Monthly Topics

Cervical Problems Can Be a Pain in the Neck
By Karen W. Smith, PT

The neck is an extremely complex and mobile structure that allows many degrees of movement in order to allow us to view our environment from a multitude of angles.  Therefore, when we have neck pain, it severely limits our interaction with our surroundings.  Problems with the neck can present in various ways from discomfort in the neck region to symptoms in the hands, wrists, elbows and shoulders including pain and/or numbness and tingling.  Thousands of Americans suffer from episodes of acute or persistent neck pain each year because of injury, strain, overuse or aging.  However, a pain in the neck should not be ignored and left undiagnosed and untreated.  Problems in the cervical spine, the first seven bones (vertebrae) in the neck running from the base of the brain to just past the shoulder blades, require assessment and treatment to prevent further, more permanent, damage. To better understand the symptoms, we first look at the anatomy that makes up the cervical spine, or neck region.

 

ANATOMY

The cervical spine is made up of bony structures called vertebrae (pink), spongy discs (blue) that lie between each vertebra, nerves (yellow) that exit at each vertebral level and travel the length of the arm and soft tissue including joint capsules, ligaments, muscles and tendons.  These structures support the neck and head to allow freedom of movement but at the same time protect the openings at each level to allow the nerves to exit without impedance.  This is crucial, as nerves supply impulses to muscles that are necessary to enable us to move our arm as well as to provide sensation to the skin.

COMMON CAUSES OF NECK PAIN

Injury or Accidents:  A common injury is whiplash resulting from being hit from behind in a motor vehicle accident.  This force throws the head backward and then forward rapidly, resulting in muscles and ligaments responding by tightening and consequently straining and stretching pain-sensitive tissue.

Old Age:  Growing older can result in degenerative changes in the vertebrae and consequently the surrounding tissue can become irritated and shortened.  Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease are known to affect the spine.  Osteoarthritis is a common joint disorder causing progressive deterioration of cartilage.  The body reacts by forming new bone termed osteophytes, or bone spurs that impact joint motion and can cause pain.  Spinal stenosis causes narrowing which leads possibly compressing and entrapping nerve roots.  Stenosis may cause neck, shoulder, and arm pain and numbness when these nerves are unable to function normally. Degenerative disc disease (DDD) can cause the intervertebral discs to become less hydrated resulting in decreased disc elasticity and disc height, or spacing.  Over time, a disc may bulge or herniate causing pressure on nerves and consequently upper extremity pain, tingling, and numbness

Everyday Life: Poor posture over time can result in muscle imbalances, weakness and shortening of tissue that will restrict normal movement and result in pain.  This also can disrupt the nerve root opening and result in numbness, tingling, pain and in more severe cases muscle weakness.  Everyday emotional stresses can produce increased tension in muscles, causing them to contract, tighten and result in stiffness and pain. 

TREATMENTS:

Physical Therapy:  Regardless of your injury or onset of injury, physical therapy is a good choice to address symptoms that do not resolve in 3-5 days.  The first stop is to your physician for a referral to receive physical therapy intervention.  The next step would involve an evaluation by a Physical Therapist to assess your specific situation.  A treatment program would then be established to address your symptoms.  Your treatment might include, but not limited to:

Ultrasound - deep heating of soft tissue
Moist Heat - superficial heating of soft tissue
Electrical Modalities - addresses pain and assists the healing process
Mechanical Traction and Manual Traction - gently stretches and lengthens spine to reduce pressure on nerves and pain sensitive tissue
Soft Tissue Massage and Mobilization
Postural Exercises
Stretching
Strengthening
Range of Motion Activities
Home Exercise Program

GOALS

The goal of physical therapy intervention is to alleviate your symptoms by breaking up the pain and abnormal movement patterns, as well as postural and mobility limitations, and ultimately get you back to your previous pain-free activity level as quickly as possible.  Persistent and untreated pain can escalate and result in the necessity to modify and/or discontinue activities that are essential to your daily life or other activities that you enjoy.