Neck Pain

by Dr. Sanjay Patil

Neck is one of the most flexible regions of the spine, which consists of vertebrae, seven shock-absorbing discs, muscles, and vertebral ligaments to hold them in place. The uppermost cervical disc connects the top of the spinal column to the base of the skull. The spinal cord, which sends nerve impulses to every part of the body, runs through a canal in the cervical vertebrae and continues all the way down the spine.

What causes neck pain?

Most people experience neck pain at some point in their lives. Neck pain can be acute, lasting for few hours or a few weeks, or it can be chronic. Neck pain that lasts several weeks or longer is considered chronic neck pain. Neck pain can be caused by an activity or injury or by a medical condition

Your head and neck region is vulnerable to many different stresses. Bad posture can cause misalignment of your neck, head, and spine. Car accident can cause whiplash. Age and wear and tear can cause arthritis. Even activities such as chewing gum and reading in bed can cause pain. How do we avoid these potential problems? And if we cant avoid them, how can we recover as quickly as possible?

CAUSES

Neck pain can result from a variety of causes, ranging from overuse injuries and whiplash to diseases such as rheumatoid arthritis and meningitis.

Muscle strains

Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. 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 experience wear and tear with age, which can cause osteoarthritis in your neck.

Nerve compression

A variety of problems in your neck’s vertebrae can reduce the amount of space available for nerves to branch out from the spinal cord. Examples include:

• Stiffened disks – As you age, the cushioning disks between your vertebrae become dry and stiff, narrowing the spaces in your spinal column where the nerves exit.
• Herniated disks – This occurs when the inner gel-like material of a disk protrudes through the disk’s tougher outer covering. The protrusion can press on nerves exiting the spinal column, causing arm pain or weakness, or on the spinal cord itself.
• Bone spurs – Arthritic joints in your neck can develop bony growths that may press on nerves

Injuries



Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and then backward, stretching the soft tissues of the neck beyond their limits.

Diseases

Neck pain can sometimes be caused by diseases, such as:


• Rheumatoid arthritis – After the joints in the hands and the feet, the joints in the neck are the next most commonly affected by rheumatoid arthritis.
• Meningitis – This infectious disease causes the lining of the brain and spinal cord to swell. One of the most common symptoms of meningitis is neck pain and stiffness.
• Cancer. – Rarely, neck pain can be caused by cancerous tumors in the spine. The cancer may have traveled to the spine from other parts of your body.

Non-specific neck pain



Many people develop a stiff and painful neck for no obvious reason. It may happen after a minor twisting injury, for example while gardening. Since the underlying cause for this type of neck pain is not fully understood hence it is called ‘non-specific neck pain’. Having nonspecific neck pain does not mean that your neck is damaged. Often it happens in people whose necks would appear completely normal under an x-ray. It is the most common type of neck pain and disappears after a few days

Activities that cause neck pain

Neck pain mostly is caused by activities that result in repeated or prolonged movements of the neck’s muscles, ligaments, bones, or joints This can result in a strain (an overstretched or overused muscle), a sprain (injury to a ligament), a spasm of the neck muscles, or inflammation of the neck joints.


• Holding your head in a forward or odd position for long periods of time while working, reading, watching TV, or talking on the telephone.
• Sleeping on a pillow that is too high or too flat or doesn’t adequately support your head, or sleeping on your stomach with your neck twisted or bent.
• Spending long periods of time resting your forehead on your upright fist or arm.
• Work that uses the upper body and arms, such as painting a ceiling or other overhead work.


Neck Pain – Medical conditions that cause neck pain

Neck pain may be caused by or related to medical conditions such as:

• Cervical Spinal Stenosis
• Cervical Spondylosis
• Illnesses, such as meningitis, which cause inflammation around the tissues of the brain and spinal cord.
• Chronic conditions such as fibromyalgia, rheumatoid arthritis, or ankylosing spondylitis
• Torticollis (wryneck): Torticollis is caused by severe muscle tightness or a shortened muscle on one side o the neck, causing the head to be tilted to one side.
• Referred pain Referred pain occurs when a problem in one place in the body causes pain in another place. For example, a problem with your jaw or your heart can cause neck pain
• Infection or a tumor in the neck area.

HOW IS NECK PAIN DIAGNOSED?

In diagnosing the cause of neck pain, it is important to review the history of the symptoms. In reviewing the history, the doctor will note the location, intensity, duration, and radiation of the pain. Any past injury to the neck and past treatments are noted. Aggravating and/or relieving positions or motions are also recorded. The neck is examined at rest and in motion. Tenderness is detected during palpation of the neck. An examination of the nervous system is performed to determine whether or not nerve involvement is present.

Further testing of undiagnosed neck pain can include X-ray evaluation, CAT scan, bone s c a n , M R I s c a n , myelogram, and electrical tests such aselectromyography (EMG) and nerve conduction velocity test (NCV).

WHAT IS THE TREATMENT FOR NECK PAIN? WHAT ARE HOME REMEDIES FOR NECK PAIN?

The treatment of neck pain depends on its precise cause. Treatment options include rest, heat or cold applications, traction, soft collar traction, physical therapy (ultrasound, massage, manipulation), local injections of cortisone or anesthetics, topical anesthetic creams, topical pain patches, muscle relaxants, analgesics, and surgical procedures. Home remedies for treatment, such as Jacuzzi treatment, neck pain relief exercises and stretches, and neck pain relief products such as neck pillows for sleep and hot pads can be very beneficial for relief of some forms of neck pain. There are many treatment options, depending on the particular neck problem and past treatment experiences. Alternative treatments that have been used for chronic neck pain include acupuncture

Conservative therapy

The primary aim of the cervical spine and associated musculature is to support the head while providing a conduit for the nervous system. The forces acting on the cervical spine are therefore smaller in comparison to the forces acting on the lower lumber spine.

It is important to remember that cervical spine is vulnerable to muscular tension forces excessive motion and postural fatigue and therefore all conservative modalities focus to reduce these causative factors.

The commonest regimen is rest, ice, massage and non-steroidal anti-inflammatory drugs. The position of the neck for comfort is essential for the relief of pain. For example patients with hyperextension injuries will feel comfortable with a flexion attitude.

Postural aspects of neck pain can be treated easily after discussing the details of work environment, personal habits etc. A computer operator will get neck pain if the monitor in front of him is at such a height that he has to keep his neck extended all the time. Many tailors and weavers are prone to neck pain because they work with their neck flexed all the time. Sleeping prone can cause neck sprains easily because one has to keep the head and neck tilted so that the nose is not obstructed.

Cervical traction is helpful in certain patients. Traction has to be applied in the position of maximum comfort and should never be continued if it increases pain. The weights should not exceed 10 pounds.

Cervical collar

A collar is most useful in a patient who is very active. Collars help because they limit excessive motion. They should be tailored to the most comfortable neck position.

Counseling for reducing stress

Neck pain is very commonly seen in patients who are involved in stressful jobs and an effort should be made to reduce the stress by suggesting various relaxation techniques.

Neck and Shoulder exercises

Exercises are most beneficial when started after the acute pain has subsided. Isometric exercises are helpful in acute phase.

I have shown some simple exercises for the shoulder and the neck. All these exercise can be done even at your place of work and they do not need any special equipment.

I recommend 2 sets of twenty minutes any time during the day.

Transcutaneous Electrical Nerve Stimulation (TENS)

This is a useful modality especially for chronic pain. A TENS machine is supplies electrical shocks of low intensity via electrodes applied to the affected area. Patient experiences these shocks as a tingling sensation. A TENSmachine is portable and is similar to a pager in size. This works on what is known as a “gait control theory” at the brain level. In simple terms by supplying continuous tingling sensation the pain fibers at the brain level are blocked so much so that patient no longer feels the pain. TENS obviously does not treat the underlying pathology.

Role of surgery

Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication, and physical therapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disk or bony narrowing of the spinal canal. Surgery may also be required

Following an injury, to stabilize the neck and minimize the possibility of paralysis such as when a fracture results in instability of the neck.

Tips To Avoid A sore Neck

• Good Posture
• Avoid Sleeping On Your Tummy
• Do Not Read in Bed
• Routine Neck Exercises
• lRead/Watch TV/ Use Computer at Eye Level
• Do Not Use A Very Thick Pillow
Most neck pain is associated with poor posture on top of age-related wear and tear. To help prevent neck pain, keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help. Consider trying to:
• Take frequent breaks
  if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
• Adjust your desk, chair and computer
  so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair’s armrests.
• Avoid tucking the phone
  between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
• Stretch frequently
  if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
• lBalance your base.
  Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
• Avoid sleeping on your stomach.
  This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.


Neck flexion


This is the movement of bringing the head forward so that the chin hits the chest and your face is staring straight down at the floor. Do slowly five times.
This exersize stretches the structures at the back of the cervical spine, which are often kept in a tight position in normal day to day postures. They can then become shortened and stop the neck moving naturally.
To make this more difficult you can retract the neck slightly to start with (see below) and then flex the head forward, increasing the stretch on the neck.

Neck extension


This is the movement of allowing the head to go back until the face is looking directly at the ceiling. Don’t do this movement fast or forcefully as it forces all the small joints at the back of the neck into an extreme position. This Avoid tucking the Mission 16 Arthritis India won’t do them any harm but might increase your pain. Allow your neck to ease back steadily as you do this, leaving your neck at the end of the movement for a few seconds.
NB If you feel dizzy when you do this leave it out. Dizziness, especially if you are older, might indicate that the blood vessels in your neck are being squeezed by the position.

Rotation
Turn your head slowly round to one side until it cannot easily go any further. Once you have done five to one side do the other. Do not go from one side to the other in the individual movements or roll your neck about.
Hold your neck at the end of the movement for a few seconds as this is the most valuable part of the movement to maintain or increase your movement.
NB If you feel dizzy when you do this leave it out. Dizziness, especially if you are older, might indicate that the blood vessels in your neck are being squeezed by the position.

Side flexions


Keep your head facing straight forward and try and tip your ear down towards the same shoulder. It’s difficult to do this well and without rotating to one side. She’s doing pretty well in the picture, just lifting her chin up a little more than ideal.
This movement is quite severe on the neck joints so don’t go hard at the exercise. Don’t move from side to side in the movement as that stops you getting to the ends of the neck range and may aggravate your joints.

Neck Retraction (Chicken Tuck)


This is one of the most useful neck movements as it counteracts the tendency we all have of allowing our heads to poke forwards in a poor posture. She’s showing the extreme position of “poking chin” here.
When we sit, which many of us do a lot of the time, we tend to slump and to keep our heads up so our eyes are horizontal we arch our necks backwards slightly This gives a continual flexion (bending) posture to the lower neck and an extension (arching) posture to the upper neck. Over time the tissues can shorten and give us stiffness and pain. Typical pains are in the neck, upper shoulders, but this posture can also give you headaches.

Here’s the end point of the movement. Keep your face straight on during the whole movement, drawing the head back and the chin down slightly.
If you get it right, you will look funny, rather like a sergeant-majorinan exaggerated military neck posture. If you do it in public people will either laugh or give you funny looks! The whole movement is like the forward and back movement that chickens make. Hold the movement at the extreme of the backward posture for a few seconds.

Upper Neck Nodding


This movement particularly moves the upper cervical joints. In our bad postural habits we tend to poke our chins forward which puts our upper neck joints into extension (arching).
The nodding movement flexes these joints Mission Arthritis India 17 and can help with upper neck pain and headaches of joint origin. This is the neutral starting position for the movement.
Lying flat on your back for this movement is the easiest way to start this movement. You can be flat on the surface like she is in the picture or have a pillow if you don’t like your head down flat on a surface.

This is the end position of the exercise. Think of your head as a bowling ball which you rotate forward to rock the neck. You should not lift the head off the surface at all. You may feel a pull in the upper neck which is often tight.
This exercise should be done with caution as you could increase your pain if you push it too hard. When you get good at the movement you can do it standing up or sitting but it is harder to get the pure joint movement than in lying down.

Related movements which may be useful
When we have neck problems it is rarely just the neck which is the problem, the pain usually involves the thoracic spine and the shoulder girdle. It is good to do shoulder girdle exercises as well to loosen up this area.
1. Shoulder shrugs Shrug your shoulders as far up as you easily can then downwards further than normal.
2. Shoulder bracing (retraction) Bring your shoulders to the front as if you are trying to get them to meet at the middle then brace them right back, pulling your shoulder blades together. Make it a large, slow, repeated movement.