Anatomy of Neck Pain

The human skull weighs around 4 kilograms for the average adult. Quite a lot of weight for a neck to support and allow a lot of freedom of action at the same time. No other part of your spine has such a range of motion: 60° of forward flexion, 75° of backward extension, 45° of side-to-side lateral flexion, and almost 80° of rotation to either side.

Anatomically, the bones in your neck form the foundation of your cervical spine and starts at the base of your skull. It contains 7 small bones called vertebrae that  are labelled C1 to C7 (the 'C' means cervical). The numbers 1 to 7 indicate the level of the vertebrae with C1  closest to the skull and C7 closest to the chest.

In between each vertebra are tough fibrous shock-absorbing pads called the intervertebral discs. Each disc is made up of an outer band (annulus fibrosus) and a gel-like inner substance (nucleus pulposus).

In addition to the bones and the discs, the neck has joints, muscles, and ligaments. They permit and actuate the incredible movement available at the neck. They also stabilize and limit the neck to operating within a range of safety for the delicate structures that pass within the neck.

All vertebrae including the cervical have a hole called a vertebral foramen that allows passage of the spinal cord and accompanying arteries and veins. Lateral foramen are passages from the side of the vertebrae that allow nerve roots to leave the spinal cord and travel to the neck, arms and chest.The nerve roots leave your spinal column and then join up in various combinations to form the nerves that send and receive information with the brain.

The neck is incredible in its capacity for movement with strength and stability. However, its  freedom of movement does contribute a high risk for pain and injury through potential misuse . This can be either traumatic such as diving in shallow water or be degenerative through overuse or poor posture.

Spinal Cord and Cervical Nerve Roots
Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). At each spinal disc level the spinal cord gives off a pair (left and right) of spinal nerve roots.The PNS is the complex system of nerves that form from various combinations of the spinal nerve roots. For example, the ulnar nerve has its origins in the spinal nerve roots C8 and T1. These nerves travel into the muscles, skin, bones, organs and gut. Everything gets a nerve supply, what will vary is which nerve roots  innervate that particular structure.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (e.g. spinal cord injury or SCI, fracture, compression, laceration). Pain, numbness, weakness, and tingling are symptoms that can develop when spinal nerves are injured, irritated, crushed or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm ( the muscle of breathing at the bottom of your chest)
C4: Upper body muscles (e.g. Deltoids, Biceps)
C5: Wrist extensors (wrist bent backwards)
C6: Wrist flexors (wrist bent forwards)
C7: Triceps
C8: Hands

Causes of Neck Pain

Neck pain comes in a variety of shapes and forms. It may be mild, moderate or severe, numb or burning, in your neck or even in your arm and/or hand. There are different symptoms and there are different causes. Some of the common causes are:

Common Neck Disorders

Cervical Stenosis

Cervical stenosis is a disorder caused by a narrowing of the spinal canal in the neck. Many factors can contribute to the development of cervical stenosis including: 


The most likely cause of the cervical stenosis is the arthritic change secondary to disc degeneration. A key characteristic  of disc degeneration is the change  that the bone undergoes. Because the normal relationships of the adjacent vertebral bones is lost, there is a condition of instability. This refers to one vertebra moving in an abnormal manner in relation to the next vertebra. In a biological attempt to address this excess motion the vertebral bone grows outward to limit intervertebral joint motion. These outward growths are called osteophytes. Osteophytes can be found near the disc spaces and around the facet joints. Osteophytes occupy space and so have the potential to grow in areas where nerves or the spinal cord  can be impinged or compressed. This spinal stenosis can cause pain, numbness, tingling, or weakness to varying degrees.

 

Cervical Disc Prolapse/Bulge and Herniation

The disc has a number of different lesions that can occur. Unfortunately the terms are often used incorrectly by both lay and professional people alike.


Disc degenerative changes can cause a variety of different lesions to occur within the spinal canal. They have potential to interfere with other structures in the spinal canal, most evident being the nervous tissues of spinal cord and nerve roots. The most common presentation is that of neck pain in the company of arm pain due to pressure on the nerve root.

Cervical Spondylosis/degenerative disease 
Cervical spondylosis is an overused medical term that gives no real indication of what it means. The term "spondylo" refers to "vertebrae" and "osis" refers to "condition of". As such the term cervical spondylosis means a "condition of the cervical vertebrae". Not very helpful.

Cervical spondylosis has come to mean the culmination of years of degenerative change. Ageing can be accompanied by slow degenerative disc breakdown, progressive intervertebral joint instability and osteophytic bone growth on the vertebral margins and facets. The changes are evident on plain film radiography. The changes correlate poorly with patient symptoms. Many people with lots of degenerative change have little to no pain despite lots of damage as seen on the xray film.

Most people have experienced neck pain at some stage of their lives. In most instances these episodes are benign and self-limited. Physical symptoms are commonly described as a soreness and  stiffness of the neck. Typically there is no strong association with an injury cause or probable precipitating event. Patients often attribute this to a "draught or chill" or "sleeping wrong" that may or may not be a factor. The great likelihood is that the patient suffers some degree of degenerative disease that permits a relatively easy aggravation of the involved joint and production of symptoms. Patients are looking for  cause of significance, "l fell down some stairs", "l was laying bluestone all weekend".  They usually can't find an explanation that they think fits.

These problems do present difficulty. The very thing that produced the degenerative change is the host of habits and functions that we do routinely and largely without thinking. A person may fall asleep in front of the TV every night or use a computer eight hours a day every day. Why did it cause a problem this time and not every time before? If we took xrays the day before the pain began they would look the same as the xrays taken the day after the pain arrived.

Degenerative disease of the spine refers to a breakdown of the normal architecture of the various components of the cervical spine. The disc as we know is a  frequent site of degeneration or breakdown with the passing of the years. The vertebral bones then come closer and closer together. Since the disc is no longer capable of bearing the forces that it usually does, the other joints of the spine are forced to take on these extra loads. This falls to the rear guides or facet joints.

The facets are designed to operate primarily as a guide and limiter of movement rather than to bear weight and movement loads. The shiney and slippery facet cartilage starts to breakdown under the stress. With repeated stress the cartilage degenerates to expose the underlying bone and initiate an inflammatory response. This causes a cascade of chemical change, irritation of the joint and the development of pain. This sets up a vicious cycle of events. The more the facet joints become degenerated, the less they are able to tolerate the increased demands. Thus, greater demands will then be placed on the intervertebral disc, causing it to further degenerate (or breakdown) as well. The changes in the intervertebral disc and facet joints are irreversable though promising research in stem cell therapy gives much to look forward to.

 

What else can be causing my neck pain? 
  It is important to differentiate neck pain related to degenerative spinal disorders from other more serious ailments.  What are some of the serious illnesses that need to be excluded?

Chiropractic Care for Neck Pain

Chiropractic have spent a great deal of time learning how to manage neck pain. Chiropractors specialize in the care of non-surgical conditions of the neck with gentle techniques that address the fundamental cause of your neck pain.

Why Consult a Chiropractor
Chiropractors are rigorously trained to diagnosis the different types of neck conditions and to then recommend specific treatment approaches for those conditions.

Chiropractors are experts in spinal manipulation. Using spinal manipulation they seek to return the patient to having normal spinal mechanics, muscles can relax and pain is resolved.

Chiropractic has developed a number of treatment approaches in addition to traditional spinal adjustments. These treatment approaches help chiropractors to address a wide range of neck pain conditions.

Neck conditions that respond to chiropractic care include:

How a Chiropractor Diagnoses the Source of your Neck Pain
A visit to the chiropractor with cervical pain will result in you having all of your spine examined. Pain in your neck can be influenced by other spinal concerns that load up your neck. For example, too much curve in your lumbar spine (lordosis) changes the position of your head and places increased pressure on the cervical joints to support this alignment change. Addressing the painful joints only will have a less than satisfactory long-term result.

Your chiropractor will determine areas of restricted joint motion (hypomobility), excessive joint motion (hypermobility),disc injury, muscle tone abnormalities, spinal assymetries and ligament injury. One investigative technique  the chiropractor uses is palpation (motion and static ),Motion and static palpation is an examination by means of touch. The chiropractor will feel for tenderness, tightness and how well each spinal joint moves through a series of directions dependent upon which vertebrae is being pushed. Each joint has its own unique design with different amounts of flexion, extension, lateral flexion and rotation available which your chiropractor has been trained in.

The chiropractor will also analyze your gait patterns (how you walk) and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and so correlate this information with the complaints you present with.

Other information your chiropractor may need to know;

All these steps in the diagnostic process will give your chiropractor more information about your neck pain. The examination will enable your chiropractor to create an effective treatment plan.

Your chiropractor has a number of Treatment Approaches for Neck Pain


The specifics of any treatment plan will depend upon your diagnosis. Your chiropractor may use a combination of spinal manipulation, machine/instrument usage, soft-tissue technique, reflex work, stretching or muscle-energy technique along with a range of other modalities and techniques.

Some people are better suited for one therapy over another. Some people have a history that precludes certain techniques being performed.

The chiropractors training and experience allow them to make these important decisions to provide the most efficient and safe outcome.

Chiropractic Limitations

Chiropractors like all professionals have a scope of practice and a limitation to what can be achieved. There are times when the best person for the job is definitley not the chiropractor. A good chiropractor determines this quickly and makes the referral of that person elsewhere. It may be to another chiropractor who has more skill and experience in the area. It may be to a rehabilitation expert for multi-practitioner care. It may be to a general practitioner to deal with infection. It may be to a surgeon because a laminectomy is the responsible way to go.

 

Prevention and Whole Person Care
Chiropractors are "whole person" doctors who view neck pain as unique to each patient. Therefore, they don't focus on just your neck pain. Chiropractic care can include  advice on nutrition, stress management and lifestyle goals (because all of those can add to neck pain, you need to address them if you really want to get to the root of your pain).

Prevention is integral to long-term health, and chiropractors strongly emphasize it. If you can learn how to prevent neck pain by using good mechanics and maintaining good posture, you'll be doing your body a favor that will last for years. This focus on prevention and self-care is another example of how chiropractors look at the whole person, not just at the pain.

Reference

1. Cassidy J, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver F, Bondy S. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Spine. 2008;33(4S): S176-S183.

 

 

 

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