Neck pain is a problem that almost everyone has encountered.This is the most mobile and fragile part of the spine, and pain syndromes of varying intensity can occur for completely different reasons.Neck pain rarely indicates a serious illness.However, periodically recurring and persistent neck pain should be a signal to look for the cause of this condition.
It is most often muscle pain;the cause can also be degenerative changes in the spine, injuries and other (non-vertebrogenic) causes: angina, infectious, endocrine, rheumatic, oncological diseases, lymph node pathology, etc.
Neck pain may be accompanied by dizziness, weakness, headaches, muscle spasms, pain and numbness in the arms, etc.
Classification, types and nature of pain syndromes
There are several classifications of neck pain:
- Depending on the duration of its evolution, it can be acute (less than 4 weeks), subacute (1 to 4 months) and chronic (more than 4 months).
- Depending on the nature of the pain syndrome, aching, dull, throbbing pain is distinguished.
- Depending on the location, pain is distinguished in the anterior, posterior and lateral parts of the neck.When the pain radiates towards the head, we speak of cervicocranialgia and towards the shoulder, cervicobrachialgia.
- Due to their occurrence, all neck pain can be divided into 2 large groups - vertebrogenic and non-vertebrogenic:
- Vertebrogenic: occurs as a result of diseases, injuries of the spine.This is the most common group of causes of neck pain.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial, musculo-tonic syndromes, myositis, cervical myopathy, poor posture, etc.
- Non-vertebrogenic: caused by other reasons (myocardial ischemia, infectious, endocrine, oncological diseases, lymph node damage, rheumatism, etc.).
Let's look at the individual reasons in more detail.
Causes that cause neck pain
Injuries (fractures, whiplash)
The whiplash mechanism is associated with a sharp curvature of the neck forward or backward 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 hernias.
There are complaints of neck pain, radiating to the shoulders, head, and interscapular area;restriction of movements;dizziness;nausea.M.b.vision problems, swallowing (dysphagia).
Other injuries that can cause include bruising, sores and muscle strain in the neck.The consequences of a traumatic injury can be neck pain, migraine, muscle spasms, reduced neck mobility, fatigue and impaired vision.
Dystrophic diseases of the spine
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the joints of the spine, due to decreased elasticity, flattening and destruction of intervertebral discs.
The damping function of the discs is gradually impaired.This leads to an increase in the load on the intervertebral (facet) joints, osteoarthritis, radiculopathy - a pain syndrome due to pinching of nerve roots by bony growths (osteophytes) and tension in the neck muscles.When the vertebral arteries are compressed, noises in the ears, flickering spots in front of the eyes, blurred vision and dizziness occur.
Little by little, the intervertebral discs lose their elasticity.When they are compressed, a protrusion (protrusion) occurs in the spinal canal with subsequent formation of a hernia.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 arms, legs and scalp is impaired with the development of numbness and paresthesias.Weakness appears in the hands, tendon reflexes change.
The pain is one-sided, throbbing in nature, increases when tilting to the painful side, throwing the head back, so the patient intuitively tilts his head forward and to the side opposite to the location of the pain.Osteochondrosis can be accompanied by cervicobrachialgia;cervico-cranialgia.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) form at the edges of the vertebral bodies.At the same time, the size of the intervertebral discs decreases.When adjacent vertebrae fuse, neck mobility is limited.
With spondylolisthesis, displacement (slippage) of the overlying vertebra occurs relative to the underlying vertebra.This pathology is manifested by pain in the localization area.The diagnosis is confirmed by radiography.
Muscle syndromes
Muscle pain – myofascial syndrome
Long-term overstrain of the neck muscles, ligament sprains and local hypothermia lead to muscle pain.They are accompanied by limited mobility and spasms of the neck muscles.When you palpate (feel) the muscles, they are tight and painful.
The pain syndrome of myofascial syndrome is of moderate intensity, short duration, intensifies with neck movements and disappears on its own if not treated.
Musculotonic syndrome (muscle spasm of the cervicothoracic region)
Clinically manifested by prolonged and persistent muscle tension, their reflex contraction - muscle spasm.Muscles become dense to the touch, swollen and painful.
Trigger points form - areas of most pronounced pain.Neck pain intensifies when turning the head, flexion and extension of the cervical spine.This may be accompanied by numbness in the fourth and fifth fingers.
Mosite
With neck myositis, inflammation of muscle fibers develops.The disease most often occurs against the background of hypothermia.It manifests itself by intense pain during movements and an alteration in muscle tone.Due to the difference in muscle tone, the head tilts to one side and a secondary torticollis forms.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by a decrease in contractility of myofibrils, progressive muscle weakness, limitation of movements, decreased tone and the development of muscle atrophy with subsequent replacement of muscle fibers with adipose or connective tissue.
Cervical plexitis
Cervical plexitis is a disorder of the cervical nerve plexus.Most 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, paresthesias - a violation of sensitivity in the form of numbness, burning, tingling.
Bad posture
Posture is disrupted when a person spends a lot of time at the computer or is in another monotonous position.Predisposing factors also include using a pillow that is too soft or too high to sleep on.With poor posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a curvature is formed.
Other reasons
Pain in the neck can also be caused by other non-vertebrogenic causes, for example, coronary heart disease (coronary artery disease. In the 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 cases of meningitis (inflammation of the soft meninges), neck and head pain are accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed with meningismus.To differentiate between these conditions, a spinal puncture is performed.
Cervical lymphadenitis, or enlarged cervical lymph nodes, is the most common cause of neck 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 in oncological pathology.The pain intensifies when swallowing, palpation (palpation) of the lymph nodes.
Neck pain may accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease begins 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.With this disease, individual vertebrae can fuse.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, primarily in exposed areas of the body.
- Scleroderma includes fibrous-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Neck pain is observed with torticollis, an orthopedic disease with deviation of the neck from the vertical axis.This congenital malformation is diagnosed in early childhood and is more common 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 esophageal lining); atherosclerosis; Reiter's syndrome; foreign bodies.
In case of pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is associated with an increase in body temperature, a feeling of heat, increased sweating, increased heart rate, increased irritability and tearing eyes.
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 deficiency of minerals (mainly calcium, phosphorus) and vitamins (D 3), bone loss develops (osteoporosis). The risk of occurrence increases in women during menopause.Osteoporosis of the cervical spine is accompanied by neck pain.
Tracheitis is characterized by increased pain when coughing, while esophagitis is characterized by increased pain when eating.
With atherosclerosis (damage to the walls of large arteries with the formation of atherosclerotic plaques that interfere with normal blood circulation) and other vascular pathologies, neck pain is associated 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 mycoplasma infection and has a chronic course.
Location of neck pain: what problems do they indicate?
Localization of pain allows you to correctly determine the cause of neck pain and take the necessary measures in time.
The main causes of pain in the front of the neck are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.Pain in the neck intensifies when swallowing, accompanied by redness of the skin on the anterior side of the neck, an increase in temperature to feverish levels (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is aching, pulling, radiating towards the neck and spine.
- Cervical lymphadenitis.
- Atypical form of ischemic heart disease.
- Tracheitis, esophagitis.
- Compression fractures of the cervical vertebrae.
Causes of neck pain:
- Osteochondrosis, disc protrusion, vertebral herniation, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Vertebral tuberculosis.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of the cervical vertebral bodies, fracture of the arches and processes of the vertebrae.
Pain on the side of the neck may occur with atherosclerosis;myofascial syndrome;foreign body;tumor process in the pharynx, larynx and thyroid gland.Lateral neck pain can lead to secondary torticollis because the patient always tries to tilt the head to the painful side.
Who to contact if you have neck pain
A therapist, pediatrician or neurologist will help you with neck pain.If 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.
Diagnosis of the disease, tests and examinations
To determine the cause of neck pain, the doctor examines the patient, asks about existing complaints, specifies the duration of the symptom, the nature of the pain, its location, irradiation, combination with other symptoms and performs palpation.Determining the cause of neck pain is important for proper treatment.
If necessary, the following are prescribed:
- consultation of restricted specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectric activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of transmission of nerve impulses along peripheral nerve fibers).
- Cervical spine x-ray, CT scan, MRI;
- myelography – contrast radiography of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound examination) of the salivary glands, thyroid gland;double-sided scanning (to assess the condition of blood vessels and blood flow).
Treatment methods
Treatment of neck pain must be comprehensive.There are conservative treatments aimed at relieving muscle pain, spasms, stopping the inflammatory process and surgical interventions carried out to stabilize the spine and ensure the outflow of pus.
Conservative treatment methods:
- Drug therapy.Prescribed only by a specialist doctor, self-medication is unacceptable!For muscular syndromes, it can be either local therapy (use of anesthetic ointments, gels) or the use of systemic medications aimed at relieving muscle pain and spasms.
- Physiotherapeutic methods of influence.These include magnetotherapy, phonophoresis, electrophoresis with medicinal substances, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite applications and others.
- Exercise therapy.The set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps to strengthen the muscles of the neck, back and form correct posture.
- Massage.It can be performed separately or in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.Helps relieve muscle tension, pain and remove blockages.
Important: physiotherapy, massage, manual therapy are contraindicated during the acute period of pain, as well as in case of injuries!
- Reflexology or influence of acupuncture points using needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will differ depending on the pathologies.
- Orthopedic techniques.This involves immobilization using a bandage or a Chance collar.It is performed for compression fractures of the cervical vertebrae, in the acute period for muscular syndromes, osteochondrosis.
- Taping or kinesio taping is the application of special patches (strips) to the skin of the neck.It is used to relieve pain, swelling, eliminate muscle spasms and pinched nerve endings, improve blood and lymphatic circulation and restore after injuries and operations.The strip application schemes differ depending on the pathologies.Depending on the method of application, the strips improve lymphatic drainage, have an anti-inflammatory and analgesic effect, normalize muscle tone and stabilize joints.
Surgical treatment is carried out for spinal hernias (if conservative treatment is ineffective), neoplasms, abscesses, cellulitis and foreign bodies in the neck.
What medications to treat
Non-vertebral syndrome is treated by specialists;each group of causes has its own therapy.To relieve neck muscle pain, the following groups of drugs are used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the enzyme cycloxygenase (COX).There is COX 1 and COX 2. The 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 with selective action on COX 2.
- Local anesthetics.They are injected into the exit area of the nerves (blockade).
- Muscle relaxers.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling and pain.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 and mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.Improve the trophism (nutrition) of cartilage tissue, promote cartilage regeneration.
- Anticonvulsants.Prescribed for convulsions and muscle spasms.
Drug treatment is prescribed only after a complete examination and identification of the cause of neck pain.
Preventing neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Organize your workplace correctly (lighting, monitor level, distance from the monitor to the eyes and other parameters should comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia;do not allow sudden bending or tilting of the head, etc.
- Monitor your posture, including when working on the computer.
- During breaks, do therapeutic exercises to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleeping, it is better to use not a high pillow, but a regular orthopedic pillow, or even better.
- Correct body weight.
- Undergo a timely medical examination.
Compliance with preventive measures will help maintain health and well-being for many years.Consulting a doctor at the appearance of the first signs of pathological symptoms and timely treatment will help avoid the chronicity of the process and the development of complications.