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The neck is the upper most part of the spine where it forms a joint with the occipital bone in the skull. It supports the weight of the head and allows the up/down and sideways movement of the skull. Neck pain is fairly common and is often nothing to worry too much about.
At the top of the spine there are seven bones (vertebrae) which make up the cervical region of the spinal column. This region is known as the neck.
The first two vertebrae have differences in structure compared the other vertebrae, as they are adapted to allow the movement of the skull.
The first vertebra of the neck is named the atlas, after the Atlas of Greek mythology. As Atlas supported the world, the atlas vertebra supports the skull. The skull forms a joint here which allows the up/down, nodding movement of the head.
The second vertebra of the neck is called the axis. It forms a joint with the atlas and allows the side to side, head shaking movements.
The whole of the spinal column houses the spinal cord which is responsible for carrying messages to and from the brain. Specific to the cervical region are openings (foramen) for arteries to pass through and allow blood flow to the brain.
Pain in the neck is often caused from wear and tear rather than an acute injury, some common neck injuries include:
Cervical Spondylosis: Occurs as the bones and tissues of the neck become damaged over time. It is estimated that it will affect 9 out of 10 people by the time they are 60, although not all will suffer with the symptoms. Between the vertebrae are discs of flexible tissue which cushion the bone. Over time these dry out and become less flexible, to compensate for this the body produces small lumps of extra bone (osteophytes) pro to stabilise the joints. However, this affects the flexibility leading to stiffness and pain. This change to the spinal column can also affect the nerves in and around the neck.
Herniated Disc: Between each of the bones in the back there are protective pads of tissue. These pads have a casing which can split causing the internal tissue to bulge out of the disc and press on to the spinal cord. The symptoms vary depending on the location of slipped disc and which nerve it affects. If it is in the cervical region of the spine it can cause pain in the arm. It is often in younger people that this occurs and is less common than the process of damage causing cervical spondylosis. Medication will help to reduce the pain and once this has eased sufficiently conservative treatment such as exercises and physiotherapy can begin.
Whiplash: The most prevalent cause of whiplash is car accidents, where a person’s head is suddenly and violently moved forwards, backwards or sideways. This damages the tendons and ligaments in the neck, causing pain, stiffness, restricted movement and headaches. Other, less common symptoms include lower back pain, dizziness, blurred vision and vertigo. At the time of the injury no symptoms may be apparent and they usually develop the following day.
Pain in the neck is a very common problem and generally should not be a cause for concern. It usually improves over a couple of days and is rarely a symptom of an underlying condition or serious problem.
Often, stiffness or neck pain is caused by the way we sleep, perhaps in an uncomfortable position or in a draught. Similarly, sitting awkwardly for any length of time, perhaps in front of your computer, can result in a stiff neck.
Anxiety and tension can also cause neck pain as we tend to hunch our shoulders if feeling tense and this can lead to pain. Frequently, however, there is no obvious cause for neck pain and you may find that your GP refers to it as non-specific pain.
The pain may also be done to a specific condition, such as:
Acute torticollis: When you awake in the morning with a painful locked or twisted neck which cannot be unlocked or moved. It can be caused by exposure to a draught or sitting in an awkward position and can take up to a week to improve. However, usually, the condition only lasts for 24 to 48 hours and can be managed at home with painkillers.
Arthritis: Neck pain can also be caused by a type of arthritis called cervical spondylosis. This type of wear and tear on the muscles in your neck can create pressure on nerves which then send pain radiating from the neck to the arms. You can try to manage the pain of a stiff neck at home but consult your GP if the pain persists. You may be referred for an MRI scan.
As the condition suggests, neck pain starts with a pain in the neck, whether that’s stiffness, pain when moving or just pain full stop. Pain is rather subjective but we all have a limit and know when an injury is either below or above that limit.
As mentioned, the majority of neck pain will improve naturally, however in the event this is not the case (the pain has not improved after a few days or you are not able to control the pain with pain killers) then you should consider booking an appointment with your GP.
Where the neck pain has resulted from trauma i.e. a car accident then any indication of neck pain will typically be assessed straight away if the emergency services have been called.
Whatever the cause of your painful or stiff neck, you can usually get on with most of your daily activities by taking painkillers to relieve the pain
Regular doses of ibuprofen and paracetamol will help and Ibuprofen gel rubbed into the neck can be particularly effective. Always follow the correct dosage of any painkiller.
Hold a hot water bottle or heat pack to the affected area to help ease the pain and reduce muscle spasms.
Sleep on a low, preferably firm, pillow and avoid pillows which force your neck to bend uncomfortably. Avoid driving if you find that the pain in your neck prevents you from turning your head fully.
Be aware of your posture, particularly when sitting down. Keep your back and neck straight and upright. Poor posture may have caused your symptoms in the first place.
You may wish to consider a neck brace to help offer additional support and comfort when mobile, though as these devices restrict movement you consider when wearing one i.e. if you’re driving them this could prove problematic.
Try simple neck exercises such as tilting your head from side to side and up and down, while you gently turn your neck from right to left, and left to right. This should increase your range of movement and ease your muscles.
Any injury which causes the head to move sharply, whether that is sideways, backward or forward, can cause injury to the tendons and ligaments in the neck. Often associated with the sudden impact of a car crash, such injuries can also be caused by a blow to the head, a slip, trip or fall or by a sports injury, particularly in contact sports such as karate, boxing or rugby.
This injury should be reported to a medical practitioner or GP who may want to conduct tests to rule out more severe problems, and who may well prescribe the use of a neck support in order to ease the initial pain of this condition.
Whiplash can cause a number of symptoms, including:
Additional problems associated with the condition include dizziness, vertigo, blurred vision, tiredness and pins and needles in the arms and hands. These side effects can also be an indication of concussion or a more serious head injury and should be checked by a medical professional to ensure that there is not a deeper underlying problem.
Usually there are no initial problems in the aftermath of the injury, with the symptoms of whiplash taking up to 24 hours to develop. Although initially slow to manifest, the pain and stiffness can continue for several weeks and sometimes longer. The condition can sometimes become chronic, lasting for months and causing anxiety and depression in sufferers.
Although a neck support is sometimes used in the earliest stages of recovery, most health professionals advise keeping the neck mobile with gentle exercises to strengthen the muscles, tendons and ligaments. Although exercise can be painful, the current trend is to keep exercising as this is believed to hasten the healing process.
For more straightforward neck injuries, over-the-counter painkillers should be sufficient. Paracetamol should be taken regularly to begin with, rather than just when pain is experienced. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be helpful in relieving any inflammation at the site of injury, but should not be used by anyone who has suffered from heart or liver problems or stomach ulcers. Doctors will prescribe codeine, often in conjunction with paracetamol, when the pain of whiplash is particularly severe.
A physiotherapist can provide exercises to help to strengthen the neck and restore it to full mobility. These will usually be accompanied by massage and manipulation to aid healing and a series of exercises will be provided to be continued on a daily basis until full neck function is restored.
Whiplash is regarded as a self-limiting condition, meaning that in most cases it will clear up on its own. However, many sufferers find they can help things along by concentrating on good posture and providing adequate neck support at night.
Cervical spondylosis is the term given to wear and tear which can affect the tissues and bones in the neck as you get older.
The most common symptoms are neck pain, headaches and a stiff neck. The headaches associated with cervical spondylosis usually begin just over the spine at the base of the head before travelling towards the forehead. The neck pain and stiff neck will usually flare up and go away, leaving suffers pain free for a while.
Occasionally, cervical spondylosis can lead to trapped nerves, causing symptoms in the hands, arms and legs. These include pins and needles, loss of feeling, radiating pain and even co-ordination problems and difficulty walking. There are many sufferers of cervical spondylosis, however, who experience no symptoms at all.
It may be surprising to learn that around 90 per cent of all people will be suffering from some form of cervical spondylosis by the age of six, although many will not even be aware that they have the condition. It is common as the effects of aging cause bone and tissues to wear down. Spinal disks, for example, can shrink and dry out and ligaments can stiffen.
More serious symptoms are usually caused by a bone or a slipped disk irritating or pinching a nerve, a condition called cervical radiculopathy, or if a person is suffering from cervical myelopathy, where the spinal canal formed by protective bones gets narrower and the spinal cord is squashed inside.
Cervical radiculopathy can cause a sharp pain to move down one arm. This is called brachialgia. Turning your head and stretching your neck can increase the pain and you may also suffer from pins and needles or numbness in your arm.
Cervical myelopathy causes some of the most severe symptoms as it can interfere with signals from your brain. This means that you may suffer from co-ordination difficulties, a weakness or heavy feeling in your legs or arms, walking difficulties and sometimes incontinence. This condition should be treated as soon as possible as it can lead to the permanent damaging of the spinal cord and disability.
If you are suffering from neck pain and your GP suspects it might be cervical spondylosis, then they will first conduct a physical exam. The stiff neck can prevent it moving to its full extent. The GP will check if you can move the head to each side and lower it in the direction of your shoulders. During the test they will also check your hand and feet reflexes and ensure there is no reduction in the sensations you feel in your limbs. This is because, along with neck pain, these could be signs of nerve damage due to the spinal cord narrowing: referred to as cervical myelopathy.
If your GP is still unsure of the diagnosis, they might decide to refer you for an X-ray. This can be used to highlight other symptoms, including osteophytes. These are sections of additional bone that are a feature of cervical spondylosis and can be a cause of the neck pain.
As well as a physical exam, there are other tests that can be used to confirm the diagnosis. These are often conducted if the medical team suspects the presence of cervical myelopathy or if you have more severe neck pain and other symptoms that are not responding to standard treatments.
An MRI scan can show up any underlying damage that has been caused to the nerves. These scans use radio waves and powerful magnetic fields to gain a more detailed view of what is inside your body.
An alternative to an MRI scan is a CT scan. During this scan, a number of x-rays are taken and these are then put together digitally to create a complex view. This offers a more detailed analysis of the bones than a traditional X-ray. In the majority of cases an MRI scan will be preferred but if a patient can’t have one for a medical reason, such as having a pacemaker installed, a CT scan will be used instead.
There are many conditions which can be characterised by neck pain. If you are suffering from a stiff neck or other symptoms of cervical spondylosis, you should speak to your GP. They will be able to carry out the initial tests and then refer you for more specialist checks or treatment if required.
Pain relief: There are a number of medications that can help relieve neck pain or a stiff neck in cervical spondylosis. These include analgesics, muscle relaxants, amitriptyline and gabapentin all of which have different actions.
Over the counter analgesics: Probably the painkillers of choice for cervical spondylosis symptoms are non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen, diclofenac and naproxen. If the first NSAID you try is not effective it is worth trying another. NSAIDs do not suit everyone, and if you have certain conditions such as high blood pressure, asthma, heart disease, liver disease or stomach ulcers paracetamol would probably be a better alternative.
Codeine: If you have severe neck pain a mild opiate analgesic such as codeine may be prescribed. This can be taken at the same time as paracetamol or NSAIDs. Codeine is unsuitable for people who have head injuries or asthma. It is not generally recommended to be taken over a long period of time, but your GP will advise you about this.
Muscle relaxants: Diazepam, a muscle relaxant, may be prescribed to relieve spasms in your neck muscles. Because it is also a sedative, it can make you feel sleepy and exacerbate the effects of alcohol. Muscle relaxants should only be used for short periods.
Amitriptyline: This medication can be effective in the treatment of nerve pain, and may be prescribed if you have persistent pain that fails to respond to the other medications.
Gabapentin: This is used to help radiating arm pain and pins and needles. It has to be taken for at least a fortnight before you will notice any improvement, but it can help with symptoms caused by nerve root irritation.
Steroid injection: If you have severe nerve root pain, a nerve root injection into the neck may reduce inflammation and relieve neck pain. This would normally be performed at a pain clinic.
All the above medications have different side effects, and should be discussed with your doctor before you decide whether they would be suitable for you.
Exercise: There are certain measures you can take to help yourself relieve the symptoms of cervical spondylosis. Swimming, walking or other low impact exercises may help to reduce neck pain.
Lifestyle changes: Sleeping with a single firm pillow can help to reduce strain and ensuring that your posture is correct when you are sitting or standing can also be helpful. A cervical collar can help to keep your neck more comfortable, although it should not be worn for over a week unless recommended by your GP.
Surgery: This is the last option and is generally only carried out when there is definite evidence that your spinal cord is being compressed or a nerve is being pinched. Surgery may also be the answer to prevent worsening of any underlying damage to the nervous system or if the pain has failed to respond to any other treatment.
A stiff neck or neck pain caused by cervical spondylosis can be treated by a variety of medications, and symptoms can also be relieved by certain self-help measures. Surgery is not usually necessary, but your GP will discuss treatment options with you.
A slipped disc in the neck is medically known as a cervical disc prolapse. It tends to affect people between the ages of 30 and 50. More commonly, a slipped disc affects the back. When it occurs in the neck, it is a result of a disc that is located in the vertebrae of the neck degenerating. Severe degeneration causes the gel-like nucleus around the disc to prolapse out of the disc.
In most cases, a slipped disc in the neck is caused by overuse of the neck, with repeated movements that lead to disc degeneration. This is usually as a result of a type of work activity where the neck is used a lot, but even sitting at a computer for long periods of time may place extra stress and pressure on the neck and back.
When neck pain strikes, the sufferer should visit their GP, who will be able to make a diagnosis on the basis of the symptoms. In some cases, an MRI scan is performed to help confirm a diagnosis.
This condition can cause sufferers to experience a lot of neck pain, which may necessitate the need for neck support aids. The pain can also radiate down the shoulder and arm. Movements of the neck and back can make the pain worse, and even simple actions such as sneezing or coughing can exacerbate the pain. Some sufferers also experience pins and needles in the hands. Muscle spasms in the neck may also be felt.
The severity of the neck pain associated with a slipped disc in the neck can vary. Some people may find the pain so intense it can affect their day-to-day lives, whereas others may find that they have no pain in the neck but experience muscle weakness or pain in the arm only.
Patients are advised to seek medical expert opinion as to the most appropriate form of treatment to alleviate their neck pain symptoms. For some, neck support aids may be all that is required, while for others a multi-approach treatment strategy may involve various methods.
There are various treatment options available for sufferers of neck pain associated with a cervical disc prolapse. Medication such as painkillers and anti-inflammatory tablets may help to ease the pain, and resting the neck is often advised. Many sufferers find the use of neck support products very helpful. For instance, a neck collar offers neck support and promotes warmth to the neck, which can aid in healing. A neck pain pillow can support correct neck alignment when lying in bed. Heat packs and massage therapy are useful to alleviate pain and muscle spasms. Traction therapy, where an upward pulling force is applied to lengthen the neck and reduce pressure on the discs, is a popular method in treating a slipped disc in the neck. It is thought this procedure can help to shrink the prolapsed disc material back into place, removing pressure on the nerve roots.
Most cases of a slipped disc in the neck improve within a matter of weeks or months. As pain eases, normal activity using the neck should be introduced very gradually. Surgery is rarely required, and only in those cases where conventional treatments have not relieved the pain or when the pain is so severe it affects daily life.
A broken neck is a very rare and very dangerous sporting injury.
A spinal injury of this nature can occur in a number of sports and can be very serious, sometimes resulting in paralysis from the neck down or even death.
The sufferer will experience neck pain which may or may not be severe, swelling, decreased sensation in the limbs and muscle weakness. A suspected neck fracture is a medical emergency, and the patient should not be moved or put into a neck support until they have undergone a full medical examination, which will include an x-ray or scan.
The neck consists of seven cervical vertebrae, any of which can fracture. A fractured cervical vertebra is known as a broken neck. It is usually caused by a blow to the head — perhaps in a car accident or as a result of a fall or a sporting injury.
Possible Causes of a Broken Neck in Sport In football this type of injury is most likely to occur if a player ‘spears’ another player. It might also occur to a gymnast who misses the bar and falls or to a diver who hits the bottom of the pool. In rugby it may occur if the scrum collapses on to the players at the front. Horse riding, surfing, wrestling, weightlifting and skiing can also lead to neck pain and neck fractures.
An injury to the cervical vertebrae is potentially very serious because the vertebrae protect the spinal cord, which runs through them to the brain.
All neck pain following a trauma should be treated as serious until the injury has been assessed by a medical professional. If one of the neck vertebrae has been fractured, the prognosis is best if it is one of the lower vertebrae that has been affected.
When the cervical fracture is in one of the vertebrae at the top of the spine, the prognosis is generally much worse. If the spinal cord has been damaged, the injured person will not be able to move their limbs and may be unconscious and have breathing difficulties.
Because of the possibility of serious consequences, it is essential that the patient is not moved until fully qualified medical professionals can treat them.
Initially, when a broken neck is suspected, specialised medical personnel will immobilise the neck in order to protect the spinal cord from further damage. Treatment will depend upon which vertebra has been fractured and the type of damage that has been sustained. For a minor compression fracture the patient will need to wear a neck brace for six to eight weeks. A more complex fracture may require traction, neck immobilisation or surgery. The patient is likely to be immobilised for a period of eight to twelve weeks. If surgery is necessary, the broken fractures of the vertebrae will be screwed together. The patient may also have to wear a neck plaster cast.
Once the neck has healed, the patient may wear a neck support for warmth and protection and to alleviate neck pain. They may also need a course of physiotherapy.
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