Neck Pain

Neck pain is most commonly caused by repetitive movements or prolonged postures. It’s also caused by trauma, such as whiplash from car accidents or sports injuries. The muscles, tendons, ligaments, joints and nerves can get sprained, strained and inflamed.

 

 

Neck pain commonly occurs with stiffness and restricted movement. Your body wasn’t designed to maintain postures or perform repetitive movements for 8 hours a day. Occupational computer work is a significant culprit. This causes low-level inflammation and microtrauma to tissues over time. It can slowly worsen over time without you being aware of it, until you reach a point where you find yourself in pain. Pain is usually the last symptom to appear. It signals that your neck has reached a point where it can no longer cope with repetitive movements or prolonged physical loads.

Shoulder pain or problems in your upper back can also cause neck pain. Anatomically, your neck connects your head to your torso, but functionally it extends down your back to T5. The muscles and joints in your upper back play an important role in your head and neck posture, and movement. The large muscles that move and support your head and neck also attach to your shoulder blades. These muscles have the dual purpose of moving and supporting your head and neck, as well as stabilising your shoulder blades so that you can move your arms and hands. If something goes wrong in your shoulder or upper back, it can lead to neck pain. Likewise, when something goes wrong in your neck it can affect your shoulders and upper back.

If you sit for a long time you may have noticed your upper back hunching. This prolonged posture can cause your upper back to get stiff and sore. When your upper back hunches, it also causes your shoulder blades to tilt. This changes the biomechanics of your shoulders because your shoulder blades are no longer in their optimal position. Over time, the muscles that stabilise and move your shoulders, that also connect to your neck, can get tight and sore.

When you hunch, your head will also move forward relative to your centre of gravity. The muscles that attach to your neck from your shoulder blades and upper back have to work harder to hold your head up against gravity. It also means that the muscles that connect your skull to your upper neck have to work hard to extend your head and neck so that you are looking in front of you. Over time these muscles will fatigue and become tight and sore. It can also lead to headaches, especially cervicogenic and tension headaches.

Your neck is also vulnerable to trauma, partly because it is one of the most mobile parts of your body. It can be injured in car accidents, or sports collisions and tackles, causing whiplash. It is capable of wide ranges of movement that require a lot of stability, which is provided by a complex arrangement of muscles and tendons. The vertebrae and their joints are shaped to allow these movements while protecting neural and vascular structures. Trauma can result in acute injury to the vertebrae, their joints and ligaments, muscles and tendons, blood vessels and nerves. This can cause neck pain, cervicogenic headaches and cervicogenic dizziness, stiffness and restricted movements.

Muscles at the front of your neck also connect to your jaw. Neck trauma can also result in jaw pain, also known as temporomandibular joint (TMJ) pain. Any trauma that causes whiplash will also cause sudden forceful movement of your head. If the force is great enough it can cause concussion. Symptoms of concussion include headaches, dizziness or vertigo, nausea, impaired cognition and memory, poor mood, fatigue, increased sensitivity to light and sound, vision changes and changes in sleep patterns. We are trained in treatment and rehabilitation of concussion.

Stability and accurate movement of your head and neck is provided by specialised sensory nerves in your upper neck, called proprioceptors. They continually update your brain, in real-time, about movement, posture and balance. Your neck possesses the second highest concentration of these nerves (the highest concentration is in your ankles). Your brain also uses this information to stabilise and co-ordinate movements of other body parts, such as your low back. The fact that your neck has the second highest concentration of proprioceptors tells us how important your neck is to posture, stability and movement of your whole body, and how much your brain relies on your neck.

Neck pain and dysfunction can result in proprioceptive errors reaching your brain. This erroneous information results in faulty movement patterns. Some of these patterns are known as “compensating”. Over time, faulty movement patterns fail, resulting in pain and restricted movements affecting your neck, and other parts of your body. Proprioceptive errors can cause cervicogenic dizziness and unsteadiness, and poor co-ordination of head, neck and body movements.

Your practitioner will take a detailed history and perform a physical examination to rule out serious causes of neck pain. They will assess your posture and movements, including other areas of your body that can affect your kinetic chain, looking for painful or dysfunctional postures and movements. They may also perform orthopaedic and neurologic exams, and check neurologic and vascular structures in your neck that may have been affected. If necessary, you will be referred for blood tests or imaging.

You will be given a diagnosis, and presented with recommended treatment options. The recommended treatments will be tailored specifically to your neck, and will be discussed with you so that you are comfortable with the treatment approach. Manipulation (also called adjustment) may be recommended, but if you are not comfortable with this then other techniques can be used.

Research shows that manual treatment and rehabilitation exercises are effective at reducing pain and stiffness, and improving function and proprioception. Manual treatments that we use include joint manipulation (adjustments), mobilisation, dry needling, soft tissue treatments, muscle energy and neuromuscular inhibition techniques, and stretches. The treatments and exercises aim to reduce tight muscles and stretch short muscles. They aim to strengthen weakened muscles or muscles that need more endurance, and strengthen muscles responsible for neck and head stabilisation, to restore correct, accurate movement to joints that are not moving correctly.

Treatment and rehabilitation depends on the structures affected. Facet joint pain is the most common joint problem in your neck (discs are the most common in the low back). The facet joints sit out to the side of the vertebrae and guide movement. These can cause intense local pain on one side of your neck and restrict the movement of your head and neck. They can also refer pain to your upper back, shoulder or arm. Compression or inflammation of a nerve root can cause intense pain, tingling, numbness or weakness into your shoulder, arm, and fingers.

Your brain controls balance, posture and co-ordinated movements. It relies on accurate sensory input from the nerves in your upper neck to do this. Your brain uses this information to control movements in your neck, as well as other parts of your body, such as your low back. Neck pain and dysfunction can cause incorrect sensory input to your brain, resulting in dizziness, unsteadiness, imbalance and clumsiness due to poor movement control. If these signs and symptoms are also present they will be addressed with treatments and rehabilitation exercises specifically tailored to you.

Neck pain doesn’t only affect the parts of your brain associated with the perception of pain. It also affects other areas that regulate your emotions and mood, cognition (your ability to concentrate and remember things) and your social and professional interactions. Every person is different — it affects some people more than others. This is known as the biopsychosocial framework, which considers the biological, psychological and social effects of neck pain on you, as a whole person. This is also taken into account with your treatments.

Analgesic (painkiller) and anti-inflammatory medications have a mixed track record, working for some but not others. Importantly, medications won’t fix your underlying functional, stability, postural or proprioceptive problems. Rehabilitation exercises and stretches are prescribed specifically tailored to you, and the problem with your neck. You will also be given occupational and lifestyle strategies. All of these are designed to get you out of pain, improve function of your neck, and reduce the probability of recurrence.

Treatments are focussed on the underlying cause and not simply providing short-term relief. Many people are free of neck pain within a couple of treatments. The research, and experience shows that other people may take months. This is common if the underlying cause has been present for a long time, or where there is significant trauma. Strengthening and retraining muscles and restoring correct, accurate function to the neck takes time. There are no quick fixes. Some people only want to get out of pain, and we respect that decision. We will always recommend treatment and exercises that are specifically tailored to you and your needs, with the aim of getting long-term, lasting results for you.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

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