Neck pain

Neck pain is something that many of us will experience at some time in our lives. Much of it is thankfully self limiting. There are some situations however where some form of medical intervention is necessary.

Woman holding neck

Some relevant anatomy will help to understand the background to many neck problems

  • The neck has seven vertebrae which join together via discs and joints to form a slight concave curve between the top of your back and skull.
  • It is the most mobile part of the spinal column.
  • Between each vertebrae a nerve emerges which supplies either part of the skull, shoulder or arm.
  • Important blood vessels also lie very close to the upper joints.
  • The movements of the neck are much affected by the position and movement of the rest of the spine, therefore there is a strong relationship between lower back pain and neck pain
  • When we move the spine, movement occurs at several small joints in the back as well as at the disc. All these structures need movement to help maintain a healthy blood supply. If movement is denied them, it seems they develope more rapid arthritic change.
  • Ligaments exist around joints. They are short tough elastic structures, designed to prevent excess movement. They can become overstretched or shortened by maintaining certain postures.
  • Discs behave slightly like sponges, in that they maintain their shape by absorbing water from the blood stream. When weight bearing during the day water is squeezed out of the disc, but happily is allowed back in again when we lie down at night! Beware however of being sent into orbit, unless you want to experience a sudden growth spurt, as happened with the first astronauts!

Although symptoms may have come on extremely suddenly, the cause is generally more long standing.

Common contributory causes

The commonest contributory causes which are increasing in frequency are:-

  • A sedentary occupation involving prolonged sitting, driving, computer/desk work with poor posture.
  • Adopting a common position known as a forward head posture. It is very common in office workers, teachers, designers etc. This occurs when the head is held in a position in which the chin is poked forward and the lower part of the neck and upper mid-back are held in a forward bent position. This results in:
    • tightness and shortening of the muscles at the base of the skull and back of the neck, which usually leads to headaches,
    • stretching of the ligaments of the middle part of the neck resulting in excessive
    • movement in the joints, leading to pain and eventually to pressure on the nerves as they emerge from the neck. It is also a major reason for developing what has come to be called a dowager's hump. The lower neck joints are held continually in a forward position and get stuck there. To compensate the very mobile joints directly above arch backwards so putting more emphasis on the disfiguring "hump". This can become very painful.
  • A stiff thoracic spine, i.e the middle of your spine between your shoulder blades. This puts too much strain on your neck which has to move more to compensate for the lack of movement in the mid back.
  • People who are excessively mobile. They sometimes will catch part of the joint lining which can double over on itself in those with sufficient movement.

Common neck complaints

  • Sudden onset acute pain restricted to the neck or shoulder. Often occurs in younger very mobile people and characterized by sudden loss of movement, forcing the head to be held slightly to one side.
  • Gradually development of neck and or arm ache which becomes more severe. This can be extremely painful. There may also be a sensation of pins and needles or numbness in the hand or arm. Muscle weakness is also a possibility. This is due to involvement of the nerves in the neck that supply the tissues of the arm. This can occur, for differing reasons, in any age group.
  • Increasing stiffness in neck movements together with a constant ache in the neck and possibly also the shoulders. This is more common in the over forties but probably due to altering work habits we are beginning to see this in the younger age group as well.
  • Headache, normally associated with some neck dysfunction

All the above would benefit from physiotherapy. This will probably involve some form of manipulation, plus exercises to improve either movement and or muscle strength and most importantly to improve the overall head/neck alignment and general spinal posture. We find this is one of, if not the most important aspect to deal with, if the problem is not to return in a few months time. All patients are given specific exercises and advice relevant to their particular problem. It is important that they follow this through.

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Useful tips when/if you have neck pain

Because no two neck problems manifest themselves in exactly the same way it is difficult to produce a universal panacea, but the following will be helpful in the majority of people. Do not do anything that markedly increases pain.

  • If the pain is so severe that most movements are impossible, folding a small towel in half lengthways and wrapping it around your neck so that initially it comes high enough to cover your mouth and the bottom of your ears and securing it with a large safety pin, will often give reassuring support. It is a useful trick to use if pain at night is a feature. It can be further reinforced by putting a newspaper in the centre of the towel. This can be better than using a collar, as these come in set sizes, whilst the towel version can be customized!
  • Pain across the shoulders and base of neck is often related to muscle spasm. Heat via a hot water bottle, heat pad or lamp can be very effective.
  • Avoid the forward head posture. Try to keep your head level and then glide your chin backwards(not downwards) It doesn't matter if you create a few double chins!
  • Rest flat on your back with your knees bent up. Try pushing the back of your neck down towards the floor. Hold for 10 to 15 seconds initially.
  • Try taking some regular over the counter analgesic or anti inflammatory tablets for 48 hours and note any alteration in your symptoms. You may need to see your G.P for further advise on this.

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Neck pain at the office

Neck pain is perhaps the single most common problem we see affecting office workers. It can be caused by several factors inherent in the modern office, including;

  1. the position and height of the computer monitor keyboard height
  2. the position of information being transposed onto the computer in relation to the monitor
  3. the firmness of the chair back & its relation to posture
  4. holding the phone with your shoulder

In order to improve posture while at work and decrease the chances of developing neck pain it is important that the factors described above be addressed.

  1. The position and height of the monitor
    Is your monitor at, above or below eye level? It should be within 20 degrees of eye level. If it is below this, try placing it on a stand or a phone book. Is it straight ahead of you when you are typing or off to one side? It should be directly in front of you, so that you don't have to turn your head to see it. This will take the strain off the upper part of your neck.
  2. The keyboard height
    The keyboard should be placed at a height such that your elbows are bent no morethan 90 degrees. This will prevent elevation of the shoulders, which can lead to tightness of the neck and shoulder muscles.
  3. The position of information being transposed
    The information being transposed should be placed so that it is close to the monitor, eliminating any unnecessary head rotation or neck flexion while typing.
  4. The firmness of the chair back
    The chair back should be set so that it allows a small amount of shock absorption when you lean against it but should not allow excessive backward motion. You should sit with your bottom right back in the corner of the chair ideally with the whole thigh supported and with your feet either on the floor or on a foot rest.
  5. Holding the telephone with your shoulder
    A definite no-no. If your job requires considerable telephone work in conjunction with other jobs at your desk, a headset may be an advisable option. This will eliminate repeated and prolonged elevation of one shoulder, which may lead to tightness of the muscles on that side.

By being aware of these factors and your posture while at work, you should be able to avoid a significant amount of neck problems. However, should you still have problems after addressing these areas, you should seek advice from a physiotherapist.

Read about more common conditions, or contact us to find out how we can help.