New research has re-affirmed that weakness of one cervical muscle group is closely tied to chronic neck pain. This unit is also implicated as a provocative factor for cervical radiculopathy, cervicogenic headache, and cervicogenic vertigo.
A 2020 JMPT study re-affirmed that weakness of the deep neck flexors is common in cervical radiculopathy patients:
“Current results confirmed the presence of cervical multifidus and longus colli muscle atrophy in subjects with chronic radicular neck pain.” (1)
The deep neck flexors include four muscles that lie behind the trachea on the front of the cervical spine. The group includes the longus colli, longus capitis, rectus capitis, and longus cervicis. Due to their proximity to the spine and their short length, the muscles are primary stabilizers of the cervical spine.
If you’re experiencing neck pain contact the office! We help ease neck pain every day.
Amiri-Arimi S, Bandpei MA, Rezasoltani A, Javanshir K, Biglarian A. Asymmetry of Cervical Multifidus and Longus Colli Muscles Size in Participants With and Without Cervical Radicular Pain. Journal of Manipulative and Physiological Therapeutics. 2020 Mar 1;43(3):206-11.
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 nerve root.
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.