Neck Pain

Neck pain is a relatively common condition, yet it reacts favourably to non-invasive and conservative treatment. Initial management is aimed at resolving the initial neck pain and restoring function.


Aims of Treatment

  • Accurate assessment
  • Alleviate pain
  • Restore function
  • Decrease recurrence rates

A multimodal approach has been found to be the most effective this may include manual therapies, exercise, dry needling and functional or sensory training.

Treatment

Assessment should include the neck, shoulders and spine eliminating any possible Red Flags.
Treatment is based on a multimodal approach and may include, manual therapies, myofascial trigger points, dry needling, functional soft tissue work, exercise, postural analysis and sensory training in the case of whiplash (WAD)

Statistics

Neck pain affects both athletic and the general population, it is a relatively common complaint affecting a large percentage of the population each year.
Epidemiological studies show that approximately 70% of the population is affected at some stage in their lives, with 40% suffering neck pain in any given year. With up to 60% suffering episodic bouts after the initial presentation.

Neck Degeneration

Neck degeneration is highly age dependent with a linear pattern.
There is a very strong genetic component 70-80% with degeneration and 30% idiopathic.
There is a positive association with heavy work and some sport (dose response).
Neck degeneration does not necessarily correlate with pain.


Referred Pain

Pain may be local, referred upwards towards the head or down towards the shoulder girdle.
This may be due to dysfunction within joints, discs, dura, vascular tissues, ligaments or muscles.


Headaches (somatic)

Dysfunction of the upper cervical complex may lead to headaches these may be felt in the occiput and frontal region of the head and face.
Pain being referred to head and face may also be commonly attributed to Trigger Points emanating from the neck and shoulder girdle muscles.


Upper Shoulder Girdle Pain

The lower cervical region may refer pain to the shoulders, scapula, upper thoracic area and the chest.


Radicular Pain

Radicular pain is pain radiating into the upper limb that may be deep or sharp in nature. Usually emanating from the nerves of the Brachial Plexus or vascular tissues.

Anatomy

The anatomy of the neck differs from the other areas of the spine allowing for a large range of mobility, as well as being able to scan our environment without any loss of stability.
When analyzing the cervical spine (neck) it is important to recognize their different functional and morphological regions.
The upper cervical complex is known as the atlanto-occipital joint C0-C1 as they support the head and allow for flexion and extension movements at the cranio-cervical region.
Next the atlanto-axial C1-C2 complex has a distinct motion segment and muscular anatomy that allows for up to 50% of our cervical rotation to occur and is crucial for the sensory movement of the head.
And thirdly, the C3-C7 area, these differ in in their neurology, morphology and motion patterns, allowing for further movement in all ranges.
The function of the cervical spine is also intimately related to the upper thorax and shoulder girdle. Due to genetic and postural factors it has a direct affect on neck posture and range of motion.
There is also a close relationship between the upper cervical region and the tempero-mandibular joint, due to its position, function and neurology.
Given the broad range of requirements and functions of the cervical spine. Neck muscles must adapt with speed and strength to the specific demands of sport, and yet be able to complement the finer movements and kinesthetic awareness in our daily living.

References

N Bogduk, B McGuirk. 2006. Management of Acute and Chronic Neck Pain. Pain Research and Clinical Management. An evidence based approach. Elsevier.

G Jull, M Sterling, D Falla, J Treleaven, S O’Leary. 2008. Whiplash Headache and Neck Pain. Research-based directions for physical therapies. Churchill Livingstone.

J A Porterfield, C DeRosa. 1995.Mechanical Neck Pain. Perspectives in Functional Anatomy. W.B.Saunders Company.

Simons D, Travell JG, Simons LS.1999. Myofascial pain and dysfunction. The trigger point manual. Upper half of body. 2.: Lippincott, Williams and Wilkins.


Neck treatments are available with Raymond Smith, Chiropractor, 114 Alexander Street, Crows Nest, NSW 2065


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