NECK PAIN TREATMENT

Neck Pain Causes

There are a number of causes of neck pain, depending on the source of pain. Here is a list of the common types we see in the clinic. I will talk briefly about each one.

• Pain from a compressed joint
• Pain from angry muscles
• Nerve compression
• Whiplash
• Degenerative Disc Disease
• Disc related pain
• Muscle Imbalances

Pain from a compressed joint

Sometimes the sensitive structures in our neck joints become trapped and painful. A typical presentation is being unable to turn your neck in one direction. This may be worse in one direction. I cant feel like something is getting caught and the pain can be sharp. Sometimes this might improve on its own over a few days. If it does not get better and you are losing sleep, you should get treatment. Other typical scenarios are waking up with it, or at the end of a long stressful day at work on the computer.

Treatment for this neck condition is fairly straight forward. Manual traction is the best initial approach to compress the joint. In the assessment we can determine which joints are involved and then be specific with the treatment. In the first few days, gentle manual traction will decrease the pain and help you sleep. As the pain decreases, other manual techniques can help to open up the joint and restore movement. Once the pain starts to decrease, mobility exercises will help you return to full movement again. It is better to get some treatment early-on as this condition can settle down with early intervention.

Pain from a pinched nerve

This condition is a more complicated version of the one above. There are nerves that come out of each joint of the neck. They combine into a complex web called the Brachial Plexus. The nerves control sensation and movement of the arms and hands. Pain from an aggravated nerve can be felt in the neck, upper shoulder, upper back, and anywhere down the arm. It just depends on what joint and which nerve is compressed or inflamed.

In the assessment we are able to determine which nerves are affected and which joints we need to treat. Each nerve has  a pattern of pain, numbness and tingling. You don’t need to get an X-Ray right away. We can advise you if and when this might be necessary. If you respond to the treatment, getting an X-Ray or MRI is not essential.

Whiplash

Whiplash is a term that describes a range of injuries caused by acceleration-deceleration injuries from car accident. There are a number of injuries that can occur, depending on how severe the damage to the structures in the neck.  Damage can occur to muscles, neck joints, discs, nerves and spinal cord, ligaments and blood vessels. It is important to be assessed thoroughly, either by a doctor or your physiotherapist. Depending on your symptoms, you may be sent for X-Ray. Both your doctor and physiotherapist should perform an exam to see if you should be referred to a specialist, before doing any rehabilitation. There is a grading used to determine the severity of a whiplash. Your MVA insurance company and physiotherapist will use this to decide which treatment plan you should receive.

We do not bill directly to MVA insurance, but we can treat you. We would still complete all the insurance forms and liaise with your adjustor. You would pay the fees directly to us, but you would be reimbursed by our insurance. By law, you have to use your private insurance benefits first and then the MVA insurance. Your adjustor will be able to explain the process.

Depending on the type of whiplash, the most essential treatment is to get your neck moving again. It is not recommended to have neck adjustments at this time. Normal movement and gradual strengthening is the most effective treatment to reduce pain. Having some massage may help, but this should not be the main focus. The research supports active rehabilitation to prevent the neck pain from becoming chronic.

As this is a traumatic injury, it is important that you receive a thorough assessment for any symptoms that may require referral to another specialist. During your treatment we will keep monitoring you to see if this is necessary. We will be checking for any symptoms related to a nerve or vascular injury.

Degenerative Disc Disease (DDD)

This sounds quite alarming, but its a normal process of aging in the spine and neck. Our discs and joints experience wear and tear. We lose some of the disc material and some of the joint become irregular from arthritic changes. All this is normal and does not necessarily lead to pain and problems. As we get older, we might feel that our neck becomes stiffer. This can be due to muscle tension or joint degeneration. Disc degeneration may be an issue if some of the joints become painful or a nerve is pinched. The treatment is the same as the previous types of neck pain. In our opinion it is not necessary or advisable to have your joints manipulated with high velocity techniques. The same effect can be achieved with more gentle joint mobilizations. The joint is massaged into the stiff movement, not thrusted. Degenerative Disc Disease is age related and so the type of treatment will be more cautious in older age groups.

Disc Related Conditions in the Neck

Sometimes discs in the neck can protrude or herniate, although it is not common. The treatment for this is similar to treatment for a pinched nerve (see above). If your pain and movement restriction is severe then an MRI is useful. However is is advisable to start treatment right away. Manual traction, massage, and neck exercises are important. The exercises and traction will help to reduce the disc from pushing on a nerve root. You will also have to avoid certain directions of movement for a while. Some home traction devices are very helpful and will help to decrease pain and reduce the disc herniation or protrusion.  Gentle movement into the restriction is important to regain the normal joint movement. Only a very small number of these cases need referral to an orthopaedic surgeon. In the initial assessment we check your upper nerve function to see if you need referral to a specialist.

Muscle Imbalances and Angry Muscles

These are the most common we see at the clinic. Over-use and flare-ups can be exacerbated by stress and staring at a screen all day. If you develop a stiff upper back, then your neck becomes more sensitive to stress and strain. Upper back mobility is important for general spinal health. We see a lot of office workers who have very immobile upper backs. Having your neck manipulated is not going to be effective in the long term. We can devise a simple upper back and neck program as an antidote to postural neck pain. Typical muscles imbalances we see include: weak shoulder blade muscles, stiff joints, tight and tonic neck muscles, and weak upper back muscles.

Angry muscles from being at a computer for too long involve the muscles that hold your head up. They just get tense and tight if your head is in one position for too long. Taking breaks and moving your spine during the day can help. Simple neck and upper back exercises can break the cycle of tension and pain. Otherwise massage and an exercise program to open up the neck and upper back will help to stop this becoming a chronic problem. If pain is an issue, some gentle mobilizations to the neck and upper back can help to calm it down.

PILATES-BASED REHABILITATION FOR NECK PAIN

Traditional physiotherapy plays an important role in treating neck pain. However some outdated treatments are still being used in physiotherapy and chiropractic clinics. Treatment ultrasound is not supported by research. Electrical modalities can be used in the acute stage for pain, but not for long. The best way to treat acute and chronic pain is through movement. The research in Pain Science supports movement based therapies. Passive treatments like massage should not be the main treatment. They should be adjuncts to movement based treatment. Physiotherapists who have Pilates training or another holistic approach are able to treat the cause as well as the symptoms. Treating pain involves looking at the whole individual and all the parts that are causing the pain. Sometimes it is not that complicated. We all get strains and sprains and they get better with good sound treatment and advice.