Neck Pain

Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body.

Neck pain affects about 330 million people globally as of 2010 (4.9% of the population).  It is more common in women (5.7%) than men (3.9%).

People are increasingly becoming aware of the association between their posture and musculoskeletal dysfunction. One common question we get asked is what is the best posture for my neck? Imagine a vertical line drawn from your ear, with a perfect posture this line should land directly in the centre of the shoulder.

Why is this important? Well it has been shown that for every inch your head moves forward beyond this ideal line, your head gains 10 pounds of weight (1). This places extra demands on the joints and tissues of the neck and upper back and over time leads to pain and dysfunction. Headaches can also be caused as the muscles under the skull have to work extra hard just to prevent your chin from touching your chest. This can put pressure on nerves, which may cause headaches, especially at the back of your head

What causes mechanical Neck pain?

Whiplash type injuries from car accidents

Poor posture, prolonged sitting at desks in the office

Sports injuries or falls

Sudden quick jerky movements of the head or neck

What structures get involved in mechanical Neck pain?

Trapped nerves

Muscle spasms can occur causing neck pain

Joints can stiffen up or lock causing neck pain

Cervical spondylosis

Disc injuries of the neck

How is it treated?

Medicines

Analgesics such as acetaminophen or NSAIDs are recommended for pain. Muscle relaxants are often prescribed and are known to be effective.  Over the counter topical creams and patches may be effective for some patients.

Surgery

Surgery is usually not indicated for lots mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary.

Surgery is usually not indicated for “pinched nerves” or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment

Spinal manipulation

Exercise plus joint manipulation or mobilisation (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders

Research shows that about one-half of episodes resolve within one year and About 10% of cases become chronic. Which suggests that some neck pain may need ongoing management and advise.

References

Kapandji (2008) Physiology of Joints, Vol 3.

Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L’Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. p. 46.

Gross AR (2010). “Manipulation or mobilisation for neck pain”. Cochrane database of systematic reviews (Online): CD004249

Huisman PA, Speksnijder CM, de Wijer A. “The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review.”. Disabil Rehabil.

Vos, T (2012 Dec 15). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.”. Lancet 380 (9859): 2163–96

Binder AI (2007). Cervical spondylosis and neck pain. BMJ 334 (7592): 527–31.