"In the Neck of Time": Proper Treatment and Prevention of Neck Pain

 The neck is one of the most commonly treated areas in chiropractic. One estimate puts the incidence rate in the last 3 months at almost 14% for adults. (Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7.   However, there are many cases of neck pain that are either not treated until further, "harder to treat" pain ensues or are treated with less effective means of treatment.  This lack of proper treatment may be due to a lack of awareness of proper neck function as well as an underestimation of the long-term consequences of a minor neck injury.  This is unfortunate, as a healthy and mobile neck is essential for a healthy and mobile life.  Part 1 of this article will explain the causes and categories of neck injury.  In Part 2, the proper diagnosis, treatment and prevention of the most common neck conditions will be discussed, so that you can manage your neck pain proactively, instead of "in the neck of time", when more severe conditions may already have developed.

First of all, let’s start with a little discussion of neck function and anatomy.  The "neck" actually refers to the cervical spine and the structures that both pass through and attach to it.  This includes the 7 cervical vertebrae, which are bony structures, and the fascia (connective tissue), ligaments, tendons, arteries, nerves, veins and glands attached to them. And as the neck also includes the spinal cord and nerve roots passing through and letting the brain communicate with the rest of the body, one can not underestimate the importance of a properly functioning cervical spine. There are both deep and superficial layers of neck muscles:

Superficial Neck Muscles

Functionally, the cervical spine of course supports the head and jaw, and allows us to both have an upright posture to use the organs located in these structures (brain, ears, eyes, nose and throat) as well as allowing for freedom of mobility for turning to move with the rest of the body and for visualizing our surroundings.  Without proper cervical spine function, the nerves passing between each vertebrae can become compromised, and so can the spinal cord.  Normal cervical spine range of motion is about 50 degrees flexion (bending your neck forward), 85 extension (backwards), 90 left/right rotation, and 40 lateral flexion. When we move and perform everyday motions as well as take part in athletic activity, we actually use "coupled" motions of more than one of these at a time.  Until one has an injured neck and loses mobility, the amazing functional capabilities of the neck region are often taken for granted.  For example, few gym exercise routines dedicate exercises to the neck region.  And without proper neck rotation, safely operating a motor vehicle, bicycle or even walking is very difficult as turning to see your surroundings and traffic can be limited.

Also often evaluated in cases of neck pain are the head, jaw, and shoulder complex.  And, for a complete biomechanical exam the thoracic and lumbar and pelvic regions as well as the lower extremity should be evaluated as all the regions of the spine and the extremities are connected through kinetic and myofascial chains, as well as neurologically.
 
Causes of Neck pain and injury: 

There are two major categories of neck injury, just as in most musculoskeletal injury: both acute or "traumatic" injury as well as "chronic" or overuse injury occur in the neck region. However, often what may appear to be an acute or sudden injury may be the result of years of neglect of a lower-level chronic injury that finally results in an acute, highly painful and disabling injury.  This is often the case with the increasingly sedentary nature of our daily lives.  And, as children are using electronic devices as early as after only a few months of age, the age of onset of some neck injury is much earlier than in the past. Also, youth sports such as soccer (heading the ball), football, wrestling and gymnastics all can result in neck injury.

Thus, since there can be overlap between the acute and chronic injury, with an ongoing chronic condition occasionally causing acute episodes of more severe pain and dysfunction, it is useful to categorize neck injury into three categories or "stages" based on the degree of tissue involvement. These 3 stages are:

1) Postural strain and deconditioning: This stage is characterized by local pain that occurs as muscles and connective tissue are stressed by overuse of certain postures and lack of full range of motion on a daily basis. Think of the poor computer or sitting posture with the shoulders rounded forward and the head extended on the neck. Or the flexed neck posture of constantly using your cell phone for texting and emails. Some muscles shorten, some weaken, blood flow decrease, and joints stiffen. Symptoms are stiffness, burning pain in muscles, and muscles and joints that are very tender to the touch.

2) Mechanical Dysfunction: "subluxation" or "joint dysfunction". This stage can either be a progression of poor posture leading to the spinal joints losing proper alignment and motion, or an acute injury that may occur more easily on the now de-conditioned cervical spine and musculature. Either case can then cause both local and referred pain down the arm or back or into the head or jaw, from the muscles and joints or from actual nerve irritation. X-rays will show altered alignment and motion but MRI studies may be normal. If left untreated, structural changes start to occur in the spine and ligaments that may not be fully reversible. This degenerative process is often considered part of “normal aging” but the rate of progression of this process is accelerated by leaving these joint and muscle dysfunctions untreated. This can eventually lead to significant pain and functional limitation, especially if the third stage of neck injury is reached.

3) Degenerative Conditions of the Discs and Joints with or without spinal nerve root or spinal cord involvement:  

If the 2^nd stage of neck injury is not treated properly, often the neck will start to display structural changes in response to the chronic stress of poor posture and altered spinal biomechanics. Diagnostic imaging studies (x-rays and MRI’s or CT scans) will show not only the altered posture and vertebral alignment, but degeneration of the intervertebral discs, disc bulges and herniation, and arthritic changes to the spinal joints. Joints can become unstable, and both the spinal cord and nerve roots can become irritated. Symptoms can now include more severe nerve pain, numbness and muscle weakness in the upper extremity or even lower extremity. The good news is that although these structural changes may be present, often if the underlying postural stress and deconditioning of Stage 1, and the mechanical dysfunction of stage 2, are addressed, the clinical significance of the degenerative changes can be minimized.

As we age, the likelihood of progressing through all of the stages of neck injury is greater.  However, as will be explained in Part 2 of this article,  if you take action and get timely treatment and follow proper "neck protective" daily habits, when it come to this area of the body you will be "in the neck of time" avoid activity and lifestyle limitations due to a "pain in the neck".  Check back for Part 2 next month!