What is neck pain?
What are some of the common causes of neck pain?
Muscle StrainsTypically muscle strains occur from overuse or misuse, if they occur from an accident or sudden injury, they can become chronic without proper management. When a movement pattern is repeated too many times, no matter how biomechanically sound that movement pattern is, it can cause an overuse strain. If a movement or position is not biomechanically sound, there is greater risk of injury. Once you have sustained soft tissue or joint injury some positions and activities may no longer be tolerated such as reading in bed, working on a laptop, driving long distances, and lounging on the couch with your feet up and head propped on a pillow. Occasionally with repetitive neck strains, sleeping becomes very difficult and patients turn to different pillows as a solution. Neck muscles essentially become fatigued and eventually strained and chronic overuse can cause chronic pain. This chronic state becomes very frustrating for patients because over time, even the smallest deviations from optimal posture, postures that you have been able to tolerate for years, are no longer tolerable.
Joint SprainsTypically joint sprains occur in the small facet joints that form the articulations between each vertebra. Over time and with repeated sprains, these joints show their wear and tear.
- Overuse is when normal forces are repeated. In this situation a pattern may be biomechanically sound and can still lead to breakdown causing tissue and joint damage. It is simply the excessive accumulation of force that produces the damage.
- Age and how we live our life. Sometimes joint damage is a result of being too active and over stressing our joints, and sometimes from being too sedentary and not stressing our joints enough.
- Misuse is when abnormal forces are repeated. Poor mechanics and biomechanics effects the health of our joints and bad patterns performed repetitively can sprain and strain joints.
Nerve CompressionNerves travel from the spinal cord to the periphery thru canals, recesses, and anatomical spaces. In a healthy state the amount of available space is adequate. There are a number of less than favourable conditions in the vertebrae which can reduce the amount of available space and subsequently may compress the nerve. A pinched nerve may occur from aging, damaged discs, herniated discs, bone spurs and/or traumatic injury. With age, the discs that lie between the vertebrae become less hydrated and stiff, narrowing the space in the lateral canal, and pinching the nerve. Herniated discs on the other hand create a different effect. When the inner gel-like material called the nucleus pulposus of the disc, protrudes through the outer annulus it can compress the nerve as it exits the spinal canal in the intervertebral foramen or lateral canal. This can cause arm pain, weakness, and/or symptoms of numbness and tingling in the arm and hand. Bone spurs are also characteristic of arthritic joints and can obstruct and compress adjacent nerves. Lastly, trauma and/or injuries sustained in motor vehicle accidents, falls, and sports injuries can cause acute trauma to the nerve.
Typical Risk Factors for Neck Pain
- Age. The neck is often affected by osteoarthritis, which is a result of wear and tear and often comes with age.
- Occupation. Your risk of neck pain may be higher if your job requires your neck to be held in one position for prolonged periods of time. Especially if this position is not one of optimal posture where the curvatures of the spine are maintained. Examples include driving and computer work. There are some positions and/or postures that stress your neck and long careers in these postures may be hazardous.
- Bad Habits. The most common aggravating and causative factors of neck pain are poor work and/or leisure postures. The effects are cumulative, where for a long period of time there may be no signs and symptoms, be sub-clinical in nature, until one day, pain becomes evident insidiously.
- Genetics. Some conditions that may lead to neck pain are genetic, such as osteoarthritis, rheumatoid arthritis, skeletal structural alignment, etc. With this predisposition thru family history, you should be even more diligent in correcting your lifestyle.
What is the prognosis of neck pain?
- Avoiding hurtful postures and positions such as sitting, bending lifting,
- Build in recovery strategies into you hard days of work
- Seek Physiotherapy Treatment immediately when your pain is significant or frequent
- Ensure enough quantity and quality of sleep.
How can physiotherapy and massage therapy help with neck pain?
Manual PhysiotherapyYour Physiotherapist will begin with an examination of range of motion to determine whether joints and/or muscles are involved and then determine the best treatment plan to improve mobility and decrease pain. The nerves will be examined to determine if there is a pinched nerve effect and/or if there is neural tension and shortening effect causing nerve like symptoms such as tingling, numbness, and “pins and needles”. Your Physiotherapist may suggest a soft collar to support your neck and help relieve acute pain by taking pressure off the structures in your neck. Manual Physiotherapists and Massage Therapists are skilled in the art and science of palpation, they are able to determine which joints are restricted and in which direction using their hands to palpate these movements. Joint motion analysis consists of manual tests called PIVOMs and PAVIMs which evaluate the small intervertebral joint movements that produce motion in the spine. With this information, your Physiotherapist can help to increase these specific articular motions and restore global neck range of motion. These small movements are known as the arthrokinematics of joint mobility. They are essential for normal function and exercises will not necessarily restore these motions.
Massage TherapyThe goal of the Massage Therapist is to reduce pain and spasm in the affected muscles, as well as decrease disc and nerve compression. By evaluating and determining where the tone and restrictions are, massage therapy can help release and restore soft tissues. Common muscles that are involved with neck pain are upper trapezius, levator scapulae, posterior cervicals, sternocleidomastoid and scalenes. The anterior cervical fasial structures are also treated in conjunction with these muscles. Techniques used for neck pain are dependent on the stage of healing and injury state, and if acute or chronic. Myofascial and gentle Swedish Massage Techniques are used during the acute phase and then progressing to deep tissue, Swedish massage and trigger point techniques. During either stage the focus is to release and decrease tone and spasm in the musculature of the neck.
Physiotherapy and Neck ExercisesYour Physiotherapist and massage Therapist may recommend neck exercises, stretches, and self release techniques. Exercises, along with Manual Physiotherapy, may improve pain by restoring muscle function, optimizing posture to prevent overload of muscle, and increasing the strength and endurance of your neck muscles. The postural approach to exercise is to reinforce corrective patterns, to focus on strengthening the back and scapular stabilizers, to stretch the chest muscles, and to mobilize the spine.
How can exercise and physical development help after neck injury or pain?
Assessment of Functional MovementWe start with a functional movement screen that looks at some of the essential movement skills for daily living and also for an activity based lifestyle. This information in addition to our previous orthopaedic assessment findings will allow us to develop a personal improvement plan just for you. This plan will have specific goals, be measurable, will call you to action, will be realistic, and will be time sensitive so that you will see progress and we will monitor and support your success from a medically based standpoint and from a sports science stand point.
Rehabilitative Exercise after Neck Pain and InjuryIt is important to regain functional neck range of motion, as well as to strengthen the muscles which help to support the neck and spine. In addition to Manual hands on therapy techniques, exercises to increase range of motion can be performed at home and at physiotherapy. These include flexion (chin to chest), extension (chin to ceiling), side flexion (ear to shoulder), and rotation (turn head to look over the shoulder). Your Physiotherapist will perform manual therapy techniques to release restrictions and follow up with range of motion exercises in order to maintain this new range of motion. Maintaining range of motion exercises can help to decrease pain and improve joint health by aiding blood and nutrients in getting to the joint. The next important goal following a whiplash injury is to regain strength and correct posture. There are a series exercises to progressively develop optimal posture. Patients will start with simple posture correction exercises that both reinforce good posture but also stretch and strengthen this postural pattern. Trunk control, engaging the scapular muscles by your shoulder blades and chin retractions in supine and later in sitting and standing are effective. Scapular retractions in different planes and during different functional movements such as when driving a car or putting dishes away or working at the computer etc. We typically start with active postural correction and then with resistance using elastic bands and cables. Your Physiotherapist will advise which exercises are appropriate at which point of each patient's treatment and will progress the exercises throughout the course of treatment.
Physical Development after Neck PainThe final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
- Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
- You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
- We look at the ergonomics specific to your workplace and home
How can low intensity laser therapy help neck pain?
Physiological effects of Low Intensity Laser TherapyWith LILT there is an increased production and release of:
- Endorphins which - natural analgesics
- Cortisol – a precursor of cortisone
- Growth hormone – instrumental in tissue repair
- ATP – improves and regulates cellular metabolism
- An increase in protein synthesis – collagen, DNA, fibroblasts
- A facilitated venous and lymphatic flow
- Increased angiogenesis – the elevation of oxygen saturation
- Enhanced immune response
What life style and self-care measures can you do for yourself to relieve acute and chronic neck pain?
- Over-the-counter pain relievers may be recommended by your doctor to relieve pain. Try over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others).
- Alternate heat and cold. Reduce inflammation by applying cold, such as an ice pack or ice wrapped in a towel, for up to 20 minutes several times a day. Or alternate the cold treatment with heat. Try taking a warm shower or using a heating pad on the low setting. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution.
- Rest. Lie down from time to time during the day to give your neck a rest from holding up your head. Avoid prolonged rest, since too much inactivity can cause increased stiffness in your neck muscles.
- Modifying your activities and postures. Your physiotherapist and massage therapist can help you determine which exercises and which activities are causing you harm than good.
- Gentle stretching. Gently move your neck to one side and hold it for 30 seconds. Stretch your neck in as many directions as your pain allows. This may help alleviate some of the pain. If these do not improve your condition your physiotherapist will be able to assess why.
Prevention Neck PainNeck pain is often associated with poor posture during the years where age-related wear and tear occurs. To help prevent neck pain, keep your head centered over your spine, in a neutral position as we call it. Some simple changes in your daily routine may help. Consider the following:
- See your healthfx Physiotherapist or Massage Therapist not just in a crisis but for preventative and proactive care as part of your personal improvement plan to keep the joints that become stiff moving. Gentle joint mobilization and soft tissue techniques can keep the articulations moving
- Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back such that your chin is tucked into your throat, your ears in line with your spine, and this will reduce neck strain. Try to avoid gritting your teeth and or eating/talking in poor posture.
- Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests, and your shoulders pull back and down in a position of scapular retraction.
- Avoid talking on the phone with the phone between your ear and shoulder when you talk. If you use the phone at work, use a headset.
- Avoid lying with your head propped up on a pillow when either reading and/or working on your computer in bed or on a couch. This bad habit is the most common cause of neck pain.
- Avoid sleeping with more than one pillow as this can cause significant neck and upper back problems and should be avoided. Instead use one narrow pillow such that when you lie on your back your ear is in line with your shoulder rather than in a forward head posture.
- Stretch frequently if you work at a desk. Every few minutes adjust your position and pull your shoulder blades back and down such that your head comes back into line with your neutral spine. This position along with a position of chin tuck with stretch the muscles
- Balance your muscles. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced your muscles.
- Avoid sleeping on your stomach. This position puts your neck at the very end of its range of motion and puts excessive stress on the muscles and joints. Choose a pillow that supports the natural curve of your neck.
Always consult your physician before beginning any exercise program. Never disregard medical advice or delay in seeing your doctor because of something you have read on healthfxtoronto.com. Any content or information provide by healthfxtoronto.com is for informational and educational purposes only and any use thereof is solely at your own risk. Neither healthfxtoronto.com nor its operators or staff or video presenters bears any responsibility thereof.
The information contained herein is not intended to be a substitute for professional medical advice, diagnosis or treatment in any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. All information contained in heatlfhxtoronto.com including but not limited to text, graphics, images, videos, information, third party information and or advice, food, recipes, exercises, diets, psychology, websites, links, including but not limited to any content by employees, consultants or writers and contributors and or any other material contained herein are for informational and educational purposes only.