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The Neck
17June/2014

The Neck

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BODY PART EXPLAINED – The Neck

BY Dr. Matthew Davidson B.Sc., M.Chiro

Neck pain is becoming increasingly common and can have a considerable impact on individuals and their families, communities, health-care systems and businesses.1

Neck pain can be a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain will not experience complete resolution of their symptoms and disability.2

And the news only gets worse for the ladies, with women more likely than men to develop neck pain, suffer from persistent neck problems, while being less likely to experience a resolution.2

The cervical spine has a unique function in which it positions our head in space. Optimal head position is achieved through proprioceptive integration (sensory receptors that create awareness of the position of one’s own body) and reflex setting of our muscle tone.

The cervical spine acts as a cage by protecting the vital spinal cord, which can be potentially damaged in acute injury events.3 As our head makes up 10 per cent of the body's total weight, this arrangement makes it extremely vulnerable to traumatic forces.4

The data reported in the Task Force on Neck Pain and Associated Disorders provides a range for the 12-month prevalence of neck pain to be 12.1% to 71.5% in the general population.5 This statistic is even higher in office and computer workers.1 Only about 25% of individuals actually seek medical care for neck pain.5

ANATOMY

The cervical spine is made up of seven vertebrae, which are different in appearance to the thoracic and lumbar vertebrae. It provides a wide range of movement on all planes of motion, allowing almost pure rotation and lateral or side flexion, in addition to flexion and extension4. The curve in the neck is an anterior convex or "C-shaped curve" that increases strength and helps to maintain our balance in the upright position. This "C-shaped curve" also helps absorb shock and protects the neck from fracture.6

There are eight sets of spinal nerves in the cervical spine and the lower four nerve roots, including that of the first thoracic, making up what is called the brachial plexus. This plexus of nerves continues down the armpit to supply sensation and strength to the upper limbs.

A complex system of ligaments, tendons, and muscles helps to support and stabilise the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement, by contracting and relaxing in response to nerve impulses originating in the brain. Some muscles work in pairs or in opposition (antagonists). This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors. Discussion of all these muscles is beyond the scope of this article.

STRENGTHENING

Strengthening the neck can be achieved by self-resisted isometric strengthening exercises performed in lateral flexion, rotation, extension and flexion. Deep neck flexors can be strengthened using a towel behind the neck or a biofeedback cuff. The neck is held in neutral and the patient nods "yes" while remaining in contact with the towel. With a biofeedback cuff the pressure sensor is inflated to 20mmHg and the patient is instructed to keep the superficial muscles relaxed and to flex the upper cervical spine slowly with a gentle nodding action, holding the position for 10 seconds.7

Neck curls with a weight and the traditional wrestler’s neck arches are dangerous and should not be attempted. Not only is an acute injury highly possible, including disc injuries and fractures, but long term use of these exercises could lead to early degenerative processes occurring.

WHAT CAN GO WRONG?

The neck is such an important structure and we often take it for granted. Just a simple fall could lead to a fracture and damage the vital spinal cord which controls everything below it. Paraplegia or quadriplegia can be a very real scenario when faced with this sort of injury. There are many other conditions that affect the neck but only a few will be discussed here.

Due to the complexity of some of the conditions listed below, specific treatment options have been outlined for each one.

Cervical Radiculopathy

Cervical radiculopathy may occur from a sudden neck injury or may be insidious. Neck pain (with or without movement) and arm pain are common complaints. There may be weakness in the hand and pins and needles in the forearm, hands and fingers.

Rupture of a disc in the neck accounts for 20-25 per cent of cases compared with the higher incidence in the lumbar spine. A further 70-75 per cent of cases are due to encroachment of bony outgrowths (osteophytes) into the holes where your nerves exit your neck and travel down your arm. These holes are called foramina.3

Treatment:

Conservative management is used in approximately 74 per cent of cases, with 90 per cent of patients recovering fully or with mild residual dysfunction.8

Traction and physical therapy can be incorporated into the treatment although care with cervical manipulation is crucial due the risk of irritating the nerve.

 

If the nerve compression is not responding, a CT guided nerve root injection with a corticosteroid usually settles it down.


 

Torticollis or Wry Neck

Presentation of this condition depends on the age of the patient and the cause. In adults the presentation is that of painful spasms of the sternocleidomastoid muscle, which runs down the side of your neck to the sternum or breast bone. This causes the head to be held in a slight rotation and sometimes flexion. Basically, your head is turned and tilted. In what is called pseudotorticollis, the person cannot move the head in any direction without pain. The patients usually state that they moved their head quickly or just woke up with it.3

There is also a congenital torticollis which occurs in infants that is most likely attributed to birth trauma. Damage usually occurs to the sternocleidomastoid muscle, causing it to become fibrous3.

Treatment:

There are many underlying possibilities when a patient presents with a wry neck. The practitioner must be cautious of what else could be going on in the neck or body, such as taking the patient’s temperature to make sure there's no high fever and ruling out meningitis3. Also, acute fracture or even an underlying disc herniation needs to be ruled out before soft tissue treatment or any form of mobilisation/manipulation takes place.

Muscle syndromes

1). Cervical strain: usually a history of whiplash or other trauma with neck pain radiating into the head, shoulders and arms.4 There is also reduced mobility. Muscle spasms are typical diagnostic indicators and treatment usually involves soft tissue modalities like trigger point pressure, massage, dry needling or Active Release Techniques®.

2). Postural Strain: usually a history of forward head position with a static loading of the neck muscles in extension. Pain can radiate into the neck, head, shoulders and arms.4 Treatment usually involves trigger point therapy, physiotherapy, exercise and postural retraining.

References

1). Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain.

 Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92.

2).  Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 2004 Dec;112(3):267-73

3). Souza, TA. Differential Diagnosis and Management For the Chiropractor: Protocols and Algorithms. 4th Edition. USA:  Jones and Bartlett; 2009.

4). Gatterman, MI. Chiropractic Management of Spine Related Disorders. USA: Williams & Wilkins; 1990.

5).  Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren A. The Bone and Joint Decade 200-2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine. 2008;33(suppl):S5-7.

6). Tortora  GJ, Grabowski SR. Principles of Anatomy & Physiology. 8th Edition. USA: Harper Collins; 1996.

7).  Brukner P, Khan K. Clinical Sports Medicine. 3rd Edition. Australia: McGraw Hill; 2006.

8). Carette S, Fehlings MG. Clinical practice Cervical radiculopathy. N Eng J Med. 2005;353(4):392-399.

Dr. Matthew Davidson B.Sc., M.Chiro.
Director, Hope Island Chiropractic Centre
Certified Active Release Technique Provider
Active Release Technique Ironman Provider Network
Member, Chiropractic Association of Australia
Member, Sports Chiropractic Australia


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