Neck pain is a problem that almost everyone has encountered.This is the most mobile and fragile part of the spine, and painful syndromes of different intensity can appear for completely different reasons.Neck pain rarely indicates a serious illness.However, recurrent periodic cervicalgia, which is persistent, should be a signal to seek the cause of this condition.
Most often these are muscle pains;Degenerative changes in the spine, injuries and other (invertebrogenic) causes can also be the cause: 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 arms, etc.
Classification, types and nature of pain syndromes
There are several classifications of cervicalgia:
- According to the duration of its course, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- According to the nature of the pain syndrome, aching, dull, shooting pain is distinguished.
- According to the location, 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 in the shoulder - about cervicobrachialgia.
- Due to their appearance, all neck pains can be divided into 2 large groups - vertebrogens and non-vertebrogens:
- Vertebrogenic: occur as a result of diseases, injuries of the spine.This is the most common group of causes of cervicalgia.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial, muscular-tonic syndromes, myositis, cervical myopathy, bad posture, etc.
- Non-vertebrogenic: caused by other reasons (myocardial ischemia, infectious, endocrine, oncological diseases, damage to the lymph nodes, rheumatism, etc.).
Let's look at the individual reasons in more detail.
Causes of neck pain
Injuries (fracture, whiplash)
The mechanism of whiplash injury is associated with a sharp bending 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, stretching of the tendon-ligament apparatus and muscles, destruction of the vertebrae (compression fractures) and intervertebral discs, subluxations and dislocations of the cervical vertebrae and the formation of hernias occur.
There are complaints of pain in the neck, radiating to the shoulders, head and interscapular area;restriction of movements;dizziness;mixed.M.b.impaired vision, swallowing (dysphagia).
Other injuries they can cause include bruises, lacerations and strained neck muscles.Consequences of traumatic injury can be cervicalgia, migraines, muscle spasms, impaired 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 that occur due to a decrease in elasticity, flattening and destruction of the intervertebral discs.
The shock-absorbing function of the discs is gradually impaired.This leads to an increase in the load on the intervertebral joints (facets), arthrosis, radiculopathy - pain syndrome due to compression of the nerve roots by bone growths (osteophytes) and tension in the neck muscles.When the vertebral arteries are compressed, there is ringing in the ears, flickering of the spots before the eyes, blurred vision and dizziness.
Gradually, the intervertebral discs lose their elasticity.When they are compressed, a protrusion occurs in the spinal canal with the further 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 head is impaired with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is unilateral, shooting in nature, increases when leaning to the painful side, throwing the head back, so the patient intuitively bends the head forward and to the side opposite to the location of the pain.Osteochondrosis can be associated with cervicobrachialgia;cervicocranialgia.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) are formed at the ends of the vertebral bodies.At the same time, there is a decrease in the size of the intervertebral discs.When the adjacent vertebrae are fused, the mobility of the neck is limited.
With spondylolisthesis, displacement (slippage) of the upper vertebra occurs in relation to the lower one.This pathology is manifested as pain in the location area.The diagnosis is confirmed by x-ray.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term overload of neck muscles, sprain of ligaments and local hypothermia lead to muscle pain.They are accompanied by limited movement and spasms of the neck muscles.When they palpate (feel) the muscles, they feel tight and sore.
The pain syndrome in myofascial syndrome is of moderate intensity, short-lived, intensifies with neck movements and goes away on its own if not treated.
Muscular-tonic syndrome (muscle spasm of the cervicothoracic region)
It is clinically manifested by prolonged and continuous muscle tension, their reflex contraction - muscle spasm.The muscles become dense to the touch, swollen and painful.
Trigger points are formed - areas with more pronounced pain.Cervicalgia intensifies during turning of the head, flexion and extension of the cervical spine.It may be accompanied by numbness of the fourth and fifth fingers.
Don't move
With myositis of the neck, inflammation of the muscle fibers develops.The disease most often appears against the background of hypothermia.It appears as severe pain during movements and impaired muscle tone.Due to the change 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, decreased tone and the development of muscle atrophy with the subsequent replacement of muscle fibers with fatty or connective tissue.
Cervical plexitis
Cervical plexitis is a disorder of the cervical nerve plexus.It most often 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 you cough, talk and is accompanied by a crawling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Bad attitude
The posture is disturbed when a person spends a long 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 bend is formed.
Other reasons
Neck pain can also be caused by other non-vertebrogenic causes, for example, coronary artery disease (coronary heart 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.
With 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 with meningism.To distinguish between these conditions, a spinal tap is performed.
Cervical lymphadenitis, or enlarged cervical lymph nodes, is the most common cause of cervicalgia (about 50% of all cases) in children.This symptom appears in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathologies.The pain intensifies during swallowing, palpation (palpation) of the lymph nodes.
Neck pain can 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 together.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in exposed areas of the body.
- Scleroderma includes fibro-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Cervicalgia 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), phlegm (inflammation of soft tissues without clear boundaries); pathology of the thyroid gland; salivary glands; plexitis; osteoporosis; tracheitis (inflammation of the mucous membrane of the trachea); esophagitis (inflammation of the lining of the esophagus); atherosclerosis; Reiter's syndrome; foreign bodies.
With pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is combined with increased body temperature, a feeling of heat, increased sweating, increased heart rate, increased irritability and tearfulness.
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 women during menopause.Osteoporosis of the cervical spine is associated with cervicalgia.
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 prevent 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 mycoplasma infection and has a chronic course.
Localization of neck pain - what problems do they indicate?
Localization of pain helps in determining the exact cause of cervicalgia and taking the necessary measures in time.
The main causes of anterior neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- Retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.Pain in the neck intensifies during swallowing, accompanied by reddening of the skin on the front surface of the neck, temperature rise to febrile levels (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is aching, pulling, radiating in the neck and back.
- 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.
- Compressive fractures of the cervical vertebral bodies, fractures 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 pharynx, larynx, thyroid gland.Cervicalgia on the side can lead to secondary torticollis, since the patient always tries to tilt the head to the painful side.
Who to contact for neck pain
A therapist, pediatrician or neurologist will help with neck pain.If neck pain is caused by 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, tests and examinations
To determine the cause of cervicalgia, the doctor examines the patient, asks him about the existing complaints, explains the duration of the symptoms, the nature of the pain, its localization, radiation, the combination with other symptoms and performs palpation.Determining the cause of cervicalgia is important for proper treatment.
If necessary, the following is recommended:
- consultation of close specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectrical activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of nerve impulse transmission along peripheral nerve fibers).
- X-ray of the cervical spine, CT, MRI;
- myelography - radiograph with contrast of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound examination) of salivary glands, thyroid gland;duplex scan (to assess the condition of blood vessels and blood flow).
Treatment methods
Treatment of cervicalgia should be comprehensive.There are conservative treatments aimed at relieving muscle pain, spasms, stopping the inflammatory process and surgical interventions performed to stabilize the spine and ensure the exit of pus.
Conservative treatment methods:
- Drug therapy.Prescribed only by a medical specialist, self-medication is unacceptable!For muscle syndromes, this can be either local therapy (the use of anesthetic ointments, gels) or the use of systemic drugs aimed at relieving pain and muscle spasms.
- Physiotherapy methods of influence.These include magnetotherapy, phonophoresis, electrophoresis with medicinal substances, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (modulated sinusoidal currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite application 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 the correct posture.
- Massage.It can be performed either alone or 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: exercise therapy, massage, manual therapy are contraindicated during the acute period of pain, as well as in case of injuries!
- Reflexology or the influence of acupuncture points using needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will vary for different pathologies.
- Orthopedic techniques.This is immobilization using a Chance bandage or collar.It is done for compression fractures of the cervical vertebrae, in the acute period for muscle 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 circulation and lymphatic flow, and restore after injuries and operations.Schemes for the application of tapes differ for different 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 performed for spinal hernias (if conservative therapy is ineffective), neoplasms, abscesses, cellulitis and foreign bodies in the neck.
What drug to treat
Non-vertebral syndrome is treated by specialists;each group of causes has its own therapy.To relieve muscle pain in the neck, the following groups of drugs are used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the cyclooxygenase (COX) enzyme.There are COX 1 and COX 2. The use of NSAIDs is symptomatic therapy aimed at relieving pain and other signs of inflammation.To reduce the risk of side effects, the use of NSAIDs with selective action on COX 2 is recommended.
- Local anesthetics.They are injected into the area where the nerves exit (blockade).
- Muscle relaxants.It helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).It 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 complex of vitamins and minerals recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.Improves trophism (nutrition) of cartilage tissue, promotes cartilage regeneration.
- Anticonvulsants.Prescribed for convulsions and muscle spasms.
Drug therapy is prescribed only after a complete examination and identification of the cause of cervicalgia.
Prevention of neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (illumination, monitor level, monitor distance from the eyes and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid currents, hypothermia;do not allow sudden bending or tilting of the head, etc.
- Watch your posture, including computer work.
- During the holidays, do exercise therapy to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- To sleep, it is better to use not a high pillow, but a regular orthopedic pillow, or even better.
- Correct body weight.
- Carry out a medical examination at the right time.
Following preventive measures will help maintain health and well-being for many years.Seeing a doctor when the first signs of pathological symptoms appear and timely treatment will help to avoid the chronicity of the process and the development of complications.