Are you aware that the chronic neck pain is the fourth leading cause of morbidity and disability in the general population?
According to a new study conducted by Cohen and associates (1), the annual prevalence of neck pain is as high as 30%. Fortunately, most case of neck pain are transient and responds very well to lifestyle modification and conservative treatments; but in more than 50% cases, neck pain usually runs a chronic course (1).
What are the complications or adverse effects of long standing neck pain?
A lot of neck pain sufferers generally avoid seeking treatment or professional help in the short run. It is imperative to mention that untreated or poorly managed neck pain can significantly alter the quality of life; for example imagine how hard it is to live with persistent and gnawing neck pain that compromises your ability to do simple things in life like turning your neck side-ways when you have to say a simple ‘NO’ or work in different postures and positions without losing concentration or productivity?
Other adverse effects of persistent neck pain are:
• Sharp shooting sensation while making sudden neck movements
• Dizziness or headaches (especially if neck pain is due to neurovascular causes
• Pain in the shoulders or referred pain in the limbs
• Degenerative damage to cervical spine and associated musculoskeletal components
Needless to say that all these factors can greatly affect the quality of your life.
Conventional Management of Neck Pain:
Pharmacological management: Acute cases of neck pain are usually manage with medications such as pain killers (that include over-the-counter analgesics such as ibuprofen, naproxen). Prescription pain-killers are usually reserved for more serious and refractory cases of neck pain).
It is imperative to keep in mind that the management of chronic neck pain is quite challenging owing to physiological wear and tear changes, inflammatory arthritis and other degenerative disorders that may worsen the intensity and severity of neck pain. In more severe cases of neck pain, surgical intervention may be needed. However, the patient compliance and satisfaction scores are generally very low with surgical intervention; here is why:
• Most surgeries address the underlying issue (i.e. radiculopathy or removal of bone spur); yet it doesn’t address the primary risk factors that are leading to neck pain in the first place.
• The healing and repair after surgical intervention is slow and challenging. Most patients have to rely on the neck collar for extended periods of time to minimize the impact of pressure on the healing neck segments.
• Surgery and resulting inflammation (or postures changes) often hasten the pace of age related wear and tear of the spinal cartilaginous elements. This leads to new symptoms or issues after primary rehabilitation.
Chiropractic Care for the Management of Neck Pain:
Most people prefer chiropractic or holistic care for the management of neck pain. This is mainly because; practitioners of natural health advice a more holistic and multi-modal approach that is based on the identification of the primary causes, which are contributing to the pathogenesis of neck pain. For most chiropractors, identification of pathophysiology is a far more important goal than management of pain and discomfort symptoms.
Here are some of the modalities that are used by chiropractors for the neck pain management:
Chiropractic Spinal Manipulation:
According to a study reported in the scientific journal BMC Chiropractic Manual Therapy (3), approximately 78% patients of acute neck pain and 40% patients of chronic neck pain admits to remarkable improvement in the symptoms of pain and discomfort with spinal manipulation therapy of 1 week.
A lot of people are under the misconception that spinal manipulation therapy for the management of neck pain is unnecessarily aggressive and may lead to complications; however, extensive literature and clinical research conducted by Cassidy and associates (4). Chiropractic manipulation involves manual re-alignment of cervical spinal components to alleviate neck pain and discomfort by:
• Alleviating persistent inflammation that is caused by mal-aligned cervical elements
• Restore neurovascular circulation to hasten natural repair and reconstruction processes
• Facilitation of regeneration and rejuvenation to minimize the age related degeneration or destruction of musculoskeletal elements.
Strengthening and Stretching Exercises:
The main-stay of most chiropractic interventions is restoration of natural balance and anatomical harmony among the components of musculoskeletal system. This goal is achieved by a variety of stretching and strengthening exercises that are designed by chiropractors according to the custom needs of the patient: Every individual is unique; and so is their musculoskeletal dynamics that are determined by the degree and type of physical activities, dietary factors, age and other non-modifiable risk factors (such as gender, congenital factors) and exposure to physical stressors such as occupational activities and recreational choices (5). The classic benefit of employing customized exercise regimen over conventional exercises are immense. Other factors are:
• Lifestyle choices and pathophysiology of neck pain
• Response to the exercise regimen
Traction Training:
The human neck is a very delicate but vital part of your body. This is mainly because; neck supports the head as well as several other structures; such as trachea, larynx, nerve trunks, blood vessels and esophagus. It is important to mention that neck muscles are under a lot of pressure owing to the free mobility and wide range of motion of head (5).
Exercise techniques like traction helps in subsiding the pressure of gravity from the neck muscles and other connective tissue elements. This strategy helps in improving the blood circulation, resolving edema and improving the pace of revitalization/ remodeling processes.
Management of Neck Pain via Immobilization:
Although moderate activity or exercises are helpful in the regulation of optimal circulation (especially in cases where neck injury is chronic or degeneration is pronounced). However, if the injury is acute or significant (such as dislocation/ fracture or sprain), it is highly recommended to limit the activity across the damaged tissue to limit the injury process.
Identification of risk factors and advice on lifestyle modifications:
It has been observed that chronic neck pain is a product of poor posture and stress related damage to the musculoskeletal support of the neck. Therefore, most chiropractors advice lifestyle modification and nutritional advices based on the history and analysis of physical examination. Lifestyle modification reduces the pace of wear and tear related damage to the nerve tissues. Following are some preventive tips for the management as well as prevention of chronic neck pain (6).
• If your occupational responsibilities demand prolonged neck activity (such as long-distance driving, computer typing or data analysis etc.); make sure to take regular breaks and move around to relax the neck muscles.
• While working on the computer, keep the screen at the eye-level to prevent neck strain.
• Do not tuck or hold the phone in between the ear and neck
• Perform stretch exercises regularly
• Avoid sleeping on the stomach.
• Make the balance base supportive
References:
1. Cohen, S. P. (2015, February). Epidemiology, Diagnosis, and Treatment of Neck Pain. In Mayo Clinic Proceedings (Vol. 90, No. 2, pp. 284-299). Elsevier.
2. Whedon, J. M., Song, Y., Mackenzie, T. A., Phillips, R. B., Lukovits, T. G., & Lurie, J. D. (2015). Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain. Journal of manipulative and physiological therapeutics.
3. Peterson, C., Bolton, J., & Humphreys, B. K. (2012). Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients. BMC Chiropr Man Therap, 20, 27.
4. Cassidy, J. D., Bronfort, G., & Hartvigsen, J. (2012). Should we abandon cervical spine manipulation for mechanical neck pain? No. Bmj, 344.
5. Dedering, Å., Halvorsen, M., Cleland, J., Svensson, M., & Peolsson, A. (2014). Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy: a protocol of a prospective randomised clinical trial. BMC musculoskeletal disorders, 15(1), 274.
6. Evans, G. (2014). Identifying and Treating the Causes of Neck Pain. Medical Clinics of North America, 98(3), 645-661.
