Neck Pain

Why do people experience neck pain?

Is it genetic, is it acquired through lifestyle exposure? Is it related to our diet, occupation, sport, posture, socioeconomic status and demographics, environmental factors? The answer is probably ‘YES’ to all the above, but rather than there being a single solution or panacea to the problem of neck pain, each individual person’s experience of neck pain if different. This means each person presenting with neck pain must be individually assessed to determine which body, behavior and environmental factors are relevant to their neck pain. Only then can meaningful, specific and functionally directed treatment be employed. Neck pain commonly arise atraumatically (without injury) and is usually associated with poor posture and undesirable work habits, e.g. long hours at a computer. Neck pain may also be as result of a strain or trauma. A common simple strain is a wry neck on awaking in the morning. A common trauma is a car accident or head-high football tackle.

What is the source of neck pain?

Any of the structures of the cervical spine and adjacent regions can produce the pain, eg. disc, ligaments, muscles, fascia, nerves, joint etc. The upper part of the cervical spine produces pain in the upper neck and head area, whereas mid-cervical problems tend to produce pain in the mid neck and top of shoulders. Problems arising in the lower cervical spine tend to refer to the shoulder blades, trunk and arms. Neck/arm pain and neck/head pain combinations are common. There is often debate between the different professional groups as to the cause of neck pain. We all have our favourite diagnoses which usually implicate our favourite treatment modalities, but if we are honest, we can’t be precisely sure which body structure is the source of the pain. As disappointing as this appears for the 21st century, it doesn’t really matter in terms of treatment, because treatment is directed at correcting the forces that impose on the pain sensitive tissue, not the pain sensitive tissue itself. That is, more important than the source, is the underlying biomechanical cause of the LBP. Once identified, this gives structure to the physio treatment plan.

How do we diagnose neck pain?

The Straight Back Physiotherapy method is to provide a comprehensive examination system that seeks to explore and expose the underlying cause of the pain. These examination systems have been developed over years of clinical experience and from exposure up-to-date research and education by world leaders in the field of neck examination and treatment. As well as trying to determine the reason for the pain, due care is given to examining the upper cervical spine to ensure your life-sustaining craniocervical ligaments are intact, as well as your vertebral artery. We’ll assess your posture, joint alignment, movement patterns, spinal stability, muscle flexibility as well as your work and sport habits, to name just a few elements. We’ll also explore the neighbouring body regions that could impose strain on the pain sensitive region. This enables the physiotherapist to profile your body and lifestyle to determine where and how to direct treatment. Once the biomechanical cause is discovered, meaningful treatment can begin to address the cause not the symptoms and education and advice can be given to help the patient understand the specifics of their neck pain and help themselves.

Do x-ray, CT scan and MRI help diagnose the neck problem?

Sometimes a radiological investigation assists the diagnostic and treatment process. In particular, where there is a strong clinical suspicion that a particular structure is damaged, the appropriate investigation can be used to confirm your hunch, eg. a patient presenting with a severe, burning pain in their shoulder blade and middle finger, and weakness in their triceps. We’d suspect a disc prolapse with C7 nerve root compression, for which MRI is a useful (and essential) investigation. MRI is useful for soft tissue and fluid filled structures such as muscle, ligaments, tendons, disc and cartilage. CT scanning is useful for bone-related problems. X-rays show bone and bony alignment. However, what is very important to understand, is that not all x-ray findings correlate with pain. That is, just because you see something on x-rays, doesn’t mean that it is the source of the pain. Unfortunately there is over-reliance on x-rays in medical practice as a substitute for poor clinical examination skills, which can provide compliant and respectful patients with incorrect and misleading information, eg. degenerative changes (arthritis) on x-rays are a normal finding in the over 30 years-of-age population and not necessarily the cause of your pain. The bottom line is skilled clinical examination can be supported and strengthened by judicious selection of the appropriate radiological test and careful interpretation of the x-ray report, it is not a replacement for it!

How do we manage neck pain?

Once the biomechanical cause(s) are determined, the physiotherapist will employ a range of hands-on techniques to re-align joints and correct muscle imbalance in and around the neck and spine to improve alignment and stability. A range of techniques are used including mobilisation, manipulation (on consent only), muscle stretching, stabilising muscle re-education, traction etc. (refer to headache section) Exploration of the individual’s work and sport environment is needed to determine if posture, exercise, sport or occupational habits are perpetuating the problem. Education is an essential ingredient to equip the individual to understand the complexities and idiosyncrasies of their neck pain and how their body-type interacts with their environment and lifestyle, in order to empower the individual to self-help. If the neck/upper back pain is associated with arm pain, and is resistant to conservative treatment, then occasionally surgery is required to relieve compression on the nerve root as it exists from the cervical spine to the arm. Common nerves involved are C5,6,7.