Neck Pain

Neck Pain

Dr Prem Pillay, The Spine Specialist

Causes, Symptoms, Treatments

Pain or discomfort in the neck is a common reason for patients to seek medical care. A muscle spasm, brought on by poor posture, sleeping position or stress, is a frequent causes of neck pain. But an aching painful neck can be a symptom of a more serious problem. Disc degeneration, narrowing of the spinal canal, arthritis and even cancer cause neck pain. If Neck pain is severe or persistent a Spine specialist, such as a neurosurgeon, should be consulted.

When To See a Spine Specialist?

A doctor should be consulted if neck pain occurs after an injury or blow to the head. Also see a specialist if a fever or headache accompanies the neck pain, if a stiff neck prevents you from touching your chin to your chest, if pain shoots down one arm, if there is a tingling/numbness in your hands, if there is weakness of the arm and/or hands; or if pain does not decrease after a week.

You can take a number of steps on your own to alleviate neck pain caused by strain or spasm of the neck-muscles. Improve your posture and change the way you sleep. Take rest breaks at work instead of silting or standing in the same position. Do exercises to stretch the neck and shoulder muscles. Use hot showers, hot compresses or a heating pad to relax tense muscles.

Understanding The Neck

The neck is part of a long flexible column of bones and other tissue, often referred to as the spinal column or backbone, that extends through most of the body. The neck region of the spinal column is called the cervical spine, which consists of seven bones or vertebrae that are shaped like building blocks.

Intervertebral discs separate the vertebrae from one another. These discs allow the spine to move freely and act as shock absorbers when a person moves.

The back of each vertebra forms a tube-like canal of bone that runs down the back. This space is called the spinal canal, through which the spinal cord and nerves travel. The spinal cord is surrounded by cerebrospinal fluid and three protective membranes called the dura, the pia and the arachnoid.

A pair of spinal nerves exit each vertebra through small openings called foramina (one to the left and one to the right). These nerves connect to the muscles, skin and tissues of the body, providing sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae. The cervical spine needs to be strong because it also holds up the head, which can weigh 10 pounds or more.

Common Disorders Of The Cervical Spine

Cervical Disc Disorders

The discs in the neck can wear out in the course of aging or can be damaged by sudden movement (whiplash), poor posture or diseases such as arthritis. Neck pain occurs when the herniated disc pinches the nerve or when arthritis progresses to the point where it involves the joints of the spine. Arthritis can lead to degeneration of the disc as well as abnormal bone growths (spurs) next to the joints. These spurs are the result of repetitive movement and can irritate the adjacent nerve and cause pain.

Cervical disc disorders are typically marked by intermittent neck pain, followed by severe neck and sometimes arm pain. The pain is sufficient to awaken a person from sleep. Irritated nerves also can lead to numbness or weakness in the arm or forearm, tingling in the fingers and coordination problems. Severe nerve impairment or even paralysis can develop if the disorder is left untreated.

Pressure on the spinal cord from a herniated disc or bone spur in the neck can also be a very serious problem. Virtually all of the nerves of the body have to pass through the neck to reach their final destination (arms, chest, abdomen, legs).

Cervical Stenosis

Cervical stenosis is a narrowing of the spinal canal that can pinch the spinal cord. The normal aging process is usually the cause. The discs dehydrate over time, causing them to lose their ability to act as shock absorbers. At the same time, degenerative changes in the vertebrae can lead to the growth of bone spurs that compress the nerve roots. The bones and ligaments that make up the spine gradually thicken and become less pliable. These changes cause the spinal canal to narrow.

Symptoms of cervical stenosis are neck pain, numbness and weakness in the hands, inability to walk at a quick pace, deterioration of fine motor skills and muscle spasms in the legs.

Diagnosing Neck Problems

Your Specialist investigates a neck problem through a medical history, physical exam and diagnostic tests. The physical examination includes an assessment of sensation, strength and reflexes in various parts of the body to help pinpoint which nerves or parts of the spinal cord are affected. The doctor may then order various diagnostic studies to determine more precisely the nature and extent of the disorder.

Treatment

Patients with neck pain are usually treated conservatively at first. Non-surgical treatments may provide relief.

Conservative treatment includes bed rest, reduction of physical activity, physical therapy and wearing a cervical collar, which provides support for the spine, reduces mobility and lessens pain and irritation.

Mild cervical stenosis and Disc Disease can be treated conservatively as long as the symptoms are restricted to neck pain. People who experience tingling/numbness, weakness in the arms or legs, pain and numbness/tingling down the arm may require additional treatments.

Treatment of whiplash injuries and Disc Injury consists of analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants and aggressive physical therapy. Gentle cervical traction and manipulation are sometimes helpful. Specialized Spine Physiotherapy is needed.

When is Surgery Necessary? Are there Less Invasive Options?

Surgery such as Disc Replacement, may be needed when conservative treatments for cervical disc problems do not provide relief and when there are neurological deficits such as weakness in the arm or hand. This is associated with the MRI showing moderate to severe nerve impingement
that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.

Surgery may also be needed for those who injure their spines from a road traffic accident, falls, sports injuries where there are spine fractures or burst discs often associated with spinal cord and spinal nerve injury and damage.

The choice of treatment and the decision as to when to perform the operation should be determined by a Neurosurgeon, the medical specialist trained in the surgical treatment of disorders of the spine.

Less Invasive options including day treatments with no scars are also available such as Specialized Spine Injections, Discoplasty, Nucleoplasty, Annuloplasty, Radiofrequency Ablation, Co-Ablation,Endoscopic and Robotics, Lasers and Superior to Laser technologies.

Surgery and Less Invasive Procedures may be advisable if:

• You miss work because of pain.
• You are unable to join in family activities because of pain or muscle weakness.
• Your pain forces you to, spend more time alone, away from friends and family.
• You feel frustrated or depressed because of your pain.
• You are otherwise in good health.

Factors in determining the type of surgical treatment include what type of disease (herniated disc or bone spurs), whether there is pressure on the spinal cord-or spinal nerves and if the spine is dislocated in addition to pressure on the cord or nerves. Other factors include age, duration of disorder, other medical conditions and previous medical history.

Surgery has its limitations. It can’t reverse all the effects of overuse or aging, and it carries risks Yet it may be the only way to relieve pain, numbness and weakness.

FAQ About Neck Pain Or Neckache

What Are The Causes Of Neck Pain?

The roots of neck pain lie in our modern lifestyle. At the workplace, prolonged sitting and many hours of computer use can cause neck pain. Travel with the carrying of hand luggage and laptops all contribute to neck pain. Recreational exercises performed improperly or without adequate warming up, massages with neck manipulation, poor posture etc can cause wear and tear of the cervical spine resulting in neck pain and shoulder discomfort. Most patients with neck pain have varying degrees of spinal disc degeneration.

How Can I Prevent Neck Pain?

Proper Posture is Often the Key

Ergonomics

This is especially important for those who use computers for long hours. This involves proper placing of the computer monitor such that your head is in a neutral position when viewing the computer screen; a proper chair with lumbar support and an arm rest such that your elbows are resting 90° to your work surface and your keyboard.

Stand up and take short breaks every 20 – 30 minutes, doing neck stretches and back stretches before resuming your work.

Another bad habit is talking on the phone with the receiver tucked between the neck and shoulder. This should be avoided as it puts a lot of strain on the neck muscles. Invest in a hands free device instead. Text Neck is now a common problem in young people who overuse mobile devices!

Neck strengthening exercises help but should be taught to you by a trained physiotherapist.

Neck stretching exercises and neck strengthening exercises should be taught to you by trained physiotherapists.

Exercising Intelligently

Exercising irregularly and without proper warm-up can put a lot of stress on your spine muscles.

Jogging or aerobics on a hard ground (high-impact activities) without proper shoes is also stressful to the spine. Remember there is an equal upward thrust on your spine for every downward step.

Swimming though a good form of an aerobic exercise, may actually aggravate neck pain especially strokes like the breast stroke and front crawl. In these strokes, the head is moved up and down or sideways to breathe.

However, specially designed exercises like Aquatic therapy (by trained physiotherapists ) is beneficial as it is specially designed to strengthen the spinal muscles.

Packs, and/or a warm shower can help in relaxing the neck muscles.

When Do I Need Seek Medical Attention For Neck Pain? When Does Surgical Intervention Become Necessary?

Surgical intervention, such as microsurgery with disc replacement, becomes necessary when pain is not relieved by conservative (non-surgical) treatment or when there are neurological deficits such as weakness in the arm or hand. This is associated with the MRI showing moderate to severe nerve impingement that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.

The decision for surgery should be made by you and your neurosurgeon. New and advanced technology is available for the replacement of discs but there is no technology available to replace or repair damaged nerves in the spine. We therefore advise patients not to not wait until their nerves are permanently damaged. After a microsurgical intervention, patients will still need to be put through a proper and organized spine therapy program. This is for long term spine strengthening and preventing relapses. We have found in our experience that a combination of aquatic therapy with physiotherapy works best.

Surgery may be the treatment of choice if:

Surgery may be advisable if:

• You miss work because of pain.
• You are unable to join in family activities because of pain or muscle weakness
• Your pain forces you to, spend more time alone, away from friends and family.
• You feel frustrated or depressed because of your pain.
• Conservative Treatment is not working
• Your symptoms are progressive in your arms and legs.
• Your hands are becoming more clumsy and weak.
• There is difficulty with walking and balance.
• It’s preventative – prevents further nerve injury.
• You are otherwise in good health.

Factors in determining the type of surgical treatment include what type of disease (herniated disc or bone spurs), whether there is pressure on the spinal cord-or spinal nerves and if the spine is dislocated in addition to pressure on the cord or nerves. Other factors include age, duration of disorder, other medical conditions and previous medical history.

ARE THERE LESS INVASIVE OR NO SURGERY OPTIONS?

Less Invasive options including day treatments with no scars are also available such as Specialized Spine Injections, Discoplasty, Nucleoplasty, Annuloplasty, Radiofrequency Ablation, Co-Ablation,Endoscopic and Robotics, Lasers and Superior to Laser technologies.