Browsing Category: "Neck Pain"
Overview
Neck pain results when the spine is stressed by injury, poor posture, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that subsides after a period of days or weeks. It can also radiate to the head, shoulders, arms, or hands. It typically resolves with rest, exercise, and other self-care measures. Some people suffer from chronic pain that continues despite treatment.
You play an important role in the prevention and healing process of neck pain. Strong, flexible muscles help to promote a healthy neck that maintains good alignment, allows movement, and provides structural support.
The neck region of the spinal column is called the cervical spine. Protected within the cervical spine are the spinal cord, nerves, and blood vessels. The seven cervical bones, called vertebrae (C1 to C7), are cushioned by shock-absorbing discs (Fig. 1). Each disc contains a rigid outer layer that surrounds a gel-like inner layer. The vertebra is held in place by muscles and ligaments that function to support and move your head. Exiting from the spinal column through the holes (foramina) on either side of the vertebra are the spinal nerves. The cervical region has the most range of motion because of two specialized vertebrae that connect to the skull. These special vertebrae allow your head to bend, turn, and move side to side. The neck can also be a prime location for injury and pain (see Anatomy of the Spine).
Types of neck pain
Neck pain ranges from mild to severe, and is classified as either acute or chronic.
Acute neck pain often relates to soft tissue injury (e.g., sprains of muscles, tendons, or ligaments) or disc herniation. Acute pain usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves with over time.
Chronic neck pain persists (lasts more than 3 months) and its source may be hard to find. Chronic pain may be present all the time, or worsen with certain activities, poor posture, and improper body mechanics. Other contributing factors may be related to nerve cell changes, tissue scarring, arthritic changes, or psychological effects of chronic pain. In some cases, the complexity of chronic symptoms requires consultation with a pain management specialist (see Pain Management).
What are the symptoms?
Signs and symptoms of neck pain may be stiffness, tightness, aching, burning or stabbing or shooting pains, pressure, or tingling. Muscles can feel sore or tense in the neck, face, or shoulders. Muscles spasm when they go into a state of extreme contraction (e.g., after whiplash). Movement may be restricted—perhaps you cannot turn your head past a certain point. If nerves are involved, tingling, numbness, or weakness may develop in your arms or hands. Where and how the symptoms manifest in the body can also indicate the level (from C1 to C7) and type of injury or disease.
Several situations signal the need for prompt medical attention. If nerve compression is severe, symptoms can include numbness and/or loss of coordination in the arms or legs, or loss of bladder or bowel control.
Neck pain accompanied by a headache, fever, or nausea could be a symptom of meningitis (an infection of the membranes around your brain) or of a hemorrhage in the brain. If your neck is so stiff that you can’t touch your chin to your chest, you should seek immediate medical attention.
What are the causes?
Neck pain can result from injury, poor posture, stress, natural wear, disease, and other sources. Poor spinal alignment (e.g., slouching, sleeping on the stomach) and improper movement (e.g., poor lifting technique) stress the cervical spine and make injuries more likely. Neck pain can result from:
- Injury or trauma: A significant force can stress the structures of the neck, for example, a whiplash injury, sports injury, or fall. Fractures, such as vertebral compression fractures, can result. A tear in the muscles and ligaments of the neck may predispose the discs to bulge or herniate.
- Bulging and herniated cervical disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve. In severe injuries, the gel bulges out and causes the outer rim of annulus to rupture or tear.
- Pinched nerve: When a spinal nerve is compressed (radiculopathy), pain may run down your arm into your hands or fingers. Pinched nerve pain differs from carpal tunnel symptoms, which usually involve numbness.
- Osteoarthritis (degenerative disc disease): As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.
- Stenosis: Narrowing of the spinal and nerve root canals occurs as facet joints enlarge and ligaments stiffen over time. As the spinal canal narrows, it presses the cord and nerves, causing them to swell and inflame.
- Spondylolysis: A weakness or stress fracture develops in one of the bony bridges that connect the upper and lower facet joints.
- Spondylolisthesis: A weakness predisposes the vertebra to slip out of normal position.
What treatments are available?
Self care: Most neck problems resolve with self-care measures such as rest, ice or heat, massage, over-the-counter pain relievers, or gentle stretches (see Self Care for Neck and Back Pain). If home treatments aren’t working within the first couple of days, see your doctor.
In developing a treatment plan, your physician or healthcare provider will assess the type of disease or condition, and its impact. A team approach for treatment of neck problems is often the most effective. Medical treatments include surgical or nonsurgical care and self-care strategies that aim toward restoring a healthy neck and preventing future re-injury.
Physical therapy and exercise: Neck pain typically resolves with nonsurgical care with options such as massage, traction, or gentle exercises for the neck. Other options are physical therapy, chiropractic care, massage therapy, acupuncture, trigger point injection, or other treatment. Maintaining good posture and proper body mechanics during activities and sleep complement treatment.
Medications: Your doctor may prescribe nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) to reduce inflammation and relieve pain. If you have spasms, a muscle relaxant may be prescribed for a short time (3 to 4 days). If the pain is severe, an analgesic that can be taken with the NSAID or muscle relaxant may be prescribed.
Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period or as an injection directly into the source of pain (see epidural steroid injections and facet injections). Steroids have the advantage of providing almost immediate pain relief within 24-hours.
Surgery: Surgery is rarely recommended unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or if the pain is severe and not resolved after a reasonable course of nonsurgical treatment.
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More than half of the human beings face neck pain at some time in their life. If neck pain lasts for long time or it creates problem repeatedly, it is said to be chronic. Generally chronic neck pain is caused by abnormalities in soft tissues either because of injury or prolonged wear and tear. Different types of chronic neck pain are caused by different reasons.
Muscle strain:
Overuse of neck creates strain in the soft tissues. It creates acute pain in the neck and back. Poor posture and work habits sustain the pain for long. Repeated overuse of muscles creates pain particularly in the back side of the neck.
Cervical Foraminal Stenosis:
Pain developing very slowly over the years and occurring after particular positions of the neck is might be due to Cervical Foraminal Stenosis. Wear and aging of the vertebral joints in the neck or at the disc margins creates this kind of pain. It is sometimes difficult to distinguish this type of pain from muscle pain if on is depending on x ray and CT scan. In such cases, an injection called as medial branch block (MBB) is done. Injection conforms that cause of the pain is facet joint.
Cervical herniated disc:
Cervical herniated disc is the main cause of the neck pain radiating down the arm in some cases to the hands and fingers. Herniated disc or bone spur compresses the spinal cord to cause the pain. Symptoms of this type of pain create suddenly and slowly. If the pain is not responding to the conservative treatment (medication, physical therapy or manipulations), surgery is also needed.
Disk injury:
Disc controls motion of the neck. When it is stressed beyond the limits it creates the pain extending to the annulus (outer wall of the disc). General case of this is the whiplash injury. Muscles and ligaments are inflamed or stressed by an accident. Neck pain sometimes flares or gets worse. Pain is increased by certain postures. In most of the cases it gets healed but for some people it creates pain in normal activities. About one forth of the patients develops neck pain due to disc injury.
©2007 health-information-articles.com.
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Neck pain can easily be resolved in most cases with the right treatment and exercises.
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Chronic neck pain
There are many conditions that can cause chronic neck pain. The following information describes symptoms of some of the more common causes of chronic neck pain.
Neck pain that radiates down the arm
Pain that radiates down the arm, and possibly into the hands and fingers, is frequently caused by a cervical herniated disc or foraminal stenosis pinching a nerve in the neck. The pain may be accompanied by numbness or tingling in the arms and/or hands. The symptoms may start suddenly or develop over time.
The approach to treatment for a cervical disc herniation is guided by how long the pain lasts, pain intensity and the degree to which the cervical nerve and/or spinal cord are affected. Most commonly, the symptoms are temporary and can be treated successfully with conservative care (such as medication, physical therapy, manipulations). If the pain does not respond within 6 to 12 weeks of conservative treatments, then surgery may be recommended.
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Introduction
Over many years, our necks are subjected to repeated stress and minor injury. These injuries may not cause pain at the time of injury. However, repeated injuries add up, and can eventually result in degeneration of the cervical spine, causing neck pain. Most neck pain is due to degenerative changes that occur in the neck. The overall condition of the cervical spine usually determines how fast you recover from an injury, and whether your neck pain will become a chronic problem.
For chronic neck pain, there may not be a quick fix or complete cure. You will need to work with your health care team to try to improve the problem causing pain and to slow down the degenerative process. The physician’s role in the treatment of neck pain is to find the main causes that need treatment right away. He or she will also try to keep your neck pain from becoming a chronic condition by teaching you how to slow down the degenerative process and prevent further injury.
The purpose of this information is to help you understand:
- The causes of neck pain
- The normal anatomy of the spine and neck
- The signs and symptoms of degenerative changes in the neck
- The treatments available to you now and later
- What you can expect from those treatments
- What you can expect long-term if you have a problem with neck pain
In order to understand your symptoms and treatment choices, you must start with some understanding of the general anatomy of your spine and neck. This includes becoming familiar with the various parts that make up the neck. You should have a general understanding of the function of these parts, that is, how they work together. The more you know, the more you will be able to talk with your doctors and health care team in words that will help them better understand your specific problem. It will also help you understand what they are telling you about your particular problem.
The purpose of this information is to help you understand your neck pain problem, so you can make the decisions that will best help you to prevent injury, make the best treatment choices, and speed up the healing process.
Anatomy
The Parts of the Cervical Spine and How They Work
In general, the neck includes the cervical spine (the upper most part of the spine) and the soft tissues that surround the cervical spine. These soft tissues include: nerves, muscles, ligaments, tendons, and blood vessels. The cervical spine is made up of the first seven vertebrae in the spine. Your doctor will usually refer to these bones as C1 through C7. The cervical spine starts just below the skull and ends just above the thoracic spine. The spine has two main functions:
- To protect and support the spinal cord
- To give structure and support to our body allowing us to stand up straight”
The vertebrae are the 24 bones that are linked together to make up the spinal column. Just as the bones of the skull protect our brain, the bones of the spine protect the spinal cord. The spinal cord is the large collection of nerves that connects the brain to the rest of the body.
In the center of each vertebra is a large hole. Because the vertebrae are all linked together, these holes line up to form a “bony tube”, called the spinal canal, through which the spinal cord passes. This bony tube makes up the spinal canal, which provides protection and support for the spinal cord.
As the spinal cord leaves the brain, it travels down the spinal canal to the tailbone. Along the way, it gives off smaller nerves that leave the spine between each vertebra through an opening called the foramen. The nerves that leave the spine in the upper area, or the cervical spine, travel into the arms to the hands. The nerves that leave the spine in the chest area, or thoracic spine, mostly go into the chest and belly area. The nerves that leave the spinal canal in the lower spine, or the lumbar spine, travel into the legs and feet.
To better understand how the parts of the spine work together, let’s look at a spinal segment. A spinal segment is made up of: two vertebrae, the intervertebral disc between the vertebrae, and the two nerve roots, one from each side that “branch off of ” the spine. The cervical vertebrae are the smallest vertebrae in the spine because they do not have the weight-bearing function of the vertebrae in the back. One pair of spinal nerves exits through the gap between the vertebrae in each segment. One common cause of pain comes from pressure on the nerve roots, sometimes causing pain and numbness in the neck or in the lower body.
The space between two vertebrae contains a large round disc of connective tissue, called an intervertebral disc. By looking at the intervertebral disc from above, we can see an outer ring, called the annulus, and a soft spongy center, called the nucleus pulposus. The annulus is the strongest part of the disc and helps keep the spongy center inside the disc. The nucleus pulposus acts as a shock absorber to cushion the bones from pressure during twisting, jumping, and weight bearing.
A joint is formed where two or more bones meet. Bony knobs, called facets, extend from each vertebra and overlap each other to form a facet joint. Facet joints link the vertebrae together like a chain, and provide a mobile connection between each vertebra. The facet joints are important because they allow the neck to bend and turn. Each vertebra can move only a little, but the chain of small movements combined makes the spine very flexible.
The Most Common Causes of Neck Pain
The disc is made up of connective tissue, which wears normally as we age. However, many of the problems that cause neck pain are from abnormal wear and tear. This process is called degeneration of the intervertebral disc. Degeneration often results from small injuries that may not cause pain at the time the injuries actually occur. Over time, these injuries add up and the abnormal wear and tear can weaken the connective tissue that makes up the disc. Once the connective tissue is weak, sudden stress, such as a whiplash type movement, may injure the disc more easily. The entire process of disc degeneration is sometimes referred to as spondylolysis. You may hear your doctor refer to your neck problem as spondylolysis of the cervical spine.
To really understand neck pain, you need an understanding of the wear and tear process, called disc degeneration. This will also help you later understand what can happen to the neck when a sudden injury can cause immediate pain and dysfunction. The next section will explain both the process of degeneration and the most common causes of pain in the neck.
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