by Alan Jordan
One of the most common ailments we come across at our clinic is neck pain. These are subdivided in categories depending on the severity and longevity of the condition. It is always very important to ascertain the factors surrounding the onset of symptoms and how the situation has progressed or regressed. Depending on what the physiotherapist is presented with, then the objective examination starts. All the factors such as neurological, structural, postural, ergonomics, muscular are considered in the assessment but emphasis is given depending on information provided during the initial interview. For more information regarding the role of the physiotherapist in the management of neck disorders please click HERE.
A ‘slipped disc’ is when there is a herniation of gel-like structure from the disc resulting from a rupture of the outer border. This material may impinge on nerves exiting the spine resulting in any of these symptoms: pain, numbness, pins and needles and muscle weakness.
A disc bulge is when there is weakening of the outer border of the disc and the original shape of the disc is distorted and may extend into the space of the exiting nerve. This may give similar symptoms to the aforementioned condition and may also be a precursor to herniation. A patient with a confirmed diagnosis of a bulging disc comes to physiotherapy to halt this progression from happening.
Spinal joints and disc degeneration is a natural occurrence with age. Postural habits, type of sporting activities, sleeping positions and also genetics may play a part in accelerating this process. These changes may occur in facet joints (joints on either sides of the spinal column that offer support and glide with movements, vertebral end plate that may form osteophytes (bony spurs), and intervertebral discs. The patient usually presents with restricted range of movement and neck pain with possible referred pain to the back of the head (cervicogenic headaches) and/or the shoulder complex depending on spinal levels affected.
Spinal Cord Compression
Spinal cord may be compromised by trauma/vertebral fracture, tumor, abscess and disc herniation. It is important to make this diagnosis early and look out for red flags (clinical signs and symptoms that require being immediate acknowledged). Radiological imaging is very important in determining the best approach to treat this condition.
Thoracic Outlet Syndrome
The thoracic outlet it the area in between the rib cage, neck and collar bone. Blood vessels, muscles and nerves tightly populate this area. Compression may affect circulation and/or nerves resulting in pain, weakness, numbness and pins and needles down the arm. This compression may be coming from an extra cervical rib or muscular tightness.
When the head is vigorously jarred forwards and backwards there may be injuries to soft tissue structures like muscles, tendons, ligaments and nerves. Wiplash injuries are common in road traffic accident and sporting activities and they are graded depending on severity – Quebec Task Force Clinical Classification of Whiplash Associated Disorders
Acute Torticollis (Wry neck)
This is a very common condition where the neck is ‘locked’ with muscle spasm and pain. This is normally a benign condition but it is important to rule out other possible causes such as certain medications, ear & laryngeal infections and more. Movement is commonly restricted in rotation and side flexion towards the same side of the pain. Physiotherapy and manipulative therapy is usually very successful with treating this condition.