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.
Upper Crossed Syndrome
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.
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 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
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
Risk Factors for Cervical
Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
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
Treatment of Cervical
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
“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.
main physical causes of this condition are:
from a commonly chewing on one side of
the mouth open for extended periods of time (like at the dentist)
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.
The best way to stop muscle wasting is to lift weight and do some form of cardio vascular conditioning.
Which weight lifting exercise are best? They are called complex movements.
Here a list:
Dead lift ( hip hinge)
Pushing movements( push ups and bench press)
Pulling movements( Lat Pull down and Pull ups)
Now you don’t have to be muscle bound to do these movements. However, doing these movements with some weight would help keep the muscle you have and possibly add some muscle.
Now you might be thinking you can’t squat because you may have bad knees or a bad back. Squatting is basically getting out of a chair. So start with that, getting out of chair 10 time is a row. Doing that a few times a day is a great way to start! You will not believe how sore you can get from this routine. Once you have done this for a few weeks move on to some thing harder. Goblet squats are the safest. Start with a light weight and just keep adding weight. It’s that easy.
Determining the right pillow is a personal choice that a person will make every so often. When it comes to thinking about sleep equipment, most people solely focus on the mattress. The mattress is one of the most important sleep equipment you will buy, but when it comes to sleep quality pillows are just as important. How you lay your head when sleeping plays a huge role in determining the type of support you need. Pillows not only impact the quality of sleep but can prevent any neck discomfort.
Why Does Your Pillow Matter?
A proper pillow will facilitate a good night’s sleep without you waking up at night or waking up with pain or a stiff neck. Having the wrong pillow over time can exacerbate unnecessary neck pain. There are a few factors that go into making a guide for yourself to determine the proper pillow for you.
Sleeping on your back might appear to be comfy, but will highlight the underlying issue of snoring if you have a pillow that allows your head to sink. As you lay your head back, gravity will push the tongue back and block your throat. A better alternative will be a pillow that offers height, neck support and keeps the throat at a comfortable level.
One of the most common positions to sleep in is on the side. You will need more support to keep the neck at a neutral angle.
Sleeping on your stomach might be comfortable for a few nights, but after a while can become taxing on your back and neck. However, having the right pillow can negate some of these issues. A firm/plump pillow will force your neck into an odd angle that might lead to some discomfort. A better alternative would be a softer option.
When Is It Time To Replace Your Pillow?
On average, a pillow should be replaced every 18 months. The old age rule “ you pay for what you get” applies to this transaction. A higher quality pillow will last longer than an inexpensive option. Something you can do to your pillow to see if you need a new one is, take it out of the pillowcase to see if there are any stains or fold it in half and see if the pillow stays folded. If either of these are a yes then it is time to replace your pillow.
In this study they found that hip weakness was linked to knee pain. I treat a lot of runners that have knee pain, and most of them have weak hips.
“Women with Patellofemoral Pain Syndrome had 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness than pain-free women. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.“
Below is a helpful exercise to strengthen your hips. As always, if you need any guidance do not hesitate to call the office!
Ferreira AS et al. Knee and Hip Isometric Force Steadiness Are Impaired in Women With Patellofemoral Pain. J Strength Cond Res. 2019 Jul 22. Link
Active rather than passive treatments are the key to recovering from “Runner’s Knee”, according to new international treatment guidelines co-authored by La Trobe University physiotherapy researcher Dr Christian Barton.
❇️ People with kneecap pain should engage in exercise-therapy, namely hip & knee strengthening
❇️ An exercise program that gradually increases activities such as running, exercise classes, sports, or walking, is the best way to prevent kneecap pain
❇️ Risk of kneecap pain can be reduced through improved leg strength, particularly the thigh muscles
❇️ Pain does not necessarily equate to knee damage
Yes, sleeping in a “bad” position can cause you to have pain. Here are some shoulder positions that could contribute to pain and also recommended solutions that could help prevent pain and help with the healing process.
1. Rotator Cuff Syndrome
Many patients have pain in the shoulder when they sleep. One of the most common complaints for patients with shoulder pain is the inability to sleep on the effected side.
There are some common positions that can contribute to shoulder pain. For example, sleeping with the arm in the overhead position. This could lead to impingement of the shoulder muscles. Another position would be sleeping with arm under the pillow while on your stomach. Both of these positions can chronically impinge the rotator cuff (shoulder muscles).
Here are some examples- minus the PJ’s- that could cause shoulder pain.
Solution: Avoid sleeping on the affected side. Consider sleeping supine(on your back) , or with the affected side up, placing a pillow or towel between the arm and body for support and to minimize the effects of traction ischemia. If you have trouble sleeping on the opposite side of the pain you could sleep with something (pillow or towel) between you and the bed. See below for examples.
Some of you might be thinking ‘I’ve slept in this position my whole life and I have no problems.’ That’s great and you might never get shoulder pain from these positions!
Like always, one size does not fit all but if you do have problems the above advice could help with healing faster.
If you’re experiencing pain in your shoulder or need help with sleeping positions please call the office and make an appointment. We can help!
Here’s another study showing that disc herniations can spontaneously resorb. The body has a amazing healing capability! We just need to give it a chance and the correct environment.
In 40 patients with lumbar disc herniation: “Based on MRI disc volume; 10% did not show any regression, 15% had a partial regression, and 75% had a complete resolution. Patients with complete resolution showed a significant improvement in the pain score and the ODI score over time.”
Kesikburun B et al. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci. 2019 Jul-Aug;35(4):974-980. Link
Cervicogenic Headache are headaches coming from the neck. There are many cause of headaches. Chiropractic has been shown to help headaches caused by neck dysfunction.
A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:
“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits.”
Call the office if you have been suffering from headaches! If you have tried medicine but you are still having headaches then give chiropractic a try.