Did you know neck pain is the fourth leading cause of years lost to disability globally after back pain, depression and general joint pain! The prevalence seems to be higher in females, peaks in middle age and can be associated with headaches. Factors that may contribute to neck pain are include trauma to the neck i.e. whiplash or certain sporting activities or work activities.
Neck pain can be regarded as non-specific in the absence of any changes on x-ray. Interestingly, the research shows that degenerative changes in neck seen on x-ray do not always correlate with the clinical presentation of neck pain. It is well documented that degenerative changes begin at a young age (most people in their early 20s). What this means for Joe Bloggs is that degenerative changes are normal for the majority of people and are unlikely to be the source of neck pain in a lot of people and an x-ray is only part of confirming the known diagnosis or ruling out anything more sinister.
There are several diagnosis for neck pain which are known as “syndromes” as the definitive source of the pain is not exactly known.
Wry neck – this is characterised by a sudden onset of sharp neck pain, limited movement and muscle spasm. It usually occurs either after a sudden quick movement or on waking. Prior to the onset of pain there may have been unusual movements or prolonged abnormal postures. There can be two sources to this pain – either joint or disc. If it is the joint that is the source of pain – patients who are usually teenagers/young adults would report a sudden movement causing a sharp pain and their range of movement in the neck is considerably reduced. They would have a lot of muscle spasm in the neck region and they may find it comfortable to hold their head to one side to relieve the pain. If a disc in the neck is the source of pain patients tend to report a more gradual onset of symptoms with the most common cause being after waking from sleeping in an abnormal posture or even sitting in an awkward position for a prolonged period of time. It is more common in the older age group with pain radiating into the shoulder blade region.
Acceleration deceleration injury – is very simply caused by a sudden or abrupt change of direction of the head on the neck. It is commonly seen in clinical practice and can occur in daily life from a fall, playing sport or in a motor vehicle accident. The symptoms seen with this type of injury usually include neck pain, reduced range of movement and possibly a headache and may not be felt immediately post injury but can take a 48hours to manifest fully.
Acute nerve root pain – is probably one of the more irritable (grumpy) conditions seen in the neck. Patients usually report neck pain with arm pain or pins and needles/numbness or combination of all of the above. In some cases, the arm pain maybe worse than the neck or neck pain may not even be present. Patients will report that they feel the pain is travelling back up the arm to the neck but it is actually the opposite that is happening. Symptoms can be made worse by compressing the structures in the neck on the side of the symptoms i.e. tilting or rotating head to the side. The symptoms are usually caused by reduction in the space where the nerve root exits the neck to travel down the arm into the hand. This can be caused by the joint, disc, degenerative changes or inflammation.
The three types of neck pain outlined above are probably the most common treated by your Chartered Physiotherapist. There are many different treatment options which is usually good as the neck patient usually presents with a complex set of physical findings. There are lots you can do to help relieve symptoms before seeing your Chartered Physiotherapist.
- Heat i.e. heatpack or hot water bottle can be applied to the area to relieve muscle spasm. Just be mindful of putting a barrier between the skin and the heat.
- Addressing and modifying posture is usually a good place to start as this maybe a contributing factor to the current episode of pain or maybe adaptive due to the pain. This is as easy as checking how you are sitting in the workplace or in the car. Try to be more upright and reduce sloppy slouching postures. This will relieve the tension on the muscles around the neck/shoulder region.
- Gentle stretching and range of movement exercises can reduce pain and prevent the loss of range of movement secondary to neck pain. Even just moving the neck within a comfortable range is a good start.
- Taping can be very helpful to provide proprioceptive feedback and help reduce the pain signals initially. This can be applied by your Chartered Physiotherapist.
- Soft tissue techniques and joint mobilisations to reduce any muscle or joint stiffness is essential before commencing an exercise program.
- Acupuncture, dry needling and TENS can be really good adjuncts to managing pain.
- An exercise program to assist with lengthening shortened muscles and strengthening of weak muscles will be appropriate for most neck pain patients as these muscle imbalances maybe longstanding and a contributing factor to the pain.