Neck Pain and Chiropractic Care

Neck pain or neck stiffness is a frequently reported musculoskeletal complaint that affects approximately 70% of the general population at some point in life. According to latest data reported in the peer reviewed journal Spine (1), investigators suggested that 1-year prevalence of neck pain is about 19.5%. It is no wonder that chronic neck pain is the second most common complaint for which individuals seek chiropractic help.

The neck is one of the strongest yet most sensitive part of your body. It stabilizes and supports your head as well as spinal cord. Any disease process that affects the integrity of neck musculature or connective tissue elements can directly compromise the activity of nervous system as well as other vital system.

What are some classic symptoms of neck pain?

The primary pathophysiological process involves straining of neck muscles or musculoskeletal components due to persistent pressure or stress. Some characteristic symptoms of neck pain include:

- Stiffness of neck muscles that affects your ability to freely move your neck
- Rigidity or tightness of neck that restricts the capacity of affected individuals to do multi-tasking or sudden neck movements
- Limited range of neck motion (in other words, onset of aging at a much younger age).
But it is imperative to understand that neck pain has much deeper impact on your physical, social and psycho-social aspects of life. Individuals who develop chronic neck pain miss out on small but most valuable pleasures of life; such as lying comfortably with their partner in bed, playing video games with children and engaging in any type of active sports with friends or family. Needless to say that neck pain has a profound effect on the professional aspects of your life as well. It is to be noted that most cases of chronic neck pain are associated with secondary complaints such as:

- Depression due to long-standing disability and gnawing pain
- Arthrosis due to persistent and ongoing inflammation
- Headaches mainly as a result of neurovascular involvement and high stress levels
- Osteoporosis and other degenerative bone/ joint conditions due to reasons discussed above.

What are some notable causes of persistent Neck pain?

Neck pain is clinically classified as acute (lasting less than 4 -6 weeks) or chronic (persistent or progressive neck pain for a period of more than 6 weeks). Primary causes of neck pain include:

- Chronic straining of neck muscles:
Certain physical activities such as chronic gritting of teeth (or clenching of jaws), improper or inadequate posture while reading/ writing or long term use of computer can lead to chronic neck pain. The pain may be acute or chronic; depending upon the intensity, severity or duration of inciting event.

- Muscular or joint degenerative disorders:
Age related wear and tear of cells and tissues is a physiologic phenomenon. However, certain lifestyle, occupational and behavioral choices can aggravate the pace of degenerative processes; thereby leading to severe symptoms and chronic discomfort. This includes; aggressive involvement in sports or certain high-risk occupations such as computer operators or long distance drivers.

- Nerve compression:
Formation of bone spur or herniation of spinal disc due to degenerative joint conditions can also lead to nerve compression that may presents with numbness, paresthesia, altered sensations and chronic neck pain.

- Injuries:
Road traffic accidents involving the head region almost always affect the associated structures like brain, spinal cord and neck. Whiplash injuries are a common cause of chronic neck pain that affects 8·4% to 70% of the individuals after moderate to severe road traffic accident or other form of traumatic injury to head and neck region (2).

- Medical conditions:
Medical conditions such as arthritis, tumor growth, migraine or tension type headaches or meningitis can also presents with neck pain or stiffness of the head and neck region. It is very important to address acute as well as chronic neck pain in order to minimize the risk of life threatening sequelae; such as stroke or encephalitis.

Traditional Management of Neck pain:

OTC or Prescription Analgesics:

Most cases of neck pain responds very well to over-the-counter pain killers; however, if the pain is severe or refractory to traditional pain-relieving interventions, the physician can also prescribe potent pain killers such as opioid analgesics. If the pain does not relieve with oral analgesics, a moderate dose of lidocaine can be injected directly into the affected nerve roots.

Sometimes, other prescription drugs are also needed to address secondary symptoms of neck pain such as depression, seizure activity, insomnia or loss of balance. This includes tricyclic antidepressants, anti-seizures, muscle relaxing agents etc.) Special precaution are needed if these medicines are prescribed. This is mainly because most conventional regimens are less effective at addressing the primary etiology of neck pain and ongoing disease process. Consequently, disease process becomes progressive and produce multiple side effects.

Steroidal injections

A steroidal injection is administered in the nerve roots to provide relief from pain. The injection can also be administered in the small facet joints or in the cervical region. The site of injection depends up on the location of neck pain.

Surgery

In case of nerve compression and tumor growth; surgery is usually recommended.

But are all these remedies useful for the management of neck pain?

According to an extensive review compiled by Steven P. Cohen and associates (3), conventional treatments are less effective in the long term management of non-specific neck pain. Interventions like home-based exercises often helps but more aggressive interventions like chronic administration of muscle relaxants, epidural injections of steroids and radiofrequency denervation of cervical facet joint can lead to unpredictable outcomes and more chronic symptoms in the long run. Same is true for conventional surgeries that may exacerbate the process of wear and tear.

Can you employ Chiropractic care for the management of Neck pain?

Owing to wide range of complications and poor satisfaction scores with most conventional regimens, most patients opt for chiropractic care that is safe, effective and predictable at improving neck pain symptoms.

Following strategies are usually employed by chiropractors for neck pain management:

- Heat and cold compresses: Application of heat and cold packs alternatively can help in reducing the pain. Place some ice in a clean towel and gently rub over the affected area with this pack for 10 minutes. Or use heat compress by utilizing heating pads. Chiropractors also advice hot baths (for at least 10-15 minutes) to effectively alleviate neck pain.
- Rest: A lot of people tend to continue hazardous activities that leads to neck pain in the first place. Chiropractors on the other hand advise limitation of neck straining movement or activities that puts too much pressure on the neck musculature. In case of constant neck activity lay back for 5 minutes before resuming the work again. Optimal rest and relaxation releases the pressure and improves neck pain.
- Massage Therapy: Therapeutic chiropractic massage helps in reducing neck pain by promoting the flow of blood across the inflamed tissues to enhance the pace of healing and recovery. Additionally, massaging also release pleasure inducing endorphins and enkephalins (4)
- Immobilization or restriction of excessive activity: Chiropractors manage neck pain by restricting the range of motion and activity across the neck with the help of a neck collar. The extra support to neck via collar is helpful in reducing the pressure and strain on inflamed neck muscles and thus hasten the recovery. Additionally, due to limited activity across the neck region, the intensity of pain can also be reduced without requiring any other intervention.
Other classic chiropractic interventions includes:

- Chiropractic neck adjustments (soft tissue mobilization and manual chiropractic manipulation)
- Rehabilitation training (exercises)
- Cervical drop techniques
- Cervical manual traction
- kinesio taping

References:

1. Fernández-de-las-Peñas, C., Hernández-Barrera, V., Alonso-Blanco, C., Palacios-Ceña, D., Carrasco-Garrido, P., Jiménez-Sánchez, S., & Jiménez-García, R. (2011). Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine, 36(3), E213-E219.

2. Häggman‐Henrikson, B., Rezvani, M., & List, T. (2014). Prevalence of whiplash trauma in TMD patients: a systematic review. Journal of oral rehabilitation, 41(1), 59-68.

3. Cohen, S. P. (2015, February). Epidemiology, Diagnosis, and Treatment of Neck Pain. In Mayo Clinic Proceedings (Vol. 90, No. 2, pp. 284-299). Elsevier.

4. Sherman, K. J., Cook, A. J., Wellman, R. D., Hawkes, R. J., Kahn, J. R., Deyo, R. A., & Cherkin, D. C. (2014). Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. The Annals of Family Medicine, 12(2), 112-120.

5. Saavedra-Hernández, M., Castro-Sánchez, A. M., Arroyo-Morales, M., Cleland, J. A., Lara-Palomo, I. C., & Fernandez-De-Las-Penas, C. (2012). Short-term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 42(8), 724-730.