Neck

Conditions We Treat:

Cervical Disc Herniation/Prolapse
Cervical Nerve Entrapment (Pinched Nerve)
Cervical Radiculopathy Cervical Spondylosis
Cervical Spondylotic Myelopathy (Spinal Cord Compression)
Fibromyositis
Myofascial Pain Syndrome
Headaches
Hypomobility Lesions
Stiff Neck
Migraines/Vertigo
Neck Pain
Sprains/Strains
Whiplash-Cervical Spine Trauma

Cervical disc Herniation

A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves or the spinal cord.

Causes:

With herniated disk:

The disk may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on one or more spinal nerves. This can lead to pain, numbness, or weakness.
The lower back (lumbar area) of the spine is the most common area affected by a herniated disk. The neck (cervical) disks are the second most commonly affected area. The upper-to-mid-back (thoracic) disks are rarely involved.

Herniated disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors may include:

Lifting heavy objects
Being overweight
Repetitive bending or twisting the lower back or neck
Sitting or standing in same position for long hours
Inactive lifestyle
Smoking

Management:

The first treatment for a slipped disk is a short period of rest and taking medicines for the pain. This is usually followed by physical therapy. Most people who follow these treatments recover and return to normal activities.

Physical therapy is important for nearly everyone with disk disease. Therapists will teach you how to properly lift, dress, walk, and perform other activities. They will teach you how to strengthen muscles that help support the spine.

Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM), or spinal cord compression, is a neck condition that arises when the spinal cord becomes compressed — or squeezed — due to the wear-and-tear changes that occur in the spine as we age. Although the condition commonly occurs in patients over the age of 40, it can occur in younger people who were born with narrower spinal canals.

Causes:

Some common causes include:

Bone spurs. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone — called bone spurs — around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also make the spinal canal narrow — compressing or squeezing the spinal cord.
Herniated disk. A disk herniates when its jelly-like center (nucleus pulposus) pushes against its outer ring (annulus fibrosus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When a herniated disk bulges out toward the spinal canal, it can put pressure on the spinal cord or nerve roots. As disks deteriorate with age, they become more prone to herniation. A herniated disk often occurs with lifting, pulling, bending, or twisting movements.
Rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium, the thin membrane that lines the joints. As the synovium swells, it may lead to pain and stiffness and, in severe cases, destruction of the facet joints in the cervical spine. When this occurs, the upper vertebra may slide forward on top of the lower vertebra, reducing the amount of space available for the spinal cord.
Injury. An injury to the neck — such as from a car accident, sports, or a fall — may also lead to myelopathy. For example, a rear end car collision may result in hyperextension, a backward motion of the neck beyond its normal limits, or hyperflexion, a forward motion of the neck beyond its normal limits. Because these types of injuries often affect the muscles and ligaments that support the vertebrae, they may lead to spinal cord compression.

Management:

In milder cases, the initial treatment may be nonsurgical. The goal of nonsurgical treatment is to decrease pain and improve the patient's ability to perform daily activities. Nonsurgical treatment will not create more space in the spinal canal for the spinal cord; in other words, it does not treat the underlying condition.

Nonsurgical treatment options include:

Soft cervical collar. This is a padded ring that wraps around the neck and is held in place with velcro. Your doctor may advise you to wear a soft cervical collar to allow the muscles of the neck to rest and limit neck motion. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.
Physical therapy. Specific exercises can help relieve pain, strengthen neck muscles, and increase flexibility. Physical therapy can also help you maintain strength and endurance so that you are better able to perform your daily activities. In some cases, traction can be used to gently stretch the joints and muscles of the neck.

Fibromyalgia

Fibromyalgia is a chronic condition that causes pain all over the body, fatigue, and other symptoms. There is no cure, but treatments can help with the symptoms.

Causes:

The exact cause of fibromyalgia is unknown. Studies of the brains of people with fibromyalgia found that they seem to process pain differently than people who don't have it. They may feel pain when others do not, and they may also have a more severe reaction to pain.

Fibromyalgia can run in families, so genetics may also play a role. Other factors may also be involved, such as having certain diseases that cause pain.

Anyone can get fibromyalgia, but it is more common in:

Women; they are twice as likely to have fibromyalgia
Middle-aged people; your chance of having it increases as you get older
People with certain diseases, such as lupus, rheumatoid arthritis, osteoarthritis or ankylosing spondylitis
People who have a family member with fibromyalgia

Management:

Lifestyle changes
- Getting enough sleep.
- Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you.
- Learning how to manage stress.
- Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your provider first. These therapies include:
- Mindfulness meditation.
- Biofeedback, which uses electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them.
- Movement therapies such as yoga and tai chi.
- Massage therapy.
- Acupuncture.

Cervical Nerve Entrapment (Pinched Nerve)

Causes:

Cervical nerve entrapment (cervical radiculopathy, or pinched nerve) occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness.

A pinched nerve is often caused by degenerative ("wear-and-tear") changes — such as arthritis — that occur in the spine as we age.

In younger people, it is most often caused by a sudden injury that results in a herniated disk. In some cases, however, there is no traumatic episode associated with the start of symptoms.

Management:

The majority of patients with cervical radiculopathy get better over time and do not need treatment. For some patients, the pain goes away relatively quickly — in days or weeks. For others, it may take longer.

It is also common for cervical radiculopathy that has improved to return at some point in the future. Even when this occurs, it usually gets better without any specific treatment.

Your doctor may advise you to wear a soft cervical collar to allow the muscles in your neck to rest and to limit neck motion. This can help decrease the pinching of the nerve roots that happens when you move your neck. A soft collar should only be worn for a short period of time, since long-term wear may decrease the strength of the muscles in your neck.

Some patients may benefit from physical therapy. Specific exercises can help relieve pain, strengthen neck muscles, and improve range of motion. In some cases, traction, or pulling in line with the spine, can be used to gently stretch the joints and muscles of the neck.

Cervical Spondylosis

Cervical spondylosis is a disorder in which there is wear on the cartilage (disks) and bones of the neck (cervical vertebrae). It is a common cause of chronic neck pain.

Causes:

Cervical spondylosis is caused by aging and chronic wear on the cervical spine. This includes the disks or cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or spurs on the bones of the spine (vertebrae).

Over time, these changes can press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect your arms, legs, and balance.

Everyday wear and tear may start these changes. People who are very active at work or in sports may be more likely to have them.

The major risk factor is aging. By age 60, most people show signs of cervical spondylosis on x-ray. Other factors that can make someone more likely to develop spondylosis are:

Being overweight and not exercising
Having a job that requires heavy lifting or a lot of bending and twisting
Past neck injury (often several years before)
Past spine surgery
Ruptured or slipped disk
Severe arthritis
Previous surgery on the neck

Management:

Your provider may refer you for physical therapy. The physical therapist will help you reduce your pain using stretches. The therapist will teach you exercises that make your neck muscles stronger.

The therapist can also use neck traction to relieve some of the pressure in your neck.

You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic provider, or physical therapist). Sometimes, a few visits will help with neck pain.

Cold packs and heat therapy may help your pain during flare-ups.

Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a pain condition originating from muscle and surrounding fascia. Patients usually present with localized pain in a restricted area or referred pain of various patterns. Moreover, the physical examinations may reveal trigger points on the involved muscles.

Causes:

The exact cause of myofascial pain syndrome is still unknown. One of the most accepted theory is energy crisis of muscle fibers, which occurs during prolonged or repetitive use of the muscles. Repetitive or prolonged activity, most often with poor form, can cause overloading of the muscle fibers which lead to muscle hypoxia and ischemia. Other risk factors of MPS include spondylosis, scoliosis, osteoarthritis, hypothyroidism, vitamin D deficiency, and iron deficiency.

Management:

The goals of MPS treatment are pain relief and correction of precipitating factors. There are many treatments to deal with MPS. All patients should be educated about stretching exercises and ergonomic modification. A common management is physical therapy, which can help strengthen, stretch and relax your muscles. Acupuncture and relaxation therapies, including biofeedback and cognitive behavioral therapy (CBT), are also good for improving sleep and reducing anxiety. Another common therapy is transcutaneous electrical nerve stimulation (TENS), in which your provider attaches pads to your skin and sends low-voltage electrical signals to the trigger points.

Neck Pain

Causes:

A common cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such activities include:

Bending over a desk for a long time (often an hour or more)
Having poor posture while watching TV or reading
Having your computer monitor positioned too high or too low
Sleeping in an uncomfortable position
Twisting and turning your neck in a jarring manner while exercising
Lifting things too quickly or with poor posture

Accidents or falls can cause severe neck injuries, such as vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Management:

For minor, common causes of neck pain:

Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, and then use heat after that.
Apply heat with warm showers, warm compresses, or a heating pad. To prevent injury to your skin, DO NOT fall asleep with a heating pad or ice bag in place.
Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
Do slow range-of-motion exercises, up and down, side to side, and from ear to ear. This helps gently stretch the neck muscles.
Try sleeping on a firm mattress with a pillow that supports your neck. You may want to get a special neck pillow.

Stiff Neck

Causes:

By far the most common cause of a stiff neck is a muscle strain or soft tissue sprain. In particular, the levator scapulae muscle is susceptible to injury. Located at the back and side of the neck, the levator scapulae muscle connects the neck’s cervical spine with the shoulder. This muscle is controlled by the third and fourth cervical nerves (C3, C4).

The levator scapulae muscle may be strained throughout the course of many common, everyday activities, such as:

Sleeping with the neck at an awkward position
Falling or sudden impact that pushes the head to the side, such as sports injuries
Turning the head side to side repeatedly during an activity, such as swimming the front crawl stroke
Slouching with poor posture while viewing the computer monitor or looking downward at a mobile phone for prolonged periods (sometimes referred to as "text neck")
Experiencing excessive stress or anxiety, which can lead to tension in the neck
Holding the neck in an abnormal position for a long period, such as cradling a phone between the neck and shoulder

Management:

Cold therapy/ice packs help relieve most types of neck stiffness by reducing local inflammation. Applying ice during the first 24 to 48 hours of a painful flare-up usually has the most benefit in terms of reducing inflammation. Applying heat to the neck can spur blood flow, which fosters a better healing environment. Some patients prefer ice, whereas others prefer heat. Both may be used alternately.

Taking it easy for one or two days gives injured tissues a chance to begin to heal, which in turn will help relieve stiffness and possible muscle spasm. For example, someone who swims may want to avoid certain swim strokes that involve lots of head twisting for a few days. However, it is recommended to limit rest to one or two days, as too much inactivity can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the neck and head.

Stretching, as soon as tolerated, helps ease the stiffness and restore the neck to a more natural range of motion. For many, it is a good idea to learn appropriate stretches with the help of a physical therapist or other qualified health professional.

In addition to stretching, any form of low-impact aerobic exercise, such as walking, is often helpful in relieving any type of stiffness. Even if walking does not directly involve the neck, it helps circulate oxygen to the soft tissues throughout the spine, which in turn promotes healing.

Depending on the person and severity of the strain or sprain, different combinations of these treatments could work better for some than others. Trial and error will likely be necessary to find the treatment plan that works best for an individual.

Whiplash-Cervical Spine Trauma

Whiplash is an injury to the soft tissues of the neck. Whiplash injury strains the muscles and ligaments of the neck beyond their normal range of motion. There is often pain and stiffness in the neck for the first few days following a whiplash injury. The pain can also be felt in the surrounding muscle groups in the head, chest, shoulders, and arms.

Causes:

Whiplash happens when your movement speed or the direction you’re traveling suddenly changes. Some of the most common events or activities that can lead to whiplash include:

Motor vehicle crashes (these are the most common cause of whiplash).
Contact sports (such as football, hockey, rugby, etc.).
Roller coasters.

While the above are the most common possible causes, whiplash can happen in many other ways. Even simple slips and falls can cause whiplash under the right circumstances

Management:

Some treatments for whiplash are most helpful right after an injury, while others are best if used to treat the long-term effects and chronic problems from a whiplash injury. Some can do both. The most common treatments for whiplash (with more about them below) include:

Immobilization: Because whiplash can affect your spine and spinal cord, it’s common for people with possible neck and spine injuries to receive some forms of protective care immediately. An example is a cervical collar (C-collar), which emergency medical personnel can put on a person’s neck at the scene of a car crash. There are also other forms of immobilization. Your healthcare provider is the best person to tell you about the available forms and which form they recommend.
Applying cold and heat: Experts recommend using cold packs during the first seven to 10 days to decrease swelling and inflammation. After that, gentle warmth and heating can help improve blood flow to an injured area, which helps promote the healing of damaged tissues.
Exercise or physical therapy: Recovering from whiplash can often involve physical therapy. This form of treatment uses guided exercises to strengthen injured areas after they heal. That can help you regain more function in the affected area and can also help ease related symptoms like pain.
Transcutaneous electrical nerve stimulation (TENS) therapy: It is a therapy that delivers a mild electrical current through your skin to surface nerve endings. Your nerves use electrical signals to communicate, so using an outside electrical current at low levels can help with pain in those areas. Using a TENS unit to ease the pain is much like using white noise to help you block out other sounds while you sleep.