Neck pain and Headaches are a very common issue in our society, and understanding the causes and prevention of them will go a long way to leading a healthy and pain free life. In this educational summary, we discuss some of the most common conditions we see in our office. Below we will discuss the following neck-related pain conditions.

1. Upper Crossed Syndrome
2. Headaches
3. Neck Sprain/Strain
4. Disc Pain
5. Cervical Radiculopathy
6. TMJ Dysfunction

Potential causes of Cervical Discogenic Pain Syndrome

• Direct trauma – falls, motor vehicle accident, whiplash, sports injury
• Overuse, fatigue, repetitive microtrauma – over hours, days, months of the same position
• Postural – can be either an intrinsic postural problem (e.g. loss of cervical curvature) or an extrinsic postural problem (e.g. prolonged stressful position, protruded head posture).
• Sudden unguarded movement.
• Degenerative disc disease.

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Symptoms of Cervical Discogenic Pain Syndrome

The symptoms will vary depending on whether the condition is caused by a herniated disc or by a degenerative disc. With a herniated disc, some people will not experience pain in the neck but will have radiating pain, tingling, and numbness down the arm or around the shoulder blade due to pressure put on the nerve root. Discogenic pain due to an injury can result in immediate pain or pain shortly after the injury. Headaches (usually cervicogenic) can also result from cervical disc pain.

Treatment of Cervical Discogenic Pain Syndrome

Treatment for cervical discogenic pain will depend on the clinical presentation. Conservative treatment can successfully manage many cervical disc herniations. Initial treatment will focus on controlling pain and inflammation. Once pain and inflammation have decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft tissue therapy, activity as tolerated, and pain-free range of motion exercises. Late rehabilitation will be administered as the condition improves and will include stabilization exercises, patient education, and postural training. Education in proper training, biomechanics, and a home exercise program will help strengthen the spine and decreases the likelihood of future injury. If you fail to respond to conservative treatment, or in cases of severe pain, diagnostic imaging (x-ray, MRI) will be warranted, and an orthopedic consult may be necessary.

Cervical Radiculopathy

Cervical Radiculopathy is a dysfunction of the cervical nerve roots resulting in various neurologic findings. The cervical spine consists of seven cervical vertebrae and eight cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or weakness and though the problem occurs at the nerve root of the cervical spine, these symptoms will often radiate to parts of the body controlled by that nerve. The seventh (C7) and sixth (C6) cervical nerve roots are most commonly affected.

In younger patients, cervical radiculopathy is usually the result of a disc herniation or an acute injury causing foraminal impingement of the exiting nerve. In the older population, cervical radiculopathy is usually due to foraminal narrowing from osteophyte formation, decreased disc height, or degenerative changes. In elderly patients with osteophyte formation, repetitive neck movements may result in a more insidious injury. Cervical radiculopathy due to sports injuries can result from several mechanisms. Typical these injuries occur from forced extension, lateral bending, or a rotation mechanism, which closes the foramen and results in the exiting nerve root being injured.

Risk Factors for Cervical Radiculopathy

• Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
• Driving or operating vibrating equipment
• Smoking
• Collision sports (e.g. football, hockey)
• Prior injuries, degenerative disc disease/osteoarthritis

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History and Symptoms of Cervical Radiculopathy

The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain or arthritis of the cervical spine. The pain may range from deep aching to severe burning neck pain. Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved. Occasionally, a motor weakness may develop of the shoulder or arm. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.

Treatment of Cervical Radiculopathy

Initial treatment will focus on reducing pain and inflammation and prevention of further neurological loss. The focus will also be on centralizing (reducing) any radicular symptoms by decreasing nerve root compression and pressure within the herniated discs. This will consist of manual traction and pain-free active non-resisted ranges of motion while avoiding positions that increase neck and arm symptoms. A cervical pillow at night can be helpful in maintaining the neck in a neutral position and limiting head positions that cause foraminal narrowing. Electrotherapy modalities may be used to help reduce any associated muscle pain and muscle spasms. Once pain and inflammation have decreased, therapy will progress to restore full range of motion and mobility of the neck and shoulder. This will include muscle stretching, strengthening and proprioceptive training, and corrective exercises as tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and as long as it does not cause an increase in symptoms. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a secondary consultation with a neurologist or neurosurgeon will be recommended.

TMJ Dysfunction

“I’ve got TMJ”  It’s a pretty common statement which is a bit of a misnomer.  Everyone has TMJ.  Why?  The TMJ is the tempo-mandibular joint(TMJ).  We all have it.  What people are probably trying to say is that they have TMJ disorder, aka pain and dysfunction of the jaw while opening or closing your mouth.

What happens is the mandible (your jaw) connects to the rest of your head at the temporal bone.  It’s a hinge joint that pivots through a cartilage disc called a meniscus in between the two bones of this joint.  Unfortunately, it’s a common place for the TMJ to become subluxated or in other words, a little bit dislodged.  After that, you can get overuse and degeneration of that joint.  One way to tell if you have this disorder is to open your mouth and measure, can you open your mouth the height of 3 fingers for your hand?  If not, you might have TMJ disorder.

The main physical causes of this condition are:

• trauma
• overuse from a commonly chewing on one side of your mouth
• keeping the mouth open for extended periods of time (like at the dentist)
• improper bite
• grinding

From a physical standpoint, the best way to prevent TMJ disorder is to wear proper mouthpieces while playing sports, wearing mouth guards while sleeping, making sure to chew food evenly on both sides of your mouth, cutting tough meats and other foods into small pieces and minimizing gum chewing. Having better posture also improve the alignment of the TMJ.