NECK
Overview:
The neck (cervical spine) comprises seven vertebrae that begin in the upper torso and end at the skull base. The bony vertebrae and the ligaments (comparable to thick rubber bands) and muscles provide stability to the spine. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion.
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Neck Pain:
Neck pain usually results from abnormalities in the soft tissues such as the muscles, ligaments, nerves, bones, and disks of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury, prolonged wear and tear, and poor posture, which can place the neck’s structure in a compromised position. In rare instances, infection or tumors may cause neck pain. For many patients, neck problems are the source of pain in the upper back, shoulders, or arms. The neck is susceptible to injury in athletic collisions and motor vehicle accidents. Physical therapy plays a crucial role in patients suffering from neck pain and addressing contributing factors to neck dysfunction. A Foothills physical therapist will complete a comprehensive evaluation to determine the musculoskeletal causes of your neck pain.
Common neck conditions: The majority of neck pain is mechanical, meaning a defined disruption in how the neck’s components are fitting together and moving. In some cases, neck pain is associated with spondylosis, everyday wear and tear of the cervical spine that occurs with aging.
Whiplash, sprains, and strains:
Whiplash, sprains, and strains of the structures in the neck are common. Sprains are caused by overstretching of ligaments, and strains are micro-tears in the muscles. Typically, a sprain/strain of the neck will occur with a fall, an accident, or contact sports. Because the neck must support the head’s weight, and there is little bony stability, muscles and ligaments provide most of the stability.
A whiplash injury from a motor vehicle accident is an example of a significant cervical sprain or strain. Following any motor vehicle accident, especially those involving high speeds, x-rays should be taken to ensure there is no underlying fracture.
Physical therapy for a cervical strain targets symptom reduction through manual, hands-on techniques, postural education, and proper movement patterns. Sometimes in severe cases, immobilization through a neck brace is needed to allow the damaged tissues time to heal.
Intervertebral disc degeneration:
This is a standard process that occurs over time with aging. With aging, the intervertebral discs lose their flexibility and become more rigid. Usually rubbery and flexible, the discs become less pliable and decrease in height. With this occurring, the articulation between vertebrae can be affected, resulting in neck pain with movement, a “stiff neck,” and restrictions in motion. In some cases, this can also result in nerve impingement as the nerve leaves the cervical spine, causing pain down the arm. The pain may worsen with specific movements.
Physical therapy is geared toward addressing faulty positioning, postures, and movement patterns that can increase symptoms. Since degeneration progression cannot be reversed, physical therapy will focus on patient education to avoid positions, postures, and movements that will exacerbate the condition. Additionally, hands-on, manual techniques will be used to reduce muscle spasms and address any movement restrictions.
Herniated or ruptured disc:
A herniation occurs when the outer ring of the disc (the annulus) becomes compromised, and the jelly-like nucleus of the disc protrudes outward, placing pressure on the nerves exiting the cervical spine. This compression results in radiculopathy, a painful condition when patients experience shooting pain down the arm. This compression can also result in weakness in muscles in the arm. The pain and weakness typically follow a specific pattern that corresponds to the cervical level where the herniation has occurred. Patients often have difficulty sleeping and finding positions of comfort.
Physical therapy can be effective in reducing symptoms from a disc herniation. Treatment may include traction (manual or mechanical) to minimize compression on the nerve root. Additionally, manual techniques and modalities may be applied to reduce symptoms. If numbness, pain, and weakness persist, a surgeon’s evaluation is warranted, and surgery can be indicated.
Cervical radiculopathy:
A condition caused by compression, impingement, inflammation, or injury to a cervical spine nerve root. Pressure on the nerve results in pain, numbness, and weakness that travels or radiates to the shoulder or arm in a specific pattern. Radiculopathy can be the result of a herniated disc, cervical spondylosis, or intervertebral disc degeneration.
Physical therapy for cervical radiculopathy is geared towards the compression source, and the physical therapist will perform specific tests and movements to identify the source of the pain. Based on their findings, treatment can include manual or mechanical traction, hands-on manual therapy, patient education, postural correction/restoration, and strengthening exercises.
Postural dysfunction:
Many cervical conditions are caused by long-standing postural and movement dysfunction that strains the neck’s structures. A forward head posture can result in excessive muscular strain and can affect the spine’s normal kinematics. Additionally, poor posture and a rounded back position jeopardize the position of the shoulder blades. Muscles that control movement and positioning of the shoulder blades during arm movements attach to the cervical spine. Faulty movement patterns can lead to additional strain on the cervical spine because of these muscles’ pull.
The foundation for physical therapy for the cervical spine is to address posture and faulty movement patterns contributing to excessive strain on the cervical region.
Temporomandibular joint (TMJ) dysfunction:
The temporomandibular joint articulates the mandible (jaw) with the skull. This joint can be affected in patients with cervical conditions, and it’s not uncommon to see these conditions related. Poor posture is the main contributing factor. Thus, any treatment for the TMJ must address the cervical spine as well.
Thoracic outlet syndrome:
The thoracic outlet is the space between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. Thoracic outlet syndrome refers to sequelae of symptoms that occur due to compression of the blood vessels and nerves as they pass through this area. Multiple factors can predispose an individual to develop thoracic outlet syndrome. These include heredity, obesity, gender, activity-work/sports, poor posture, muscle imbalances, and movement dysfunction.
Symptoms can include numbness and tingling in the arms, pain in the neck, shoulder, arm, fatigue, and weakness. Because this condition affects nerves and blood vessels, upper extremity circulation can also be affected. Symptoms worsen with overhead activities.
Physical therapy treatment focuses on addressing poor posture and faulty movement patterns that contribute to the condition. Treatment includes specific stretching and strengthening activities of muscles in the shoulder and neck. Additionally, the focus will be on patient education and lifestyle changes, including workstation evaluation, positioning, and modifying activities that aggravate the condition.