NECK PAIN

Neck Pain and Causes

NECK PAIN

Neck pain has become one of the most common health problems of recent years. One out of every 3 people around us suffers from neck pain at least once in their lifetime.

It is frequently observed in office workers, desk workers, people with stressful work tempo and women.

One of the characteristics of neck pain is that it is not only limited to the neck circumference and back due to the nerves coming out of the neck, but can also affect the shoulders, arms and head area and even the fingertips. For this reason, back-shoulder pain, pain radiating to the arm, numbness in the hands, dizziness, imbalance and headache can be seen with neck pain.

CAUSES;

Pain originating in the spine and soft tissues;

Pains that develop as a result of strains such as posture disorder. The main problem is that the neck stays in an inappropriate position for a long time, as in office workers and bench-desk workers.

Pain due to hernias develops as a result of the discs between the cervical vertebrae compressing the nerve in the canal. Pain in the neck can radiate to the back and arm, and muscle atrophies known as numbness, loss of strength and thinning of the muscles can be seen with pain.

Calcification is a cause that occurs especially after the age of 45. It is observed in 25 per cent of the population in the 50 age group.

PAIN RADIATING TO THE NECK REGION;

Although the cause is not in the neck, the neck is where the pain is felt.

Stress-related neck pains; It is a concept that today's busy working people are accustomed to, in which all muscles, especially the stomach, intestines and neck-back, are affected.

Fibromyalgia and myofascial pain syndrome;

It is one of the most common causes of neck pain. It is a group of diseases defined by persistent pain, stiffness, fatigue, deep sensitivity at some points of the body. The most important symptoms in patients are intense neck and back pain. Especially stress causes contraction in the neck muscles and neck pain and tension headache occur. Patients state that they wake up in the morning without rest. Complaints increase with cold and humid weather, fatigue, psychological tension and inactivity.

DOES NECK PAIN CAUSE HEADACHE?

Contrary to popular belief, headaches are not always caused by disorders of the brain or other structures in the head. It has been determined that headache can also originate from the neck and in 1983, the International Headache Society defined "neck headache". In this type of pain, disorders in various structures in the neck cause headache.

DO NECK PROBLEMS CAUSE VERTIGO (DIZZINESS)?

More than half of the dizziness is caused by the cervical spine or muscle. Wear and tear in the neck bones can cause vertigo by reducing the blood flow in the vessels passing through these bones and feeding the brain stem and cerebellum.

WHAT IS NECK FLATTENING?

Muscle spasm due to neck pain causes the lordosis, which is the normal curvature of the neck, to deteriorate and flatten. It is often the beginning of a problem rather than a neck problem.

NECK PAIN AND PHYSICAL THERAPY

Physiotherapy clinics play the biggest role in the treatment of neck disorders, which are becoming increasingly important today. Physiotherapy not only treats the pain and complaints of the patients, but also ensures that they are less affected by the wear and tear process that continues throughout life.

The aim of the treatment is to accelerate the healing process of the damaged tissue and if the source of the pain is nerve compression, the pressure is removed with physical therapy modalities and the muscles are strengthened with the appropriate exercise programme and the balance is restored. If the source of the pain is the muscles, it is to provide relaxation by relaxing the muscles and then to prevent the problem from occurring again by strengthening.

What is Neck Hernia?

There are 7 vertebral bodies in the neck. The only difference in their structure from the lumbar vertebrae is that they are smaller. Between each vertebra, there are cartilages called cushions. This cartilage structure tears and presses on the spinal cord travelling inside the spine or the nerves distributed to the arm, and the resulting disease is called cervical hernia. The patient has a severe neck pain, pain radiating to the arm and numbness. Over time, if the torn cartilage presses on the nerves, there is weakness in the arm.

WHAT IS THE STRUCTURE OF NECK VERTEBRAE?

There are 7 vertebral bodies starting from the skull base. In the centre of each vertebral body is the spinal cord, which is the continuation of the brain. Sensations returning to the brain from various parts of the body or orders from the brain to the body are travelled in the spinal cord. In the neck region, the nerves emanating from each vertebral body spread to the arm and back, providing sensation and movement of these regions.

The disc tissue, which we call the cushion between the vertebrae, has an outer part (annulus fibrosus) and an inner part (nucleus pulposus). A herniated disc occurs when the gelatinous inner part tears the outer part consisting of a stronger connective tissue and compresses the spinal cord and nerves. The main difference from a herniated disc is that not only the nerves but also the spinal cord itself are compressed, resulting in partial or complete weakness throughout the body.

WHAT ARE THE RISK FACTORS IN NECK HERNIA?

* Early degeneration of the cartilage between the cervical vertebrae due to misuse of the neck

* Sudden and strong neck movements. Heavy lifting, sudden reversals.

* Long-term work with head tilted forward: Desk work.

* Sudden braking or traffic accidents, especially for those who drive without wearing a seat belt.

* Previous neck trauma, sports injuries.

WHAT ARE THE DISEASES ASSOCIATED WITH NECK HERNIA?

* Fibromyalgia: It is a frequently recurring spasm of the neck and waist muscles. It is popularly known as muscle rheumatism.

* Diseases of the Shoulder Joint: It is characterised by hardening of the shoulder joint and very severe pain radiating to the arm. The disease causes more severe pain especially at night.

* Nerve entrapment: It is the compression of the nerves coming out of the spinal cord at certain points in the arm. The best known is the Hand-Wrist Canal Disease (carpal tunnel syndrome), which causes pain and numbness that spreads to the entire arm at night, especially in women past middle age or in anyone who requires wrist strength. If it is associated with cervical hernia, it is called double entrapment and both should be treated at the same time.

* Tenosynovitis: It occurs as a result of swelling of the sheath of the muscles in the arm due to strain or rheumatic causes. It is characterised by regional pain.

WHAT ARE THE METHODS USED IN DIAGNOSIS?

Clinical examination, cervical MRI, cervical CT, EMG. Clinical examination and cervical MRI must be performed. EMG is used if necessary to differentiate nerve entrapments.

WHAT IS THE STAGING AND TREATMENT OF NECK HERNIA?

The patient diagnosed with neck hernia may be in any of the following clinical conditions.

1-Mild pain in the neck area.

2-Moderate recurrent pain and limitation of movement.

3-Severe neck pain and or nerve damage findings such as weakness or numbness in the arm with pain in the arm.

4-Significant loss of strength in the arms with pain or gradual increase in loss.

WHAT ARE THE PRINCIPLES OF TREATMENT ACCORDING TO STAGE?

In stages 1-2-3, primarily medication, use of neck collar, physiotherapy and neural therapy should be applied. The improvement of the disease in this period is aimed at reducing the compression and inflammation in the ruptured disc tissue and surrounding tissue with these treatments. This should occur within 1 month.

The purpose of all the various types of cervical collars: To reduce the pressure of the head on the cervical vertebrae and to provide rest and healing by immobilising the neck.

In stage 4, surgical treatments should be considered if the pain does not decrease and strength loss increases despite the treatments applied. In international studies, spinal surgery is 2-3% in such cases. In other words, 2 or 3 of every 100 patients with neck or back problems go to surgery.

Myofascial Pain Syndrome

It is a disease characterised by pain, tenderness and stiffness in one or more muscle groups. It is commonly referred to as earache, muscle rheumatism and windstroke. It is often confused with fibromyalgia syndrome. However, pain is more widespread in fibromyalgia syndrome, whereas myofascial pain syndrome involves fewer muscle groups. Fibromyalgia is more common in women, while myofascial pain is equally common in both sexes. In fibromyalgia, pain, stiffness and tenderness are widespread throughout the body, whereas in myofascial pain they are located in one or a few areas. Fatigue and insomnia are absent or milder in myofascial pain. Myofascial pain is easier to treat than fibromyalgia.

What are the causes of myofascial pain?

Genetic factors, excessive fatigue, repetitive movements, work accidents, neck and lumbar hernias, occupational and family dissatisfaction, poor working conditions are the most important causes of myofascial pain.

Other causes of myofascial pain are poor pösture, prolonged inactivity, prolonged bed rest, vitamin B deficiencies, mineral deficiencies such as potassium, calcium, iron, magnesium and selenium, hypoglycaemia, hypothyroidism, oestrogen deficiency, viral infections, psychological and social problems.

What are the complaints of the patient in myofascial pain?

Patients with myofascial pain syndrome have pain, stiffness and tenderness in the muscles, as well as a feeling of tightness and burning. There is a slight restriction in the range of motion and fatigue. Most of the time, patients do not complain of muscle stiffness, but of various pains such as headache, back pain, neck pain, chest pain, low back pain, sciatica and shoulder pain. The pain may be mild or sometimes very severe. Although the pain is not life-threatening, it significantly reduces the quality of life. The pain may radiate to areas that are not related to the muscles and trigger points.

How are myofascial pain syndromes diagnosed?

History and physical examination are diagnostic in myofascial pain syndromes. Laboratory and radiological examinations may be required to reveal the causes and differential diagnosis.

How are myofascial pain syndromes treated?

Stretching exercises can partially inactivate trigger points in myofascial pain. A combination of spraying with ethylchloride sprays and stretching exercises gives better results.

Trigger point injections are the most effective treatment. Neural therapy in particular is one of the best treatments for myofascial pain syndrome. The risk is very low, the application method is easy and the effect occurs in a short time. The aim is to increase the blood supply to the tissue so that it can function normally again.

In addition, massage, active and passive movements, analgesics, muscle relaxants, antidepressants can be used.

TENS and other physiotherapy applications are very useful. The most important point in treatment is to relax the strained muscle and then strengthen it with the necessary exercise programmes.

General principles of neck protection

WHILE SITTING

Keep your chin slightly bent with your eyes facing forward and your neck pulled back. Good neck health is possible with good posture. Maintain the normal curvature of your neck. Use chairs with armrests that support the back and back. Do not relax; keep your whole spine straight or close to straight, resting on the chair backrest. If you use the chair arms as a support for your arms, it will help prevent unnecessary strain on your neck due to forward bending. Do not stare too intently with your chin forward.

A chair that supports the neck and waist is very important when working.

WHILE STANDING

As in a sitting position, keep your chin slightly bent with your eyes facing forward and your neck pulled back. Likewise, try to keep your waist and back straight. Do not lean forwards without bending your knees. Do not stay in the same position for a long time, as standing still and leaning forward increases the pressure on the discs.

LYING DOWN

The way of sleeping is important in neck pain. If the person feels pain in his/her neck when he/she wakes up in the morning, his/her sleeping position and pillow should be reviewed. Do not sleep face down. It is better to sleep on your side. Keep your head and neck in a normal posture with the help of a pillow, and keep your arms down. If the pillow is thin when the person is lying down, the neck falls back and to the side, so that the nerve is pinched in the canal. If the pillow is thicker than normal, the neck is suspended and the surrounding tissue of the neck is stretched and causes pain. If you want to sleep on your back, put your pillow under your head and neck. The pillow should support your head and neck in a neutral position. Avoid tense neck position.

Sleeping in a sitting position is very harmful for the neck. Watching television and reading books while lying down strains your neck muscles. It is harmful to put your arms under your head or keep your arms at head level while lying down.

WHEN DRIVING A CAR

Sit high in the car. Your seat (preferably hard) should be neither too low nor too far back so that you do not have to stretch and bend to look over the steering wheel. A polyurethane back cushion may be useful for support; the cushion should be 1-2cm thick, the width of your back and level with your shoulders. Adjust the mirrors well. Those with neck pain should turn with their waist, not their neck, when reversing. Do not open the windows unnecessarily, the wind you will get can cause a stiff neck.

It is very useful to use a neck brace on long journeys. Stretch your neck, back and waist muscles by taking a break every 3-4 hours during long journeys.

WHEN LIFTING AN OBJECT

Proper lifting of an object is very important for neck and back health. Bend your knees and use your leg muscles for lifting. Avoid sudden movements. Keep the weight close to your torso and do not try to lift anything above head level. Do not lift weights while holding your breath because you will damage your spine. If you need to reach a shelf higher than your head, get up on a chair. Avoid lying down or looking up for long periods of time.

WHILE WORKING

The moment when today's people spend the most time is the working moment. It is now accepted as compulsory for people who work sitting for more than 4 hours a day to comply with ergonomics rules. If the neck stays in the same position for a long time in an inappropriate way, it damages the tissues. The neutral position, which we call the neutral position, the head being in the centre line on the body, preserving its natural curvature reduces the risks. It is important to take frequent breaks from the work and bring the neck back to its normal shape.

The position of the torso during work is important. The monitor should be directly opposite the torso and torso rotation should be avoided.

The seat should support the waist and back and the seat should be upright and approximately 10-15º inclination. The chair height and backrest height should be adjustable.

The upper limit of the monitor should be at the eye level of a person standing upright, and the distance should be an arm's length away.

The keyboard should be at a usable height and close to the body when the elbow is 90°.

The mouse should be next to the keyboard, and there should be no unnecessary bending of the wrist when using both the keyboard and the mouse, so that tendon and nerve damage does not occur in the wrist.

The phone should never be squeezed between the neck and ear.

OTHER POINTS TO NOTE

* Lying by clenching the teeth (teeth grinding) causes spasm in the neck muscles, resulting in neck pain and pain in the chewing muscles.

* Squeezing the phone between the neck and shoulder while talking on the phone may damage the neck muscles.

* Low back pain and neck pain are diseases that affect each other. For this reason, those who have neck pain should also pay attention to their waist and those who have waist pain should pay attention to their necks.

* Working in environments with poorly adjusted lighting can strain your neck and back muscles.

* Do not watch television from too far or close distance.

* Especially those with long hair, if they go out without drying it thoroughly, there will be spasm in the neck muscles. For this reason, hair should be dried after washing.

* Visual impairments require you to pay much more attention to see objects. This situation tires the neck muscles and prepares the ground for neck and shoulder pain. For this reason, visual impairments should be treated on time.

* Using your hands higher than shoulder level or at very low levels strains the neck area. For this reason, neck pain is common in teachers, wall and ceiling workers.

* If you are a teacher, when writing on the blackboard, do not write above shoulder level and do not write at very low levels.

* You can get cervical herniated disc and other neck pains even in very rare inappropriate activities such as hanging curtains. Minimise this risk by raising the platform you are standing on or if you have neck problems, it is best not to do it at all, ask for help from someone more suitable.

* Conditions such as lack of sleep, overwork, nervous tension, dissatisfaction with work, lack of appreciation can cause tension in the neck muscles and disrupt the nutrition of the discs.

Treatment of Neck Pain and Physiotherapy