Chronic Neck Pain
It has been reported that 48% of the population will experience neck pain at some stage in their lifetime.
Neck pain is a common musculoskeletal complaint that can be attributed to a variety of factors, ranging from acute injury to chronic postural strain. The implications of neck pain are far-reaching, often impacting an individual’s ability to perform daily activities and work duties, and diminishing overall quality of life.
Let's look at a case study of a patient I've recently been treating in my clinic. See if you recognise some similarities to your presentation. Then look at the strategies I've used to solve this issue. I'm positive you'll be able to apply these principles to your neck pain and start making some solid improvements too.
Chronic Neck Pain Patient - Mr A
Name: Mr A
Age: 46
Occupation: Office Manager
Hobbies: Walking his German Short-Haired Pointer Max, Watching Movies
Clinical Presentation:
18-month history of intermittent neck pain. Now worsening and becoming more persistent, he is now experiencing daily pain in the neck and shoulders.
He is also complaining of increased headaches.
He experiences pain throughout the day but has no night pain.
He often wakes with a stiff neck, leading to a dull ache in the neck and shoulders as the day progresses.
Sometimes taking ibuprofen and paracetamol helps with the pain but he prefers not to use this if he can help it. Heat packs provide temporary relief.
Treatment Journey
Mr A had initially tried to manage his symptoms with medication and rest. When this did not help he approached a local chiropractor for help. He had 4 sessions of chiropractic treatment. This helped with his symptoms initially. He found that he would get 2-3 days of decreased pain following treatment but after this time his pain would always return. Disheartened he stopped attending.
For the next few months, he continued taking medication and also tried some gentle stretching of his neck. This helped to some extent but he admitted to not being particularly regular with his stretches, only performing them when his neck pain or headaches were at their worst.
During this time his pain started to increase in intensity. He noticed his neck was hurting whilst engrossed in long bouts of driving or focused PC work.
He became worried about his increasing pain and attended his local GP clinic for a consultation with his doctor. His doctor recommended Physiotherapy and prescribed some stronger anti-inflammatories.
Initial Assessment
I conducted a thorough assessment and took a full history.
During a physiotherapy physical assessment, I look at and evaluate:
- Range of Motion of the neck, shoulders and spine.
- Strength of the upper limb musculature.
- Length of the upper limb musculature
- Neuro Examination
- Rule out any sinister pathology
As well as a physical exam, I take a full history, including medical and drug history, social history and history of present condition.
This information provides me with a working diagnosis. I can evaluate the severity of the condition, the level of irritability and the nature of the symptoms and from this I can develop a highly individualised treatment plan aligned to the patient's goals.
Findings
Mr A had a flattened thoracic kyphosis. This means that the normal curvature of his mid-back was flatter than usual. This can sometimes indicate spinal arthritis or weak and tight spinal muscles.
His shoulders had crept forward and he also presented with a slight chin poke posture.
The thoracic spine (the portion of the spine between the neck and the lower back) was stiff and lacked mobility.
Testing of the muscles of the upper limb revealed tight and weak scalenes and also the sub-occipital muscles. The scalenes help to stabilise the head whereas the sub-occipital muscles help to extend the neck and head. The pectorals were tight.
Palpation of the cervical spine revealed some right-sided stiffness and pain around C5/6. This is the segment of the lower portion of the neck.
This is a common presentation for someone who is experiencing chronic neck pain.
Plan
- Release the tightness in the thoracic spine.
- Improve the strength of the scalenes and sub-occipital muscles.
- Release the tightness of the pectorals.
- Mobilise the stiff and sore segment of the neck.
- Education regarding postural healthy habits.
Treatment 1
I developed a home exercise plan for Mr A and explained why this was important. The direct correlation between his weak and tight muscles and his neck pain.
At the initial treatment session, I also used manual therapy to work on the stiff thoracic spine, stiff and painful neck joint and the muscles of the upper back, neck and chest. This manual therapy included spinal manipulation, joint mobilisation, traction and deep tissue massage.
After the initial session, Mr A reported that his pain had reduced by 50% and that he had fully engaged in the exercise plan although he found this difficult, he also noticed that his neck pain improved directly after completing the exercises. One exercise in particular made his neck slightly worse so we replaced this with another.
Treatment 2
The next treatment was performed after 2 weeks.
Mr A reported that his pain had reduced significantly and that his incidences of headaches had reduced by 50% He'd been able to complete the exercises 90% of the time only missing a day or two.
He felt confident that he was pursuing the right course of action.
I re-evaluated him and was pleased to find that the stiffness in his mid-back and neck was improving.
We completed another session of manual therapy, ran through the exercise techniques and made a few minor tweaks.
At this session, we also talked about the importance of adequate hydration and talked through some additional supplements that he could take. For him I identified that he was not eating enough oily fish in his diet so recommended a quality fish oil (with a high DHA content). He resolved to drink 2 litres of water a day and invest in some Omega 3 capsules.
Treatment 3
One month after our initial session Mr A attended his second follow-up session, his third session in total. He reported that his headaches had resolved over the last week. His neck pain was 90% improved. He felt more flexible and stronger. In the month since the initial session, he had set up good desk health routines. He was getting up regularly and performing some basic mobility drills throughout the day. He was so inspired he researched some yoga classes and attended his first session.
Apply This To Your Neck Pain
Mr A’s presentation is typical of how neck pain can become a chronic problem if not treated appropriately. Although the manual therapy administered helped with pain relief, the main resolution happened after identifying the structures that were causing the pain and working hard to strengthen these and return them to optimal function.
1. Assess Your Posture
In Standing
Look at your posture in standing in a full-length mirror.
Looking face on, are you standing tall? If not try imagining that you have a balloon attached to the centre of your head which is floating you gently towards the sky.
Turning side onto the mirror, do your shoulders look rounded and rolling forwards giving you a hunched upper back? Does your chin jut out ahead of your forehead? A strategy here to correct this would be to practice pulling your shoulder blades down and holding this position for 10 seconds, repeating this for 10 repetitions.
In Sitting
If you spend long periods at a desk for work, make sure that your desk set-up is as optimal as possible.
Make sure your chair height is correct so that your elbows are horizontal to your desk so that it is easy to see your monitor which you have placed at eye level. The final major thing to ensure is that your wrists are straight and that all regularly used equipment is within easy reach.
2. Check your Strength
From your posture check earlier you’ll have noticed several things which are probably indicative of weakened longer muscles in the main. Chin poking forwards for example often indicates a weakness of the deep neck flexor muscle group along with some weakness of the muscles which stabilise your head and shoulder blades.
Look to try exercises which work the strength of these muscles such as the scapula retraction exercise I mentioned above. Chin retractions are another great option. To perform these start by looking straight ahead. Now tuck your chin in without looking up or down. Hold for 2 seconds and relax. Repeat this exercise for 2 sets of 10 repetitions.
3. Check your Muscle Length/Mobility
To begin with, look left and right. Does one side feel tighter than the other? Although this movement can incorporate joint stiffness too, it’s a good place to start.
If one side does feel tighter than the other start by slowly stretching the tight side. Practice by doing an assisted stretch to the side by holding the chin and pushing it slightly further around if pain allows.
Next, let’s test your thoracic spine (the bit between your neck and lower back!)
A simple way to assess this is in standing extend your right arm so that it is parallel to the ground. Now rotate your arm around you to the right side keeping your arm straight at all times. Take it around the body as far as you can go. Now repeat the process for the left arm. Which arm went further?
If you notice a difference between the right and left arm, or if you generally feel tight when performing this test then your thoracic spine may be tight.
Maintaining a healthy thoracic spine is important for managing neck pain.
4. Check your workstation set-up
Particularly if you spend prolonged periods at a desk for work or recreation.
The basics of this are to have your monitor at eye level and your elbows at 90-degree angles to your body with your keyboard directly in front of you.
5. Consider adequate Nutrition, Hydration and Supplementation
Making sure that you are adequately hydrated is an important part of maintaining healthy joints. Maintaining a healthy weight can also help. There is more evidence to suggest taking a good quality omega-3 supplement can also contribute to healthier joints.
Conclusion
There is a lot that you can do yourself to overcome chronic neck pain. Making a few basic adjustments to your life and identifying and improving weak muscles, and tight structures can go a long way to improving your quality of life.
If you want an expert assessment and a personalised treatment plan together with some manual therapy you should book an appointment to see your local physiotherapist. They can get you back on track to overcoming neck pain.
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Good Luck!
