Physical Therapy Series: Neck Pain
Why Does Everyone Seem to Have Neck Pain?
Neck pain, also known as cervical spine pain, affects 10-20% of adults. With the increasing use of technology, neck pain is becoming more common. Many people spend their days looking down at smartphones and computer screens, putting strain on their cervical spines.
Common Symptoms of Neck Pain
Common symptoms of neck pain include pain and stiffness with difficulty moving the neck. It is commonly associated with headaches. If a cervical nerve is involved, patients may experience pain, numbness, and tingling in the arm or upper back.
What's Happening with Your Neck?
Your neck is designed to hold your 12-pound head upright. When you lean forward to look at a phone or computer screen, the force on your neck increases to 25-30 pounds. This constant strain leads to neck pain.
Here's what's happening: Your cervical spine is like a stack of delicate building blocks, with each vertebral body representing a block. These blocks are cushioned by vertebral discs, acting like shock absorbers between them.
Just as a building needs a strong foundation, the spine is supported by ligaments and spinal muscles, ensuring its stability. The spinal canal houses the spinal cord, which is like a vital information highway.
The facet joints connect the blocks at the back, allowing for flexibility and movement. Lastly, the nerves that branch out from the spine reach out to the upper back and arms, providing vital communication and sensation.
What are the common causes of neck pain?
Aging: The most common cause of neck pain is aging. Everyone will get Degenerative Disc Disease as they age. The discs in our necks simply wear out.
Chronic Straining: Physical strain can cause neck pain, such as a sudden injury from strenuous lifting or chronic strain from poor posture. Chronic strain, or "tech neck," is becoming far too common.
Whiplash: Trauma from falls, contact sports, or car accidents can result in "whiplash," leading to cervical pain.
Mental Stress: Many people respond to mental stress by unconsciously tightening their neck muscles, which can cause neck pain.
Impingements: Growths from disc herniations or disc bulges, bone spurs, cysts, or tumors can impinge on the spinal cord or the cervical nerves.
Cancer: Finally, cancer or meningitis are rare causes of neck pain.
Two Types of Neck Pain
The two types of neck pain are axial neck pain and radicular neck pain.
Axial neck pain - remains in the cervical spine. This pain can originate from the vertebral bodies, facet joints, vertebral discs, ligaments, or muscles.
Radicular neck pain - originates from the spinal nerves as they leave the spinal canal at the foramen. These nerves can be pinched or irritated by narrowing of the foramen. The foramen can be narrowed by ruptured or bulging discs or arthritis in the facet joint, which causes enlargement of the joint or bone spurs. An irritated or pinched nerve will cause pain, numbness, and/or tingling to shoot down the arm or upper back.
Do You Need Surgery to Treat Neck Pain?
The vast majority of patients do not need surgery to treat their neck pain.
However, cervical pathology from injury or disease that results in weakness or paralysis may need emergent surgery. Infections, tumors, or cancer could as well.
All other causes of axial neck pain or radicular pain will usually respond to conservative care. Keep in mind that surgery is oftentimes reserved for those patients who fail to respond to conservative care.
Almost everyone has some degree of arthritis and degenerative discs or bulging discs as we age, so do not be alarmed by the findings on your MRI or X-ray. Most radiologic abnormalities will respond to non-surgical treatment.
Inflammation and Neck Pain
If your pain is due to inflammation and muscle spasms, your doctor will often start an anti-inflammatory medicine such as an NSAID (examples: Motrin, Advil, Aleve) for moderate pain or a steroid (example: Medrol dose pack) for severe pain.
Pain due to inflammation that fails to improve may require a cortisone injection to get relief. You may be referred to a pain specialist or spine center to get an injection around the nerve root, spinal cord, or into the facet joint under fluoroscopic (live-action X-ray) guidance to get relief. There are also numerous supplements that can help with inflammation.
If muscle spasms are an issue, you may be prescribed a muscle relaxer.
What's the Next Step?
The first line of treatment for neck pain or radicular pain is physical therapy. As with other joints, a stiff and weak joint is a painful joint. Some patients cannot imagine starting physical therapy when they are in pain.
Physical therapy modalities will also help decrease pain and inflammation, so it's best to begin therapy immediately instead of waiting for pain relief. In most cases, the quicker you start therapy, the faster you will heal and decrease the chance of a prolonged recovery.
These modalities can include heat/cold treatments, massage, muscle stimulation, gentle stretching, and spinal traction.
If you have a stiff neck or mild to moderate pain, you can start with some simple stretches at home. For more severe pain or pain down the arm with numbness, tingling, or weakness, you should see your physician.
If you have been to the therapist and had good results with cervical traction you can try home traction with some simple equipment. You can use a pillow or rolled up towel without buying equipment.
This video starts with an excellent explanation of cervical anatomy and causes of neck pain with some simple exercises.
The Journey of Physical Therapy
As you progress, your therapist will introduce a variety of motion exercises and strength-building activities. Upon completing therapy, you will be placed on a home program, where you will dedicate time each week to completing neck exercises, which will decrease the chance of the pain returning.
Changing Poor Posture
If your pain is related to poor posture, your therapist will recommend exercises to improve your posture as well as suggestions to improve the ergonomics at work and your neck position when sleeping.
Employers are becoming more aware of this problem and are often willing to improve the ergonomics of the workspace to prevent injuries.
Ergonomics - is the study of the working environment. An ergonomically designed worksite would be a space designed to maximize worker safety.
In regards to people with desk jobs, this would be a workspace that allows proper posture when working on the computer. As more people are working from home, we have seen an increase in neck pain likely related to the lack of an ergonomically designed workspace.
Working from your couch, bed, or lounge chair might be comfy at first, but it may be causing long-term neck issues.
What to Do If You Have "Tech Neck"
Improve your posture by making sure your screen is at eye level.
Get a supportive chair.
Take frequent stretch breaks.
Consider investing in a standing desk.
Standing Desks: Are They Worth the Hype?
You may have heard that sitting is the new smoking. This is why standing desks have become popular. Although some of the claimed health benefits are questionable they do help improve posture when working at a desk. Most of the desks are actually sit-stand desks so you can alternate between positions.
How Sleep Affects Your Recovery
Sleeping well is a vital part of recovery, and if you’re having a hard time getting a good night’s rest due to neck pain, here are two videos on the benefits of sleeping with your neck in neutral alignment.
Conclusion
As stated before, everyone gets degeneration of the cervical spine as we age. Our goal is to keep you pain-free! If you have recovered from an injury, recovered from surgery, or would like to avoid neck pain totally, it is important to routinely stretch your neck and maintain good posture. This applies to all of us, even surgeons who work long hours looking down while operating.
In addition, decreasing your levels of chronic inflammation with nutrition, exercise, sleep, and stress management will make you more resistant to chronic neck pain.
Not sure where to start reducing the inflammation in your body?
Read my blog post Inflammation 101 to learn more.