Patients with neck pain may present with joint, muscular or nerve dysfunction which can all cause restricted movement.
Acute neck pain and stiffness can occur insidiously or due to a road traffic accident, known as a whiplash injury.
Acute neck pain is characterized by a sudden onset of sharp pain and limitation of movement. It typically occurs either after a sudden, quick movement or upon waking from sleep.
In some patients, pain is caused by posture alone, usually as a result of forward head posture (e.g. working at a computer screen).
In the older patient, osteoarthritis may particularly affect the joints, which can cause headaches as well as neck pain and stiffness.
Severe, stabbing pain and/or sensations of pins and needles and weakness referring to the arm, hand and fingers suggest nerve root compression at the cervical (neck) joints.
Treatment is aimed at restoring normal muscle tone and range of movement. Soft tissue techniques such as massage and trigger pointing can be very effective.
Manual therapy techniques such as mobilisations and manipulations can be used to treat stiff and painful joints. The aim when treating joint dysfunction is to restore full, pain-free range of movement. Traction, either manually or by a machine can also be used to increase range of movement.
NERVE ROOT / NEURAL DISCOMFORT
Acute nerve root pain is characterized by moderate to severe arm pain which is very irritable. Neck pain may or may not be a feature. The pain is aggravated by movements of the cervical spine (neck) or any movement or posture that increases tension in the nerve root. There may be associated sensory symptoms , such as pins and needles, numbness and muscle weakness, and possibly reduced reflexes.
Nerve root pain may be insidious in onset, especially following prolonged abnormal posture. Treatment consists of techniques that open up the joints or foramen, where the nerve root exists the vertebrae. Sustained traction (usually mechanical) can be very effective in some cases. Treatment should include discussion of sleeping positions and a full explanation of the problem. This should be accompanied by local measures to reduce pain and inflamation, such as, ice, heat, Interferential stimulation and analgesic medication.
In motor vehicle accidents, resulting in rear-end or side-on collisions, symptoms can include, neck pain, headache and reduced neck mobility. The patient may not feel pain immediately, but symptoms may increase gradually in the 48 hours following injury. Muscles, joints, ligaments and nerves may all be affected.
Early mobilisation of the cervical spine (neck) is essential in the management of acute whiplash, including postural advice and range of motion exercises within a comfortable range. After the acute phase, treatment should focus on increasing function and return to normal activity as soon as possible with continuation of therapeutic exercises.
Patients tend to present with a forward head posture, rounded shoulders and increased upper cervical lordosis, leading to a chin protrusion. It may be seen in athletes whose sport requires them to adopt prolonged postures such as cyclists and hockey players. Similar problems occur in the workplace among people working at a computer screen, painters and production line workers. Problems arising from the workplace may benefit from an ergonomic asessment.
Treatment includes a multimodal approach, with therapeutic exercise, manual therapy (mobilisations, massage) and postural retraining.
Exercise is an important component of the treatment of a patient with neck pain. Inparticular, range of motion exercises, such as active flexion, rotation and side flexion should be performed regularly within the pain-free range. Caution is required with extension exercises as they may irritate the condition. Circular combined movements should not be performed.