Neck Pain

Neck pain ranks 4th for global disability and 21st for global burden of pain with these figures expected to rise. 48% of the worlds population will experience some form of neck pain in their lifetime. The intensity of persisting neck pain is twice as high as that for low back pain. 

There are 3 classes of risk factors for first-time neck pain of any source: 

    • Individual Lifestyle 
    • Physical or Biomechanical 
    • Psychosocial

Listed below are common forms of neck pain treated in this office. Please click the link for more detailed information:

    1. Posture-Related Neck Pain 
    2. Discogenic Neck Pain (Disc Related) 
    3. Cervicogenic/Tension-Type Headaches 
    4. Neck Sprain/Strain 
    5. Cervical Radiculopathy/Pinched Nerves

1. Posture-Related Neck Pain  

This is first on the list because poor upper cervical posture can be a predictor OR make you more susceptible to the other forms of neck pain described on this page: 

    • Disc-Related Neck Pain 
    • Cervicogenic/Tension-Type Headaches 
    • Neck Sprains/Strains 
    • Cervical Radiculopathy

The highest prevalence of people with Posture-Related Neck Pain are seen in those who sit for long periods at a time, like long haul drivers and office workers. Another population this is becoming increasingly prevalent in and does not get as much attention is in the school-aged individuals. We all remember those days watching the teacher with our heads on the desks!

Upper Crossed Postural Syndrome is the technical term for the “slouched” postural presentation and, as such, isn’t even a syndrome! Think rounding of the shoulders with associated forward head posture OR “Tech Neck”.

    • It is characterized by a PREDICTABLE pattern of tight (facilitated) and weak (inhibited) muscles. 
    • Upper crossed syndrome can be painful or uncomfortable, especially when in the prolonged slouched positions usually created by their job or lifestyle. However, these individuals are also more susceptible to the other neck pain conditions listed above especially headaches and disc-related problems.

Co-Morbidities include: sedentary lifestyle, little to no physical activity that is reinforced by a poor sitting posture. Prevention is the best strategy! However, correction is achievable with proper treatment as well as lifestyle and workplace modifications 

    • Treatment for this problem consists of chiropractic adjustments, muscle release techniques and corrective exercises to reduce and reverse the symptoms related to Upper Cross Syndrome. 
    • Patient education is also very important to show them what they can do for themselves!

2. Discogenic Neck Pain

It has been suggested that approximately 80% of all neck pain conditions can be related to cervical disc derangement 

  • One study even showed that approximately 92% of neck pain patients were classified as cervical disc derangements.

Symptoms of cervical discogenic pain can vary and sometimes may not even be felt in the neck!

  • Numbness and/or tingling, or radiating pain down the arm or into the shoulder blade are common features – considered a radiculopathy – due to pressure being applied to the nerve 
  • Cervicogenic/tension-type headaches can also be a result of a disc problem

Causes of Discogenic pain include: 

  • Direct trauma 
  • Overuse, fatigue, or repetitive microtraumas – over long periods of time 
  • Postural problems – which can be intrinsic (loss of the cervical curve) or extrinsic (Upper Crossed Syndrome) 
  • Sudden, unguarded movements 
  • Degenerative disc disease 

Early management is necessary to avoid developing a chronic issue. Conservative treatment of this problem begins with controlling pain and inflammation. 

  • Once decreased the focus is shifted to early rehabilitation protocols to prevent chronicity and disability

Initial treatments consist of: 

  • Osseous adjustments 
  • Soft tissue 
  • Pain-free range of motion exercises

Late-stage rehabilitation is necessary to strengthen the spine and prevent reoccurrence. This will begin as the condition improves and consists of:

  • Stabilization exercises 
  • Postural training 
  • Patient education 
    • Proper training 
    • Biomechanics 
    • Home exercise program

Failure to respond to these conservative methods may warrant an MRI and possible referral to an orthopedic specialist. 

Loss of the normal cervical curve, called a cervical lordosis, has been linked to increased susceptibility for cervical disc bulges and/or herniations as well as increased cervical spinal cord compression. It is also usually proportionate to degree of degenerative change seen in cervical X-rays. 

Loss of the curve changes creates an imbalance on the forces being applied to the top and bottom of the disc. If this imbalance is sustained over a long period, the disc will become weakened in the higher-pressure areas and a bulge will develop. This can eventually lead to a disc herniation and potentially increased symptoms. 

  • Of special note is that the degree of disc herniation and height of the disc space can recover with recovery of the normal cervical lordosis.

The function and posture of the upper to mid thoracic spine can also play a role in the development of cervical disc-related problems.

  • This means treatment of the thoracic spine could produce positive clinical outcomes in some patients with disc-related neck pain as well as posturalrelated neck pain

3. Cervicogenic/Tension-Type Headaches

Headaches come in different varieties and nearly everyone will experience one in their lifetime. The different types of headaches will present with a different pain pattern. We will be discussing the most common type of head: the cervicogenic or tension-type headache.

  • Cervicogenic headaches tend to develop from the base of the skull and spread out around the head as if your head was being squeezed. Severe forms can wrap all the way around to the forehead. 
  • Characterized by a slow, gradual onset of moderate, dull pain

Causes include: Poor Posture, Bulged/Herniated Discs, Stress, Diet/Exercise Habits, Trauma, Smoking, Hormonal Imbalances, Allergies 

  • Associated with loss of strength and endurance in the deep cervical flexor musculature, in addition to further muscular imbalances in posterior neck, anterior shoulders and upper back.

Every inch of Forward Head Posture (FHP) adds “weight” to the skull and forces the muscles in the back of the neck and upper back work harder than they should be. 

Management starts with assessment of lifestyle habits, posture, and body habitus as they are the usual culprits and are the simplest to diagnose and manage. Patient involvement is necessary in developing the proper strategies for the patient. 

  • Chiropractic adjustments coupled with therapeutic modalities such as corrective exercise, soft tissue modalities, postural analysis/correction are very effective ways to manage these types of headaches.

4. Neck Sprains and Strains

Sprains and strains are very common in the cervical spine due to the lack of support for that area of the spine. 

  • These injuries typically originate from a specific injury or impact (like a car accident or sports-related injury) or from prolonged sustained positions (like sleeping with your neck in an awkward position).

Sprains are classified as an injury to the ligaments and/or joints and hurts with PASSIVE movement. Strains are classified as an injury to the muscles and hurts with ACTIVE movement. 

  • A common theme to both sprains and strains are that pain is typically felt at the end range of the movement.

Headaches are a common feature of these problems as well, which may not be directly apparent that the source of the headaches is the sprain or strain. 

The main physical causes are: 

  • Automobile accidents 
  • Whiplash injuries 
  • Contact sports injuries 
  • Repetitive/overuse injuries 
  • Prolonged poor posture

Unfortunately, automobile accidents, whiplash injuries or contact sports injuries can be difficult to avoid and there are no steps for prevention when it comes to these types of injuries. 

When the injury stems from overuse/repetition, poor posture or improper exercise there are steps that can be taken to avoid injuries from happening. Proper ergonomics in the workplace, addressing posture and instilling healthy movement tendencies are necessary for recovery and prevention of further issues.

5. Cervical Radiculopathy/Pinched Nerves

By definition, a cervical radiculopathy occurs when there is dysfunction/compression of one or more of the 8 cervical nerve roots. This results in a myriad of symptoms depending on the nature of the injury. 

  • Symptoms can include various forms of pain (deep, dull and aching to severe, burning, sharp and shooting), numbness, tingling, loss of sensation and/or weakness in the neck, shoulders, arm, or hand. 
  • Symptoms in the arm will depend on which nerve root of the cervical spine is involved.

Symptoms can be influenced both positively and negatively with certain arm and neck positions. 

Causes for cervical radiculopathy can vary 

  • The condition may be due to an injury to the neck or be of unknown cause. There could also be a previous history of multiple episodes of neck pain that was left untreated 
  • In younger patients, it is typically the result of a disc herniation or an acute injury that causes foraminal narrowing on the nerve as it exits the spinal canal. 
  • For older patients, cervical radiculopathy is typically the result of foraminal narrowing due to osteophyte (bone spur) formation, decreased disc height or degenerative changes – sometimes called degenerative disc disease or spinal stenosis. 
  • Traumatic cervical radiculopathies from auto accidents or contact sports injuries are the result of a forced extension, lateral bending or rotation (or combination of) from the impact. This creates a dynamic closure of the foramen and puts an enormous amount of pressure on the exiting nerve causing injury. 
  • Risk factors include:
    • Heavy manual labor that requires lifting more than 25 lbs (especially in a repetitive nature) 
    • Driving or operating vibrating equipment 
    • Smoking 
    • Collison Sports 
    • Trauma 
    • Degenerative disc disease/osteoarthritis 
    • Poor posture

Treatment will initially focus on reducing the pain and inflammation around the area and prevent further neurological loss of function. Decreasing nerve root pressure will allow the symptoms to centralize (come out of the arm). 

  • This is achieved by applying axial traction to the cervical spine as well as introducing pain free ranges of motion while avoiding the movements or positions that increases your symptoms. 
  • EMS/TENS therapy can also be an effective tool at reducing inflammation and muscle pain /soreness 
  • Once inflammation and pain are under control, the focus of care is shifted to restoring full range of motion. This is based on the patient’s tolerance and can include:
    • Spinal manipulation 
    • Muscle stretching/strengthening 
    • Corrective exercises 
    • Proprioception training  
  • If there is a failure to respond to these conservative methods or in the case of a severe neurological deficit, a secondary consultation with a neurologist or neurosurgeon will be warranted.

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