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Neck Pain

The Problem:
The neck, or “cervical spine” is a stacked collection of 7 bones, or “vertebrae,” running from the head to your shoulders, each separated by discs, and all are bound together by supportive ligaments. Muscles attached to vertebrae help to move the trunk. The discs are fibrous gel-filled shock absorbing structures that keep the bones gapped or spaced evenly and provide shock absorption to the spine during movements or loading.  The cervical vertebrae have a longitudinal channel contained within them to allow for the passage of nerves (the spinal cord) from the brain to your trunk, arms, and legs. Most causes of neck pain are either from stretch or strain of the ligaments or muscles joining the bones together, from arthritic friction from one vertebra to another, or from stretch or rupture of the walls of the disc. Muscle, ligament, bone, or disc wall injuries in the neck produce neck pain alone. But if disc spaces collapse, and adjacent vertebrae drift closer to one another, this might cause bone or disc wall crowding of nerves traveling within the spine. Signs of nerve impingement usually includes pain shooting down the arm, sometimes accompanied by arm or hand numbness or weakness.  In severe instances, structural neck abnormalities can interfere with nerves targeted to all regions of the body below the neck,  altering sensation, strength, balance or even bowel/ bladder control.  The vertebrae and disc spaces can easily be seen on plain x-rays, but detailed views of the discs and nerve structures requires an MRI.

The Solution:
Neck pain can be alleviated by rest. It is important to make sure that you keep your neck straight (not bent forward) during sustained postural tasks. It is also important to use the proper pillow size when you sleep at night.  Too large or small a pillow at night may result in a twisted position of your neck, and might contribute to morning neck stiffness. Medications such as muscle relaxers can be of some help, and anti-inflammatory medicines can reduce local neck inflammation /swelling. McKenzie’s Exercises, a series of routines for the neck, were designed by its author Robin McKenzie, as a means to bolster your self-help repertoire when confronted with neck pain from disc bulges. He discusses in detail how postural neck flexion causes many instances of neck pain, and shows you why periodic neck extension can reverse the trend.  I would encourage you to go to your local library, to sign-out either of two books written by Robin Mckenzie on this subject:  Treat Your Own Neck, or Seven Steps to a Pain Free Life.

A Physical Therapist can often reduce pain through the application of heat, massage, and gentle stretching. They often use cervical traction as a way to unload the forces on the neck. If traction helps, home traction units can be purchased at your local pharmacy.  If neck pain persists despite the above conservative treatment approaches, and especially if you are experiencing ongoing arm pain, numbness, or weakness (nerve pinch symptoms), then neck surgery comes into play. Cervical decompression or Cervical Anterior Fusion procedures are used to remove disc or bony fragments that are crowding adjacent nerve structures, and stabilize the position and interactions of the cervical spine.

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