Neck pain is a problem that almost everyone has encountered.This is the most mobile and vulnerable part of the spine, and pain syndromes of different intensity can develop for completely different reasons.Neck pain rarely indicates a serious illness.However, periodically recurring cervical pain that is persistent can serve as a clue to uncover the cause of this condition.
Most often these are muscle pains;degenerative changes of the spine, injuries and other (non-vertebrogenic) 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, arm pain and numbness, etc.
Classification, types and nature of pain syndromes
There are several classifications of cervicalgia:
- Depending on 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.
- Depending on the location, the pain can be distinguished in the front, back and side of the neck.When the pain radiates to the head, they speak of cervicocranialgia, and to 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 and spinal injuries.This is the most common group of causes of cervicalgia.According to statistics, more than 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.
- Not vertebrogenic: caused by other causes (myocardial ischemia, infectious, endocrine, oncological diseases, damage to lymph nodes, rheumatism, etc.).
Let's look at each reason in more detail.
Causes of neck pain
Injuries (fractures, whiplash)
The mechanism of injury caused by whiplash involves a sharp bending of the neck forward or backward, followed by a further kickback in the opposite direction.This type of injury is typical for accidents.In this case, the tendon-ligamentous apparatus and muscles are stretched, the vertebrae are destroyed (compression fractures) and the intervertebral discs, subluxations and displacements of the cervical vertebrae, and the formation of hernias occur.
There are complaints of neck pain radiating to the shoulders, head and interscapular area;restriction of movement;dizziness;nausea.m.b.visual impairment, swallowing (dysphagia).
Other injuries that can cause bruises, cuts and strained neck muscles.The consequences of a traumatic injury can be cervicalgia, migraine, muscle spasm, impaired movement 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 the decrease in elasticity, flattening and destruction of the intervertebral discs.
The shock-absorbing function of the disks is gradually impaired.This leads to an increase in the load on the intervertebral (facet) joints, arthrosis, radiculopathy - a pain syndrome caused by pinching of the nerve roots by bone growths (osteophytes), as well as tension in the neck muscles.When the vertebral arteries are compressed, there is noise in the ears, flickering of the spots in front of the eyes, blurred vision and dizziness.
Gradually, the intervertebral discs lose their elasticity.When compressed, a protrusion (elevation) is formed in the spinal canal, with further herniation.This leads to compression and pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome intensifies, the sensitivity of the arms, legs and scalp deteriorates, with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is one-sided, shooting in nature, intensifies when tilting to the painful side, when the head is thrown back, so the patient intuitively bends his head forward and to the side opposite to the location of the pain.Osteochondrosis can be accompanied by cervicobrachialgia;cervicocranial pain.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) develop at the edges of the vertebral bodies.At the same time, the size of the intervertebral discs decreases.When adjacent vertebrae are fused, neck mobility is limited.
In the case of spondylolisthesis, displacement (slippage) of the overlying vertebra occurs compared to the underlying vertebra.This pathology manifests itself as pain in the area of localization.The diagnosis is confirmed by an X-ray.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term overexertion of the neck muscles, ligament sprains and local hypothermia lead to muscle pain.They are accompanied by limited movement and spasm of the neck muscles.When the muscles are palpated (palpated), they feel tension and pain.
The pain syndrome in myofascial syndrome is of moderate intensity, lasts for a short time, intensifies as a result of neck movements, and goes away on its own without treatment.
Muscle tone syndrome (muscle spasm of the cervicothoracic region)
Clinically, prolonged and persistent muscle tension and their reflex contraction - muscle spasm - manifests.The muscles become dense to the touch, swollen and painful.
Trigger points are formed - areas of the most pronounced pain.Cervicalgia intensifies when turning the head, bending and extending the cervical spine.It may be accompanied by numbness in the fourth and fifth fingers.
Please
In the case of cervical myositis, inflammation of the muscle fibers develops.The disease most often occurs against the background of hypothermia.It manifests itself as severe pain during movement and muscle tone disorders.Due to the difference in muscle tone, the head tilts to the 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, limited movement, reduced tone and the development of muscle atrophy, followed by the replacement of muscle fibers with fat or connective tissue.
Cervical plexitis
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 on the anterolateral surface of the neck and radiates to the ears, chest, and back of the head.The pain intensifies during coughing and speaking, and is accompanied by a crawling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Bad posture
Posture breaks when a person spends a long time in front of a computer or is in another monotonous position.Predisposing factors include using a pillow that is too soft or too high for sleeping.In case of bad posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a hunchback is formed.
Other reasons
Neck pain can also be caused by other, non-vertebrogenic causes, such as coronary artery disease (coronary artery disease. In an atypical form, the pain may radiate to the neck, left arm, shoulder. This disease is characterized by changes in the ECG. Clinical symptoms include chest heaviness, shortness of breath, weakness with minimal physical activity.
In case of meningitis (inflammation of the soft meninges), pain in the neck and head is accompanied by neck stiffness, fever and vomiting.A similar clinical picture can be observed with meningism.A spinal tap is performed to distinguish between these conditions.
Cervical lymphadenitis, or enlarged cervical lymph nodes, is the most common cause (about 50% of cases) of cervicalgia in children.This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathologies.The pain increases when 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 include:
- 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, which is an orthopedic disease with a deviation from the vertical axis of the neck.This congenital disorder is diagnosed in early childhood and is more common in girls.
Neck pain accompanies neoplastic 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 mucous membrane of the trachea); esophagitis (inflammation of the mucous membrane of the esophagus); arteriosclerosis; Reiter's syndrome; foreign bodies.
The pain syndrome is combined with the pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis) with increased body temperature, feeling of heat, increased sweating, increased heart rate, increased irritability and lacrimation.
Sialadenitis is inflammation of the salivary glands.The pain intensifies during chewing and swallowing.There is swelling at the site of the salivary glands, dry mouth, weakness, chills and fever.
In the absence of minerals (primarily calcium, phosphorus) and vitamins (D3), osteoporosis develops. The risk of its occurrence increases during menopause in women.Osteoporosis of the cervical spine is accompanied by cervicalgia.
Tracheitis is characterized by increased pain during coughing, while esophagitis is characterized by increased pain during eating.
In the case of atherosclerosis (damage to the walls of large arteries with the formation of atherosclerotic plaques that obstruct normal blood flow) and other vascular pathologies, neck pain is combined with dizziness and tinnitus.
Reiter's syndrome is a set of symptoms that manifests itself in the classic triad: damage to the urogenital 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 to correctly determine the cause of cervical pain and take the necessary measures in time.
The main causes of anterior neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue in the pharyngeal space.The pain in the neck intensifies when swallowing, it is accompanied by redness on the front surface of the neck, and the temperature rises to a feverish level (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is aching, pulling, radiating to the neck and spine.
- Cervical lymphadenitis.
- An atypical form of ischemic heart disease.
- Tracheitis, esophagitis.
- Compression fractures of the cervical vertebrae.
Causes of neck pain:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Spinal tuberculosis.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of cervical vertebral bodies, fracture of vertebral arches and processes.
Pain in the side of the neck can occur with arteriosclerosis;myofascial syndrome;foreign body;tumor process in the pharynx, larynx, thyroid gland.Lateral cervicalgia can lead to secondary torticollis, as the patient always tries to tilt the head to the painful side.
Who should you contact for neck pain?
A therapist, pediatrician or neurologist can help with neck pain.If neck pain is caused by an injury, consult a traumatologist or surgeon.Depending on the cause of the pain, the therapist and pediatrician may also refer the patient to a specialist, such as a rheumatologist, infectious disease specialist, cardiologist, oncologist, or otolaryngologist.
Diagnosis of the disease, tests and examinations
To determine the cause of cervicalgia, the doctor examines the patient, asks about the existing complaints, clarifies the duration of the symptom, the nature of the pain, localization, irradiation, combination with other symptoms, palpation.Determining the cause of cervicalgia is important for proper treatment.
If necessary, the following are prescribed:
- consultation of narrow specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of the 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 - contrast radiography of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound examination) of the salivary glands and thyroid gland;duplex scanning (to assess the condition of blood vessels and blood flow).
Treatment methods
Treatment of cervicalgia should be comprehensive.There are conservative treatments aimed at alleviating muscle pain, spasms, stopping the inflammatory process, and surgical intervention to stabilize the spine and ensure drainage of pus.
Conservative treatment methods:
- Drug therapy.Self-medication only prescribed by a specialist is unacceptable!In the case of muscle syndromes, this can be 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, 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.Exercises are selected individually, depending on the cause of the pain.Gymnastics therapy helps to strengthen the muscles of the neck and back and to develop the correct posture.
- Massage.It can be performed separately or in combination with exercise therapy and manual therapy.It improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.It allows the release of muscle tension, pain and blocks.
Important: exercise therapy, massage, and manual therapy are contraindicated in the acute period of pain and in case of injuries!
- Reflexology or influencing acupuncture points with the help of needles, cauterization, hirudotherapy.The combination of points, the duration and number of procedures are different 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, in case of muscle syndromes, osteochondrosis.
- Taping or kinesio taping is the application of special patches (bands) to the skin of the neck.It is used to relieve pain and swelling, eliminate muscle spasms and pinched nerve endings, improve blood circulation and lymph flow, and recovery after injuries and surgeries.The scheme of applying tapes is different for different pathologies.Depending on the method of application, the tapes improve lymphatic drainage, have anti-inflammatory and pain-relieving effects, normalize muscle tone, and stabilize joints.
Surgical treatment is performed for spinal hernia (if conservative therapy is ineffective), tumors, abscesses, cellulitis and foreign bodies in the neck.
What drugs should be treated
Non-vertebral syndrome is treated by specialists;each group of causes has its own therapy.The following drug groups are used to relieve muscle pain in the neck:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the cyclooxygenase (COX) enzyme.There is COX 1 and COX 2. The use of NSAIDs is a symptomatic therapy aimed at relieving pain and other signs of inflammation.In order to reduce the risk of side effects, the use of NSAIDs with a selective effect on COX 2 is recommended.
- Local anesthetics.They inject 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).Reduces inflammation, tissue swelling and pain.It is usually used when NSAIDs are ineffective or in combination with them.
- Vitamin 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 bone fractures.
- Chondroprotectors.It improves the trophism (nutrition) of the cartilage tissue and promotes cartilage regeneration.
- Anticonvulsants.It is prescribed for spasms and muscle spasms.
Drug therapy is prescribed only after a full examination and identification of the cause of cervical pain.
Prevention of neck pain
In order to avoid neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (lighting, monitor level, monitor distance from 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.
- Pay attention to your posture, including when working in front of a computer.
- During breaks, do movement therapy to strengthen the muscles of the neck and shoulder girdle.
- Optimizes physical activity.
- For sleeping, it is better to use a normal, or even better, orthopedic pillow, rather than a high one.
- Correct body weight.
- Have a medical examination on time.
Taking preventive measures will help you maintain your health and well-being for many years.If you consult a doctor when the first signs of pathological symptoms appear, and timely treatment will help to avoid the process from becoming chronic and developing complications.