Possible causes of Neck Pain
Neck Pain may be divided firstly into categories:
(a) Acute Neck Pain following an accident, incident or sudden movement, following a prolonged sustained posture such as sleeping awkwardly.
(b) Chronic Neck Ache which the sufferer may have for a period of months or years. This could be caused by sedentary lifestyle, poor posture and muscle imbalances, repetitive sports or activities, structural problems etc.
(c) Acute on chronic pain, where the sufferer has a flare up of a chronic or previous neck pain.
Any of these may be associated with referral of pain or peripheral symptoms such as headaches, jaw or face pain, forearm or elbow pain.
Types of Neck Pain
Any of the following can be the structure which causes your neck pain or ache, if it is due to a mechanical cause.
- Facet joints
It may also be a combination of several of these.
Neck Pain – DISCS
Disc injuries are not as common in necks as they are in backs, but when they occur in the neck they have the potential to be more serious as if the spinal cord is severely distorted at this level it can effect the upper and lower limbs. This is why accurate diagnosis and care during treatment is essential. No one should ever ever attend a non qualified person to have their neck manipulated. Most disc bulges are only mild however, and the following applies.
Discs are the shock absorbers of the spine. They are found between the bones and are made up of a jelly like centre (like a wine gum consistency) surrounded by tight criss crossing diagonal bands that attach to the bones above and below. They are called the annulus while the centre is called the nucleus.
The nucleus of the disc could be likened to a ball bearing in that it acts as a medium between two solid structures (the vertebrae bones) and allows movements in all directions between the bones, while the ligaments and muscles keep the alignment of these bones.
Most people have poor upper body posture. Most commonly we see people with their head in front of their body instead of on top of their spinal column. As a result some of the discs in the neck can bulge backwards. As a result the nucleus, or little ball of jelly, bulges towards the back (disc bulge A in diagram below).
Over a period of time this bulge may become so large that it presses on the neural structures which travel in the spinal canal, down the spine, behind the discs and this will cause local pain. This may happen gradually after a period of prolonged bending forward over a desk or something.
More commonly a sudden jerk forward or to the side will cause immediate damage to the disc
Some common symptoms of this are:
- Difficulty or inability to bring the neck into line.
- Pain on cough or sneeze.
- Eased by supporting the head.
- Worse in morning.
- Aggravated by certain movements.
- Symptoms in the shoulder or arm.
The early treatment would involve using ice and trying to lie flat on your back with your head supported.
Analgesics are often useful in the early stages until the acute bulge settles a little. However, it is important to seek physiotherapy assessment and treatment early.
The majority of these central discs do settle spontaneously and some professions feel you should wait and see does it settle.
In my opinion, it is extremely important to contact a chartered physiotherapist at this stage, not necessarily for treatment only, but certainly for advice, because if this is your first episode, it may be well be the beginning of a cycle.
Nipping it in the bud or breaking a cycle of recurrent disc bulges is easily done with exercises which must be accurately prescribed.
If you do, or have already entered the cycle of recurrent disc bulges you will find that they tend to get more severe and last for longer each time. This is because the damage to the outer ring (annulus) increases with each episode making subsequent bout of back pain worse.
Neck Herniated or slipped Disc
If the jelly like nucleus in the centre of the disc bulges out through the outer ring or annulus, then you have a herniated disc. This is really what is meant by a “slipped disc” which is a term inappropriately used to describe a bulging disc (disc B below).
If the nucleus or centre of the disc actually protrudes out through the annulus or outer ring of the disc then it is a ruptured disc (disc C in the diagram below) and this will not respond to conventional treatment and surgery may be required.
Your GP or physiotherapist should refer you for an MRI scan if they suspect this and referral to an orthopaedic or neurosurgeon should be considered.
As with the back, people vary a lot, and so giving blanket advice on the neck is inappropriate as although the symptoms described in this article may appear to be “exactly what you have”, there are many other neck complaints with similar signs or symptoms. So an accurate diagnosis should be made before starting any exercise programme. The one sure piece of advice I can give you is don’t just live with it – do something about it.
The prognosis is very good but is dependent on a number of factors.
- The severity of the bulge
- The number of previous episodes
- The stage at which intervention is sought
- The ability of the patient to follow advice
MORE ABOUT DISCS
“The Quick Fix”
When a person suffers neck pain and it is due to a bulging cervical disc, the pain can be very severe and debilitating, and in most cases the sufferer just wants relief by whatever means.
The lengths I have heard some people go to to get relief is unbelievable. The advice some people receive and worse still – actually believe – can be frightening. Going to a non qualified person for neck pain, and having a manipulation can be an exceptionally risky thing to do. Remember, you wont hear about the people who have had a bad experience with a non qualified person, because they will be too embarrassed to talk about it
It is essential that whoever you choose to diagnose and treat your neck problem has a proper qualification.
Not all Advice is Good Advice
How often are we warned about using other peoples prescribed medication.
In a similar way, exercises prescribed for one individual may be contra indicated for another.
For example, depending on the direction of a disc bulge, the exercises prescribed for your friend may actually exacerbate your disc bulge.
“THE QUICK FIX MAY NOT BE THE BEST FIX”
Let me give you an analogy.
Imagine you had a drawer at home that was a bit stiff and got stuck every now and then. Imagine that every time it’s stuck, you hit it a little kick. As a result, the drawer would open and close freely again; for a while. Eventually it would start to stick again and so you’d give it another little kick. And so on and so on, until one day you’d kick it and it falls apart.
Now, if you had taken that drawer out the first time it stuck, and looked for the reason why it stuck, and did something about that, then the drawer would move smoothly from then on.
Similarly if every time you get a bulging disc you get it a “quick fix” and knock it “back into place”, then it will continue to bulge again. These episodes will start to happen more frequently and become more severe until one day the “quick fix” just doesn’t work anymore and the disc is so badly damaged from repeated trauma that it requires surgery.
Now, the first few times you get a bulging disc, if you went and sought accurate diagnosis, advice and treatment, the cause of your specific bulging disc would be recognised. This may be any number of things, such as:-
- Weak muscles
- Too much movement at one segment of your neck due to prolonged poor posture
- Too little movement at one segment of your neck due to prolonged poor posture
- Tight muscles in one area
- Your posture
- Your job or lifestyle to name but a few.
If the cause of the problem was addressed and dealt with, then you should be able to break the cycle of disc injury and so heal your disc.
Also, you will be properly advised on how to prevent disc injuries, how to recognise when a disc is beginning to bulge, and what to do at the first sign of a disc bulge. As a result, you should be able to stop the cycle of disc bulges which you are already in, or just about to face into.
NECK PAIN – JOINT PROBLEMS
Each vertebrae (bone) in the spine is made of a body at the front . These are the weight bearing part of the bone, and they are separated by the discs . At the back of each vertebrae is a space (the spinal canal) through which the spinal cord passes.
Behind the main body of the vertebrae there are two little joints which lie at an oblique angle, making them ideal for movement but not for weight bearing.
How Pain occurs
The most common ways which pain can be caused by the facet joints are :-
- Displacement or subluxation
- Ligament damage
We’ll look at impingement here as this is the most common type.
This usually occurs over a period of time if the facet joints are pressed close together . It will ultimately cause wear and tear of the joints and possibly arthritis. It occurs because of a combination of any of these-
- Poor Posture
- Muscle spasm
- Post injury
- Post disc problems
Signs and Symptoms
- Pain after prolonged desk work or sitting
- Reduced movement in certain direction in neck
- Darts of pain on certain movements
- Sometimes shoulder / arm pain.
As this is often a chronic problem, management will involve changing or removing the cause of the problem. Even if the initial cause of the dysfunction was a disc injury or trauma to the spine the posture needs to be altered to fully alleviate the symptoms.
Often before you can start to change posture, you need to have the offending joints mobilised, and have tight muscles stretched. Pressure will need to be taken off the neural structures, or myofascial trigger points may need to be released to alleviate symptoms in the shoulders or arms.
While treatment of the above is taking place, you need to do a stretching and strengthening programme so that when the pressure is taken off the joint the spine will be supported in its correct alignment to prevent the further problems.
Your job, lifestyle and hobbies should be examined to see if there are any minor changes which could be introduced to take pressure off your joints.
It’s never too late to start this.
Aching shoulders, Arm pain, Stiff Neck, Headaches, Disc Injury, neck pain