A neck condition is often called recurrent when it is recurring episodes of pain or chronic mechanical neck pain when pain never really goes away completely. The word ‘mechanical’ indicates that there is no specific disease process (for example, rheumatoid arthritis).
Symptoms are variable. The pain can be felt anywhere between the base of the skull and the upper shoulder region. It may spread to the head (neck-related or cervicogenic headache), or into the upper back or upper arm regions. Where the pain spreads to depends on the part of the neck affected.
There are many possible reasons why neck pain becomes recurrent or chronic in nature. One common reason is a build up of repeated minor strain caused by poor or prolonged sitting postures at work. This situation may worsen by prolonged ‘head-down’ postures at home, such as texting or playing games on the phone or other electronic devices.
People in occupations involving sustained neck postures or working or lifting in awkward positions are prone to repeated minor strains and pain. Postural or position-induced pain occurs across the scope of occupations (for example, people who work at a desk, tradesmen, drivers and professionals).
Other causes of neck pain include disc degeneration and osteoarthritis of the small joints in the neck. Osteoarthritis can occur in any age group, but is more common in the middle-aged to older population. Arthritis may be secondary to injury or over-loading of the neck, but it also appears that some people have a genetic predisposition to developing osteoarthritis.
The degeneration and osteoarthritis can in some—especially in late middle-age to older people—advance to such a stage that it narrows the canals through which the nerves or spinal cord run. When this advances to a symptomatic state, it is called cervical radiculopathy and central canal stenosis respectively.
Recurrent neck pain is characterised by repeated episodes of neck pain over many months or years. Chronic neck pain is more continuous pain, although it may fluctuate in intensity, on a weekly, monthly or yearly basis. The pain will be felt in the back of the neck and may spread into the head, if the upper joints are symptomatic, or down the back or into the arms, if It is a lower neck problem.
Other symptoms that may come from the neck include feelings of light-headedness, unsteadiness in balance and sometimes disturbances in vision.
The diagnosis is made on the symptoms rather than on any X-ray findings. There is not a direct link between the amount of neck pain and what is seen on X-rays. It is not uncommon for people with quite severe pain to have normal X-rays, and the opposite—for people with significant changes on X-ray to have no pain. Current guidelines suggest that X-rays should only be taken when a pathology such as a fracture is suspected or there are clinical indications of advanced pathologies affecting the nerves or spinal cord in the neck.
Your physiotherapist will first aim to fully understand your concerns about your neck, and how the neck pain, and any other symptoms are affecting your daily activities and sleep. They also aim to understand whether the neck pain is limiting or preventing your participation in work, home or recreational activities.
They will then undertake a comprehensive clinical examination to analyse postures and tasks that aggravate the pain, and any other symptoms, such as light-headedness or unsteadiness. Further, a series of physical tests will determine how the neck pain disorder is affecting the movement and muscle function of the neck region.
Physiotherapists will use a variety of treatment methods in a management program to provide best practice management.
Education, advice and assurance
It is understandable to feel a little anxious or a bit miserable because of your recurrent or chronic neck pain. It is important for you to understand your pain and neck disorder, so that any concerns are alleviated, and that you actively participate in the care of your neck and be able to take charge of your neck pain.
Manual therapy
This is an effective treatment method used to help ease the neck pain and associated symptoms, as well as restore movement.
Exercise
There are many different types of exercise that have different purposes. All types of exercise usually helps to ease pain. These will be prescribed depending on your requirements. Exercise programs are designed to:
- improve posture and postural habits during work and recreation
- improve movement and flexibility of the neck
- train the supporting muscles of the neck and shoulder girdle
- train strength and endurance of the neck muscles
- train balance, neck movement accuracy, and head and eye movement control when light-headedness or unsteadiness are symptoms of the neck pain disorder
- improve general fitness.
Additional treatments
There are other methods that may be used to ease the pain, including heat, acupuncture, dry needling and various massage techniques. These methods are used to make the neck more comfortable, which helps to ensure the exercise program is performed as well as possible. When neck pain is severe, it may be necessary to consider taking analgesics. A GP will prescribe appropriate medication for the condition.
Advice for work and home
It is well known that factors such as prolonged and awkward postures, poor lifting and carrying techniques, and awkward performance of various work and home activities will aggravate the neck and contribute to the recurrent or chronic nature of neck pain. You and your physiotherapist can work together to develop best work, activity and lifestyle habits to relieve unnecessary strain on the neck.
Self-management program
It is important to care for your neck to help prevent recurrent episodes. Your physiotherapist will work with you to devise a program of simple and convenient exercises and lifestyle habits relevant to your needs. It is best to try to merge them into daily routines, so that good neck postures and movement become normal habits. A plan is developed for managing and settling any future flares of neck pain rapidly.
There is evidence that individual treatment methods help neck pain, but management programs for the neck are most effective when they address the different aspects of neck pain concurrently. This is called a multimodal management program, and may simultaneously include education, manual therapy, exercise therapy, work practices advice and self-management strategies.
The challenge of preventing recurrent episodes or chronic neck pain is yet to be met, which emphasises the importance of looking after your neck, by adopting best work and lifestyle habits and undertaking a simple exercise regime.
