Our spinal columns are made of twenty four vertebrae stacked one above another on the pelvis, joined together at the front by discs and at the back by facet joints. When we bend forward, the vertebra above tilts and slides forward, compressing the disc and stretching the facet joints which join the vertebrae at the back. When we bend backward, the disc compression is reduced at the front and the facet joints are compressed at the back. In the upper neck and thoracic areas, we tend to have more facet joint strains and in the low cervical spine and lumbar spine areas, disc injuries are more frequent. This is because our upper spine joints allow us to turn our heads to see, hear and smell, so need mobility but they do not support much weight. Our lumbar spine bears around half our body weight and as we move and sit there is a huge, sustained compressive load on our discs.
CAUSES OF NECK PAIN
Neck muscles may be painful but they are seldom the only pain producing structure. Muscle pain often develops as the muscles contract to prevent further damage, as they protect the primary underlying painful structures. This muscle pain is secondary to the underlying pathology and when the muscles are massaged, given acupuncture etc, there is temporary relief but the pain usually returns, as the muscles resume their protective bracing. The most common sources of primary pain are the facet joints, discs and the joint ligaments.
A facet joint strain is much like an ankle sprain. The joints are strained by excessive stretching or compressive forces and the joint ligaments, joint lining and even the joint surfaces can be damaged and produce pain.
Facet joint sprains typically occur during excessive bending, backward, lifting or twisting movements. Trauma such as a car accident causing whiplash or repetitive and prolonged forces such as when slouching are also common causes.
Disc injuries occur mainly with sudden loading such as when lifting, or during repetitive or prolonged forces such as slouching, rowing, hockey and cycling. A flexed posture during slouching and bending is a frequent cause of disc damage because of the huge leverage forces caused as those structures resist the huge leverage and compressive forces caused by gravity pulling down on the mass of the head.
It is important to understand the damage from small disc injuries is cumulative and if discs are damaged at a faster rate than they can heal, the damage will eventually increase until it is painful. As sensory nerves are only on the outside of the disc, even small pain of disc origin, indicates the disc is already significantly damaged internally.
There is often a previous history of pain coming and going as the damaged area became inflamed and was treated or rested and then settled for a while. As the underlying problem still remained, the pain has then flared up repeatedly since and is known as chronic pain. This type of disc injury responds very well to Physiotherapy treatment.
A marked disc injury causes the outer disc to bulge, stretching the outer disc nerves. In a more serious injury, the central disc gel known as the nucleus, can break through the outer disc and is known as a bulge, prolapse or extrusion. When there is a significant disc bulge, there may be irritation or compression of the adjacent nerve root, resulting in referred pain across the shoulder and perhaps into the arm, forearm or hand.
There are many other sources of neck pain including arthritis, crush fractures and various disease processes. Your Physiotherapist will advise you should a more serious condition be suspected.
SYMPTOMS OF NECK PAIN
Where there is a structural problem, the symptoms of neck pain are always affected by movement. This is important to understand. Symptoms are often intense and may be sudden in onset but also may be mild and with gradual onset. There are other conditions such as heart attack which can produce neck, arm and chest pain and thoracic problems which can also cause low back pain. If you have symptoms in these areas which are not affected by movement, you must consult a doctor urgently.
Facet joints, discs, muscles and other structures are all affected by our positions and movements. More minor problems produce central pain. With more damage, the pain may spread to both sides and with irritation of a nerve, the pain may spread into the arm, forearm and hand. As a general rule, disc pain is worse with bending, lifting and slouching and facet joint strains are worse turning, bending backward or sideways. A severe disc problem is often worse with coughing or sneezing and on waking in the morning.
DIAGNOSIS OF NECK AND BACK PAIN
Neck injuries are complex and require a full understanding of the onset history and a comprehensive physical examination. It is important for your Physiotherapist to establish a specific and accurate diagnosis to direct the choice of treatment. In some cases, the pain may arise from several tissues or co-existing pathologies and these are treated as they are identified. Where the Physiotherapist requires further information or perhaps management may require injections or surgery, the appropriate x-rays, scans and a referral will be arranged.
UPPER BACK AND NECK PAIN RELIEF
Eighty percent of adults will experience severe spinal pain at some time in their life. Musculoskeletal Physiotherapists have developed specific diagnostic skills and specific treatment techniques targeted to specific structures. We will identify the reasons for the development of the damage and advise strategies to prevent further damage and promote healing.
Specific techniques are chosen to correct the structural and mechanical problems. Among many choices, treatment may include joint mobilisation, stretching, ice, strengthening and education. As the damage repairs and normal function returns, there is a reduction in the inflammation and pain.
When normal movement has been achieved, the inflammation has settled and the structures have healed, your new strategies will reduce the possibility of the problem recurring. We use this specific approach to prevent, reduce or stop chronic pain.
While we have the choice to manipulate, adjust or click joints, those with ongoing pain will seldom benefit from repeated adjustment. This is because our tissues are elastic and the benefit of the quick stretch of manipulation is lost as the elastic tissues tighten and shorten up again. Adjustments of this type have little long term benefit and often can lead to an unhealthy dependence on the provider. Your physiotherapist will choose a safer and more appropriate treatment for you.
PROGNOSIS OF NECK PAIN
Physiotherapy for neck pain can provide outstanding results but treatment is a process, not magic. The damage which produces pain in a neck takes time to develop and also time to repair and heal. There are often several interacting factors to deal with and patient compliance is necessary.