Chronic Neck Pain Revisited

Earlier, I wrote a blog about chronic neck pain after an accident. I want to make a few more points about managing chronic neck pain that I think are worthwhile.

• Less is more: The structures of the cervical spine are small. Look at your little fingernail. That is the size, more or less, of the facet joints in the cervical spine. Imagine how much force you put your shoulder through and compare the size of the joints! So the "less is more" idea speaks to doing only a few exercises at a time. I like to limit the reps to 6 (yep, six), and also suggest 6 times a day.
• Move into the pain: Unlike the lower back, it makes a lot of sense in the neck to move into the direction of the pain. If it hurts on the right and you avoid right rotation for example, you will quickly find that you cannot turn right.
  
• Heat or Ice? I mostly say that ice is the ticket, but for some reason, heat around the neck will help the muscles relax more. Remember this: Heat only helps WHILE it is on, take it off and the muscles tighten right up.
  
• Posture, posture, posture: Try to get your head over your shoulder girdle. It makes all the difference.
• Fit or fat? It turns out that aerobic exercise stimulates the accessory muscles of respiration. This will help your neck settle down. 30 minutes a day every day.

Hope this helps,

Neil

When I Turn My Head I Get Pain in My Arm

In the neck we think of anterior column and posterior column issues. The anterior column is typified by the intervertebral disc, while the posterior column is typified by the facet joints. When you have pain that is not accompanied by weakness, then the pain is not likely to be caused by a bulging disc. Pain associated with weakness or weakness without pain implies that the disc is at fault. This is because in the cervical spine, the spinal nerve roots are distinctly motor nerve or sensory nerve roots. The anterior nerver roots are motor nerves and therefore are more likely to be impacted by a disc bulge or herniation, while the posterior nerve roots are sensory nerves in which case several factors might irritate them.



You can see in this illustration the difference between a disc herniation causing nerve root compression and a normal cervical relationship. Nerve root compression can involve sensory AND motor nerve compression, although it is possible to have pure motor nerve compression. In contrast, posterior column disorders typically produce only sensory changes. These could take the form of increased or decreased sensation as well as pain. Absent sensation implies a nerve root compression, while anything less than that suggests a nerve root irritation.

Got all that?

OK so you turn your head to the left and you feel a loss of sensation and pain in your arm and hand. You do not feel weakness, and you do not feel any numbness. When you turn your head away, it feels better. When you backward bend your head, it feels worse, forward bending feels better. Assuming all else is normal, this picture would lead me to believe that you have a posterior column problem with an irritated nerve root.

If I am correct, and again, I assume that you have had your health checked by your doc, you don't feel sick or nauseated and you are otherwise healthy - then you probably have an irritated facet joint at least. In any event, we need to provide a gaping drill to help you unload the structure.

Here is how you unload the RIGHT SIDE posterior column: Start by sitting on your right hand. Then

1. Forward bend your head to a natural stop.

2. Side bend your head to the left side until you encounter a natural stop

3. GENTLY rotate your head to the RIGHT again and again and again PAIN FREE

This should reduce your pain and give you relief by gaping and unloading the right side facet jionts.

Why does Aerobic Exercise Help My Neck Feel Better?

The case for aerobic exercise in management of neck pain is an interesting one. At first blush, it does not seem to make much sense, but lets look a little closer.



Besides the obvious short term benefits of aerobic activity, including improved circulation and muscular relaxation as well as pain inhibition. Aerobic exercise causes one to breathe deeply by expanding the rib cage, which is obvious lower down in
the rib cage. That process is really designed to get oxygen deeper into the lungs during exercise when more oxygen is needed in the working muscles. One thing often overlooked is that the rib cage is also expanded in the region of the upper rib case with the upper ribs expanding upwards to further expand the lungs. This upper rib cage action is controlled by the accessory muscles of respiration which are mostly neck muscles.


The cervical spine, the rib cage and shoulder share many muscles, muscles that originate in the cervical spine, for example and insert into the first two ribs like the Scalene muscles, or muscles that originate on the Scapula and insert into the cervical spine like the Levator Scapula.









The Levator Scapula, because of this relationship is the muscle primarily responsible for the experience of a stiff neck.

Aerobic exercise raises the body temperature, relaxes the neck muscles, improves circulation, and calms the mind through the manufacture of endorphines, natural opiates, even as it really helps to reduce neck pain.

I routinely advise people suffering cervical spine dysfunction to perform aerobic exercise as a critical component of their rehab program. It helps tremendously.

My Neck Still Hurts Months After the Accident!!

I have often seen post "whiplash" victims, rear end collision victims who sustained a true "whiplash" months and even years before who continue to suffer from post accident symptoms even though they have been treated by otherwise competent practitioners.

The secret to dealing with this sort of injury is to go back to the original accident and determine the mechanism of injury. Mostly, you will find that the anterior musculature of the cervical spine, especially the deep muscles including Longus Coli and the Scalenes as well as more superficial anterior muscles like the Sterno Cleido Mastoid are all really irritable.




The theory is that there was initial trauma with those anterior muscles being strained (occasionally the anterior Longitudinal Ligament and even the Anterior aspect of the discs are irritated as well. The theory continues that once irritated, because of the mechanics of the cervical spine, the size of the muscles and the consequences of contraction of the muscles due to the pain experienced after the trauma, that those structures essentially remain in a state of dysfunction for as long as they do until they are addressed directly.

At home, you can:
- Massage the muscles of the anterior cervical spine with your fingers. Be careful not to grab the front of your neck with your thumb because you can actually fracture the Hyoid bone that lives in that part of your neck!

- Back bend the neck as follows: Using a rolled up hand towel, put the towel behind the neck and hold on with both hands pulling downward with the hands. retract your face, (pull back) and then back bend over the towel until the head stops naturally, gently rotate your head left and right a small distance each way (pain free of course. Come back to upright and repeat several times (5 or 6 times to be precise).

- Posture, posture, posture.Try as hard as you can to catch yourself slouching. Try to sit and stand a little taller with your head positioned over your shoulder girdle. Catch yourself while on the phone, catch yourself while working at the computer, catch yourself while driving, catch yourself while standing inline.

- Stretch Gently. Only use the smallest forces to stretch the neck. The muscles are small. The joints as big as your little finger nail. Be gentle. Do NOT swing your head around in a biiiig circle. You can cause real damage to important structures if you do.

Try implement these ideas, and you will hopefully have more luck resolving your chronic neck pain than in the past.