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"You give me a pain in the neck!"
"I'm not sticking my neck out for you!"
"I got it in the neck"

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Wonder why those and other phrases referring to the vulnerability of that part of the anatomy are so ubiquitous in our language? Think about this unguarded column sticking up between your shoulders and supporting the weight of your head. Starting from the inside there are some pretty vital structures encased by it. In front, just under a thin layer of skin, chock-a-block full of sensory nerve endings, (more than on any other body surface) is the thyroid gland, overlying the trachea (windpipe) and the larynx (voice-box.) The next layer encloses the esophagus, and then, more deeply, the vertebral column or spine, this last structure enclosing the spinal cord. Branches of the spinal nerves exit through spaces between the vertebrae and spread out to supply the neck and upper extremity organs, muscles, blood vessels and skin. Major arteries and veins pass from the heart through the neck to branch out in the skull, brain and scalp. In back of the spinal column lie muscles responsible for supporting and moving the head with overlying skin and scalp. These too are replete with small blood vessels and nerve endings extremely sensitive to touch.

Nobody has to tell you that your neck is some kind of seriously important, delicate and vulnerable complex. Your brain is aware of this on a subconscious level and on that level is quite protective. The slightest threat is registered and responded to reflexively.

That's why there's so much neck pain and related problems with the shoulders and arms going around. Your average run-of-the-mill stiff neck: This is usually related to fatigue, stress, to long-standing poor posture or a combination of the aforementioned. Work at the computer or shrugging a phone between the shoulder and the ear can exacerbate the situation. The neck muscles tighten up, partially as a misguided and inappropriate protective mechanism. As often as not, this may be accompanied by a "tension" type headache.

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What to do? The acute situation can be addressed through simple measures such as acetaminophen,aspirin, ibuprofen, massage and osteopathic manipulation. That much we can do for you, but more important is what you can do to help yourself, particularly to prevent recurrences. First, ergonomic factors need to be modified: if necessary, a head set; proper positioning of the work space to minimize strain on the eyes and neck. Second, where possible, postural corrections should be made. This can be effected even in people middle aged or older. Extensive and expensive diagnostic tests are unnecessary. Stiff necks may also be associated with arthritis of the cervical spine, but from the standpoint of treatment, there is no essential treatment difference.

Your not so average stiff neck with pain radiating into the upper back, shoulder and/or arm:
Several possibilities here. Ranging from less to more serious, they are:

A. Very much the same as above. Poor posture, stress or injury with superimposed inefficient or traumatic movement factors can produce localized areas of muscle irritability known as trigger points. These may be associated with myofascial pain syndromes - muscle pain, spasm, weakness, limited movement - in areas remote from the trigger points. (See previous CSOM newsletters or my web site).

Such problems may be partially resolved through some of the same methods outlined above, particularly exercise, postural reeducation and ergonomic corections where indicated.

Other measures may be necessary, including trigger point injection with a local anaesthetic, osteopathic manipulation, ultrasound and electric stimulation, non steroid anti-inflammatory medication and muscle relaxants. Small doses of tricyclic antidepressants, much too small to have any antidepressant effect may be extremely effective in ameliorating myofascial pain. There may be many perpetuating factors contributing to these syndromes such as pelvic and low back muscle imbalances, flat or over-pronated feet, etc. These must also be corrected to ensure successful resolution.

B. Myofascial pain may be excruciating, radiating into the head, neck, upper back, shoulder and arm, but it is usually a deep ache and doesn't follow a specific nerve pathway. This pain can often be relieved by finding a position of comfort. Not so when the source of the pain is irritation of a nerve root due to the impingement of a protruding disc or a bony spur. The pain in this case is sharp, lancinating or boring, often likened to a "toothache in the arm". It follows a relatively consistent distribution, is often accompanied by pins and needles or numbness, very specifically demarcated along the course of the nerve involved. Muscle weakness and atrophy is often noted in the later stages. The pain is usually increased by extending the head to the rear or rotating or bending it to the painful side. It characteristically gets much worse at night, frequently interfering with sleep, particularly in the horizontal position.

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Treatment of this "pinched nerve" really depends on:
1. An accurate diagnosis;
2. Supporting the weakened muscles with a cervical collar for a short period;
3. Acupuncture, analgesic and muscle relaxant medication, supplemented by nonsteroid antiinflammatories (NSAIDS);
4. Osteopathic manipulative therapy and physical therapy including cervical traction, myofascial release, ultrasound and electrogalvanic stimulation are often of benefit;
5. More resistant cases may require short-term corticosteroid administration;
6. Very occasionally, neurologic consultation is needed, and even more rarely, spinal surgery;
7. Postural retraining and strengthening exercises are the key to full recovery.

C. Less frequently, neck and upper back pain may accompany acute or chronic shoulder pain as inappropriate muscles in the upper back and neck substitute for the injured shoulder muscles. The diagnostic clue is pain and restriction of motion at the gleno-humeral joint between the upper arm and the shoulder blade. Neck and arm pain due to shoulder dysfunction should respond well to management of the shoulder problem. (Once again, see www.bonesdoctor.com or my discussion of shoulder pain in the Spring 1995 issue of this newsletter)

Whatever the cause, the odds are pretty good that we'll find an answer to your neck problem at the Center for Sports & Osteopathic Medicine.

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All of these treatment modalities are available at the Center for Sports & Osteopathic Medicine

The information contained in this website is for educational and informational purposes only and should not be regarded or interpreted as anything else. Diagnosis and treatment of disease, injury, pain or disability is the province of your health professional who should be consulted in regard to any medical symptoms or conditions before adopting any course suggested in this website. By proceeding to the table of contents page, you agree to accept the provisions of this disclaimer.

Copyright © 1996-2006 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113

©2006 Richard Bachrach- 
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