Neck pain

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.[1]

Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Neck pain affects about 5% of the global population as of 2010.[2]

Neck pain
Other namesCervicalgia
Neck pain illustration
A person with neck pain
SpecialtyNeurosurgery

Differential diagnosis

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal, or be referred from other areas of the body.[3]

Major and severe causes of neck pain (roughly in order of severity) include:

More common and lesser neck pain causes include:

  • Stress – physical and emotional stresses
  • Prolonged postures – many people fall asleep on sofas and chairs and wake up with sore necks.
  • Minor injuries and falls – car accidents, sporting events, and day to day injuries that are really minor.
  • Referred pain – mostly from upper back problems
  • Over-use – muscular strain is one of the most common causes
  • Whiplash
  • Pinched nerve

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

More causes can include: poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.

Treatment

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations in which it helps alleviate symptoms include applying heat or cold.[5] Other common treatments could include medication, body mechanics training, ergonomic reform, and physical therapy.

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain.[6][7] Muscle relaxants are often prescribed and are known to be effective. However, one study showed that one muscle relaxant called cyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other etiologies or chronic neck pain).[8] Over the counter topical creams and patches may be effective for some patients.

Surgery

Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy.

Alternative medicine

Exercise plus joint manipulation has been found to be beneficial in both acute and chronic mechanical neck disorders.[9] Both cervical manipulation and cervical mobilization produce similar immediate-, and short-term changes.[10] Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate to long-term follow-up.[10] Thoracic manipulation may also improve pain and function.[10][11] Low level laser therapy has been shown to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients that experience chronic neck pain.[12]

Epidemiology

Neck pain affects about 330 million people globally as of 2010 (4.9% of the population).[13] It is more common in women (5.7%) than men (3.9%).[13] It is less common than low back pain.[14]

Prognosis

About one-half of episodes resolve within one year.[1] About 10% of cases become chronic.[1]

References

  1. ^ a b c Binder AI (2007). "Cervical spondylosis and neck pain". BMJ. 334 (7592): 527–31. doi:10.1136/bmj.39127.608299.80. PMC 1819511. PMID 17347239.
  2. ^ March, L; Smith, EU; Hoy, DG; Cross, MJ; Sanchez-Riera, L; Blyth, F; Buchbinder, R; Vos, T; Woolf, AD (June 2014). "Burden of disability due to musculoskeletal (MSK) disorders". Best Practice & Research. Clinical Rheumatology. 28 (3): 353–66. doi:10.1016/j.berh.2014.08.002. PMID 25481420.
  3. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. p. 46. ISBN 978-1-4051-4166-6.
  4. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. p. 47. ISBN 978-1-4051-4166-6.
  5. ^ Garra, Gregory; Singer, Adam J.; et al. (2010). "Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy". Academic Emergency Medicine. 17 (5): 484–9. doi:10.1111/j.1553-2712.2010.00735.x. PMID 20536800.
  6. ^ Machado, Gustavo C; Maher, Chris G; Ferreira, Paulo H; Day, Richard O; Pinheiro, Marina B; Ferreira, Manuela L (2 February 2017). "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis". Annals of the Rheumatic Diseases. 76 (7): annrheumdis–2016–210597. doi:10.1136/annrheumdis-2016-210597. PMID 28153830.
  7. ^ "UpToDate Inc".
  8. ^ Khwaja SM, Minnerop M, Singer AJ (January 2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial". CJEM. 12 (1): 39–44. doi:10.1017/S1481803500012008. PMID 20078917.
  9. ^ "BestBets: Manipulation and/or exercise for neck pain?".
  10. ^ a b c Gross, Anita; Langevin, Pierre; Burnie, Stephen J.; Bédard-Brochu, Marie-Sophie; Empey, Brian; Dugas, Estelle; Faber-Dobrescu, Michael; Andres, Cristy; Graham, Nadine (2015-09-23). "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment". The Cochrane Database of Systematic Reviews (9): CD004249. doi:10.1002/14651858.CD004249.pub4. PMID 26397370.
  11. ^ Huisman PA, Speksnijder CM, de Wijer A (January 2013). "The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review". Disabil Rehabil. 35 (20): 1677–1685. doi:10.3109/09638288.2012.750689. PMID 23339721.
  12. ^ Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials". Lancet. 374 (9705): 1897–1908. doi:10.1016/S0140-6736(09)61522-1. PMID 19913903.
  13. ^ a b Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
  14. ^ Deen, Hanifa; Bartleson, J. D. (2009). Spine disorders medical and surgical management. Cambridge, UK: Cambridge University Press. p. 3. ISBN 978-0-521-88941-4.

External links

External resources
Alexander Technique

The Alexander Technique, named after its creator Frederick Matthias Alexander, is an educational process that was created to retrain habitual patterns of movement and posture. Alexander believed that poor habits in posture and movement damaged spatial self-awareness as well as health, and that movement efficiency could support overall physical well-being. He saw the technique as a mental training technique as well.Alexander began developing his technique's principles in the 1890s in an attempt to address voice loss during public speaking. He credited his method with allowing him to pursue his passion for reciting in Shakespearean theater.Some proponents of the Alexander Technique say that it addresses a variety of health conditions related to cumulative physical behaviors, but there is little evidence to support many of the claims made about the technique. As of 2015 there was evidence suggesting the Alexander Technique may be helpful for long-term back pain, long-term neck pain, and may help people cope with Parkinson's disease. However, both Aetna and the Australian Department of Health have conducted reviews and concluded that the technique has insufficient evidence to warrant insurance coverage.

Brianne Tutt

Brianne Tutt (born June 9, 1992) is a Canadian speedskater from Airdrie, Alberta.

She skated in the 1500 m event at the 2014 Winter Olympics. Just over a year before the Sochi Olympics, Tutt was run over by another skater as she stood waiting to do a practice start at the Calgary Olympic Oval. The collision resulted in severe injuries to Tutt including two broken neck vertebrae, fractured skull, two broken ribs, broken collar bone, hearing loss, Bells Pasly and a concussion. Despite this prognosis, Tutt would overcome most of these injuries with only hearing loss, nagging neck pain, and concussion symptoms as a long-term result. She continues to skate in pursuit of making the 2018 Olympic Team.

Carotid artery dissection

Carotid artery dissection is a separation of the layers of the artery wall supplying oxygen-bearing blood to the head and brain and is the most common cause of stroke in young adults. (In vascular medicine, dissection is a blister-like de-lamination between the outer and inner walls of a blood vessel, generally originating with a partial leak in the inner lining.)Dissection may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or chiropractic manipulation, but may also happen spontaneously.

Chiropractic

Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Some proponents, especially those in the field's early history, have claimed that such disorders affect general health via the nervous system, through vertebral subluxation, claims which are not based on scientific evidence. The main chiropractic treatment technique involves manual therapy, especially spinal manipulation therapy (SMT), manipulations of other joints and soft tissues. Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and "innate intelligence" that reject science. Chiropractors are not medical doctors.Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results. Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain. A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition. Spinal manipulation may be cost-effective for sub-acute or chronic low back pain but the results for acute low back pain were insufficient. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Several deaths have been associated with this technique and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.Chiropractic is well established in the United States, Canada, and Australia. It overlaps with other manual-therapy professions such as osteopathy and physical therapy. Most who seek chiropractic care do so for low back pain. Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues. Many chiropractors describe themselves as primary care providers, but the chiropractic clinical training does not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed. Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "innate intelligence", and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.D. D. Palmer founded chiropractic in the 1890s, after saying he received it from "the other world", and his son B. J. Palmer helped to expand it in the early 20th century. Throughout its history, chiropractic has been controversial. Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" in 1966 and boycotted it until losing an antitrust case in 1987. Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.

Electrotherapy

Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments.

Grisel's syndrome

Grisel’s syndrome is a non-traumatic subluxation of the atlanto-axial joint caused by inflammation of the adjacent tissues. This is a rare disease that usually affects children. Progressive throat and neck pain and neck stiffness can be followed by neurologic symptoms such as pain or numbness radiating to arms (radiculopathies). In extreme cases, the condition can lead to quadriplegia and even death from acute respiratory failure. The condition often follows soft tissue inflammation in the neck such as in cases of upper respiratory tract infections, peritonsillar or retropharyngeal abscesses. Post-operative inflammation after certain procedures such as adenoidectomy can also lead to this condition in susceptible individuals such as those with Down's syndrome.

John Banaszak

John Arthur Banaszak (born August 24, 1950) is an American football coach and former player. He was formerly the head football coach at Robert Morris University. Banaszak played in the National Football League with the Pittsburgh Steelers from 1975 to 1981. He is a three-time Super Bowl Champion. Banaszak was a starter at right defensive end for the Steelers in Super Bowl XIII and Super Bowl XIV. He later played in the United States Football League (USFL), winning a championship as a starting defensive end for the Michigan Panthers in 1983. Banazak played for Michigan in 1983 and 1984 and for the Memphis Showboats in 1985.

After his football career, owned a chain of oil change centers and worked for the Peters Township Recreation Department. In 1995, Banaszak became defensive coordinator of Washington & Jefferson College football team. He was promoted to head coach in 1999. He was fired from W&J after publicly exploring other coaching jobs. He left the college as the third-most winning coach in school history.Banaszak was an assistant football coach under Joe Walton at Robert Morris University in Pittsburgh. He officially began his duties as head coach at Robert Morris in December 2013

Banaszak was hospitalized in Pittsburgh on April 23, 2009 in serious condition. It was first reported that he had suffered multiple aneurysms. That was later found to be incorrect and he may have suffered from an overdose of aspirin which was being taken for neck pain.

Low-level laser therapy

Low-level laser therapy (LLLT) is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function.

The effects of LLLT appear to be limited to a specified set of wavelengths of laser, and administering LLLT below the dose range does not appear to be effective.Despite a lack of consensus over its validity, some studies suggest that LLLT may be modestly effective, in relieving short-term pain for rheumatoid arthritis, osteoarthritis, acute and chronic neck pain, tendinopathy, and possibly, chronic joint disorders. The evidence for LLLT being useful in the treatment of low back pain, dentistry, and wound healing is unclear.

Musculoskeletal causes of back pain

Most cases of back pain are related to issues in human musculoskeletal system and are not related to severe diseases. Musculoskeletal problems also called mechanical because many of them linked to vertebrae physical motions.

Neck

The neck is the part of the body, on many vertebrates, that separates the head from the torso. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the carotid arteries and jugular veins, and the top part of the spinal cord.

In anatomy, the neck is also called by its Latin names, cervix or collum, although when used alone, in context, the word cervix more often refers to the uterine cervix, the neck of the uterus. Thus the adjective cervical may refer either to the neck (as in cervical vertebrae or cervical lymph nodes) or to the uterine cervix (as in cervical cap or cervical cancer).

Neck stiffness

Neck stiffness, stiff neck and nuchal rigidity are terms often used interchangeably to describe the medical condition when one experiences discomfort or pain when trying to turn, move, or flex the neck. Possible causes include muscle strain or sprain, cervical spine disorders, meningitis, and subarachnoid hemorrhage.Nuchal rigidity due to irritation of the lining of the brain and spinal cord is one of the main symptoms of meningitis.

Orthopedic pillow

An orthopaedic pillow is a pillow designed to correct body positioning in bed or while lying on any other surface. Its design conforms to orthopaedic guidelines to ensure the right placement and support of one or more specific parts of the body to provide safe and healthy rest to the sleeper.

Pillows have been traditionally made of foam and fiber, but other types now exist, such as pillows made of memory foam, a heat sensitive material that can acquire the shape of the body lying upon it. It may or may not recover its original shape immediately when the body is removed from the pillow.

Orthopaedic pillows are regarded as therapeutic pillows based on claims that they can help relieve various conditions including sleep apnoea, snoring, insomnia, breathing difficulty, blood circulation problems, acid reflux, gastroesophageal reflux disease, lower back pain, sciatica pain, neck pain, whiplash, rotator cuff injury, amongst others.There are many types of orthopaedic pillows for almost every part of the human body, as well as orthopaedic beds, mattresses, top mattresses, supports and cushions for different orthopaedic problems. Some of them have multi-purpose and multi-position designs for different physical ailments and sleep disorders.

Sequela

A sequela (UK: , US: ; usually used in the plural, sequelae) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Typically, a sequela is a chronic condition that is a complication which follows a more acute condition. It is different from, but is a consequence of, the first condition. Timewise, a sequela contrasts with a late effect, where there is a period, sometimes as long as several decades, between the resolution of the initial condition and the appearance of the late effect.

In general, non-medical usage, the terms sequela and sequelae mean consequence and consequences.

Spinal manipulation

Spinal manipulation is an intervention performed on spinal articulations which are synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints.

National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.A 2004 Cochrane review found that spinal manipulation was no more or less effective than other commonly used therapies such as pain medication, physical therapy, exercises, back school or the care given by a general practitioner. There is not sufficient data to establish the safety of spinal manipulations.

Subacute thyroiditis

Subacute thyroiditis is a form of thyroiditis that can be a cause of both thyrotoxicosis and hypothyroidism. It is uncommon and can affect individuals of both sexes, occurring three times as often in women than in men. and people of all ages. The most common form, subacute granulomatous, or de Quervain's, thyroiditis manifests as a sudden and painful enlargement of the thyroid gland accompanied with fever, malaise and muscle aches. Indirect evidence has implicated viral infection in the etiology of subacute thyroiditis. This evidence is limited to preceding upper respiratory tract infection, elevated viral antibody levels, and both seasonal and geographical clustering of cases. There may be a genetic predisposition. Nishihara and coworkers studied the clinical features of subacute thyroiditis in 852 mostly 40- to 50-year-old women in Japan. They noted seasonal clusters (summer to early autumn) and most subjects presented with neck pain. Fever and symptoms of thyrotoxicosis were present in two thirds of subjects. Upper respiratory tract infections in the month preceding presentation were reported in only 1 in 5 subjects. Recurrent episodes following resolution of the initial episode were rare, occurring in just 1.6% of cases. Laboratory markers for thyroid inflammation and dysfunction typically peaked within one week of onset of illness.

The River (1997 film)

The River is a 1997 Taiwanese film directed by Tsai Ming-liang and starring Lee Kang-sheng, Miao Tien, and Lu Yi-ching. The plot centers on a family who has to deal with the son's neck pain. In 2003, a critic called it Tsai's "bleakest film."

Vertebral artery dissection

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.Vertebral dissection may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or chiropractic manipulation, but may also happen spontaneously. 1–4% of spontaneous cases have a clear underlying connective tissue disorder affecting the blood vessels. Treatment is usually with either antiplatelet drugs such as aspirin or with anticoagulants such as heparin or warfarin.Vertebral artery dissection is less common than carotid artery dissection (dissection of the large arteries in the front of the neck). The two conditions together account for 10–25% of non-hemorrhagic strokes in young and middle-aged people. Over 75% recover completely or with minimal impact on functioning, with the remainder having more severe disability and a very small proportion (about 2%) dying from complications. It was first described in the 1970s by the Canadian neurologist C. Miller Fisher.

Vertebral subluxation

In chiropractic, a vertebral subluxation is a purported misalignment of the spinal column, not necessarily visible on X-rays. It has no biomedical basis, lacks clinical meaningfulness, and is categorized as pseudoscientific.Straight chiropractors continue to follow Palmer's vitalistic tradition, claiming that subluxation has considerable health effects and also adding a visceral component to the definition, while mixers consider it a historical concept with no evidence identifying it as the cause of disease.The use of the word subluxation should not be confused with the term's precise anatomic usage, which considers only the anatomical relationships."

Whiplash (medicine)

Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquialism. "Cervical acceleration–deceleration" (CAD) describes the mechanism of the injury, while the term "whiplash associated disorders" (WAD) describes the injury sequelae and symptoms.

Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including headbanging, bungee jumping and falls. It is one of the most frequently claimed injuries on vehicle insurance policies in certain countries; for example, in the United Kingdom 430,000 people made an insurance claim for whiplash in 2007, accounting for 14% of every driver's premium.Before the invention of the car, whiplash injuries were called "railway spine" as they were noted mostly in connection with train collisions. The first case of severe neck pain arising from a train collision was documented around 1919. The number of whiplash injuries has since risen sharply due to rear-end motor vehicle collisions. Given the wide variety of symptoms associated with whiplash injuries, the Quebec Task Force on Whiplash-Associated Disorders coined the phrase 'Whiplash-Associated Disorders'.While there is broad consensus that acute whiplash is not uncommon, the topic of chronic whiplash is controversial, with studies in at least three countries showing zero to low prevalence, and some academics positing a linkage to financial issues.

By region/system
Tests
Related concepts
Spinal disease (M40–M54, 720–724, 737)
Deforming
Spondylopathy
Back pain
Intervertebral disc disorder

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