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Neck Pain Treatment


Neck Pain treatment, causes, help - An MSK Therapy perspective

Neck Pain treatment

One of the author's most common complaints seen in a clinic setting is patients seeking neck pain treatment and related issues. It is common to see other areas of pain associated with the cervical spine, hence why shoulder and neck pain often occur. Equally, upper back and neck pain are common, and there are associations between neck pain and headachesor migraines. The author has been treating within the musculoskeletal / MSK field for nearly sixteen years and has seen a gradual increase in the number of people experiencing such problems. Patients seeking treatment for unresolved neck injuries and persistent pain are all too common (see the article on Persistent Pain for further details on aspects of such conditions and treatment). Such patients often require a slightly different approach, yet results can be very positive, even for long-standing problems. Many musculoskeletal type injuries can often occur for one or a combination of reasons, such as lack of use, misuse, overuse or abuse (as noted by the late Osteopath Leon Chaitow), though infections or diseases can also cause injury.

However, modern-day life and habitual behaviours (habits), what we do, and how we use our bodies play a huge part in developing a sore neck . The advent of smart devices and the amount of time spent using such devices can certainly place a great deal of additional strain on the musculoskeletal system and result in a stiff neck. Terms such as "Text Neck " have become a popular way to describe the resulting neck-related conditions/symptoms associated with the modern way of life. It is also worthy of note that "stress" can have a significant impact on the musculoskeletal system and result in a combination of shoulder and neck pain and even tension or migraine headaches , (see the article on headaches for further details. There are also threes articles about the topic of stress, which include further details about the human stress response, what happens, the impacts on the body, and techniques to help manage stress. Please follow the link to read the first article on Stress, the Individual, Wellbeing, Performance and the Workplace (Part One).


Cervical anatomy and neck pain

The cervical spine is the most mobile spinal section, consisting of seven relatively narrow vertebrae. The shape of the cervical vertebrae enables a high degree of mobility, though at the expense of structural strength and stability. In contrast, the lumbar spine has much thicker vertebrae, is far less mobile and has far more structural strength and stability than the cervical section. The lumbar section of the spine has to carry the weight of everything above it, unlike the cervical spine, which only has to carry the weight of the head. Contrary to the lumbar spine, the cervical spine relies much more heavily on soft tissue structures for its stability than the actual shape of the vertebrae. Hence, generally speaking, the neck is more susceptible to injury from direct and indirect injury mechanisms, partly due to the head and body weight at either end of the cervical spine. Typically, complexity increases the opportunity for something to go wrong. The complexity of tissues and structures working to create a highly mobile and normal pain-free neck movement increases the opportunities for neck injuries . Some forms of neck trauma can have severe and life-changing consequences due to structures passing through the cervical spine from the head and brain to other parts of the body. Hence, there are direct links between neck trauma and other conditions affecting the upper back, extremities and other parts of the body.

Cervical Spine anatomy - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

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Cervical injuries resulting in neck pain

Neck Pain injury mechanisms and habits

Much like other parts of the spine, the pain-free functioning of the cervical spine relies on multiple soft tissues and other structures seamlessly working together. Injuries to individual components enabling normal neck function result in restrictions in mobility, pain and inflammation. Neck pain symptoms may occur due to unresolved trauma elsewhere within the body or due to pain referral. Injury mechanisms are highly relevant to the type and extent of what is injured, leading to cervical pain symptoms. Neck pain symptoms may occur due to injury or the impact of an injury on a combination of tissues and structures within and passing through the cervical spine, including:-

  • Intervertebral Discs
  • Zygapophyseal Joints
  • Zygapophyseal Joint Capsules
  • Muscles
  • Ligaments
  • Tendons
  • Vertebral Bodies
  • Vertebral Elements
  • Nerves
  • Veins
  • Arteries
  • Lymphatics
  • Organs - Visceral tissue
  • Fascia

Bowling balls, gravity and adaptation

Neck Pain and head weight bowling ball

We often forget that our limbs are relatively heavy and that external forces such as gravity are constant. Muscles and other body structures work together to maintain any given bodily position but have a finite capacity to do so (postural fatigue). How quickly tissue fatigues will depend on multiple variables/factors, including strength, conditioning of said tissues, given position, loading, previous injuries, existing adaptations, specific medical conditions, hydration, etc. In some respects, the adult human head resembles a bowling ball weighing 10 lbs or more. Many muscles are involved in maintaining normal head carriage, and these vary in size, strength, anchor points (origins and insertions) and thus endurance ability. Some of these muscles relate directly to the cervical spine and head, while others directly or indirectly relate to the upper back, shoulders and other body parts.

Trying to maintain a set or given position for hours on end and without moving can be equivalent to making said muscles run a preverbal marathon. Unfortunately, although the maintenance of a normal head position requires the use of a wide variety of muscles, amongst other things. Many of these muscles are relatively small and not suited to marathons. Leg muscles, on the other hand, are far larger and more suited to endurance activities. Most people would not think twice about the fact they experience aching and pain after running a marathon and yet make their neck muscles do similar daily. However, running involves movement and a carefully coordinated combination of muscles contracting and opposing muscles relaxing. Equally, there are different muscle contractions (concentric, eccentric, isometric), and movement typically involves a combination of such muscle actions.

Sitting for long periods requires the body to hold specific joint structures against the forces of gravity and in a set position via isometric muscle contractions, leading to sore neck muscles . Specific muscles perform a stabilising function during any given movement. However, when maintaining a fixed position, all muscles involved in holding that position will provide a stabilising role and isometrically contract. In effect, prolonged isometric contractions do not give muscles or tissues a break, unlike when one moves. Just imagine holding a feather at arm's length without any support. It would not take long for the feather to start feeling heavier as muscle fatigue sets in, along with aching and pain.

Regular movement is also critical for veinous and lymphatic circulation of nutrients and waste products around the body and to prevent build-up within tissues. The flow works via muscles contracting and relaxing, which differs greatly from prolonged isometric contractions. The foam roller article has more of an explanation of how muscle actions squeeze fluid through the veinous and lymphatic systems. Excessively prolonged isometric muscle contractions are generally not normal for the body to do for prolonged periods, and the tissues adapt accordingly. As tissues fatigue, head carriage changes, and other tissues and structures take additional load. Each degree of increased forward head carriage exponentially increases the loads placed on soft tissues and upper back and neck structures. The human body then has to adjust to the new demands placed on it, which can result in visible postural changes and a hunching appearance.

Postural and soft tissue changes can result in pain, discomfort, reduced mobility and myofascial trigger points (MTrPs), (see the article on Myofascial Pain for a more detailed explanation of trigger points). A more detailed explanation of adaptive changes is available via the related article on Tissue Adaptation. Hence, the reader might see some reasons that pain can become chronic, and as a musculoskeletal professional, the author sees such issues all too commonly. Research has shown links between Trigger points and myofascial pain affecting the neck and shoulders and some forms of headaches and migraines , hence why it is common to see patients within a clinic setting who suffer from headaches and neck pain .


Neck Pain causes and conditions

Neck Pain causes and conditions

Medical conditions affecting the cervical spine will involve the body's inflammatory response, which, regardless of injury mechanism and severity, will impact an area around the site(s) of injury. Hence, there is a direct link between the amount of trauma sustained and the extent of the area impacted by the inflammatory response. The article covering tissue healing explains more about how the body repairs and the inflammatory process. Some medical conditions directly affect the structural integrity of vertebrae within the neck, as seen with fractures or osteoporosis. Other degenerative conditions, such as rheumatoid arthritis or osteoarthritis, can damage the smooth cartilage surfaces of vertebrae, which normally reduce friction between bony joints. The neck also consists of multiple types of joint structures with slightly differing components based on function.

The main joints involve the vertebral bodies, smooth cartilage surfaces, invertebral discs and ligaments holding the discs in place between most vertebrae within the neck (C7-C2). Discs provide a shock absorbing function to help lessen the head load on the relatively small veberbrae and smooth surfaces. Discs consist of fibrocartilage rings, which look similar to the rings in a tree, though the centre of the disc has a more jelly-like substance (nucleus pulpous). Too much load on discs can result in varying degrees of bulging, as the jelly material squeezes through the rings of fibrocartilage to deform the shape of the disc. In the worst case, in a sequestrated disc, the jelly material bursts through all the rings of fibrocartilage and leaves the cervical disc body . Disc injuries can press on other structures, including ligaments and nerves. However, the good news is that discs can heal and even reabsorb the jelly-like material, given the correct healing environment. Not all bulging or herniated discs are painful and often routinely seen on imaging, yet the patient has no symptoms. In other cases a patient has symptoms, and imaging highlights disc pathology.

The neck also consists of many small synovial joint structures consisting of smooth articular cartilage surfaces, a capsular membrane reinforced with ligaments and a synovial fluid lubricant. Such joints are found throughout the cervical spine and between more minor parts of the individual vertebrae (superior and inferior articular processes), as opposed to the main vertebral body. Injuries can occur to individual components of these Zygapophyseal Joints or the capsules, resulting in pain and immobility. There are also other specific synovial joints between the skull and C1 and between C1 and C2, which may also get injured.

Although neck pain may originate from an injury to a specific joint or components thereof, invariably, there is always wider soft tissue involvement. Many ligaments and muscles cross multiple joint structures and have multiple attachment sites, not to mention the fascial network (see the article on Biotensegrity for further details on the relevance of the fascial network). These soft tissues can transmit force and are rich in sensory inputs, which the brain can interpret as pain. Hence, some more painful neck problems can involve protective muscle spasms, such as "wry neck or torticollis", which are often easily treated in a treatment or two. Protective muscle spams can occur as a means of preventing a perceived injury or to prevent further injury. Muscle spasms effectively splint an area to prevent further movement and involve strong and sustained muscle contractions around the area requiring protection. In essence, the body easily turns the protective mechanism on but does not necessarily turn it off again, resulting in severe pain and restricted mobility. Other structures such as nerves, veins, arteries and lymphatics run between all the soft tissues. Changes in soft tissue tension can then effectively press on these structures to produce differing symptoms, including neurological pain. The author cannot think of a single form of injury mechanism that would have no impact on soft tissue structures due to the underlying anatomy and physiology of the body. Hence, any treatment needs to consider such factors and adopt a holistic approach to health.


Neck pain treatment and self-help

Neck Pain treatment and self-help

As briefly mentioned, many injuries and symptoms can occur over time, creating adaptations and affecting biotensegrity. Although there are various self-treatment techniques, there are always limits to the effectiveness of said methods in a self-help context. Limitations of the effectiveness of self-treatment options depend on multiple factors, such as the actual limitations of what the treatment technique can do, the ability to apply the method correctly in a self-context and if there are any technique contraindications. There are times and situations when treatment techniques may present a danger or worsen symptoms and are ill-advised (contraindicated). The other risk with some self-treatment options is knowing what condition you are dealing with and trying to treat, increasing the risks of making things worse. The general back pain article contains valuable insights into some common self-help strategies relevant to neck pain, such as rest, the use of heat and cold, stretching, body positioning and things to avoid. The article also covers some of the pitfalls of self-diagnosing via the Internet and the risks of self-treatment based on what social influencers or forum members suggest. No two injuries are the same due to unique environmental and person-specific factors, meaning that what works for one person may not work for another. Even with all the experience, training and knowledge the author has as a musculoskeletal and soft-tissue therapist, he would struggle to treat his neck, shoulders or back effectively. The limitations of techniques and applying them in a self-treatment context apply to him, though it is possible to achieve more than somebody without such knowledge.

One can apply basic risk management principles to help identify and limit neck painor other musculoskeletal-related conditions. There can be many factors or variables concerning musculoskeletal conditions, and there is no difference in neck pain . Even sleeping position and correct pillow height can have links to the onset or continuance of back, neck and shoulder pain. Over the years, the author has developed a great deal of understanding about the types of things (factors) that can play a part in the onset of pain. In some cases, there is an apparent direct or indirect injury mechanism, though in others, there is not. By indirect, the author means some form of historical injury, adaptation or combination of such factors which results in biomechanical changes elsewhere within the body. Over time, Such changes can impact other areas of the body, and in some cases, it may take years before the patient notices any pain or symptoms in the neck or elsewhere. Typically, active people, in particular, tend to pick up on small and noticeable changes earlier on, especially elite-level athletes. Active people push their bodies often, meaning problems can become apparent sooner. Athletes also tend to have a high level of self-body awareness and are highly motivated to continue being active or competing.

Resolving neck pain can sometimes be challenging, especially when chronic (over six months), due to many tissue adaptations that can occur over time. However, it is still possible to produce positive change within a few treatments in most cases and even severe neck pain cases. Injury mechanisms, injury severity, chronicity and individual attitudes to following aftercare advice can also affect outcomes. Equally, resolving neck pain or other musculoskeletal issues can be challenging if one cannot identify the probable cause or the "irritant" factor. One can only manage risk if one knows what the risk is, and many variables can be at play. A relatively common reason for neck and back pain can relate to an incorrect work setup, likely leading to quicker muscle fatigue. One can create a simple, ergonomic computer setup with little cost or effort. An ergonomic computer setup should help, though one should still take breaks and other measures. See related article on setting up ergonomic computer setup. Poor working posture and forward head carriage, can result in increased loads on the back resulting in combinations of upper and lower back pain (see the article on back pain for further details).

The author is acutely aware of the relationship between the upper back, neck and shoulders and the pain one can experience. Before working within the Musculoskeletal health field, the author served in elite British forces and gained experience carrying heavy rucksacks for prolonged periods. When rucksacks have a poor or no hip belt, as with standard-issue rucksacks of the time, virtually all the weight ends up on the shoulders. Carrying such weight requires that the upper back, neck and shoulder muscles maintain sustained isometric muscle contractions even when walking or running. The combination of the sustained isometric muscle contractions, shear equipment weight and physical duration can prove painful. Also, the neck muscles must do additional work to counterbalance the weight on the back, effectively pulling the head carriage forward, especially when going uphill. However, the body still adapts to its demands over time.


Why bother seeking external treatment help?

Neck pain treatment

Although some may have initial concerns about seeking professional help due to perceived costs or previous bad experiences, it is possible to gain neck pain relief in a relatively small number of treatments. However, bad actors operate within the musculoskeletal health field and may try to drag out treatment plans or prompt treatment as a lifestyle choice to achieve optimal health or performance. Equally, it is essential to understand that resolving neck pain is a two-way active process involving effort from both the treating professional and the patient. Unfortunately, patients who take a passive approach to treatment by not following aftercare advice open themselves up to bad actors. Bad actors may also push the idea that a patient is taking an active approach to their health and wellness by seeking multiple short-duration treatments a week for prolonged durations when this is a passive treatment approach. The article on finding an ethical musculoskeletal professional provides some tips on things to look for and avoid.

The author's assessment and treatment process involves a detailed initial consultation and testing to help identify the reason for neck pain symptoms and any related structural and functional adaptive changes. Treatment then involves a combination of manual therapy techniques to address the related structural and functional changes causing the patient's symptoms. Myofascial release techniques can be very effective for treating acute and chronic neck pain symptoms, especially when combined with other treatment methods. Techniques such as Gua Sha can also effectively treat neck pain symptoms . Prescriptive exercises alongside hands-on therapies can aid recovery, help with risk management and injury prevention and produce better treatment outcomes.

Some members of the public may want instant fixes for neck pain , it is worth considering how long symptoms have existed and, thus, how much tissue adaption has taken place. It may be possible to relieve neck pain in a single treatment, but that certainly does not mean the other adaptations have resolved. Equally, a single treatment provides no opportunity for the effects of aftercare advice to take effect either. Unfortunately, there is also a common perception that there are only issues if there is pain or things will sort themselves out. The author often sees many problems that simple and occasional maintenance work may have avoided. Preventative work also helps identify potential issues, manage those and help patients develop better body self-awareness. Many neck problems the author sees in a clinical setting require minimal treatments, typically only two to three. Good results are even achievable in cases of chronic neck pain in two to three treatments, though often further work is needed. Ideally, seek treatment as soon as possible, thus minimising the likely number of treatments needed due to prolonged adaptive changes.

The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

The Morningside clinic occasionally runs promotional treatment rates for new and existing patients, which are available via the online booking calendar. If you liked this article or found it interesting, feel free to share the content with others. There are lots more articles available via the TotalMSK main Health, Wellness and Sports Injury blog page, which has a brief description of all the articles to date.


About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.