| Neck pain is not a disease or injury, but a symptom. Neck pain can be of traumatic or atraumatic origin, and/or associated with systemic disease. Neck pain complaints with no other physical signs may be related to a cervical strain or sprain type injury. Most neck pain, however, develops spontaneously with no known trauma. Cervical spine pain also may be associated with shoulder pathology. When not attributable to a more serious and definite cause, neck pain is often called cervicalgia.
The neck or cervical spine includes seven cervical vertebrae and has 37 joints. It supports the head, and moves the head in space hundreds of times an hour. Causes of neck pain include musculoskeletal conditions, neurological conditions, systemic conditions (e.g., osteoarthritis), and rheumatoid-related conditions (e.g., rheumatoid arthritis, polymyalgia rheumatica). Neck pain may be related to soft tissue disorders, sustained use or sustained immobility of the neck, structural abnormalities, joint degeneration, psychological stress, or trauma. Soft-tissue-related neck pain can be caused by consistently poor posture while sitting or standing, repetitive activity, sports injuries, or the presence of an underlying condition such as a cervical disc degeneration or cervical disc herniation. Referred neck pain may originate from conditions in any organ system, including myocardial ischemia, gallbladder disease, hiatal hernia, gastrointestinal ulcers, and pancreatitis.
Neck pain is considered chronic when it has continued for at least 6 months. The etiology of chronic neck pain may be difficult to determine. Considerations include cervical zygapophyseal pain following a whiplash injury, soft tissue injury, cervical disc disease, and other conditions listed above. A link has also been suggested between chronic neck pain and the individual’s psychological state; many chronic pain conditions are believed to have some psychological impact or component.Risk: Smoking, substance abuse, depression, obesity, history of chronic headache, and heavy physical work, such as repetitive heavy lifting, increase the risk of neck pain. A history of whiplash associated with automobile accidents is a significant risk factor for chronic neck pain; the average age of affected individuals is late 40s (Hunter). Incidence and Prevalence: Neck pain is one of the most frequent complaints encountered by primary care physicians and neuromusculoskeletal specialists. Eighty-five percent of cases result from acute or repetitive neck injury, including an annual estimated incidence of 3.8 cases of whiplash in every 1000 individuals (Hunter). The lifetime prevalence of clinically significant neck pain is 40% to 70% (Rindfleisch); the one-year prevalence is 16% to 18% (Hunter). |
Source: Medical Disability Advisor
| History: Individuals often complain of stiffness or pain in the neck region. The pain may be affected by neck motion. Complaints of pain, weakness, or numbness in the arms may be reported. In some cases, the individual may report pain developing following a traumatic event such as an automobile accident or sports injury. Physical exam: A physical exam may include feeling for points of tenderness (palpation), testing range of motion (ROM), and performing a complete neurological exam of the upper and lower extremities to detect possible cervical spine injury (see cervical disc disorder with myelopathy). Tests: Plain x-rays of the cervical spine may be indicated if severe trauma has occurred and fracture or instability suspected. X-rays may be ordered if symptoms have persisted for 30 days or more. CT and/or MRI, electromyography (EMG), nerve conduction, and laboratory studies may be ordered when soft tissue or nerve damage is suspected. |
Source: Medical Disability Advisor
| Treatment for neck pain varies based on its source and degree of the discomfort.
Treatment for acute pain usually includes pain medication and modification of activity by avoiding painful movements and positions. Proper neck position during sleep and avoidance of prolonged flexion of the neck during daily activities (e.g., carrying a shoulder bag with a strap, leaning over a work station or desk, repeatedly looking over the shoulder) are important. If the neck muscles are extremely painful, a soft collar worn for a day or two may help to relieve pain. The collar also provides support for the spine and reduces mobility. The benefit of soft collars is not statistically proven and is controversial; some physicians believe that early mobilization is superior to the use of cervical collars in treating neck pain (Rindfleisch). Prolonged use of a cervical collar should be avoided to prevent deconditioning of the neck muscles. Activity should be increased as tolerated.
Mobilization of the soft tissues of the neck or manipulation through massage, physical therapy, or chiropractic may help to decrease neck pain, particularly in the first 4 to 6 weeks after the onset. Persistent or chronic pain may require further evaluation with imaging studies and selective injections or participation at a pain management clinic. |
Source: Medical Disability Advisor
| With time and appropriate treatment, including treatment of any underlying illness, neck pain will resolve in most cases. Treatment may help to alleviate symptoms and to make the individual more comfortable; attention to and treatment of underlying conditions causing the symptoms may be necessary for recovery. Individuals should be educated about symptoms that may indicate a progressive disease.
Twenty to seventy percent of individuals with neck pain following injury in a motor vehicle accident still report pain 6 months later. (Hunter). |
Source: Medical Disability Advisor
| Note on research and authorship The goals of rehabilitation for neck pain are to help individuals manage their symptoms, primarily by decreasing pain, and to increase their ability to function. Much research in the management of neck pain is available, with some conflicting findings (Viljanen).
As a first step toward decreasing pain, therapy may, in conjunction with pharmacological management, employ thermal modalities. Because immobilization with a soft collar is rarely indicated, it should be used for only a very short period of time to manage severe pain. While managing pain, the rehabilitation specialist should instruct individuals in gentle exercises (Gross). Despite symptoms, such exercise should be encouraged as it promotes improved circulation to the involved soft tissues, and may reduce discomfort. Initial exercises may include isometrics, stretching, and gentle range of motion (Randlov). Neck manual therapy may be more beneficial in relieving more severe symptoms (Savolainen). The therapist should initiate postural training as soon as it can be tolerated by the individual.
Once range of motion is restored, therapy should progress to strengthening and stabilization exercises of the neck, shoulders and upper trunk (Philadelphia Panel).
When therapy proceeds to strengthening and stabilization exercises, the therapist should instruct the individual in a home exercise program that complements the supervised rehabilitation (Ylinen). Individuals should also be instructed in how to care for and protect the neck from recurrence of injury.
If neck pain is chronic, it is best addressed by a multidisciplinary team (Karjalainen; Storro; Taimela). However, research has shown that even for individuals with chronic neck pain, neck exercise is beneficial.
For both acute and chronic neck pain, an ergonomic evaluation can provide information regarding the avoidance or modification of activities and positions at work that may aggravate the symptoms. Psychological intervention such as cognitive and behavioral pain management may be indicated to identify associated factors that might be contributing to the symptoms. |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical Therapist | | Up to 12 visits within 6 weeks | |
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| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Neck pain due to damaged nerves or cervical discs, or from conditions such as osteoarthritis, rheumatoid arthritis, or spondylosis, would change the prognosis. Chronic neck pain may persist if any of these diagnoses remains untreated. |
Source: Medical Disability Advisor
| Work that involves flexing or extending the neck should be avoided. Careful attention must be paid to the proper position of chairs, table heights, and computer keyboards; ergonomic adjustments to the work environment may be necessary. Repetitive activities involving the neck may increase symptoms. Heavy lifting and carrying should be avoided as it may aggravate symptoms. Lifting and working overhead may need to be restricted. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have any other diagnosed diseases or disorders?
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Does the individual have a history of headache or depression?
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Was the cervical spine evaluated for possible injury?
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Were other causes of the symptoms ruled out by CT, MRI, neurologic tests?
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Has a second opinion with an appropriate specialist been obtained?
Regarding treatment:
- Did individual follow the prescribed therapy including activity modification, ice, and heat?
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Did individual complete the recommended course in physical therapy? Did individual show any improvement during physical therapy?
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Were pain behaviors noted during therapy?
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Is individual inappropriately using a soft collar for more than a few days (pain behavior)?
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Did range of motion exercises help individual regain neck mobility? Were isometric resistance exercises effective in strengthening the muscles of the neck?
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If individual has other muscle or joint pain near or at the cervical spine (e.g., a herniated cervical intervertebral disc), were modifications made by the physical therapist?
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Is individual being treated for a psychiatric disorder?
Regarding prognosis:
- Does individual continue to gain mobility and strength in the neck region?
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Would individual benefit from being enrolled in a pain management clinic?
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Has individual been instructed in these signs and symptoms?
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Would individual benefit from psychological counseling or psychiatric treatment?
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Source: Medical Disability Advisor
| Gross, A. R., et al. "Physical Medicine Modalities for Mechanical Neck Disorders." Cochrane Database System Review 2 (2000): CD000961. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 10796402>.Hunter, Oregon K., and Michael Freeman. "Cervical Sprain and Strain." eMedicine. Eds. Martin K. Childers, et al. 29 May. 2008. Medscape. 10 Feb. 2009 <http://emedicine.medscape.com/article/306176-overview>. Karjalainen, K., et al. "Multidisciplinary Biopsychosocial Rehabilitation for Neck and Shoulder Pain Among Working Age Adults." Cochrane Database System Review 2 (2003): CD002194. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 12804428>. Philadelphia Panel. "Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Neck Pain." Physical Therapy 81 10 (2001): 1701-1717. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 11589644>. Randlov, A., et al. "Intensive Dynamic Training for Females with Chronic Neck/Shoulder Pain. A Randomized Controlled Trial." Clinical Rehabilitation 12 3 (1998): 200-210. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 9688035>. Rindfleisch, Adam J. "Neck Pain." Integrative Medicine. Eds. David Rakel, et al. 2nd ed. Philadelphia: Saunders, 2007. 697-708. Savolainen, A., et al. "Active or Passive Treatment for Neck-Shoulder Pain in Occupational Health Care? A Randomized Controlled Trial." Occupational Medicine (London) 54 6 (2004): 422-424. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 15358840>. Storro, S., J. Moen, and S. Svebak. "Effects on Sick-Leave of a Multidisciplinary Rehabilitation Programme for Chronic Low Back, Neck or Shoulder Pain: Comparison with Usual Treatment." Journal of Rehabilitation Medicine 36 1 (2004): 12-16. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 15074433>. Taimela, S., et al. "Active Treatment of Chronic Neck Pain: A Prospective Randomized Intervention." Spine 25 8 (2000): 1021-1027. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 10767816>. Viljanen, M., et al. "Effectiveness of Dynamic Muscle Training, Relaxation Training, or Ordinary Activity for Chronic Neck Pain: Randomised Controlled Trial." BMJ 327 7413 (2003): 475. Ylinen, J. J., et al. "Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial." JAMA 289 19 (2003): 2509-2516. National Center for Biotechnology Information. National Library of Medicine. 20 Nov. 2008 <PMID: 12759322>. |
Source: Medical Disability Advisor
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