Chronic neck pain

Chronic neck pain

The chance that you will have neck pain at some point over your lifetime is nearly 50%.

This tends to be most prevalent in middle aged people.

On most occasions, an acute episode of neck pain with treatment from a physio will resolve in 2-8 weeks (very case dependent) however, CHRONIC neck pain can persist in 10-30% of people.1

Chronic neck pain is pain that lasts for 12 weeks or more and is often associated with restricted movement, associated pain, muscle or joint tightness and often sore to touch.

Causes / Risk Factors

  • Sustained postures or movements that strain the neck

  • Very common in occupations which require a lot of work with their arms above shoulder height

  • Roles with exposure to conflict or high stressors

  • Office/desk workers with poor workspace ergonomics i.e. looking down for long periods of time 2

How to fix it and avoid neck pain from occurring

Manual therapy (Joint-mobilisations) + an exercise program produces greater long-term improvement in neck pain compared to other forms of treatment. This includes conditions like cervicogenic headaches (neck-related headaches), chronic neck pain/stiffness and neck pain with associated radicular or referred pain i.e. neck pain + pain down your arm or into your shoulder blade for example4

Strength and mobility exercises to target and offload specific structures around the neck and shoulder are important. We train many muscles of the body but neck or upper back muscles are commonly left untrained. Weakness, poor technique or overuse to muscles of our neck can lead to the joints of our neck being exposed to higher loads than they can manage which often leads to pain.

Workplace ergonomic assessments 

Due to the recent increase of working from home, our desk or workstation setup may not be as ergonomically friendly to our neck and upper back region. Quite often forward neck postures are being adopted which are placing higher stressors onto the surrounding muscles, ligaments and joints of our neck causing pain 2

Managing stressful situations 

When the body is stressed, muscles tense up, it’s the body's own defence mechanism against stress to guard you from injury or pain. Once stress passes, the muscle tension releases. When this becomes problematic is when we have chronic stresses being experienced meaning that muscles are in almost a constant state of protection. When this occurs, this can trigger other reactions in the body secondary to the initial reaction to stress.

Cervicogenic headaches / Neck related headaches

A headache can come from a number of different causes and can often be missed. If the following is sounding familiar to you or someone you know then you/they may be suffering from a neck related headache or more commonly known as a Cervicogenic Headache.

A cervicogenic headache is the most common cause of chronic headaches.

Symptoms

  • One sided headache

  • Reduced neck range of motion

  • Tenderness on upper neck (C1-C3)

  • Tightness in surrounding muscles

 

INTERESTING FACT

Our C1-C3 nerves relay pain (nociception) signals to a specific area of the head and neck called the ‘trigeminal nucleus’. This connection can have the output of referred pain to some of our facial nerves which helps give us the feeling of a ‘headache’.

**Please note this is a very brief explanation of a very complex system**  

Causes

Referred pain from an irritation of structures innervated by spinal nerves C1-C3.

So what does this mean?

Structures around the upper part of your neck such as the joints, disc, ligaments and muscles can be dysfunctional in different ways which then activates the specific nerves associated.

The most common example is our facet joints of C1-C3 (top of your neck) being stiff and sore. Like any spinal injury this can be acute or chronic in nature.4

Our spinal nerves C1-C3 messages share the same region as our facial nerves so when we have an irritation to these structures the output can be referred pain to some of our facial nerves resulting in a headache! Weird isn’t it!

Treatment

If the cause is likely from the facet joints being stiff and sore within your neck, then the obvious treatment is through manual therapy to those joints affected.

Manual therapy can reduce pain, reduce stiffness with a joint and improve function. Once we begin to help increase our joint mobility around the affected joint then there is less stress on our C1-C3 nerves which should result in REDUCED HEADACHES! 5

Following Manual therapy, specific exercises are likely to be prescribed to help prevent this reoccurring again. 

How we can help at UPG 

Firstly, our UPG physios can identify and treat chronic neck pain and the potential associated headaches. Treatment varies from person to person but our very skilled physios excel with their manual therapy skills to make you feel better than ever. Once symptoms have been relieved, then specific exercises will be prescribed to ensure that this type of pain can stay away.

At UPG we are happy to help, don’t suffer from chronic neck pain and associated headaches any longer. Book in for your initial assessment before your pain and symptoms worsen.

References 

1. Hogg-Johnson S, Van der Velde S, Carroll L, Holm L, Cassidy D, Guzman J, Côté P, Haldeman S,
Ammendolia C, Carragee,14,15 Eric Hurwitz E, Nordin, M, Peloso P. The Burden and Determinants of Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eur Spine J. 2008 April; 17(Suppl 1): 39–51.

2. Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, Winkel J, Isacsson SO; Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort. Malmö Shoulder Neck Study Group. J Epidemiol Community Health. 2005 Sep; 59(9):721-8. 


3. Al Khalili Y, Jain S, Murphy PB. 2019 Headache, Cervicogenic

4. Becker WJ. Cervicogenic Headache: Evidence that the neck is a pain generator. Headache. 2010;4 699-705

5. Fritz JM, Brennan GP. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Physical Therapy. 2007;87:513-524.

 

 

 


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