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Neck/Head Articles

Neck Pain

Neck Pain

Neck pain can be so mild that it is merely annoying and distracting. Or it can be so severe that it is unbearable and incapacitating.

Most instances of neck pain are minor and commonly caused by something you did. That is, if you keep your head in an awkward position for too long the joints in your neck can “lock” and the neck muscles can become painfully fatigued. Poor postures while working, watching TV, using a computer, reading a book, or talking on the phone with the receiver held against your shoulder and under your chin can be responsible for neck pain.

 

Neck pain that persists for many days or keeps coming back may be a sign that something is wrong. Disease, an injury (such as whiplash in an auto accident), a congenital malformation, or age-related changes may be responsible for more significant pain. A trained medical professional must determine the underlying causes of such neck pain. Examination and diagnosis by a medical doctor and treatment by a physical therapist may quickly relieve your pain or help you deal with it on a long-term basis.

Who suffers from neck pain?

Almost everyone experiences some sort of neck pain or stiffness at one time or another during their life. Because you walk upright and your head is “balanced” on top of your spine like a golf ball on a tee. The head weighs between 10 and 15 pounds. If the muscles that support your head and neck are not kept flexible and strong, poor and prolonged postures can put too much stress on the head and neck muscles and joints. This can lead to strains of the muscles and sprains of the ligaments that support your head and neck.

As we age, our joints wear out (this is called osteoarthritis) and the discs in the spine dry up and flatten (this loosely describes Degenerative Disc Disease). You may experience pain that radiates into the top of the shoulders or in between your shoulder blades. Occasionally, a pinched nerve (called radiculopathy) occurs and you may feel tingling, pain, and/or numbness radiating into the arm, forearm, hand, and fingers. As always, with persistent pain you should be evaluated by a medical doctor and seek treatment from a trained physical therapist.

Possible Treatments

Possible Treatment Goals

    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Decrease Nerve Compression
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

Additional Resources

Whiplash Associated Disorder (WAD)

Whiplash Associated Disorder

Whiplash or Whiplash Associated Disorder (WAD) – a “whiplash” is the term that describes the sudden forward and backward movement of the head and neck most commonly occurring during a motor vehicle accident. It can also occur during a variety of other activities such as recreational and competitive sports. Note that a whiplash could also occur with a rapid side-to-side movement as well.

WADs are estimated to cost consumers and the insurance industry billions of dollars each year. With a WAD there can be soft tissue injury, bone fracture, and nerve damage. Because of the considerable number of structures (bone, spinal cord, brain, ligament, intervertebral disc, muscle, joint capsule, and tendon) involved, recover can take months or years. However, most cases of whiplash resolve in a couple months or less.

A classification of WAD was offered by the Quebec Task Force (a group that did extensive study on Whiplash):

  • 0 – No complaints about the neck, no physical signs.
  • 1 – Neck complaints of pain, stiffness, or tenderness only No physical signs.
  • 2 – Neck complaint AND Musculoskeletal signs (decreased range of motion and point tenderness).
  • 3 – Neck complaint AND neurological signs (decreased or absent deep tendon reflexes, weakness, and sensory deficits).
  • 4 – Neck complaints AND fracture or dislocation.

X-rays and other diagnostics may be performed by your physician to rule out fractures.

Physical therapy can be very helpful with the recovery of range of motion, strength, endurance, and the management of pain. Soft collars are of little benefit but rigid collars may be helpful in the acute stages of recovery.

Possible Treatments

Possible Treatment Goals

    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

Additional Resources

TMD (aka TMJ)

Temporomandibular Disorders (TMD)

Temporomandibular disorder (TMD), is a term that describes an entire group of disorders involving the temporomandibular joint or joints (TMJ).

The TMJs are the jaw joints. There is one on each side of your head just in front of your ear canals. Like many other joints in the body, they consist of:

  • muscles that control joint movement,
  • ligaments that hold the bones together,
  • cartilage that provides a smooth surface for the bones to move on,
  • a disc that helps with proper movement, of the bones,
  • elastic tissue that helps hold the disc in place.

One or more of the above tissues can cause symptoms. In fact, studies suggest that one third of the population at any one time experiences TMJ symptoms such as pain with chewing, yawning, or jaw opening. Women seem to have TMJ problems much more often than men and it is estimated that 3-6% of the population might benefit from treatment.

There are a variety of temporomandibular disorders. The muscles (myogenous), joint(s) (arthrogenous), or a combination of the two may cause pain.

Since physical therapists treat muscle and joint problems, they are ideally suited to address a TMD. Moreover, a majority of patients diagnosed with TMD, also have associated neck pain. Both respond well to treatment provided by a physical therapist. No other healthcare practitioner is better suited to address both the TMD and neck pain.

TMD may appear to be a complex condition and it shouldn’t be. This website and your physical therapist can help to insure the following:

  1. You are properly educated,
  2. that your treatment is conservative, cost-effective, and reversible,
  3. goals are realistic,
  4. your examination is brief and meant to identify your source(s) of pain.

When a physical therapist performs the examination, they will be able to classify you as having one or more of the following:

  1. An inflammatory condition
  2. Limited jaw range of motion
  3. Excessive jaw range of motion
  4. Arthrogenous Disc Displacement
  5. Jaw muscle pain
  6. Neck pain causing related headaches (sometimes mistaken as TMD)

Once the involved structures are identified, the therapist will be able to provide you with the appropriate treatment.

Possible Treatments

Possible Treatment Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Muscle Strength and Power
    • Improve Proprioception
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

Additional Resources

Benign Paroxysmal Positional Vertigo

Epley Maneuver is Helpful for Vertigo

Vertigo, in particular “benign paroxysmal positional vertigo (BPPV)”, is a common disorder in which the patient complains of spinning and dizziness with rapid changes in head positions. BPPV is typically idiopathic (of unknown cause) in nature. Other reported causes are head trauma, vestibular neuritis (inflamed vestibulo-cochlear nerve), vertebrobasilar ischemia (inadequate blood flow to the brain), and inner ear infection.

It is hypothesized that small particles, (called otoconia) in the semi-circular canals, over-stimulate the sense organs (hair cells and cupula). This results in patient complaints of dizziness and the observation of nystagmus in the direction of head rotation. The dizziness may last anywhere from a few seconds to a minute and there may be associated nausea.

Brandt-Daroff and canalith repositioning movements (Epley Maneuver) are the most common therapeutic interventions. The goal of these treatments is to move the small particles within the semicircular canal to the utricle where they no longer are able to stimulate the sense organs within the canal.

Hi-quality research studies show significant numbers of patients that experience a resolution of symptoms and negative diagnostic tests for BPPV after treatment intervention as compared to the control groups.

While BPPV is a common diagnosis for those suffering from dizziness, there are other causes of vertigo (both central and peripheral). It is important to consult your doctor and physical therapist regarding proper diagnosis and treatment of vertigo.

More on Vertigo at the Mayo Clinic

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