Neck Pain

The spinal column supports our head and protects the spinal cord, which is the main structure linking the nerves throughout our body (Versus Arthritis, 2019).

Our neck is made up of 7 bones, called cervical vertebrae, ligaments to support it, muscles to help support and mobilise it, discs which sit in between each vertebra, and nerves which branch out from the spinal cord and between the joints, to supply the sensation and power down the arms to our fingers.

(Image from Versus Arthritis, 2019).

There are different causes of neck pain. Most of the time, there is no serious underlying cause for the symptoms.

At Kingsland Physiotherapy, we commonly treat:

• Stiff or restricted neck range of movement
• Facet joint pain (the joints on the side of the vertebrae)
• Muscle tightness and active trigger points
• Postural problems

Causes can include:

• No obvious reason or injury, and can be due to high stress, lack of sleep, awkward positioning when sleeping, prolonged postures
• Whiplash – the neck is moved suddenly forwards and backwards causing soft tissue injury e.g. car accident, sports injuries, falls or other trauma
• Muscle strain
• Ligament sprain caused by a fall or sudden twist that overloads a joint in your neck
• Cervical spine pain with radiculopathy – neck pain with referred upper limb altered sensation or numbness, which is indicative of a nerve root irritation
• Cervicogenic headaches – some types of headaches can be linked to the joints and muscles of your neck
• Between the vertebrae, there are discs which act as shock absorbers. There is a jelly like substance in the middle of the disc, which can protrude out the disc and irritate the nerve. This is known as a disc herniation, and can be caused by either repeated or a sudden, forceful stress to a spinal joint.
• Rarely, the symptoms can be due to an underlying inflammatory problem e.g. ankylosing spondylitis or polymyalgia rheumatica (Versus Arthritis, 2019)

Risk Factors

Some factors have been suggested to predispose a patient for chronic (over 3 months) neck pain (Physiopedia, 2019):

• Aged over 40
• Low Back Pain
• History of neck pain
• Frequent cycling
• Reduced hand strength
• Worried
• Poor quality of life
• Reduced fitness

When should I see someone?

It is worth seeing a Physiotherapist if you have:

• Generalised neck pain with no history of trauma
• Neck pain following an injury e.g. skiing, cycling, whiplash, work related
• Loss of movement in your neck
• If you have associated headaches
• You should see a Physiotherapist or a Doctor if you have any tingling or numbness down one or both of your arms or legs

You should seek urgent medical attention if you have any of the following:

• Severe neck pain after a significant injury e.g. car accident, a fall
• Difficulty passing urine, loss of control of your bowel or numbness around this area
• Loss of function in your arm – significant weakness, persistent loss of feeling, altered speech
• If you suspect a spinal cord injury, call 911, keep still and ask someone to place towels on either side of your neck to keep your spine immobilised. Avoid moving and await medical assessment.
• Have flu like symptoms, fever, headache along with a stiff and painful neck, and difficulty bending your head forwards (Sinicropi, 2017)

What can I do?

• Keep moving – change your position regularly
• If you are struggling to sleep or mobilise due to pain it may be worth speaking to a GP or pharmacist about pain relief for short term relief to let you get moving
• Try wrapping heat in a towel e.g. hot water bottle/wheat bag (don’t burn your skin) and apply to the back of the neck/around shoulders for 10-15 minutes. This helps the muscles relax
• Wearing a collar or immobilising the neck is not helpful
• Sometimes people report clicking or grinding noises. This is known as crepitus, and can be caused by air bubbles popping, or the tissues and bones moving over each other (Versus Arthritis, 2019). This is common, but it’s not serious

You can also try these exercises, around 10-20 second holds in the pain free range, 2-3 times daily:

Neck retraction – Lying on a folded up towel, tuck in your chin as if making a double chin. Breathe normally. Keep head resting on the towel.

Sitting neck retraction – a great exercise if you are sitting or flexing over something for a prolonged time. Tuck your chin in as if making a double chin.

Neck side flexion – sitting, hold on to the side of the chair. Bring your ear down to your shoulder to feel a stretch in the neck. Cradle your head to gently assist this movement, don’t pull down. Hold for 10-20 seconds, then turn your head as if looking at your armpit to change the area of the neck getting stretched, and hold for a further 10-20 seconds.

Thoracic mobility – another great exercise if you have been sitting for a long time, or feel tight between your shoulder blades. Lie on the floor or a mat, on a rolled up towel longitudinally. Rest your head on a pillow or folded up towel for neck comfort if you need. You can lie for 30 seconds to 2 minutes if comfortable.

Pec stretch – a nice stretch if you have been sitting for a long time, or working in a flexed position for a long time. Stand with your arm in a door frame or wall, with your elbow bent and sitting around shoulder height. Turn your body and feet away from the wall to feel a stretch across the front of the chest.

References:

Physiopedia. 2019. Neck Pain. Clinical Practice Guidelines. [online]. [Accessed 19^th June 2019]. Available from: http://www.physio-pedia.com

Sinicropi, S. 2017. When Neck Stiffness may mean Meningitis. [online]. [Accessed 26^th June 2019]. Available from: http://www.spine-health.com

Versus Arthritis. 2019. Neck Pain. [online]. [Accessed 19^th June 2019]. Available from: http://www.versusarthritis.org

Exercise Images. 2019. Syme, K. Kingsland Physiotherapy.