NECK / CERVICAL PROBLEMS

CERVICAL SPONDYLOSIS

  • The condition also known as the arthritis of neck, is usually described as the result of degeneration of the intervertebral discs in the cervical spine.
  • It may be also caused by bony overgrowth which results in pinching of the adjacent nerve roots, physical inactivity, disc herniation, ligamentous instability, traumatic injury, as a result of overuse injury, history of faulty posture, or prolonged immobilization after injury

Possible Characteristics:

  • Cervical pain aggravated by movement like coughing/ sneezing/ moving neck backwards or rotation of neck , referred pain over the shoulder blade, cervical stiffness, numbness or tingling sensation down the hand or muscular weakness in upper limb, dizziness or vertigo, frequent headaches and may be poor balance.
  • In some cases this degeneration leads to posterior protrusion of the annulus fibres of the intervertebral disc. Protrusion can cause compression of the nerve roots, motor disturbances, muscular weakness.

Treatment-

  • Electrotherapy modalities
  • Cranio-osteopathy
  • Specific manual therapy techniques
  • Soft tissue manipulation
  • Nerve stretching
  • Core muscle strengthening
  • Postural ergonomics
  • Functional re-education

CERVICAL STENOSIS

  • Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord or the nerve roots, and is most frequently caused as a result of aging or bony overgrowth.
  • The space between the vertebrae shrinks and the discs lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken resulting in wear and tear of the cartilage.
  • Common symptoms include neck or arm pain, numbness or tingling sensation in hands, muscular weakness, unsteady gait when walking, loss of coordination, poor reflexes, bladder and bowel incontinence or even paralysis if left untreated.

Treatment-

  • Electrotherapy modalities
  • Postural re-education
  • Strength and flexibility training
  • Gait training
  • Balance training
  • Manual therapy techniques

CERVICAL NERVE ROOT IMPINGEMENT

    Causes-

    • Spinal stenosis
    • Disc herniation (C5-C6 or C6-C7 are most common)
    • Chronic muscular tension/ facet joint syndrome
    • Ligamentous instability
    • Traumatic injury

    Symptoms-

    • Radiating pain in the upper extremity (shoulders, arms, forearms or hands)
    • Sharp, shooting pain increased at night
    • Pain over the shoulder blade
    • Trapezius spasm
    • Numbness/ tingling sensation in one or both hands
    • Vertigo or dizziness
    • Frequent headaches
    • Motor weakness

    Treatment-

    • Electrotherapy modalities
    • Soft tissue manipulation
    • Neuro-dynamics
    • Postural re-education
    • Core rehabilitation
    • Manual therapy techniques

SPRAIN/STRAIN SYNDROME

    Inflammation from sprain (ligaments) /strain (muscles) may irritate nerve roots in close anatomical orientation to affected area and may produce neurological symptoms.

    Strain to the posterior cervical , scapular, and upper thoracic muscles and fascia is common with postural stresses such as prolonged sitting at a computer terminal.

    It results in painful neck movements specially rotation or coupling movements. Pain may be referred to shoulder.

    Treatment-

    • Electrotherapy modalities
    • Cryotherapy
    • Gentle range of motion exercises
    • Stretching
    • Postural ergonomics
    • Functional rehabilitation

COMPRESSION FRACTURE

    Any excessive compression loads usually causes end-plate or vertebral body fractures resulting in reduced vertebral height. Pain may occur with or without nerve root involvement which may be referred pain in the extremities.

    In some cases, the fracture may lead to paralysis.

    Treatment-

    • Electrotherapy modalities
    • Gentle isometric exercises
    • Postural ergonomics
    • Functional re-education

FACET JOINT/ JOINT CAPSULE INJURY

    This usually occurs after any kind of trauma like falling or a motor vehicle accident.

    SYMPTOMS:

    • Joints swelling (effusion)
    • Limited range of motion
    • Muscle guarding (spasm)
    • The swelling may cause foraminal stenosis and neurological symptoms.
    • Persisting point tenderness
    • Painful neck movements
    • Morning stiffness

    Treatment-

    • Electrotherapy modalities
    • Cervical manipulation
    • Rehabilitation protocol
    • Strength training
    • Postural re-education

VERTIGO

    Vertigo is being disoriented or a feeling of head spinning around, swayed or being pulled in one direction while the person is standing or sitting still. It is often a complication of cervical spondylosis where the C1 & C2nerve roots which supplies the brain gets pinched resulting in compromised blood flow to the brain.

    It may be accompanied by nauseating feeling, dizziness, abnormal or jerking eye movements, frequent headaches.

    Treatment-

    • Cervical manipulation
    • Cranial osteopathy
    • Postural ergonomics
    • Functional rehabilitation

UPPER CROSSED SYNDROME

    It is a result of muscular imbalances in the neck and shoulder region which creates joint dysfunction generally at atlanto-occipital joint, gleno-humeral joint, cervico-thoracic joint, C4-C5 segment, T4-T5 segment. It is mostly found in people who have prolonged sitting jobs, or who work for long hours on computers/laptops. This instability exhibits poor postural changes like forward head posture, increased cervical lordosis (curve) or thoracic kyphosis (hunch-back), elevated or protracted shoulders, rotation of scapula.

    Treatment-

    • Postural correction
    • Manual therapy techniques
    • Correct muscular imbalances
    • Postural ergonomics
    • Strengthening and flexibility training

MECHANICAL NECK PAIN

    Mechanical neck pain is often caused by overuse injury of the muscles or the poor posture leading to muscular instability. The pain does not radiate to arms, it remains localised to neck, or shoulders

    Symptoms-

    • Morning stiffness
    • Painful movements especially bending and rotation
    • Muscular spasm
    • Cervicogenic headache
    • Heaviness over the shoulder blade
    • Localised tenderness

    Treatment-

    • Electrotherapy modalities
    • Soft tissue manipulation
    • Strength and flexibility training
    • Mobilisation of cervical spine
    • Postural ergonomics
    • Functional rehabilitation

TORTICOLLIS

    A condition characterised by tightness or spasm of sternocleidomastoid, trapezius and other neck muscles prominent on one side more than other resulting in twisted/tilted posture of neck which gets fixed if left untreated.

    It may be a result of trauma, present by birth or due to structural changes. The head appears to be tilted on one side and chin on the opposite side.

    It causes muscular tightness, headaches, shoulder pain, uneven shoulder levels, swollen lymph nodes.

    Treatment-

    • Electrotherapy modalities
    • Heat therapy
    • Stretching
    • Manual traction
    • Strengthening of weak muscle group
    • Functional re-education

TRAPEZIUS SPASM

    Muscular spasm is a result of overuse injury or muscle strain leading to compromised blood flow to that muscle because of stiffness

    Symptoms-

    • Restricted and painful neck movements
    • Stiffness in neck
    • Heaviness over shoulders
    • Pain may extend to mid back
    • Cervicogenic headaches

    Treatment-

    • Electrotherapy modalities
    • Stretching
    • Manual therapy techniques
    • Ischaemic compression
    • Postural ergonomics
    • Cryotherapy
    • Strength training

TEXT-NECK SYNDROME

    "Text-Neck Syndrome" also known as "Facebook-Whatsapp Syndrome" is now-a-days very common caused due to repetitive strain injury or overuse injury. The neck remains hanging down (forwards) while looking at the phones or wireless devices for a extended period of time causing neck pain and soreness.

    Symptoms-

    • Mechanical neck pain
    • Stiffness in neck, shoulders or upper back
    • Cervicogenic headache
    • Muscular spasm
    • Sharp, nagging pain
    • Cervical Instability
    • May result in pinched nerve leading to radiating pain down the arms
    • Poor posture
    • Straightening of cervical spine

    Treatment-

    • Electrotherapy modalities
    • Cryotherapy
    • Soft tissue manipulation
    • Joint mobilisation
    • Neck stabilisation exercises
    • Manual therapy
    • Strength and flexibility training
    • Functional re-education
    • Postural ergonomics

STRAIGHTENING OF CERVICAL SPINE

    In patients with neck pain, generally instability or biomechanical changes causes loss of normal cervical lordosis resulting in straightening of cervical spine which may affect blood flow to the brain and leads to faster degeneration of the intervertebral discs due to increased weight transfer.

    Treatment-

    • Postural ergonomics
    • Strengthening protocol
    • Osteopathic and chiropractic manipulation
    • Manual therapy techniques
    • Joint mobilisation
    • Functional re-education

THORACIC OUTLET SYNDROME

    The condition characterised by the compression of the nerves or blood vessels or both between the collar bone (clavicle) and first rib. It may be caused due to repetitive injury or sports injury, pregnancy, anatomical defects like presence cervical rib (extra), heavy weight lifting, tumours in chest or trauma.

    Symptoms-

    • Pain and stiffness in neck and shoulders
    • Painful movements
    • Numbness or tingling sensation in arms
    • Cold extremities
    • Impaired circulation to extremities leading to discoloration
    • Weak or no pulse in affected arm
    • Blood clots in veins or arteries in upper areas of body
    • Muscular weakness

    Treatment-

    • Electrotherapy modalities
    • Cervical manipulation
    • Postural ergonomics
    • Strength training
    • Weight reduction
    • Functional re-education

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