What can cause Neck Pain?
Chronic Neck Pain is often considered within the ‘biopsychosocial’ model of pain, meaning there is not always one thing causing the pain, instead there are multiple, individual factors at play which can vary greatly from person to person.
Causes of Neck Pain include intervertebral disc, muscle, ligament and facet joint injuries. When the nervous system is affected, it could be due to nerve root compression, spinal stenosis or cervical myelopathy. However, in the majority of chronic neck pain cases, a specific structure can not be identified as the cause of pain.
This Venn Diagram, from a research paper in the British Medical Journal, demonstrates the known contributing factors to chronic pain. For example, you may have a problem with a neck joint, which may only become painful if you have coinciding factors such as reduced sleep, high levels of stress or lack of frequent exercise or movement.
Disc issues of the Neck (Cervical):
“Degenerative Disc Disease” of the neck is common in people who have no neck symptoms and is thought to be a natural ageing process. However disc injuries can cause irritation to the nerve roots of the neck that supply the arms, like Sciatica can with the leg. When nerve pain into the arm is present due to a neck issue it is called Cervical Radiculopathy. This is more likely to occur in middle age.
Another common cause of Cervical Radiculopathy we see as Osteopathic Therapists is due to intervertebral stenosis (usually in older age), which is a reduction of space where the nerve root exits the spine. Symptoms include, neck stiffness and pain, with a change in sensation of the arm, forearm, and/or hand. Muscle wasting and weakness of the arm and hand may also be a feature. Symptoms are typically aggravated by coughing or sneezing, neck and arm movements.
Will Cervical disc injuries get better?
Studies have shown that most patients improve within 6 months, with complete improvement taking 2-3 years in 83% of people.
Imaging studies (such as MRI) have shown that approximately 50% of disc herniations will naturally decrease in 6 months, and 3/4 will reduce by more than 50% in 2 years.
Acute Neck Pain
The onset of acute neck pain can be traumatic or less sinister such a prolonged unaccustomed position or a sudden unexpected movement, or for no apparent reason.
A common diagnosis in acute neck pain is cervical facet joint pain. Typically it will feel very difficult to extend the neck (look up) and it will feel painful to side bend the head to the affected side and less painful to side bend the head away from the affected side. The pain is commonly local to the neck but can refer into the shoulder blade region or the back of the head.
The majority of patients will recover from acute neck pain within 2 weeks.
Osteopathy and Neck Pain
People with neck pain frequently consult Osteopathic Therapists for diagnosis and treatment.
As Osteopathic Therapists our first job is to screen our patients for what we refer to as “red flags”. Red flags are things such as cardiovascular, rheumatological, autoimmune conditions etc that could be causing neck pain and would lead us to referring our patients to be investigated by other health care professionals.
Osteopathic Therapy aims to promote optimal function of the tissues of the neck through a wide range of hands on techniques, designed to move and stretch the joints and tissues through a full range of motion and to relax the tissues.
Osteopathic Therapy has been shown to reduce pain in people with chronic neck pain, and when combined with exercise therapy has been shown to be more effective at reducing pain compared to treatment that just included exercise.
How can Exercise help with Neck Pain?
Exercising the neck has been shown to reduce pain, improve function and reduce future episodes of neck pain. There hasn’t been one exercise type that has proven to be more effective over anything else; Strength, Motor Control Exercises (exercise to improve control and coordination), Pilates, Yoga and Tai Chi/Qigong have all been shown to be effective.
However we need to put this into the context of your sport, lifestyle and symptoms, here’s some examples:
- If you’re at risk of concussion from hockey, football, horse riding or martial arts for example, it is known that neck strength gives some protection against concussion. If your neck is weak you’re more likely to sustain a concussion.
- If your neck pain is related to fatigue, due to having to hold prolonged postures such as a mechanic, a cyclist or an office worker, working on the endurance of your neck muscles is more suitable.
- If your neck pain is related to stress/tension and lack of movement, perhaps, Pilates, Yoga, Tai Chi/Qigong are good choices.
- If you find that your neck “goes out” easily, locks up frequently, or you suffer from frequent acute episodes when playing sport, motor control exercises could be more appropriate
You’ll see the best results when the exercises are done frequently over a prolonged period of time, so choose something that you enjoy, can make progress with and that you feel you can stick to for at least 2-3 months.
References:
Cohen, S.P. and Hooten, W.M., 2017. Advances in the diagnosis and management of neck pain. British Medical Journal, 358.[Online] Available at: https://www.bmj.com/content/358/bmj.j3221
Franke, H., Franke, J.D. and Fryer, G., 2015. Osteopathic manipulative treatment for chronic nonspecific neck pain: a systematic review and meta-analysis. International Journal of Osteopathic Medicine, 18(4), pp.255-267. [Online]. Available at: http://dx.doi.org/10.1016/j.ijosm.2015.05.003
Groisman, S., Malysz, T., da Silva, L.D.S., Sanches, T.R.R., Bragante, K.C., Locatelli, F., Vigolo, C.P., Vaccari, S., Francisco, C.H.R., Steigleder, S.M. and Jotz, G.P., 2020. Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with non-specific chronic neck pain: A pragmatic randomized controlled trial. Journal of Bodywork and Movement Therapies, 24(2), pp.189-195. [Online]. Available at: https://www.sciencedirect.com/science/article/pii/S1360859219303973
de Campos, T.F., Maher, C.G., Steffens, D., Fuller, J.T. and Hancock, M.J., 2018. Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. Journal of physiotherapy, 64(3), pp.159-165. [Online]. Available at: https://www.sciencedirect.com/science/article/pii/S1836955318300535
De Zoete, R.M., Armfield, N.R., McAuley, J.H., Chen, K. and Sterling, M., 2021. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. British journal of sports medicine, 55(13), pp.730-742. [Online]. Available at: https://bjsm.bmj.com/content/bjsports/55/13/730.full.pdf
