Neck Pain

Neck pain is common in people of all ages and is usually caused by how we use our necks. Neck pain can be acute (occuring immediately as a result of an injury) or chronic (occurring gradually over a period of time) and has a profound effect on quality of life.

 

In surveys, 25 % of women and 20 % of men report neck pain in an apparently healthy population. In the UK, 15 % of hospital-based physiotherapy referrals are for neck pain. An acute attack usually settles within days or weeks, but at long-term follow-up, 58 % of patients who suffer an attack still have pain in the neck at 1 year.

 

Anatomy of the Neck

 

The cervical spine is made up of 7 vertebrae. The first 2, C1 and C2, are highly specialized and are given unique names: atlas and axis, respectively. C3-C7 are more classic vertebrae, having a body, pedicles, laminae, spinous processes, and facet joints.

 

C1 and C2 form a unique set of joints that provide a great degree of mobility for the skull. C1 serves as a ring or washer that the skull rests upon and articulates in a pivot joint with the dens or odontoid process of C2. Approximately 50% of flexion extension of the neck happens between the occiput and C1; 50% of the rotation of the neck happens between C1 and C2.

 

The cervical spine is much more mobile than the thoracic or lumbar regions of the spine. Unlike the other parts of the spine, the cervical spine has transverse foramina in each vertebra for the vertebral arteries that supply blood to the brain.

 

Intervertebral discs are located between the vertebral bodies of C2-C7. They serve as force dissipators, transmitting compressive loads throughout a range of motion. The discs are thicker anteriorly and therefore contribute to normal cervical lordosis. The intervertebral discs are involved in cervical spine motion, stability, and weight-bearing. Interverebral discs in the neck are vulnerable to injury by rotation force.

 

Causes of Neck Pain

 

Neck pain can result from a variety of causes, including:

 

  • Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
  • Worn joints. Just like all the other joints in your body, your neck joints tend to undergo wear and tear with age, which can cause osteoarthritis in your neck.
  • Nerve compression. Herniated disks or bone spurs in the vertebrae of your neck can take up too much space and press on the nerves branching out from the spinal cord.
  • Injuries. Rear-end auto collisions often result in whiplash injuries, which occur when the head is jerked backward and then forward, stretching the soft tissues of the neck beyond their limits.
  • Diseases. Neck pain can sometimes be caused by diseases, such as rheumatoid arthritis, meningitis or cancer.

 

Work Related Neck Pain

 

The spine is not suited to sitting in front of a computer or behind the wheel of a car for long periods. Poor posture plus lack of muscle strength and sitting for long periods in one position will result in muscle spasm and pain. Stiffness may occur as the muscle fibres become inflamed and stick together or there is local swelling. Awkward movements and bad posture cause musculoskeletal disorders which affect the full length of the spine, from the neck to lower back, as well as the shoulders, arms and fingers.

 

Investigations for Neck Pain

 

In some cases, your chiropractor may refer for imaging tests to identify and direct management of neck pain. The most common imaging tests for neck pain are:

 

X-rays. X-rays can reveal areas in your neck where your nerves or spinal cord may be pinched by bone spurs or a bulging disk.

Computerized tomography (CT) scan. CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.

Magnetic resonance imaging (MRI). MRIs utilize radio waves and a strong magnetic field to create especially detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.

Many people with neck pain have X-ray or MRI evidence of structural problems in their neck without experiencing any symptoms. Your chiropractor will correlate symptoms with imaging tests to direct treatment.

 

If your chiropractor suspects that your neck pain may be related to a pinched nerve, a referral for electromyography (EMG) can be made. This test involves inserting very fine needles through your skin into a muscle to determine whether specific nerves are functioning properly. Blood tests can sometimes provide evidence of inflammatory or infectious conditions that may be causing your neck pain.

 

Serious Symptoms with Neck Pain

 

Danger signs (or “red flags”) for neck pain include fever or night sweats, unexpected weight loss, a history of arthritis, cancer or serious infections (such as TB or HIV), immuno-suppression or drug dependency; also the severity of the pain, pain keeping you awake all night, swelling of glands and local tenderness of one of the bones of the neck.

 

Signs suggestive of a myelopathy include problems with walking or difficulty in using the hands and, if you have had osteoporosis or a previous neck operation, see your GP right away. Occasionally, older people get “drop attacks”, especially when moving the neck, which suggest vascular disease.

 

References

 

1. Binder Al: Cervical Pain Syndromes in Oxford Textbook of Rheumatology, 3rd Edition, Oxford, Oxford Medical Publications 2004; pp 1185-1195

 

2. Aker PD et al: Conservative Management of mechanical Neck Pain: Systematic Overview and Meta-analysis, BMJ 1996; 313:1291-1296

 

3. Waling K et al: Effects of Training on Female Trapezius Myalgia: An Intervention Study with a 3-year follow-up Period Spine 2002; 27:789-796

 

4. Bronfort G et al: Efficacy of spinal Manipulation and Mobilization for low Back Pain and Neck Pain: A systematic Review and best Evidence Synthesis Spine J 2004;4:335-356

 

5. Philadelphia Panel. Evidence-based clinical Practice Guidelines on selected Rehabilitation Interventions for Neck Pain Phys Ther 2001;81:1701-1717