Neck (cervical spine) is among the commonly injured areas, as stability is compromised due to excessive need of movement in this area. Neck affection can give symptoms localized to neck, but it can also be the source of headaches, pain in the arms and interscapular area.
The neck as a result of enormous amount of movement undergoes wear and tear of supporting muscles and ligament giving rise to strains and sprains in these structures. Moreover as a result of sustained activities on the desktop/laptop in a wrong posture has increased the incidences of cervical stains. The hectic schedules in metro cities with people carrying their laptops/ files and lunch across their shoulder contribute to their cause.
A majority of neck pain gets better over time without much intervention, however, a few symptoms are indication of possibly serious medical condition and patients should seek immediate medical attention. Cervical symptoms that need immediate medical attention are-
• Neurological deficit like weakness in the arms or loss of feeling and coordination in the arms or legs could indicate nerve damage. • Excessive pain accompanied with appetite loss, excessive weight loss, and nausea and vomiting or fever, there could be a spinal tumor or infection.
Common causes of neck strains and sprains (soft tissue injuries around neck) include:
• Sleeping in wrong position – patient often wakes up with a wry/ stiff neck due to sleeping in an awkward or atypical position or overextended neck that strained the muscles and ligaments around the neck. • Sports injury – Injury to neck muscles while sporting activity is common. A collision or fall in an unusual manner can have severe consequences like nerve entrapment between cervical vertebras or fractures of cervical spine. • Poor posture – Working for long hours in a faulty posture give rise to cervical strain, and in the long run other serious problems related to neck. Text neck is a common problem these days with excessive use of cell phones. • Repetitive motions – Activities such as dancing and sports that involve repetitive neck twisting and turning can give rise to strains and sprains of neck. • Whiplash injury – In a whiplash injury, the head and neck are forced suddenly backward and immediately forward with a great deal of force resulting into tear or rupture of soft tissues around the cervical spine. A motor vehicle accident or contact sports injury can be whiplash type.
ACUTE NECK PAIN
The acute neck pain often arises due to soft tissue injuries around the neck as discussed under the strains and sprains above. Most of these injuries to the ligaments, tendons and muscles in the neck usually heals in a couple of days, but, if the problem persists it’s better to see a physiotherapist in time before it gets worse.
CHRONIC NECK PAIN
A Neck pain that has persisted for more than 6-8 weeks is considered chronic. The most probable structures involved in chronic conditions are facet joints, the cervical vertebrae or disc. It can be at single level (i.e. structures between two vertebrae) or multiple levels.
Common causes include-
Degenerative Disc Disease (DDD)
The natural wear and tear on the cervical spine over time takes places as a process of aging. The disc gradually loses its hydration and its ability to cushion the spinal vertebrae. If the wear and tear of spine has progressed significantly it can lead to painful irritation of a cervical nerve in various ways, such as a herniated disc, pinched nerve, or changes in the facet joints (facetal arthropathy) and spondylosis.
Disc Herniation (PIVD)
Herniation of cervical disc is when the jelly-like inner layer, the nucleus pulposus, leaks out through a tear in the disc’s protective outer layer, the annulus fibrosus. A herniated disc may compress a cervical nerve giving rise to radicular pain in the hands, condition known as cervical radiculopathy.
The disc inbetween the vertebrae flattens with aging resulting into approximation of vertebrae and facets over time. The friction in the approximated cervical vertebrae leads to overgrowth of bones at the margins of the vertebrae called osteophytes. This leads to significant pain and stiffness in neck. This condition is known as cervical spondylosis.
The facet joint also loses its smooth gliding rather produces grinding sound as a result of reduced space leading to facetal arthropathy.
Spinal Stenosis/ Myelopathy
In advance stage of cervical spondylosis, severe osteophytes (bone spurs) leads to narrowing of spinal canal. Spinal canal narrowing can also occur from severe central disc bulge (herniation in the central canal). This condition is known as spinal stenosis. Myelopathy results when the narrowing of central canal is severe enough to compress the spinal cord. Symptoms like weakness or problems with coordination in the arms, hands, legs, or feet are features of advanced stage Myelopathy.
The vertebral foramen is present at the sides, formed between articular pillars of two adjacent vertebrae. The foramen space can be compromised due to facetal joint arthropathy (bone spurs at facetal joint) or Posterolateral disc herniation (disc bulge to the sides). This can compress the exiting nerve root at that level giving rise to symptoms of pins and needle and numbness along the distribution of the same nerve. This nerve root irritation at cervical level is also known as cervical radiculopathy.
By identifying the pattern of numbness, reflex changes and muscle weakness a physiotherapist can easily predict the nerve root involved and the level at which nerve is compressed.
Foraminal stenosis can co-exist with cervical Myelopathy.
As a result of defect in pars interarticularis a vertebra slips over the vertebra below it. This can result from traumatic fracture or ligament laxity. Spondylolisthesis may present as radiculopathy of the involved segment.
Neck is often involved in later stage of Ankylosing Spondylitis. This is a form of progressive arthritis that affects the spine and large joints of the body. Pain and stiffness is present throughout the spine and in advance stage all the vertebra fuses to form a rigid spine giving a bamboo like appearance.
Non-Specific causes of Neck Pain
Some non-specific causes of neck pain include: • Emotional stress. Stress, anxiety, or depression can tighten the muscles of neck producing trigger points in and around the neck which most of the time causes referral pains in head, jaw, over eyebrow, chest and arms.
• Infection. Eg. Meningitis.
• Myofascial pain. The adherence of muscles with its surrounding connective tissue results into chronic pain especially in neck and upper back region. This condition also features the pain points called trigger points.
• Fibromyalgia. Neck is one the most common area to be involved in cases of fibromyalgia.
• Spinal tumor. Cancerous growth can occur in the cervical spine or metastasized from other body part to cervical area and press against the cervical nerve.
Patients with neck pain associated with one or more of the following symptoms should immediately see a physician/ orthopaedician – • Fever or chills • Nausea or vomiting • Clumsiness with hands, such as dropping items or trouble buttoning a shirt • Increased difficulty with walking or bowel or bladder control • Fatigue, trouble with memory or thinking that persists • Pain that does not improve after a few days and continues to disrupt daily activities, such as dressing, driving, and/or sleep.