Neck pain is a very common complaint among people of all age groups. It is, however, more commonplace among people in their thirties and onwards. Neck pain is mainly due to degenerative or wear and tear changes in the spine and is most often part of a progressive disease. It means that the underlying problem responsible for neck pain will slowly but surely get worse in time.
It is therefore of paramount importance that treatment focuses on supporting the structures of the neck and to prevent excessive stress on the spine.
There are three types of neck pain: mechanical neck pain, referred pain and radicular pain.
This is pain that is caused, as the name suggests, by the mechanics of movement. There are muscles, tendons, vertebrae, discs and joints between the vertebrae, nerves and other structures that can cause pain. Mechanical pain is based on inflammation of these structures and the aggravation of this inflammation by movement. Over time, either due to postural stresses or past injury, the way the neck moves changes. We develop fibrous reinforcement through our soft connective tissues of the neck to help us cope with prolonged sitting posture or to repair injured tissue. This reinforcing tissue (adhesion) is strong but not very elastic and the tissue that it is thread through loses its ability to elongate as our joints in the neck move.
We develop altered movement patterns where some joints don’t move enough and others have to move more to get the same overall movement. Turning and bending the neck is uncomfortable and frequently associated with crunching sounds and a feeling of stiffness. It is often worse on the one side. It is frequently associated with referred pain.
This is pain that spreads from the inflamed tissue in the neck along nerves to other parts of the body. Referred pain is not due to nerve compression and is a more vague and non-specific pain which spreads to the head, shoulders, between the shoulder blades and even behind the eyes. This is directly associated with mechanical neck pain. It should NOT be confused with radicular pain. Referred pain is a frequent cause of headaches. The nerves that supply the skin of the head come directly from the neck and pain can spread along these nerves. The treatment for referred pain is the same as for mechanical neck pain, since the cause is the same in both cases and based on inflammation of tissue.
Radicular pain is due to nerve compression (pinched nerve). Dermatomes are skin maps that indicate which area of the skin is being supplied with sensation by a specific spinal nerve. This will allow your Chiropractor to have a reasonable suspicion about which nerve is being compressed if you have radicular pain. The fifth cervical nerve root (leaving the spinal canal between the fourth and fifth cervical vertebrae), for instance, is called C5 and extends from the shoulder to the wrist on the inside of the arm. When there is compression of this nerve root, you will experience pain over the area supplied by that nerve which may be present as a sharp-shooting electric pain with associated numbness, tingling and/or weakness. Both the physical compression of the nerve root and the inflammatory changes in and around the nerve root are responsible for the pain.
Treatment is aimed at restoring the neck movements so that the soft tissue and joint of the neck can move freely and cope with normal activity without getting distressed.
We massage and loosen the tight structure that are involved so that we can gently and safely restore movement to the less mobile joint and thus reducing the workload of the overly mobile joints. The methods of loosening joints are decided by you after discussing options with your chiropractor. Spinal manipulation in the form of gentle adjustments may be offered or alternatively a specialised mobilisation technique that Steve has developed may be used. Some people have contraindications or may be fearful of manipulation so for these people the mobilisation technique is a great choice.
Our Chiropractors always screen the arteries in the neck to address the risk of strokes in patients. We also place a big emphasis to limit any manipulation to an extremely gentle force. We then advise the patient on postural tips and preventative exercises.
Treatment for radicular pain is similar to mechanical pain however manipulation of the neck may not be offered if we think that there is an increased risk of aggravating the nerve. Mobilisation is a great alternative for these patients. There are only a small percentage of people who do not improve, in which further action will be discussed thoroughly.