Neck pain is a problem that almost everyone has faced.This is the most mobile and fragile part of the spine, and painful syndromes of varying intensity can occur for completely different reasons.Neck pain rarely indicates a serious illness.Nevertheless, periodically recurring cervical pain that is constant should be a signal to search for the cause of this condition.
Most often these are muscle pains;the cause can also be degenerative changes in the spine, injuries and other (non-vertebral) causes: angina pectoris, infectious, endocrine, rheumatic, oncological diseases, lymph node pathology, etc.
Neck pain can be accompanied by dizziness, weakness, headache, muscle spasms, pain and numbness in the hands, etc.
Classification, types and nature of pain syndromes
There are several classifications of cervical pain:
- According to the duration of the course, it is acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- According to the nature of the pain syndrome, painful, dull, shooting pain is distinguished.
- According to the localization, the pain is distinguished in the front, back and side of the neck.When the pain radiates to the head, they talk about cervicocranialgia, and to the shoulder - about cervicobrachialgia.
- Due to their occurrence, all neck pains can be divided into 2 large groups - vertebral and non-vertebral:
- Vertebrogenic: occur as a result of diseases, injuries of the spine.This is the most common group of causes of cervical pain.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial, muscle tone syndromes, myositis, cervical myopathy, poor posture, etc.
- Non-vertebral: caused by other causes (myocardial ischemia, infectious, endocrine, oncological diseases, damage to the lymph nodes, rheumatism, etc.).
Let's look at the individual reasons in more detail.
Causes that cause neck pain
Injuries (fractures, whiplash)
The mechanism of whiplash injury involves an abrupt forward or backward twisting of the neck with further recoil in the opposite direction.This type of damage is typical of an accident.In this case, there is stretching of the tendon-ligamentous apparatus and muscles, destruction of the vertebrae (compression fractures) and intervertebral discs, subluxations and dislocations of the cervical vertebrae, and the formation of a hernia.
There are complaints of pain in the neck, radiating to the shoulders, head and interscapular region;restriction of movements;vertigo;nauseaM.b.impaired vision, swallowing (dysphagia).
Other injuries they can cause include bruises, sores, and strained neck muscles.Consequences of traumatic injury can be cervical pain, migraine, muscle spasms, impaired mobility of the neck, fatigue and impaired vision.
Dystrophic diseases of the spine
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the joints of the spine, which occur due to reduced elasticity, flattening and destruction of the intervertebral discs.
The cushioning function of the discs is gradually impaired.This leads to an increase in the load on the intervertebral (facet) joints, arthrosis, radiculopathy - a pain syndrome due to pinching of the nerve roots by bone growths (osteophytes) and tension in the neck muscles.When the vertebral arteries are compressed, tinnitus, flickering spots before the eyes, blurred vision and vertigo occur.
Gradually the intervertebral discs lose their elasticity.When they are compressed, a bulge (protrusion) occurs in the spinal canal with further herniation.This leads to compression and the development of pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome intensifies, the sensitivity of the hands, feet and scalp is disturbed with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is unilateral, shooting in nature, intensifies when leaning to the painful side, throwing the head back, so the patient intuitively bends his head forward and to the side opposite to the pain site.Osteochondrosis can be accompanied by cervicobrachialgia;cervicocranial pain.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) are formed on the edges of the vertebral bodies.At the same time, a decrease in the size of the intervertebral discs is observed.When adjacent vertebrae are fused, neck mobility is limited.
In spondylolisthesis, there is a displacement (slippage) of the upper vertebra in relation to the underlying one.This pathology manifests itself as pain in the area of location.The diagnosis is confirmed with an X-ray.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term neck muscle strain, stretched ligaments, and local hypothermia lead to muscle pain.They are accompanied by limited mobility and spasm of the neck muscles.When palpating (feeling), the muscles feel tight and painful.
The pain syndrome of myofascial syndrome is of moderate intensity, short duration, increases with neck movements and disappears on its own if not treated.
Muscular-tonic syndrome (muscle spasm of the cervico-thoracic region)
It is clinically manifested by prolonged and persistent muscle tension, their reflex contraction - muscle spasm.The muscles become dense to the touch, swollen and painful.
Trigger points are formed - areas of the most pronounced pain.Cervicalgia is aggravated by turning the head, flexion and extension of the cervical vertebrae.It may be accompanied by numbness in the fourth and fifth toes.
Mosite
In myositis of the neck, inflammation of the muscle fibers develops.Most often, the disease occurs against the background of hypothermia.It manifests itself with severe pain during movement and impaired muscle tone.Due to the difference in muscle tone, the head tilts to one side and secondary torticollis is formed.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by a decrease in the contractility of myofibrils, progressive muscle weakness, limitation of movements, reduced tone and the development of muscle atrophy with subsequent replacement of muscle fibers with fat or connective tissue.
Neck plexite
Cervical plexitis is a disorder of the cervical nerve plexus.More often it develops against the background of injury or hypothermia.The pain is localized in the area of the anterolateral surface of the neck and radiates to the ear, chest and back of the head.The pain intensifies when coughing, talking and is accompanied by a crawling sensation, paresthesia - a sensitivity disorder in the form of tingling, burning, tingling.
Bad posture
The posture is disturbed when a person spends a long time in front of the computer or is in another monotonous posture.Predisposing factors also include using a pillow that is too soft or too high for sleeping.With bad posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a hunchback occurs.
Other reasons
Neck pain can also be caused by other, non-vertebrogenic causes, for example, coronary artery disease (coronary heart disease. In an atypical form, the pain can radiate to the neck, left arm, shoulder. This disease is characterized by changes in the ECG. Clinical symptoms include heaviness in the chest, shortness of breath, weakness with minimal physical activity.
In meningitis (inflammation of the soft meninges), pain in the neck and head is accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed in meningism.To distinguish between these conditions, a spinal tap is performed.
Cervical lymphadenitis, or enlarged cervical lymph nodes, is the most common cause of cervical pain (about 50% of all cases) in children.This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathology.The pain intensifies when swallowing, palpation (palpation) of the lymph nodes.
Neck pain can accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease makes its debut before the age of 16 and is characterized by joint damage and extra-articular manifestations.
Other systemic collagenoses that can cause neck pain:
- Ankylosing spondylitis is a connective tissue disease that affects the spine.In this disease, individual vertebrae can fuse together.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in exposed parts of the body.
- Scleroderma involves fibro-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Cervicalgia is observed in torticollis, an orthopedic disease with deviation of the neck from the vertical axis.This congenital malformation is diagnosed in early childhood and occurs more often in girls.
Neck pain accompanies tumor diseases; purulent-inflammatory processes: abscesses (limited inflammation of soft tissues), phlegmons (inflammation of soft tissues without clear boundaries); pathology of the thyroid gland; salivary glands; plexites; osteoporosis; tracheitis (inflammation of the tracheal lining); esophagitis (inflammation of the lining of the esophagus); atherosclerosis; Reiter's syndrome; foreign bodies.
In pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is combined with increased body temperature, feeling of heat, increased sweating, increased heart rate, increased irritability and lacrimation.
Sialadenitis is an inflammation of the salivary glands.The pain intensifies when chewing and swallowing.There is swelling in the area where the salivary glands are located, dry mouth, weakness, chills and fever.
With a lack of minerals (mainly calcium, phosphorus) and vitamins (D 3), bone loss (osteoporosis) develops. The risk of its occurrence increases in menopausal women.Osteoporosis of the cervical vertebrae is accompanied by cervical pain.
Tracheitis is characterized by increased pain when coughing, while esophagitis is characterized by increased pain when eating.
In atherosclerosis (damage to the walls of large arteries with the formation of atherosclerotic plaques that impede normal blood flow) and other vascular pathologies, neck pain is combined with dizziness and tinnitus.
Reiter's syndrome is a complex of symptoms manifested by the classic triad: damage to the genitourinary system (urethritis + prostatitis), joints, conjunctivitis.It is most often caused by a mycoplasma infection and has a chronic course.
Localization of neck pain - what problems do they indicate?
Localization of pain helps to correctly determine the cause of cervical pain and take the necessary measures in time.
The main causes of front neck pain are:
- Pathology of the thyroid gland.
- Sialadenite.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.The pain in the neck intensifies when swallowing, accompanied by reddening of the skin on the front surface of the neck, an increase in temperature to febrile levels (38-39 °).
- Neck plexite.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is painful, pulling, radiating to the neck and spine.
- Cervical lymphadenitis.
- Atypical form of ischemic heart disease.
- Tracheitis, esophagitis.
- Compression fractures of the cervical vertebrae.
Causes of pain in the back of the neck:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Spinal tuberculosis.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of the bodies of the cervical vertebrae, fracture of the arches and processes of the vertebrae.
Pain in the side of the neck can occur with atherosclerosis;myofascial syndrome;foreign body;tumor process in the pharynx, larynx, thyroid gland.Lateral cervicalgia can lead to secondary torticollis because the patient always tries to tilt his head to the painful side.
Who to contact for neck pain
A therapist, pediatrician or neurologist will help you with neck pain.If the neck pain is caused by an injury, then you should contact a traumatologist or surgeon.Depending on the cause of the pain, the therapist and pediatrician may also refer the patient to specialists such as a rheumatologist, infectious disease specialist, cardiologist, oncologist, or otolaryngologist.
Disease diagnosis, research and studies
To determine the cause of cervical pain, the doctor examines the patient, asks him about the existing complaints, clarifies the duration of the symptom, the nature of the pain, its localization, irradiation, combination with other symptoms and performs palpation.Determining the cause of cervical pain is important for proper treatment.
If necessary, the following is prescribed:
- consultation with narrow specialists;
- instrumental research methods: ECG, Holter monitoring, EMG - electromyography (determination of the bioelectric activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of nerve impulse transmission along peripheral nerve fibers).
- X-ray of the cervical vertebrae, CT, MRI;
- myelography - contrast radiography of the subarachnoid (subarachnoid) space of the spinal cord.
- Echography (ultrasound examination) of salivary glands, thyroid gland;duplex scan (to assess the state of blood vessels and blood flow).
Methods of treatment
Treatment of cervicalgia should be comprehensive.There is conservative treatment aimed at relieving muscle pain, spasm, stopping the inflammatory process, and surgical intervention, which is performed to stabilize the spine and ensure drainage of pus.
Conservative treatment methods:
- Drug therapy.Prescribed only by a medical specialist, self-medication is not allowed!For muscle syndromes, this can be either local therapy (use of anesthetic ointments, gels) or the use of systemic drugs aimed at relieving muscle pain and spasms.
- Physiotherapy methods of influence.These include magnetotherapy, phonophoresis, medicated electrophoresis, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite applications, etc.
- Exercise therapy.The complex of exercises is selected individually depending on the cause of the pain.Exercise therapy helps to strengthen the muscles of the neck, back and the formation of correct posture.
- massage.It can be carried out both separately and in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.It allows you to relieve muscle tension, pain and remove blocks.
Important: Physical therapy, massage, manual therapy are contraindicated during the acute period of pain, as well as in case of injuries!
- Reflexology or influencing acupuncture points using needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will differ for different pathologies.
- Orthopedic techniques.This is immobilization using a bandage or Chance collar.It is performed for compression fractures of the cervical vertebrae, in the acute period for muscle syndromes, osteochondrosis.
- Taping or kinesio taping is the placement of special patches (tapes) on the skin of the neck.It is used to relieve pain, swelling, eliminate muscle spasms and pinched nerve endings, improve blood circulation and lymph flow, recovery after injuries and operations.Banding schemes differ for different pathologies.Depending on the method of application, the tapes improve lymphatic drainage, have an anti-inflammatory and analgesic effect, normalize muscle tone and stabilize joints.
Surgical treatment is performed for spinal hernias (if conservative therapy is ineffective), neoplasms, abscesses, cellulitis and foreign bodies in the neck.
What drugs to treat
Non-vertebral syndrome is treated by specialists;each group of causes has its own therapy.The following groups of drugs are used to relieve muscle pain in the neck:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the enzyme cyclooxygenase (COX).There is COX 1 and COX 2. The use of NSAIDs is a symptomatic therapy aimed at relieving pain and other signs of inflammation.To reduce the risk of side effects, it is recommended to use NSAIDs with selective action on COX 2.
- Local anesthetics.They are injected into the area where the nerves exit (blockade).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling, pain.It is usually used when NSAIDs are ineffective or in combination with them.
- Vitamins B, C (ascorbic acid), D and minerals: calcium, phosphorus, potassium, magnesium.Calcium is a vitamin-mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.Improves trophism (nutrition) of cartilage tissue, promotes cartilage regeneration.
- Anticonvulsants.It is prescribed for convulsions and muscle spasms.
Drug therapy is prescribed only after a complete examination and identification of the cause of cervical pain.
Preventing neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (illumination, monitor level, distance of the monitor to the eyes and other parameters must meet generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia;do not allow sudden bending or tilting of the head, etc.
- Watch your posture, including when working at the computer.
- During breaks, do exercises to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleeping, it is better to use not a high, but an ordinary or even better orthopedic pillow.
- Correct body weight.
- Get medically checked in a timely manner.
Adherence to preventive measures will help maintain health and well-being for many years.Visiting a doctor at the first signs of pathological symptoms and timely treatment will help to avoid chronicling the process and the development of complications.