If a particular movement does cause pain, it’s recorded. During the exam, your doctor may also feel the curvature of your spine, neck and look for muscle spasms. He or she may also conduct a neurological exam which may include testing your reflexes, pain severity tests, motor ability and muscle strength evaluations. Sometimes, X-Rays can be helpful. They can reveal underlying issues such as the presence of bone spurs, fractures, the constriction of space between vertebrae (Stenosis), and other physical abnormalities, such as osteoarthritis. To see“inside” your body and view soft tissue, and MRI (Magnetic Resonance Imaging) may also be ordered. MRI”s are used to detect the presence of herniated or bulged discs. Other more specialized neurological tests may also be performed.

Treatment

While all that may seem complex, the good news is that neck strain responds to conservative treatment. That means surgery is not normally needed and more conservative treatments can reverse and/or eliminate neck pain.

This is where physical therapy comes in. One of the biggest advantages is that physical therapy is a proven way to treat neck pain without surgery. Your physical therapist can relieve pressure and control muscle spasms, decreasing the pain you experience. He or she may also employ the following treatments:

1. Cervical Collars – Cervical collars reduce the pressure on the neck and restrict the neck’s movement, providing relief. Typically, we’ll use cervical collars only in the initial stages of recovery.
2. Traction – Traction creates a subtle pulling motion. This stretches the neck muscles and decompresses pinched discs and nerves by increasing the openings (foramen), resulting in decreased pain.
3. NSAID’s – This stands for “non-steroidal, anti-inflammatory” drugs. These drugs provide relief by reducing inflammation. Also, muscle relaxants and other painkillers may be prescribed.
4. General Physical Therapy – Heat, cold, ultrasound and massage help to soothe and relax sore muscles. This, in turn, can reduce the pain and inflammation, leading to pain reduction. Your physical therapist may also educate you on relaxation, proper body mechanics and teach you exercises to build your neck strength.
   Surgery

Unfortunately, in some rare cases, surgery is ultimately needed. This is true if a patient’s pain does not respond to more conservative treatments such as physical therapy, if the pain is experienced for a long period of time or if the neck is exceedingly weak. Surgery, however, is always the last resort. Also, advanced spinal stenosis, a fractured vertebrae or a ruptured vertebral disc are some situations where surgery may be the best course of treatment. As I said a moment ago, the vast majority of patients with neck pain do NOT require surgery. More conservative treatments such as physical therapy must first be exhausted before a patient moves onto neck surgery.

Recovery

To correct neck pain, two factors must be present: professional medical attention and time. With that in mind, it’s best to focus on preventing neck pain before it strikes. As the old saying goes, “An ounce of prevention is worth a pound of cure”. Strive to protect your neck by exercising regularly, stretching properly, maintaining good posture and losing weight. And if you do experience neck pain, be sure to call your physical therapist or doctor right away.