Neck pain is a very common problem and can be caused by muscles, bones, joints, tendons, ligaments, or nerves. Neck pain can be related to shoulder, jaw, head, or upper arms. Causes can be Neck strain, muscle tension, overuse, sitting at a desk for longer periods, sleeping in an awkward position, falls, accidents, car accidents, whiplash injury. Bodyset Physical Therapy Johns Creek has created this guide for patients suffering from neck pain.

• Neck pain is also known as cervicalgia

• Approximately 50% of individuals will experience a significant episode of neck pain in their lifetime

• Radiculopathy – Neck pain caused by irritated nerves radiates to upper back, shoulder blades, shoulders, arms, or hands.

Acute Neck Pain

Short lived discomfort that resolves quickly over a short period of time

Chronic Neck Pain

Persistent symptoms, long lasting and at times contribute a big effect on patient lives

What is the neck made up from?

• Vertebrae

• Facet joints

• Neck muscles

• Intervertebral disc

• Nerve roots

• Arteries

What causes neck pain?

• Sedentary lifestyle – being inactive

• Improper sleeping position

• Stress and anxiety

• Muscle sprain/strain

• Underlying conditions such as arthritis, disc degeneration, etc.

What are the signs and symptoms of mechanical neck pain?

• Pain – Neck, Shoulder, Shoulder blade, Upper chest, Back of your head, Behind your eye, ear or forehead

• Pain type – Sharp, Stabbing, Dull, Aching,Throbbing, Tingling

• Tenderness, Tight muscles and Stiffness

• Numbness or tingling – pins and needles

• Weakness

• Clicking – crepitus

• Muscle spasms

• Decreased Range of Motion – Difficulty looking up

• Decreased Rotation – Difficulty looking over the shoulder

• Increased pain when coughing, sneezing, reaching, or sitting

• Inability to stand straight or sit up straight

• Poor Posture

• Headaches

• Inability to remain in one position for a long period of time, such as sitting or standing, due to pain

• Pain that is worse in the morning or at night

• Sleeping Difficulties

Interesting things about Pain

• Extreme pain is not uncommon & Pain does not always mean a serious problem

• No pain with damage is possible

• Severe pain with no damage is also possible

• Mood, Emotions, Lifestyle choices and Beliefs influence pain

• Some people avoid social interaction and important activities when in pain

Anatomy of Spine (33 Vertebrae)

• Neck – 7 cervical

• Mid-back – 12 thoracic

• Low back – 5 lumbar

• Sacral – 5 fused

• Coccyx – 4 fused

When should I speak to a doctor about my spinal pain?

• Pins and needles or numbness increasing in both arms or legs at the same time

• Dizziness, vertigo, light-headedness

• Double vision

• Trouble swallowing food

• Slurred speech

• Fainting or blackouts

• Facial numbness

• Nausea with spinal movements

• Uncontrolled movement of your eyes (nystagmus)

• Walking difficulties or balance impairments

• Increased clumsiness or weakness with arms and legs

• A feeling of slapping your foot/feet when you are walking

• Severe night pain or night sweats

• Rapid unexplained weight loss

• If you develop severe pain and you have osteoporosis (thinning of the bones)

• If you are less than 20 or over 50 years old and the pain develops for no reason

• If you have a history of cancer, drug misuse, HIV infection, if you have a poor immune system or have been on steroids for six months or more

• If you are feeling generally unwell, for example, have a high temperature or have unexplained weight loss

• If you have had a recent infection

• If your pain does not change with movement or a change of position

• If your pain fails to improve over a reasonable period of time (two to four weeks of treatment)

• If your pain is associated with severe stiffness in the morning lasting for one to two hours or more

• If your spine changes shape or you develop lumps or bumps

• Cauda Equina Syndrome – rare serious medical condition – which requires emergency medical care within 12 to 24 hours

Common Neck Conditions

• Neck Sprains & Strains

• Radiculopathy/Nerve Impingement

• Sciatica

• Scoliosis

• Spinal Fractures

• Spinal Stenosis

• Bulging/Ruptured/Herniated Disc

• Degenerative Disc Disease

7 SIMPLE STEPS – GUIDE FOR NECK PAIN

7 simple tips and tricks that you can try today to help ease your neck pain, improve your posture and take control of your life.

1) REDUCE FEAR

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest Wang et al. (2016).

Try not to worry. It is only natural to feel worried. Feelings such as worry, anxiety and fear, or negative expectations about treatment are barriers in preventing people recover.

Although neck pain can be quite scary in the majority of cases it is not due to any serious damage to the area.

Most people are not aware of how frequent and common neck pain is. Childs et al(2008) reported that at any given time, 10% to 20% of the population reports neck problems.

The good news is when handled properly neck pain does not have to be scary. All you need is the guidance of one of the physical therapists who know exactly what they are doing and follow their instructions.

2) PAINKILLERS & MANUAL THERAPY

• Manual therapy – ease symptoms for a short period to help you move and exercise normally.

• Medications decrease the pain and allow more movements.

• Do not exceed the daily allowance

• Always consult a health professional or pharmacist

• Prescribed medication – Take regularly as directed

• Medications can cause side-effects

• Side-effects vary from person to person

• Possible side-effects listed on medication package

3) HEAT/ICE

• A hot pack or ice pack helps to control pain

• Use ice pack for 10 minutes every 2-3 hours

• Use a hot pack for 20 minutes every 2-3 hours

• Use what works best for you

• Ice is better in early stages while a hot pack works best after a few days of onset

• Care for your skin

• Ask a health professional when in doubt or need advice

4) MODIFY TRAINING LOAD

The spine is one of the strongest parts of the body, with its main functions being movement and stability. The neck is surrounded by a vast amount of muscles and ligaments to both support and help you move.

Joint stiffness in the neck region can be very painful and uncomfortable, but movement will prevent the joints in your neck from becoming stiff and this will reduce the pain. Did you know that resting for a couple of days after a neck injury can prolong the recovery.

In fact, your neck needs to move, it needs to do its main functions of movement and stability. Movement of the neck after an injury may seem scary but in fact, it will help in the long run.

5) STRENGTHEN FOR PREVENTION

The common misconception is that once your initial pain has subsided and you feel a little better is to think that everything is fixed.

Just because the pain has decreased or gone away doesn’t mean you have solved the underlying cause of the pain. Pain is the last symptom to arrive and the first symptom to leave. This means it is important to keep up the exercises our Physical Therapists give you.

Due to the pain leaving first, you will feel pain free before the health of the muscles or ligaments around your neck have fully healed. This is why it is important to have a series of exercises designed to improve and strengthen the muscles around your neck. Strength training is the number one way to prevent further injuries and recurring injuries to the neck.

6) DAILY LIFESTYLE TIPS

• Changes in lifestyle and modifying your activities can reduce your symptoms and stop things getting worse. Many things you can do to help manage your symptoms.

• Lifestyle modification and adaptations can help

• Try to spread activities out

• Take short breaks regularly before pain starts

• Change your position regularly

• Take rest breaks when driving long distances

• Avoid sitting for more than 20 mins

• Try to maintain a good posture

• Ensure you have a good mattress

• Try to keep your desktop screen at eye level

• Stay hydrated

• Maintain a healthy diet and lifestyle

• Exercises daily

• Improve your General Health

• Take care of yourself

• Stop or reduce smoking

• Lose extra weight

• Increase strength and endurance – overall fitness

• Use proper pillow and mattress

• Reduce stress

• Try Relaxation/mindfulness

• Aim for a balance between exercise and relaxation.

• Practise healthy sleep habits – Extremely important for healing and repair.

7) VISIT YOUR PHYSICAL THERAPIST

The fastest way to put an end to your neck pain is to visit a physical therapist. It is really sad when we see people who have been suffering for some time due to their neck pain and are heading down a dark slope.

Our licensed physical therapists will help ease your fear, relax your tight muscles and help so you can go back to doing the things you love to do pain-free and not worrying about the neck pain.

Combine these tips with a visit to us and you will quickly improve your symptoms and regain control of your life.

EXERCISES

MOBILITY EXERCISES

1) Active Flexion/extension – Rotations – Side Flexion

• Start in a seated position looking straight forward.

• Look down towards the floor, look up towards the ceiling.

• Look over your right shoulder, look over the left shoulder.

• Take your right ear to your right shoulder, take your left ear to your left shoulder.

• Keep your shoulders down at all times.

STRENGTHENING EXERCISES

1) Deep neck flexor activation in supine

• Lie on your back with your knees bent and your feet flat on the floor.

• Place a pillow or towel under your head and look up towards the ceiling.

• Visualise a pivot point going through your ears.

• Gently nod your chin as though rotating around that pivot point without tensing your side neck muscles.

• Use the muscles, deep at the front of your throat instead.

• This is a very subtle exercise and will take practice to tuck your chin in just enough so you feel the back of your head a little heavy on the pillow but without the activity of your side neck muscles.

• These deep neck muscles are important to retrain to help headaches and neck issues from office or computer work.

• Hold your chin downwards as advised and continue to breath in a controlled manner by expanding and contracting your lower ribcage.

• Contract your lower stomach and pelvic floor muscles at the same time throughout the movement.

2) Deep neck flexors in supine

• Lie on your back with a folded towel under your head.

• Lengthen the back of your neck by tucking your chin down towards your chest and drawing the back of your head upwards slightly.

• Note, the back of your head should not move off the towel.

• Press your tongue to the roof of your mouth at the same time.

• Hold and repeat.

3) Deep Neck Flexor Strengthening In Sitting

• Sit on a ball in a neutral position with your stabiliser muscles activated.

• Gently nod your chin as though rotating around that pivot point going through your ears without tensing your side neck muscles.

• Visualise using the deeper muscles that sit behind your throat whilst keeping relaxed.

• Hold this position for the required duration while continuing to breathe in a controlled manner by expanding and contracting your lower rib cage.

• This is subtle exercise and takes practice to perform without activity of the side neck muscles.

• These deep neck muscles are important to retrain to help headaches and neck issues from office or computer work.

References

1) Physiopedia. Epidemiology of Neck Pain. Physio-pedia.com Accessed Dec 20, 2022. https://www.physio-pedia.com/Epidemiology_of_Neck_Pain

2) Slosar, Paul. Cervical Spine Anatomy. Spinehealth.com. Accessed Dec 20, 2022. https://www.spine-health.com/conditions/spine-anatomy/cervical-spine-anatomy

3) Steven P. Cohen. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings. Volume 90, Issue 2, 2015, Pages 284-299, ISSN 0025-6196. https://doi.org/10.1016/j.mayocp.2014.09.008

4) Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718095