Neck pain is a problem that almost everyone faces.This is the most flexible and vulnerable part of the spine, and pain syndromes of varying intensity can occur for completely different reasons.Neck pain rarely indicates a serious illness.However, persistent neck pain that reoccurs periodically should be a sign to search for the cause of this condition.
The most common is muscle pain; the cause may also be degenerative changes of the spine, injury and other (non-vertebral origin) causes: angina, infection, endocrine, rheumatism, neoplastic diseases, lymph node pathology, etc.
Neck pain may be accompanied by dizziness, weakness, headache, muscle spasms, arm pain, and numbness.
Classification, types and nature of pain syndromes
There are several categories of neck pain:
- According to the duration of the disease, it can be divided into acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- According to the nature of pain symptoms, it can be divided into soreness, dull pain, and tingling pain.
- According to the location of the pain, the pain can be divided into front of the neck, back of the neck, and side of the neck.When the pain radiates to the head, they say it is cervicocranial pain, and when the pain radiates to the shoulders, they say it is cervicobrachial pain.
- Depending on the context in which it occurs, all neck pain can be divided into two main categories - vertebral and non-vertebral:
- Spondylosis: Occurs due to spinal disease or injury.This is the most common cause of neck pain.According to statistics, >70%.The most common cause is muscle pain.It can be caused by myofascia, muscle tension syndrome, myositis, cervical myopathy, poor posture, etc.
- Non-vertebral origin: caused by other causes (myocardial ischemia, infection, endocrine disease, tumor disease, lymph node damage, rheumatism, etc.).
Let's look at the individual reasons in more detail.
Causes of neck pain
Injuries (broken bones, whiplash)
The mechanism of whiplash involves sharp bending of the neck forward or backward and further recoil in the opposite direction.This type of damage is typical of an accident.In this case, stretching of the tendon-ligamentous apparatus and muscles, destruction of the vertebrae (compression fractures) and subluxation and dislocation of the intervertebral discs, cervical spine, and the formation of hernias occur.
Complaints of neck pain radiating to shoulders, head, and interscapular area; limitation of movement; dizziness; nausea.M.b. Impaired vision, difficulty swallowing (dysphagia).
Other possible injuries include bruises, cuts and strained neck muscles.The consequences of trauma can be neck pain, migraines, muscle spasms, impaired neck mobility, fatigue and impaired vision.
spinal dystrophic disease
Osteochondrosis is characterized by age-related degenerative dystrophic changes in the spinal joints that occur due to decreased elasticity, flattening, and destruction of the intervertebral discs.
The shock-absorbing function of the intervertebral discs gradually becomes impaired.This can lead to increased loading on the intervertebral (facet) joints, arthropathy, radiculopathy - a pain syndrome caused by bone growth (osteophytes) compressing nerve roots, and neck muscle tension.When the vertebral artery is compressed, symptoms such as murmurs in the ears, flashing spots in front of the eyes, blurred vision, and dizziness may occur.
Gradually, the intervertebral discs lose their elasticity.When they become compressed, a protrusion (herniation) can develop within the spinal canal, which can lead to a hernia.This leads to compression of the spinal cord and pathological changes (myelopathy).As a result, pain syndromes intensify, sensitivity of the arms, legs and scalp is impaired, numbness and paresthesia develop.There is weakness in the hands and changes in tendon reflexes.
The pain is unilateral, shooting in nature, and is intensified when tilting toward the painful side and tilting the head back, so the patient intuitively bends the head forward and turns to the side opposite the location of the pain.Osteochondrosis may be accompanied by neck and arm pain; neck and cranial pain.
Spondylosis is often accompanied by osteochondrosis.In this pathology, bony growths (osteophytes) develop at the edges of the vertebral bodies.At the same time, the size of the intervertebral discs also decreases.When adjacent vertebrae fuse, the range of motion in the neck is limited.
With spondylolisthesis, the upper vertebrae shift (slip) relative to the lower vertebrae.This pathology manifests itself as pain in the area.Diagnosis is confirmed by X-ray examination.
muscle syndrome
Muscle Pain-Myofascial Syndrome
Long-term overstrain of neck muscles, ligament sprains, and local hypothermia can cause muscle pain.They are accompanied by limited neck muscle movement and spasms.When the muscles are palpated (feeled), they will feel tight and sore.
The pain syndrome in myofascial syndrome is of moderate intensity and short duration, intensifies with neck movement, and will resolve spontaneously if left untreated.
Muscle tension syndrome (cervicothoracic muscle spasm)
Clinically, it manifests as long-term sustained muscle tension and its reflex contraction - muscle spasm.The muscles become dense, swollen, and painful to the touch.
Trigger point formation – the area where pain is most noticeable.Neck pain is exacerbated when the head is turned and the cervical spine is flexed and extended.This may be accompanied by numbness of the ring and ring fingers.
Most
Neck myositis causes inflammation of the muscle fibers.The disease most commonly occurs in the setting of hypothermia.It manifests as severe pain during movement and impaired muscle tone.Due to differences in muscle tone, the head tilts to one side, forming secondary torticollis.
cervical myopathy
Myopathies, or degenerative pathologies of muscle tissue, are characterized by decreased contractility of myofibrils, progressive muscle weakness, limitation of movement, decreased tone, and subsequent muscle atrophy with replacement of muscle fibers by fat or connective tissue.
Cervical plexitis
Cervical plexitis is a disease of the cervical nerve plexus.More commonly, it occurs in the context of injury or hypothermia.The pain is localized to the anterolateral surface area of the neck and radiates to the ears, chest, and back of the head.The pain intensifies when coughing, talking, is accompanied by a crawling sensation, paresthesia - violation of sensitivity in the form of numbness, burning, tingling.
bad posture
Posture can become disrupted when a person sits in front of a computer or in other monotonous positions for long periods of time.Triggers also include sleeping on pillows that are too soft or too high.When posture is poor, the load on the ligaments and muscles of the neck increases, causing the head to move forward, forming a hunchback.
other reasons
Neck pain can also be caused by other nonvertebral causes, such as coronary artery disease (coronary artery disease).In atypical forms, pain can radiate to the neck, left arm, and shoulder.The disease is characterized by changes in the electrocardiogram.Clinical signs include chest heaviness, shortness of breath, weakness, and minimal physical activity.
With meningitis (inflammation of the leptomeninges), you experience neck and head pain along with neck stiffness, fever, and vomiting.Similar clinical manifestations have been observed in meningitis.To differentiate between these conditions, a spinal tap is performed.
Cervical lymphadenitis, or swollen lymph nodes in the neck, is the most common cause of neck pain in children (accounting for about 50% of all cases).This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis media, stomatitis, ARVI, influenza, sinusitis, measles, mononucleosis, tuberculosis) and in neoplastic pathology.Pain that worsens when swallowing or palpating (palpating) lymph nodes.
Neck pain may accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease presents before the age of 16 years and is characterized by joint damage and extra-articular manifestations.
Other systemic collagen hyperplasia that may cause neck pain:
- Ankylosing spondylitis is a connective tissue disease that affects the spine.With this disease, individual vertebrae may fuse together.
- Dermatomyositis is characterized by inflammation of the muscle tissue and skin, similar to photodermatoses, primarily in exposed areas of the body.
- Scleroderma includes fibrosclerotic changes in the skin, muscles, joints, blood vessels, and internal organs.
Neck pain is associated with torticollis, an orthopedic disorder in which the neck deviates from its vertical axis.This congenital malformation is diagnosed in early childhood and is more common in girls.
Neck pain is often associated with neoplastic diseases; purulent inflammatory processes: abscesses (limited inflammation of soft tissues), cellulitis (inflammation of soft tissues without clear borders); thyroid pathology; salivary glands;
In thyroid pathology (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is accompanied by increased body temperature, sensation of heat, increased sweating, increased heart rate, irritability and increased tearing.
Sialadenitis is inflammation of the salivary glands.Pain that worsens when chewing and swallowing.Swelling of the salivary glands, dry mouth, weakness, chills, and fever.
Bone loss (osteoporosis) occurs due to a lack of minerals (mainly calcium, phosphorus) and vitamins (D 3).Menopausal women are at increased risk of this condition.Cervical osteoporosis can be associated with neck pain.
Tracheitis is characterized by pain that worsens when coughing, while esophagitis is characterized by pain that worsens when eating.
Neck pain can be accompanied by dizziness and tinnitus due to atherosclerosis (damage to the walls of large arteries, forming atherosclerotic plaques that block normal blood flow) and other vascular pathologies.
Reiter's syndrome is a complex symptom manifested by the classic triad: damage to the genitourinary system (urethritis + prostatitis), joints, and conjunctivitis.It is most commonly caused by mycoplasma infection and has a chronic course.
Localization of neck pain - what problem do they indicate?
Pain localization helps to correctly determine the cause of neck pain and take necessary measures in a timely manner.
The main causes of front neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.Neck pain worsens when swallowing, accompanied by redness of the skin on the front surface of the neck, and body temperature rises to febrile levels (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is aching, pulling, radiating into the neck and spine.
- Cervical lymphadenitis.
- Atypical forms of ischemic heart disease.
- Tracheitis, esophagitis.
- Cervical spine compression fracture.
Causes of back of neck pain:
- Osteochondrosis, disc herniation, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Spinal tuberculosis.
- osteomyelitis.
- Wright syndrome.
- Cervical vertebral body compression fractures, vertebral arch and vertebral process fractures.
Pain on one side of the neck may be related to atherosclerosis; myofascial syndrome; foreign bodies; tumors growing in the pharynx, larynx, and thyroid gland.Neck pain on one side may lead to secondary torticollis as the patient tries to tilt their head to the side with pain.
Who to contact for neck pain
A therapist, pediatrician, or neurologist can help relieve neck pain.If your neck pain is caused by an injury, you should contact a traumatologist or surgeon.Depending on the cause of the pain, therapists and pediatricians may also refer patients to specialists such as rheumatologists, infectious disease specialists, cardiologists, oncologists, or otolaryngologists.
Diagnosis, testing and examination of disease
To determine the cause of neck pain, the doctor examines the patient, asks about his existing complaints, determines the duration of the symptoms, the nature of the pain, the location of the pain, exposure, combination with other symptoms, and palpation.Determining the cause of neck pain is important for proper treatment.
If necessary, stipulate as follows:
- Consultation with experts within the scope;
- Instrumental examination methods: electrocardiogram, dynamic electrocardiogram monitoring, electromyography - electromyography (measurement of bioelectrical activity and neuromuscular transmission of muscles), electroneurography (measurement of the speed of nerve impulse transmission along peripheral nerve fibers).
- Cervical spine X-ray examination, CT, MRI;
- Myelography - A contrast-enhanced X-ray of the subarachnoid space of the spinal cord.
- Ultrasound examination (ultrasound) of salivary glands and thyroid; duplex scan (evaluation of blood vessels and blood flow).
Treatment
Treatment of cervical spondylosis should be comprehensive.Conservative treatment aims to relieve muscle pain, spasms, stop the inflammatory process, and perform surgical intervention to stabilize the spine and ensure drainage of pus.
Conservative treatment methods:
- Medication.Self-medication with only a prescription from a specialist is unacceptable!For muscle syndrome, topical treatment (with numbing creams, gels) or systemic medications designed to relieve muscle pain and spasms can be used.
- Effects of physical therapy methods.These include magnetic therapy, sound wave therapy, drug electrophoresis, ultrasound, laser, UHF (heat therapy), cryotherapy (cold irradiation), SMT (sinusoidal modulated current), UVT (shock wave therapy), MLT (magnetic field + laser irradiation), paraffin/ozokerite application, etc.
- Exercise therapy.Choose a set of exercises individually based on the cause of your pain.Exercise therapy helps strengthen the muscles of the neck, back and develop correct posture.
- massage.It can be performed alone or in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms and normalizes muscle tone.
- Manual therapy.Allowing you to relieve muscle tension, pain and eliminate blockages.
Important note: Exercise therapy, massage, and manual therapy are prohibited during the acute phase of pain and when injured!
- Reflexology or the use of needles to affect acupuncture points, cautery, leech therapy.The combination of points, duration and number of surgeries will differ for different pathologies.
- Orthopedic Technology.This is done using a bandage or Chance collar for immobilization.It is used to treat cervical spine compression fractures, acute phase muscular syndrome, and osteochondrosis.
- Taping or kinesio taping involves placing a special patch (tape) on the skin of your neck.Used to relieve pain, swelling, eliminate muscle spasms and nerve ending compression, improve blood circulation and lymph flow, and promote recovery after injury and surgery.The protocols for applying tape vary for different pathological conditions.Depending on how it is used, the tape can improve lymphatic drainage, have anti-inflammatory and analgesic effects, normalize muscle tone and stabilize joints.
Surgical treatment is indicated for spinal hernias (if conservative treatment fails), tumors, abscesses, cellulitis, and foreign bodies in the neck.
What medication is used to treat
Non-spinal syndromes are treated by specialists; each group of causes has its own treatment.To relieve neck muscle pain, the following groups of medications can be used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit cyclooxygenase (COX).There are COX 1 and COX 2.Use of NSAIDs is a symptomatic treatment aimed at relieving pain and other signs of inflammation.To reduce the risk of side effects, it is recommended to use NSAIDs that act selectively on COX 2.
- Local anesthetic.They are injected into the area where the nerve exits (blockade).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Agents that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling, and pain.Usually used when NSAIDs are ineffective or when used in combination with NSAIDs.
- Vitamins B, C (ascorbic acid), D and minerals: calcium, phosphorus, potassium, magnesium.Calcium is a vitamin and mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectant.Improves nutrition (nutrition) of cartilage tissue and promotes cartilage regeneration.
- Anticonvulsants.Used for convulsions and muscle spasms.
Medication should only be given after a thorough examination and determination of the cause of your neck pain.
Prevent neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Arrange your workplace properly (lighting, monitor level, monitor-eye distance, and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia; do not allow sudden bending or tilting of the head, etc.
- Pay attention to your posture, including when working at the computer.
- During rest, exercise therapy is performed to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- When sleeping, it is better not to use a high pillow, but a regular pillow, or even better, an orthopedic pillow.
- Correct weight.
- Have a timely physical examination.
Taking preventive measures will help maintain health and well-being for many years.Seeing a doctor at the first signs of pathological symptoms and prompt treatment will help avoid the chronicity of the process and the development of complications.