Neck pain and upper back pain is a common and sometimes debilitating problem. If you are worried or would like Fay Pedler Clinic to check you out, please get in touch.
Cervical spine / neck pain
Cervical spine or neck pain is a very common complaint reportedly affecting between 10 and 21% of the population per year. Although symptoms can be extremely painful, we know from experience that in most cases, they improve quickly and similar to mechanical low back pain, there is rarely a serious underlying cause. For some, neck pain can continue for months and even years however most can be managed independently with the help and guidance of experienced Physiotherapists.
Symptoms and causes of neck pain
Neck symptoms can be associated to a variety of factors and reasons with incidence rising due to modern sedentary lifestyles. The majority of people will experience neck pain and stiffness at some point in their lives. In most cases this is postural related (mobile phone use, gaming consoles..) and overuse (repetitive movements, shoulder bags) however pain can be caused through trauma such as falls, road traffic accidents (whiplash) and contact sports. No matter what the cause we know it can have a significant impact on your life, both physically and emotionally.
Neck symptoms can be felt as mild, moderate and severe depending on the cause and structure involved. Pain is predominantly felt in the neck, shoulders, around your shoulder blades and into your upper spine. Symptoms are often described as burning, aching and sharp that can be constant and or intermittent. Should a nerve be compressed in the spine then pain can be felt through shoulder and into the arm, hand and fingers. Nerve related symptoms are reported as burning, electric shock type pains, numbness and tingling, pins and needles.
No matter what the cause of neck pain, movement and function will be compromised. In some cases, this can be in just one or two directions however you may find that all movements cause discomfort. Patients report taking time off work to rest and manage their symptoms and its common for sleep patterns to be disturbed. Disturbed or broken sleep is non-restorative, reducing resilience leading to further frustration, negative thoughts and mood disturbance.
It’s important to remember that despite the levels of pain and distress often associated with neck problems, the majority are not serious and are likely to ease off within a day or up to eight weeks.
Chartered Physiotherapists are expertly placed to collect a detailed medical history and provide a thorough spinal assessment to be able to safely diagnose neck pain.
Medical history forms the foundation of the assessment which will include your current presenting symptoms, when and how symptoms began, levels/types/frequency of any pain, medication, previous trauma/surgery/spine problems.
More in depth questioning regarding dizziness, visual problems, speech and wording finding issues as well as grip strength, sleep pattern and weight will provide plenty of clues to the underlying cause of the problem and eventual diagnosis.
The physical examination includes cervical, thoracic and shoulder range of movement, strength, flexibility, stability and joint tests. Some of the tests undertaken may be uncomfortable, however, this is necessary and useful for the physiotherapist as it can highlight the structure that is causing the discomfort.
If at any point you feel unsure about the tests or assessment, then all you need to do is ask for clarification. Your physiotherapist will be more than happy to answer your questions.
A neurological examination to include muscle power, sensation and reflexes will highlight any variation from normal values. The three nerves in the arm (median, ulnar and radial nerves) will be assessed for any signs of tension.
The spine will be palpated/mobilised systematically assessing the mobility of each spinal segment and any underlying muscle spasm or guarding.
When your physiotherapist has undertaken the assessment they will provide you with information regarding what they have found so that you have a thorough understanding of the problem. They will highlight treatment goals, time scales for recovery and all available treatment options from the best and most current evidence-based practice. Your treatment will commence once you and your therapist have chosen the best course of treatment that suits your individual needs.
The majority of assessments will conclude symptoms are safe to treat however on occasion and possibly following a short course of treatment further tests and investigations may become appropriate. Your GP may choose one of the following:-
- X-ray – An X-ray of the cervical spine may be appropriate following trauma if a fracture is suspected
- Blood tests – to evaluate raised inflammatory or bone markers
- MRI/CT scans – are not routinely required however provide an excellent picture of any structural cause (disc, degeneration, nerve compression, infection, fracture..).
The decision to refer for further investigations is often taken if a change of management is required, i.e. will imaging change the treatment/outcome? If spinal surgery or corticosteroid injections are to be considered then imaging is definitely required.
Stretches and exercises can be prescribed and progressed as symptoms improve and confidence returns. Exercise encourages blood flow to the muscles encouraging spasm to subside. Natural pain relieving chemicals are released during exercise helping to settle symptoms further.
Spinal mobilisations may be administered to reduce stiffness in the spinal joints as will mobilisations to the shoulder blades and ribs if highlighted as a problem in your assessment. The purpose of treatment is to enable stretches and exercises to be performed.
Massage therapy may be offered which is beneficial in reducing muscular spasm further allowing muscular stretches and exercises to be performed more freely.
Acupuncture may be advised if symptoms are particularly irritable and again can be beneficial in reducing muscular spasm, reducing pain and nerve sensitivity.
Finally, if following your initial assessment we feel that physiotherapy is not appropriate, we will advise on how best to manage your condition.
We have established links and understanding of local NHS pathways, Orthopaedic and Spinal Surgeons, Podiatrists and local General Practitioners. If onward referral is required we will be only too happy to facilitate this.