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Neck Pain


Basic Neck Anatomy
The neck is composed of seven cervical vertebrae.  These vertebrae form a “C” shaped (lordotic) curve when look from the side. It connects the head and the thoracic region of the body.  While its mobility is high, it takes up the important role of supporting the weight of the head.
The spinal cord is located within the spinal column.  It brings information from the brain to the body.  Spinal nerves are nerves that arise from the spinal cord.  They go through small holes between vertebrae towards the shoulders. 
The inter-vertebral disk is located between each vertebrae.  The disc acts as shock absorber during walking, running and jumping.  Under pathological conditions, these discs protrude out of their space, and cause pain by putting pressure on the spinal cord or nerves around it.
The spinal column needs soft tissue to support its integrity.  Ligaments and muscles are the two major supporters of the spinal column.  The ligaments keep the column in place under normal circumstances. However, when the spinal column experiences sudden, excessive neck movements, the ligaments can be injured and cause pain.
Muscles at the neck also provide support to the vertebral column.  Muscles in the neck can also be tight and painful for someone if the person stays in poor position for a long time.  Injury to the neck muscles would cause pain also.
Common Causes of Neck Pain
Five major Categories:
1. Inflammatory and infectious disease
e.g. arthritis (joint inflammation) involving the neck or when germs enter into bone/ joint and causes infection.
Osteoarthritis and rheumatoid arthritis are the most common.  Osteoarthritis is from joint degeneration due to wear and tear.  Rheumatoid arthritis causes the destruction of the joints in the neck and causes pain.
2. Mechanical disorders
e.g. herniated inter vertebral disc, wear and tear of spine
About 50% of people who evidence of degenerative changes of the spine by 50 years old.  The reason being that the inter-vertebral disk (the shock absorber of the spine) starts to wear out from its long term use.  The disc may by then, herniated or collapse and causes neck pain.
3. Trauma 
e.g. Motor vehicle accident (e.s. Whiplash injury), contact sports, hitting against hard surface, or fall from height.
The neck is very vulnerable to injury, because it is very flexible and it has the role to support the head.  As for whiplash injury, the neck mimics a whipping movement during a sudden stop of a vehicle in a matter of seconds.  Similar to other trauma, this would create a sudden, excessive movement of the neck and traumatize neck structures.
4. Tumors (less common)
Pain in neck can be the first sign of a serious neck condition such as a tumor.
5. Congenital abnormalities of the spine (less common)
Neck Pain Diagnosis
Neck pain diagnosis is the process to find out what is actually happening at the region to cause that pain.  Neck pain with different reason behind may require treatments that are completely different.  For example, the treatment of neck muscle strain and cervical vertebrae tumor are very different.
Diagnosis of neck pain is often made through taking a complete history of the condition, physical examination and radio graphic evaluations.
History taking and physical examination are commonly used by doctors and physical therapists to evaluate neck pain.  Physical examination involves feeling and looking at neck movements and testing nerve and muscle integrity.
Doctors often use radio-graphic examinations to assist them to make diagnosis, here are some common examples:
X-ray studies: Looking at bony structures and joint spaces
MRI (magnetic resonance imaging): Evaluate soft tissues, spinal cord and nerve roots
CT (computed tomography): Evaluation of bone and spinal canal
EMG (electromyogram): Evaluates never and muscle function
Neck Pain Physical Therapy
Physical therapy treatment for neck pain often involves:
Heat- relieves pain
Ice- controls inflammation
Electrotherapy- controls pain
Ultrasound- control pain, relief muscle spasm, improve circulation
Manual therapy- manual maneuvers to relieve pain and correct posture
Therapeutic exercises- specific exercises to control pain, improve alignment
Education- educating client to improve on posture, lifestyle change, ergonomic advice (i.e. modify settings st job/home that may lead to pain)
Acupuncture- helps to relieve pain and spasm, and accelerates recovery
Home Exercises for Neck Pain
Home exercises for neck pain should be prescribed by the physical therapist.  It should not be done if numbness in chest, shoulder or arm is currently experienced.  A proper evaluation of the condition should precede.
Stretching Exercises:
1. Neck forward stretch
-Allow head to hang forward, apply small amount of forward force at the occipital area (back of the head), hold for 30 seconds when stretch is felt at the back of the neck.
2. Neck rotators stretch (left neck rotators)
-Turn head to right side as far as possible
-Hold it there for 30 seconds
-Reverse the stretch for right neck muscles
3. Neck sideways stretch (Left Neck Muscle)
-Bent neck to the right side
-Rest your right hand on the left side of the head
-Gently, with your right hand, pull head towards the right side until you feel the stretch on the neck muscle on the left neck
-Reverse the stretch for right neck muscle
Strengthening Exercises (self resistive)
1. Resisted neck forward bent
-Place palm of your hands on the forehead
-Bend your neck forward while the hands try to gently resist the forward motion
-Hold for 5 seconds, do three sets of five each
– Be careful not to put excessive force on the neck while resisting
2. Resisted neck rotation (left rotators)
– Place left hand on left side of head
-Turn head towards left side while the left hand tries to gently resist the turning
-Hold for 5 seconds, do three sets of five each
-Reverse the exercise for right neck muscle
-Be careful not to put excessive force on the neck while resisting
3. Resisted neck sideways bent (Left side)
-Place left hand on left side of head
-Side- bent neck to left side while left hand gives gentle resistance to the motion
-Hold for 5 seconds, do three sets of five each
-Reverse the exercise for right neck muscle
-Be careful not to put excessive force on the neck while resisting
4. Chin tuck
-In sitting. Standing, tuck your chin in and hold for 5 seconds, repeat six times.