What is Neck Pain or Cervicalgia?
Many of us have experienced severe Neck Pain or Cervicalgia at some point in our lives. It can be caused due to a variety of reasons such as not sleeping in a correct position, being in an accident leading to whiplash injury or twisting the neck during strenuous physical activity. Severe neck pain can also lead to headaches or dizziness. Symptoms may resolve in a few days or there may be persistent pain that limits everyday activities.
The cervical spine is a very intricate and flexible structure with the capability to support a head weighing 15 or more pounds while moving in several directions. Cervical spine has the maximum freedom of movement when compared to other parts of the spine. Cervical spine is capable of moving the head in many directions like 90 degrees of flexion (forward motion), 90 degrees of extension (backward motion), 180 degrees of rotation (side to side), and almost 120 degrees of tilt to either shoulder. Due to this combination of complexity and flexibility, the neck, or the cervical spine region, is more prone to pain and injury. Cervical spine is composed of 7 small vertebrae along with intervertebral discs to absorb shock, joints, the spinal cord, 8 nerve roots, vascular elements, 32 muscles, and ligaments. The nerve roots start from the spinal cord like tree branches through vertebral foramen. Each nerve root transmits nerve impulses or signals to and from the brain, shoulders, arms, and chest. A combination of 4 arteries and veins comprise of the vascular system that run through the neck to circulate blood between the brain and the heart. Joints, muscles, and ligaments enable movement and aid in stabilizing the cervical spine structure.
Classification and Types of Neck Pain or Cervicalgia
Acute Neck Pain or Cervicalgia:
This is severe pain in the neck with stabbing, shooting pain referred into the shoulders and arms. Patients having the following symptoms should seek medical attention immediately: Progressive neurological deficit such as weakness in the arms or loss of feeling and coordination in the arms or legs may indicate nerve damage. Persistent or increasing pain accompanied by lack of appetite, unplanned weight loss, nausea and vomiting with fever/chills/shakes could be an indication of spinal tumor or infection.
Chronic Neck Pain or Cervicalgia:
Chronic neck pain is prolonged pain present for a long duration of time. It is accompanied by pain that radiates down the arms, and into the hands and fingers. Cervical herniated disc or foraminal stenosis pinching a nerve in the neck is the common cause. Treatment for cervical disc herniation depends on the duration of the pain, intensity of the pain and the extent to which the cervical nerve and/or spinal cord are affected. Usually, the symptoms are temporary and can be treated successfully with nonsurgical care such as medication, physical therapy, manipulations etc. If the pain persists beyond 6 to 12 weeks despite conservative treatments, then surgery is recommended.
The Causes of Pain in Neck or Cervicalgia Include:
- Injury, Trauma and Accidents: Whiplash injury is a common injury sustained during an accident. This type of injury is termed as a hyperextension and/or hyperflexion injury because the head is forced to move either backward and/or forward rapidly in such a way that is beyond the neck's normal range of motion. The muscles and ligaments in the neck get affected by this abnormal and forceful movement and the muscles react by tightening and contracting leading to muscle weakness resulting in pain and stiffness.
- Getting Older: The spine is affected by degenerative disorders like osteoarthritis, spinal stenosis, and degenerative disc disease. One of the common joint disorders causing increasing deterioration of cartilage is osteoarthritis. Due to this, the body responds by forming new bones called osteophytes (bone spurs) that affect joint motion. Spinal stenosis is another degenerative disorder that narrows the foramen and the small neural passageways leading to compression and entrapment of nerve roots. Due to stenosis, the nerves are unable to function normally leading to neck, shoulder, and arm pain and numbness. Degenerative disc disease (DDD) affects the intervertebral discs such that they become less hydrated resulting in impaired disc elasticity and height. As the disorder progresses, a disc may bulge or herniate causing upper extremity pain, tingling, and numbness.
- Day-to-Day Life: The spine's balance is affected by poor posture, obesity, and weak abdominal muscles causing the neck to bend forward in order to compensate. Other conditions like stress and emotional tension may also cause the neck muscles to tighten and contract causing pain and stiffness.
- Other Diseases and Conditions: Neck pain is usually caused by strain, but persistent pain and/or neurologic insufficiency is a cause for worry and should be taken seriously. These symptoms could be due to spinal infection, spinal cord compression, tumor, fracture and other disorders. If the patient has suffered a head injury then the chances are that the neck has been affected too. Therefore it is prudent that medical attention is sought immediately.
Pathophysiology of Neck Pain or Cervicalgia
Several structures are responsible for causing neck pain such as bones, nerves, discs, longitudinal ligaments, muscles, facet joints, and dura. All these structures cause pain when they are irritated or inflamed. The pain can be classified as nociceptive, neuropathic, or idiopathic in origin. Nociceptive pain is the most common type of pain. Acute pain is often of nociceptive origin, but when it becomes a chronic pain then the influence of psychologic and social factors becomes more apparent. The activation of peripheral primary afferents gives rise to nociceptive sensation of pain. Impulses are conducted by a part of myelinated A-delta fibers and unmyelinated-C which are produced by noxious stimuli and transmit sensations that are considered pain. Primary nociceptive afferents ascend contralaterally and stimulate spinothalamic and spinoreticular neurons in the dorsal horn of the spinal cord by mediating neurotransmitters, such as glutamate, aspartate, substance P, and calcitonin gene-related peptide. The axons transmit the stimulus to the brain travelling in 3 primary ascending tracts that project to the thalamus and the reticular formation. Damage or dysfunction of peripheral nerves or the central nervous system (CNS) causes neuropathic pain. Neurons may be sensitized to react to even an extremely slight stimulus that normally won't cause pain. Neuropathic pain often appears as chronic pain. Reorganization of central processing is thought to be related to this pain state. Infections such as herpes zoster, metabolic diseases like diabetes, and traumatic injuries to the spinal cord and strokes that involve ischemic damage to the ascending nociceptive pathways are the most common causes of neuropathic pain. The pain is termed as idiopathic when no damage in tissues or neurons can be found.
- Neck soreness on one or both sides.
- Burning pain.
- Tingling sensations.
- Pain around shoulder blades.
- Numbness or weakness in arms.
- Difficulty in swallowing, talking, writing, or walking.
- Night sweats.
- Blurred vision.
- Unintentional weight loss.
- Lymph node (gland) swelling due to viral infection of the throat causing neck pain.
- Swishing sounds in the head.
- Facial pain.
Immediate Medical Attention Should Be Sought For The Following Symptoms:
- High fever.
- Acute tenderness with neck movement.
- Numbness, weakness, and/or tingling.
- Recently sustained head or neck injury.
Treatment of Neck Pain or Cervicalgia:
Treatment depends on the cause of the neck pain. Usually neck pain originates from strain and can be treated non-surgically. This involves relieving neck pressure and muscle spasm. Other methods include:
- Cervical Collars: These restrict movement and support the head taking the burden off the neck. Lying down also helps in limiting the neck movement and reducing pressure (weight) thus giving the muscles rest while healing.
- Cervical Traction: This is usually prescribed for use at home. Cervical traction gently pulls the head and stretches the neck muscles thus increasing the size of the neural passageways (foramen).
- Oral Medications: Medicines like non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and narcotics may be prescribed for short-term use. Trigger point injections are beneficial in some patients.
- Physical Therapy (PT): This is also helpful in relieving neck pain and is incorporated into the treatment plan. Heat/cold applications, ultrasound, and massage are some of the passive forms of PT and may help in alleviating pain and stiffness. Therapeutic exercises help in building strength and increasing range of motion. Patients also benefit from learning about their condition and about correct posture and relaxation techniques.
- Surgery: Neck pain rarely requires surgical intervention. Some of the indications for surgery may be spinal cord dysfunction, severe pain not responding to conservative measures and persistent pain and/or weakness. The type of surgical procedure depends on the patient's needs. The patient's medical history, age, general physical condition, occupation, and other factors are taken into consideration by the surgeon. Cervical spinal surgery is complicated and requires a skilled surgeon.
Tests to Diagnose Neck Pain or Cervicalgia
- Patient's medical history along with physical and neurological examination is done.
- Radiographic studies such as x-ray can reveal narrowing of disc space, fracture, osteophyte formation and osteoarthritis.
- MRI is done to detect bulging discs and herniations that are usually responsible for neurologic symptoms.
- Nerve conduction studies and/or electromyography are done to find out if there has been any nerve damage.
- Bone scan detects spinal problems like osteoarthritis, fractures or infections.
- Discogram helps in confirming or ruling out the disc(s) as the source of pain.
- Myelogram helps in finding out any spinal canal or spinal cord disorder.
- Nerve Conduction Velocity Test (NCV).
Exercises for Neck Pain or Cervicalgia:
Neck Flexion Exercise For Neck Pain or Cervicalgia:
Stand straight and move your head forward so that your chin touches the chest or comes as close as possible to the chest as shown in the video. Neck Flexion stretches the muscles of your neck at the back of the cervical spine and gives relief from the neck muscle tightness.
Neck Extension For Neck Pain or Cervicalgia:
Stand straight and tilt your head back, not fast or forcefully, until your face looks directly at the ceiling. Neck extenstion movement stretches the front of your neck muscles. Don't continue this movement if you feels dizzy.
Neck Rotation For Neck Pain or Cervicalgia:
Stand straight and slowly turn your head to the right as much as you can, looking over the right shoulder. Hold the position at the end of the movement for 20-30 seconds. Repeat this exercise 5 times. Then do the same exercise on the left side.
Lateral Flexion of the Neck For Neck Pain or Cervicalgia:
Keep your head straight and tilt your head down your right ear towards right shoulder, until you feel a slight stretch. Hold the position for 20-30 seconds. Do the same movement on your left side.
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