By Michael Hall
Neck pain now rivals low back pain as one of the most common complaints in modern day life. And it seems that with our mounting modern day emotional and psychological stresses, increasingly sedentary lifestyles, prolonged work positions, poor postures and routine movement patterns, the incidence of neck and upper back pain is on the increase. Symptoms arising from structures in the neck and upper back may be experienced as headaches, facial pain, neck pain, shoulder blade pain or pain, pins and needles, numbness radiating down the arms to the hands.
It is well known that the neck and upper back structures can and often do contribute to upper and lower arm pain. What is less well known is that upper and lower arm pain can lead to neck pain. Consequently, neck pain is a complex issue, often involving many causative factors and numbers of different types of structures. As the body is a system, affecting one structure will cause other structures to be affected and this will further complicate the presentation of the problem. What this means, is that if treatment of neck pain is to be successful in the long term, it must address all the factors involved in the presentation of the problem as well as the different stages of healing.
The structures involved in neck pain
Neck pain can come from any structure that is innervated by a nerve such as:
• joint surfaces
• the capsule or ligaments surrounding joints and holding them together
• muscles and also
• vertebral artery.
Whilst each structure may be cause pain in its own right, it is more likely is it that a number of structures will be involved in any particular injury and therefore will be responsible for the pain or dysfunction being experienced.
What are the causes of neck pain?
There are many causes of neck pain. These include:
• Disease- e.g. Rheumatoid Arthritis
• Trauma- e.g. whiplash, concussion, direct impact - contusions
• Acute injuries- e.g. muscle strains, joint sprains
• Lifestyle injuries- e.g. work/posture and movement related pain
These last two factors can be broken down into:
• Poor posture
• Poor movement patterns
• Poor training techniques
And these may be further influenced by:
• Psychological factors
• Equipment or environmental factors such as chairs, beds and work stations
The pathology of neck pain
The last two factors are important because in addressing them, we have the opportunity to limit and perhaps even to prevent neck pain and its associated symptoms. The reason for this is that poor posture and poor movement patterns become habits and as such place the same stresses on the same structures day in and day out. Most people without being aware it are slightly bent forward and consequently have rounded shoulders and an increased upper back forward stoop. This results in a protruding head and a stiff upper back which means that as a person looks forward, the joints of the upper cervical spine will become compressed leading to stiffness and possibly headaches and even arm pain. These may cause further movement and posture changes which may perpetuate the problem or perhaps lead to other problems.
Aims of Treatment
The aims of treatment include:
1. Identify and eliminate the causative factors
2. Decrease inflammatory response
3. Promote growth of new tissue
4. Improve quality of tissue repair
5. Prevent recurrences
Treatment as your solution to neck pain
Treatment of any injured tissue must take into account the stage of healing at which the tissue is. Each particular stage determines the aims of treatment and together with the structure identified to be at fault during the examination, dictates the type and intensity of techniques which will be of most benefit.
In the acute stages for example, the focus is on reducing inflammation, preventing further injury and eliminating the causes of the injury through resting from any aggravating activities, cold packs, anti-inflammatory cream and medication. As pain settles, the emphasis shifts to promoting tissue healing through the use of electrotherapy, massage, joint and neural mobilisation and exercise.
A progressive exercise regime must then be gradually implemented which targets deficits and taps into the specific activities and goals of the individual. Exercise must be progressed from gentle stretching and isometric holding to concentric, eccentric and finally functional activities.
For complete effectiveness, this program must also address the lifestyle components of the person’s problem such as working/home environment, the equipment involved, the activities to be performed, the postures to be maintained as well as other wants and needs of the individual. Only by addressing all of these factors can abnormal or excessive stresses in the body be eliminated, tension levels be reduced and the body able to completely heal and recover.
It is our experience that patients who do not undertake a comprehensive conditioning program and combine this with removing excessive neck stresses and more generally in the body, will not achieve a good, long-term result.
For more information or for an appointment, please call Bodywise Health on 1 300 263 994.
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• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.