Neck

ACUTE NECK PAIN

Acute neck pain is a general descriptive term used for pain that has been present usually for less than six weeks. It is a time description and the term covers pain that may have started for a variety of reasons. Neck pain is felt anywhere between the base of the skull and the upper shoulder region. It is often in a very local area on the back or side of the neck, but, on occasions, the neck pain may spread. When pain is coming from structures in the upper part of the neck, it may spread to the head—a neck-related headache. Pain coming from structures in the mid to lower part of the neck may spread to the upper back region or into the upper arm. 

What causes acute neck pain?

Acute neck pain is often described as an ache when the head is still. The movements of the neck are frequently reduced and, in some circumstances, a sharp pain may be felt with certain movements such as turning quickly or looking up. For some people, it may be the first episode of pain or, for others, it is a subsequent episode.

There may be a specific incident that causes acute neck pain. It may come on suddenly from a trivial incident, such as a quick turn of the neck or sleeping in an awkward position. Sometimes the neck feels as though it is ’stuck’. On the other hand, there may be a more substantial injury such as hitting the head and bending the neck on the side of a pool or in a fall from a bike.

In many other cases, the pain comes on gradually over hours or days, and is often related to unfamiliar activity, for instance, after painting ceilings all weekend or working in a poor or awkward posture.

As a result of the incident or unfamiliar activity, the joints and ligaments of neck may become strained and painful. The muscles usually react to limit movement and they too may become painful.

 

How do I know if I have acute neck pain?

Acute neck pain can range in intensity from mild to moderate severity, and is usually made worse by head and neck movements. The neck is usually tender to touch and sleeping may be uncomfortable.

Your physiotherapist will undertake a clinical examination of the neck to identify the likely cause of pain. X-rays are usually unhelpful and unnecessary. The exception is after a forceful injury, when it is necessary to rule out fractures.

On very rare occasions, acute neck pain may have a serious medical cause. For instance, pain felt running up the front of the neck may be coming from the heart. A rapid onset and rapidly worsening upper neck pain, with a very unusual, severe headache, may indicate a problem with an artery in the neck and requires immediate medical investigation.

 

How can treatment methods used by physiotherapists help acute neck pain?

Physiotherapists first undertake a clinical examination to determine the reason for the pain and how it is affecting the movement of the joints, and how it has affected the muscles of the neck—some muscles may be in spasm, others may not be working properly because of the pain.

Treatment methods used by physiotherapists that have proven to help ease the pain and restore normal function of the neck include:

  • explaining the reason for the pain and providing assurance
  • gentle manual therapy
  • gentle, specific exercise and self-help strategies.

Physiotherapists often use manual therapy consisting of rhythmic movement (mobilisation) to treat the neck pain, but, on occasions, a manipulation may be deemed necessary. The evidence suggests both of these manual therapy methods are equally helpful.

The gentle, specific exercises have several purposes:

  • to ensure the muscles supporting the neck continue to work
  • to help ease pain
  • to help restore normal neck movements.

The exercises are progressed as pain settles, as it is important that normal movement and muscle function return after an acute episode of pain.

Your physiotherapist will also advise on self-management strategies to be used at home.

The use of ice, but usually heat, can be soothing for a sore neck. The most comfortable sleeping position will depend on the individual. It is usually lying on the side or the back, ensuring that the head and neck are adequately supported by one or two pillows. Lying on the stomach is not recommended, as it places the neck in near end range positions. It is important that the exercises are practised at home and normal activities are resumed as soon as possible.

 

How effective are the treatment methods used by physiotherapists for acute neck pain?

An episode of milder acute neck pain may get better of its own accord in a few days. However, when pain is stopping normal activities and not seeming to get better, treatment methods such as education on the nature of the neck pain disorder, manual therapy and therapeutic exercise are effective in relieving most neck pain. The advice on care of the neck, lifestyle and the exercises that your physiotherapist prescribes for self-management at home and work will also help the neck recover.

 

What can I do at home?

Good self-management at home will help ensure a speedy recovery. When neck pain is acute, heat may soothe the pain. It is important to limit activities to ones that do not aggravate your neck, but at the same time, to stay generally active. Be aware of staying for too long in one neck posture, and try to avoid slouched postures that can be uncomfortable for the neck. Move regularly. Often simple head movements in each direction can be helpful. Gentle exercises to ensure all muscles are working again can be started almost immediately and they also help to ease the pain.

The descriptions of a full range of exercises for the neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.

 

How long until I feel better?

The time for recovery is variable. The acute episodes of neck pain may settle in a few days. For many, the neck pain will settle in 3–6 weeks and for some it can take up to 12 weeks or a little longer. It is important to resume as many of your normal activities as possible as the neck pain settles. Continue home exercises for three months, even though the pain may have gone, to ensure the neck regains its normal movements and muscle function.

Source: Choose.physio

NECK RELATED HEADACHE (CERVICOGENIC)

There are many causes of recurrent headache that can persist for many years. Three common types are tension-type headache, migraine, and headaches secondary to a disorder in one of the top three or four joints in the neck. These neck-related headaches are commonly called ‘cervicogenic’ headache. Cervicogenic headache is usually felt on one side of the head. It is always the same side and, unlike migraine, neck headaches do not swap sides. Cervicogenic headache is of mild-to-moderate intensity and is always accompanied by neck pain. Most typically, the pain begins in the neck and then spreads to a headache. 

What causes cervicogenic headache?

Excessive strain caused by poor working postures (prolonged sitting, working in awkward neck postures) can irritate the upper joints of the neck and cause a headache. The joints can also be injured by trauma. This could be a sporting or recreational injury or a motor vehicle crash. In the late middle-aged to older age groups, osteoarthritis of the upper neck joints is another common cause of cervicogenic headache.

Neck pain and headaches are typically made worse by sitting or working for a long time in one (often poor) posture, and are typically aggravated by neck movements. The neck is tender and movements are often slightly restricted or stiff. About one-third of people with cervicogenic headache also report some light-headedness, unsteadiness or visual disturbances.

 

How do I know if I have cervicogenic headache?

It can sometimes be confusing to know if you have a cervicogenic headache, as the symptoms of different types of headaches are often quite similar. Neck pain and tenderness are common symptoms of migraine, tension-type and cervicogenic headache. In migraine and tension-type headache, this neck pain is often a spread of the headache into the neck. In cervicogenic headache, it is the opposite. The neck pain starts and then spreads into the head. This headache is from a local cause in the neck. Likewise, neck movements are stiff and painful in cervicogenic headache.

Correct diagnosis is important, as each headache type requires a different treatment method. GPs, neurologists and physiotherapists may all play a role in diagnosis.

 

How can treatment methods used by physiotherapists help with neck-related (cervicogenic) headache?

Your physiotherapist will first undertake a full examination to determine if the headache symptoms fit the pattern for cervicogenic headache, and if there are problems with the joints and muscles, particularly in the upper part of the neck.

There are several possible results of this examination.

  1. The clinical examination might indicate that the headache is coming from the neck (cervicogenic headache), and physiotherapy treatment is the best management.
  2. The examination might suggest the headache is another type (eg, migraine or tension-type headache)—that is, the neck joints and muscles were found to be normal. In these cases, management by your GP is the primary treatment, and some physiotherapy methods such as relaxation therapy and soft tissue therapy may assist in management as part of a multidisciplinary approach.
  3. People with migraine and tension-type headaches may have problems in their neck that are independent of their headache. In these cases, physiotherapy treatment of the neck may offer some help in conjunction with treatment from the GP.

Physiotherapists use a variety of treatment methods for best practice management of cervicogenic headache.

Education, advice and assurance

This is to ensure the person understands the nature of their headache, is assured of its benign nature, and has the knowledge to actively participate in the care of their neck.

Manual therapy

This is an effective treatment method used to help ease the headache, neck pain and any associated symptoms.

Exercise

The exercises are prescribed depending on your requirements, and are designed to:

  • ease pain
  • improve posture and postural habits
  • 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, movement accuracy, as well as head and eye movement control when light-headedness or unsteadiness are symptoms of the headache disorder.

Advice for work and home

Prolonged and awkward postures, as well as poor lifting and carrying techniques will aggravate the neck pain and headache. Your physiotherapist works with you 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 headaches. 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 include them into daily routines so that good neck postures and movement become normal habits. A plan will be developed to help manage and rapidly settle any future flares of headache and neck pain rapidly.

 

How effective are treatment methods used by physiotherapists for cervicogenic headache?

There is an increasing body of evidence supporting the treatments offered by physiotherapists for the treatment of cervicogenic headache, particularly manual therapy and exercise. A comprehensive management program will include education, manual therapy, exercise therapy and work practice advice. Self-management strategies are vital to help you look after your neck, and adopt best work and lifestyle habits as well as a simple exercise regime.

There is no convincing evidence that methods used by physiotherapists help migraine headache. However, some people with tension-type headache may gain some relief with relaxation, massage and other soft tissue techniques.

 

What can I do at home?

Be aware of neck postures, and try to avoid prolonged sitting and slouched postures at work or at home that can aggravate your neck pain and headache. Regularly sit upright and tall, and hold the posture for 10 seconds, to relieve strain on joints and muscles. Correct posture at least twice an hour for waking hours. Move regularly. Other exercises can be performed two to three times per week to ensure all muscles are working well and are supporting your neck and the weight of your head.

The descriptions of a full range of exercises for neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.

 

How long until I feel better?

The time for improvement varies between people, and clinical trials indicate there can be relief within 2–6 weeks of beginning management. Some people take longer and this will often depend on the nature of your neck disorder.

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PINCHED NERVE (CERVICAL RADICULOPATHY)

Cervical radiculopathy is commonly thought of as a pinched nerve in the neck. It is a condition where a nerve is irritated or compressed as it passes through the tunnel made by two adjacent vertebrae in its path to the arm. Cervical radiculopathy usually occurs from middle-age onwards in both men and women. People often think they have a pinched nerve in the neck, but in most cases their pain is coming from joints or muscles in the neck. A truly pinched nerve is less common than having sore joints as the cause of neck pain.

What causes cervical radiculopathy?

Cervical radiculopathy occurs when the nerve is irritated or compressed (pinched) as it passes through the tunnel on its path to the arm. The nerve is often irritated by inflammation from neighbouring joints or the disc. The size of the tunnel may be reduced in height as a factor of ageing, but that alone will not pinch the nerve. Another factor is usually present. The tunnel may be further narrowed by some bony outgrowth from a neighbouring joint or by a fragment of disc that has split away. The resulting inflammation of the nerve is often the cause of pain.

When a nerve is truly pinched, there may be pain in the neck and shoulder region, but the worst pain is commonly felt in the arm. It is also common to feel sensations of pins and needles in the fingers or parts of the arm. There may be some numbness in the tip of the thumb, or one or two fingers, depending on which nerve is involved. Muscles in the arm or hand may also become weak. Symptoms are often quite severe and it is difficult to find positions of relief. It is often difficult to sleep. 

 

How do I know if I have cervical radiculopathy?

The most notable symptom is the rather-severe ‘nerve pain’ in the arm. It is often a shooting, or burning type pain that is difficult to obtain relief from. The diagnosis is made from consideration of the nature of the pain and other symptoms, as well as an examination of the neck and neurological examination, which involves testing of reflexes, muscle strength and sensation in the arm. An X-ray or MRI may help confirm the clinical diagnosis.

 

How can treatment methods used by physiotherapists help cervical radiculopathy?

Acute phase

In the acute stage (first 1–6 weeks), the treatment is a combination of pain-relieving medication for nerve pain prescribed by your GP, gentle physiotherapy and rest. Physiotherapy methods that have proven helpful to help ease the pain include gentle manual therapy and other treatment techniques. In addition, individualised education about the pain is provided, as well as instruction on best sleeping and working positions and how to care for the neck.

Subacute phase

Once the severe pain has reduced, your physiotherapist will progress treatment to include manual therapy to gently mobilise both the joints and nerves of the neck to further decrease residual pain. Gentle exercises are added to ensure that the nerves can move normally with day-to-day movement of the arms, and to ensure return of good control of your neck by the neck muscles. Exercises are progressed when pain has reached minimal levels to ensure return of normal muscle strength of your neck and shoulder girdle. Advice and education are provided on self-care methods for your neck to prevent recurrent episodes.

Persistent phase

Some people have intermittent but lesser pain in the arm that persists for several weeks or even months. In these cases, physiotherapy methods, such as manual therapy for the joints of the neck and nerve structures can be helpful in addition to education about pain, self-care methods and lifestyle features. A comprehensive exercise program is an important aspect of management.

Usually physiotherapy is the first treatment approach, but if severe pain is not easing and the muscles are becoming weaker, neck surgery may be considered. Studies that have investigated those who do and do not have surgery show that there is no difference in the final result some two years later.

 

How effective are treatment methods used physiotherapists for cervical radiculopathy?

Cervical radiculopathy is a very unpleasant condition and quick cures are rare to non-existent. The conservative management methods used by physiotherapists help progressively ease the symptoms of cervical radiculopathy. The time for recovery is highly variable and it may take many months before symptoms completely go away. Some people will have surgery if the level of pain is not tolerable and activities are severely limited. However, it has been shown that the outcome after one to two years is similar for those who do and do not have surgery.

 

What can I do at home?

When the arm pain is severe, the first thing is to find positions of the neck or arm that ease the pain. Some rest is helpful. Try different heights of pillows in bed or support the arm on a pillow. Consult your GP, as often some type of pain killer is necessary to help sleep. Sometimes, sitting tall and undertaking a few repetitions of an exercise, in which you gently draw your chin back may assist, but do not do these exercises if they make the pain worse. As the arm pain eases, some gentle exercises for the neck and arm can be commenced with care.
 

How long until I feel better?

The time for recovery is variable and ranges from several weeks to several months. For some individuals, it may take up to a year or even two for all symptoms to go away. During this period, it is important to provide the neck with a balance of rest and normal activity.

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RECURRENT OR CHRONIC NECK PAIN

Many people, after having one episode of neck pain, will have another episode of neck pain some months or years later. The evidence suggests that this may occur over their lifetime or for a good part of a lifetime. About one-third of people with chronic or recurrent neck pain also report symptoms as light-headedness or a dizzy feeling, some unsteadiness with balance and, occasionally, visual symptoms.

Tell me more about recurrent or chronic neck pain.

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.

 

What causes recurrent or chronic neck pain?

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.

 

How do I know if I have recurrent or chronic neck pain?

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.

 

How can treatment methods used by physiotherapists help with recurrent or chronic neck pain?

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.

 

How effective are treatment methods used by physiotherapists for recurrent or chronic neck pain?

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.

 

What can I do at home?

  • Effective self-management will help to ensure a good recovery.
  • Be aware of neck postures, and try to avoid slouched postures at work or at home that can aggravate your neck pain.
  • Move regularly.
  • Perform daily head movements in each direction to keep your neck mobile.
  • Other exercises can be performed for the neck and shoulder region to ensure all muscles are working well and are supporting your neck and the weight of your head.

The descriptions of a full range of exercises for the neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.

 

How long until I feel better?

The time for recovery is variable. An episode of recurrent neck pain might settle in a few weeks, but for others, it may take up to 12 weeks or a little longer. In some cases of chronic pain, the pain may never go away completely but can settle down to mild or tolerable levels that allow you to continue with your normal activities. It is important to resume as many of your normal activities as possible as the neck pain settles. Undertaking effective self-management is essential for a comfortable and active lifestyle.

Source: Choose.physio