Neck Pain aka Cervical Spine Sprain/Strain
Neck pain is one of the most common musculoskeletal problem encounter by manual therapists. It typically refers to acute pain arising from injured soft tissue around the neck including muscles, tendons and/or ligaments. One of the main causes of cervical pain is often due to acceleration-deceleration injuries frequently labelled as a whiplash injury.
Injury to the bony, articular (disks and facets), nerves (including root and spinal cord) and soft tissue are most likely the sources of dysfunction and pain. Neck strain usually refers to injury of the muscle or tendon produced by an overload injury due of excessive forces working on the spine. The muscles of the neck and shoulders need to support the heavy load of the head. With repetitive strains, postural weakness or long hours working at the computer, the muscles of the head, neck and shoulders can fatigue which increases the risk of injury. The muscles respond to injury by contracting, with the surrounding muscles recruited in an attempt to support the injured area. This can lead to localised pain, reduced movement in the neck and shoulders and inflammation.
As we age, numerous lifestyle factors can influence the integrity of the joints in the spine. Diet, exercise, smoking, alcohol intake, genetics and environmental factors have all been shown to influence degeneration in the spine. In particular, the articular facets (aka apophyseal joints) have a significant impact on how well the neck can move in all ranges of motion. These facet joints are the connecting (articular) surfaces of adjacent vertebrae and directly impact range of motion.
In the video below, we can see how the cervical (neck) vertebrae move in relation to each other in perfect harmony, sliding and gliding with minimal friction. As these joints are susceptible to damage over time, we can see how the cartilage (articulating surface) wears down leading to the formation of bone spurs. That perfect harmony of sliding and gliding now has to work even harder to resist the increasing friction between the two joint surfaces. This leads to inflammation of the joints causing a localised pain syndrome which may refer along the involved nerve roots and decrease range of motion of the involved spinal segments. Facet joint pain is typically described as unilateral (one side) with a dull or aching pain referring into the base of the skull or into the upper shoulders.
Review of Evidence for Management:
There are a number of studies that examine how manual therapy can help cervical pain by reducing compression on the facet joints. A 2010 Cochrane Review demonstrated that a combination of mobilisation (increasing movement), manipulation and exercise were critical in achieving positive clinical outcomes. Improvements in pain reduction, patient satisfaction and return to activities of daily living were also noted. The authors concluded that early mobilisation and return to function were essential in early rehabilitation programs.
Strengthening and stretching exercises also play an important role in reducing pain associated with cervical strains. Massage, proprioceptive feedback techniques (muscle energy techniques or resisted stretching) and dynamic-resisted stretching, demonstrated positive correlations with treatment outcomes. Proper patient education is also critical, as susceptibility to re-injury is often high. Setting realistic treatment outcomes and managing patient expectations are both essential for full recovery.
At Embrace Wellness Centre, Tweed Heads South, NSW, we often encounter neck pain caused by strains, sprains or degeneration. By using evidence-based Osteopathic techniques we work with a number of treatment outcomes list above to ensure you get back to health as quickly, but safely as possible. Our treatments are individualised, working gently with the joints, ligaments and muscles of the spine. With proper nerve function, blood supply and drainage the tissues can begin the natural healing process. Once the tissue has resolved the initial injury, we can start to strengthen the area making sure we minimise the risk of further injury to the area.
“We are here to help!”
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Retrieved from http://iTunes.apple.com, Cervical Sprain & Strain.