Physiotherapy for Back and Neck Pain

Causes of Mechanical Neck Pain

Mechanical neck pain simply refers to pain that is caused by injury to the joints, muscles and nerves of the cervical spine. Whereas non-mechanical neck pain can be caused by a disease process like meningitis or ankylosing spondylitis. This article deals with the mechanical type, but later we will discuss how to identify if your neck pain could be non-mechanical and if you should seek medical testing to investigate the problem.

As suggested mechanical neck pain comes as a result of an injury. Some of these injuries can be obvious like whiplash, or a trauma. More commonly people's necks become injured over time, from relatively small forces that are repeated many times. Some of the common causes of neck pain are;

• Poor sitting posture - especially forward head posture (IMAGE - forward Head Posture)
• Working overhead for extended periods (Ex: painting a ceiling)
• Sleeping in a poor posture
• A weakness of neck muscles and shoulder girdle muscles
• Congenital and hereditary factors
• Some hobbies and sports (ex: Road cycling, surfing)

Figure: An example of an individual with a poor sitting posture that can lead to neck pain

Common Symptoms Associated With Neck Pain

Obviously, pain in the neck is the most common symptom. However, there are many other ways that severe neck pain can present. It is important to have a full understanding of the symptoms so that patients do not become anxious that they are developing a more serious medical condition. Some common neck symptoms are;

• Stiffness or immobility. Often being unable to turn or side-bend the neck at all without pain.
• Arm pain. When the nerve roots that exit the neck and run down the arm become involved it can cause pain to radiate down the arm in a specific pattern associated with that nerve called a "dermatomal pattern"

Figure: Dermatomes of upper extremity

• Weakness. This can be from nerve injury or be the result of pain.
• Shoulder blade pain. Often patients have pain that radiates down their back near the shoulder blade or will report a 'knot' around their shoulder blade.

Can Neck Pain Cause Vertigo?

Yes. The upper cervical spine is very important to your sense of balance. It provides critical information to your brain about your orientation in space. This information gets combined with input from your visual and vestibular systems. When all of the information matches, you have a normal sense of balance. When there is a mismatch, vertigo can develop. An upper cervical spine injury can create the imbalance required for patients to feel vertigo or imbalance. Vertigo has many possible causes. If it is one of your primary symptoms you should consult a doctor or vestibular physiotherapist.

Why Does Sleeping Cause My Neck Pain?

When we sleep our muscular system is very relaxed. This means that we are not supporting the joints of our cervical spine. This is why sleep posture is so important. A position that places strain on the neck may be comfortable enough to fall asleep, but after several hours it can cause ligaments and joints to become painful. This is often the case with 'stomach sleepers'. People who sleep lying on their stomachs tend to have their necks turned to the extreme of rotation. For many people, this is enough to cause significant pain when they wake up. If a pillow is too large it can also cause excessive stress on the cervical spine. Ideally, you want your neck in a neutral position, meaning that it is not at the extremes of rotation, side bending or flexion but rather it is closer to the position you achieve when standing up straight.

When is Neck Pain Serious?

Rarely is neck pain in isolation a sign of serious pathology, but it can be one of several symptoms of a serious condition. If you have an associated fever, you feel generally unwell and/or your condition is consistently worsening, it is important to get checked out by your doctor to rule out more serious pathology.

Mechanical neck pain can develop into a serious condition if it causes pressure on the spinal cord. When this happens patients experience widespread numbness, weakness and in-coordination of their arms or legs and have changes to their reflexes. If you are experiencing pain, numbness or weakness in multiple limbs along with your neck pain, be sure to see your doctor right away.

How Do I Relieve My Neck Pain?

To relieve acute neck pain, try the following;

• Apply heat to your neck in a safe manner (commercially available heating pad).
• Gentle neck traction can relieve acute pain (applied with a device or by a therapist).
• Some patients find acupuncture or dry needling to be helpful to their pain.
• Anti-inflammatory medication may be useful in the early stages - talk to your doctor first.
• Gentle range of motion exercises to restore mobility.

To resolve the problem on a more permanent basis consider the following after the acute pain settles down;

• If your neck muscles are weak, get an exercise program to strengthen them.
• If the muscles around your shoulder blade are weak - make sure to strengthen them.
• If you have a poor sitting posture, improve your ergonomic set-up to relieve stress on your neck.
• If you tend to wake with neck pain - consider changing your sleep position. Use pillows to prevent yourself from rolling onto your stomach and consider a change of pillow under your head.
• See your physical therapist for manual therapy treatment to restore range of motion and to get a targeted home exercise program.

Physical therapy is the treatment of choice for mechanical neck pain. Make sure to find an experienced orthopedic physiotherapist to fully examine your problem. They will target the causes, screen you for serious medical conditions and develop a treatment plan that will get on track to living pain-free.