WHAT REALLY IS NECK PAIN?
The cervical spine (neck) is made up of 7 vertebrae, with each vertebra being separated by a gel-like disc. The purpose of the discs is to provide shock absorption for the spine. The spinal cord travels through a central canal in the cervical vertebrae. Nerve roots extend off of the spinal cord and branch off into specific locations into the arm and hand. These spinal nerves provide signals to our muscles to contract or relax, as well as provide sensory input such as pain, pressure, and temperature. If any type of abnormal pressure is placed on these spinal nerves, then we get an impingement, or “pinched nerve.” Some causes of impingement may be:
- Herniated or bulging discs from wear and tear due to aging
- Arthritis caused by wear and tear due to aging
- Spinal stenosis, which is a narrowing of the spaces where the nerves exit
- Tumor, either malignant or benign, that puts pressure on the nerve
When spinal nerves are impinged, they can not receive proper sensation or properly send signals from the muscles to the brain. This can affect the entire course of the spinal nerve, which is why an impingement in the neck can result in pain, weakness, pins and needles, or even numbness in the arm, even though the compression is in the neck. It’s much like getting a kink in a garden hose–even though the kink is in a specific spot, everywhere down the rest of the hose will be affected.
WHAT MIGHT NECK PAIN FEEL LIKE?
- Pain in the neck, shoulder, shoulder blade, upper chest, or arm–pain can also radiate into the fingers as well
- General dull “ache” or numbness anywhere down the length of the arm/hand
- Pain may be described as “sharp,” or “pins and needles”
- Weakness in the shoulder, arm, or hand
- Pain may possibly be relieved by lifting the arm over and behind the head
CAN YOU BE A LITTLE MORE SPECIFIC AS TO WHERE THESE SYMPTOMS ARE ORIGINATING FROM?
- C5 nerve root (between vertebrae C4 and C5): Shoulder pain, numbness, weakness in upper arm (deltoid muscle, front and side of shoulder)
- C6 nerve root (between vertebrae C5 and C6): Shoulder pain, weakness in biceps (muscle in the front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
- C7 nerve root (between vertebrae C6 and C7): Pain in shoulder; weakness in triceps (muscle in the back of the upper arm) and wrist; numbness/tingling in the back of the arm and the middle finger of the affected hand
- C8 nerve root (between vertebrae C7 and T1): Weakness with hand grip; numbness/tingling in little finger
The most common nerve root levels are C6 and C7.
HOW IS NECK PAIN DIAGNOSED?
- How and when did the pain start?
- Was there an immediate onset caused by trauma, or a gradual onset that became progressively worse over time?
- Where are you experiencing the symptoms, and have they changed in terms of location?
- What makes the symptoms better or worse?
- What type of work do you do?
- What do you enjoy doing for leisure that you can no longer enjoy because of discomfort?
Your Physical Therapist should then conduct a thorough exam to look at Range of Motion of the neck, shoulders, and back, check strength of the neck and upper extremities, check sensation of the upper extremities, check reflexes for the upper extremities, palpate for painful areas, and conduct other tests specific to the cervical spine/shoulder to rule out other conditions. In some cases, further diagnostic testing may be indicated, such as a MRI, if the Physical Therapist feels the problem is neurological rather than musculoskeletal. A referral to an orthopedic surgeon or neurosurgeon would also be recommended as well, but most of the time is not needed.
HOW CAN PHYSICAL THERAPY HELP WITH NECK PAIN?
FUNCTIONAL TRAINING–As your symptoms resolve, your Physical Therapist will work on functional exercises to help you return to your job, sport, or other daily activities.
CAN NECK PAIN BE PREVENTED?
Your Physical Therapist should educate you on the best ways to prevent neck pain from occurring or recurring. These may include:
- Maintaining proper posture–this is extremely important with sitting at a desk or riding/driving in a car, and may include use of support pillows/cushions
- Adjusting workstation to relieve stress/strain on the neck/spine. This may include use of a hands-free phone (headset), adjusting your chair/armrests to their proper height, adjusting computer monitor/mouse.
- Perform regular exercise to maintain neck and spine flexibility and strength, including shoulders, upper back, and core
- Maintain a proper weight by eating healthy to minimize placing undue stress on the neck/spine