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 arise for completely different reasons.Neck pain rarely indicates a serious illness.However, cervical pain that recurs periodically and is persistent should be a signal to look for the cause of this condition.
In most cases it is muscle pain;The cause may also be degenerative changes in the spine, injuries and other (non-vertebrogenic) causes: angina pectoris, 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 course, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- Depending on the nature of the pain syndrome, aching, dull, stabbing pain is distinguished.
- Depending on the location, the pain is distinguished in the anterior, posterior and lateral part of the neck.When the pain radiates to the head, it is called cervicocranialgia and to the shoulder, it is called cervicobrachialgia.
- Due to their appearance, all neck pain can be divided into 2 large groups: vertebrogenic and non-vertebrogenic:
- Vertebrogenic - occur 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 syndromes, tonic-muscular syndromes, myositis, cervical myopathy, poor posture, etc.
- Non-vertebrogenic - caused by other reasons (myocardial ischemia, infectious, endocrine, oncological diseases, damage to 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 is associated with a sharp curvature of the neck forward or backward with greater recoil in the opposite direction.This type of damage is typical of an accident.In this case, there is a 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 pain in the neck, which radiates to the shoulders, head and interscapular zone;restriction of movements;dizziness;nausea.Megabyte.vision problems, swallowing (dysphagia).
Other injuries they can cause include bruises, wounds, and strained neck muscles.The consequences of a traumatic injury can be neck pain, migraine, muscle spasms, reduced neck mobility, fatigue and vision problems.
Dystrophic diseases of the spine.
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the joints of the spine that occur due to decreased elasticity, flattening and destruction of intervertebral discs.
The shock absorption function of the discs gradually deteriorates.This leads to an increased load on the intervertebral (facet) joints, arthrosis, radiculopathy, 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, noises in the ears, flashing spots before the eyes, blurred vision, and dizziness occur.
Little by little, the intervertebral discs lose their elasticity.When they are compressed, a protrusion (protrusion) occurs into 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 scalp is impaired with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is unilateral, stabbing in nature, increases when leaning towards the painful side, throwing the head back, so the patient intuitively tilts his head forward and to the side opposite to the place of pain.Osteochondrosis may be accompanied by cervicobrachialgia;cervicocranialgia.
Spondylosis often accompanies osteochondrosis.With this pathology, bone growths (osteophytes) form on the edges of the vertebral bodies.At the same time, a decrease in the size of the intervertebral discs occurs.When adjacent vertebrae fuse, neck mobility is limited.
With spondylolisthesis, a displacement (slip) of the overlying vertebra occurs in relation to the underlying one.This pathology manifests itself as pain in the location area.The diagnosis is confirmed by x-ray.
muscle syndromes
Muscle pain - myofascial syndrome
Prolonged overstrain of the neck muscles, sprained ligaments 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 feel tight and sore.
The pain syndrome in myofascial syndrome is of moderate intensity, short-lived, intensifies with neck movements and disappears on its own if untreated.
Muscle tonic syndrome (muscle spasm of the cervicothoracic region)
Clinically it is manifested by prolonged and persistent muscle tension, its reflex contraction: muscle spasm.The muscles become dense to the touch, swollen and painful.
Trigger points form, areas of more pronounced pain.Cervical pain intensifies when turning the head, flexion and extension of the cervical spine.It may be accompanied by numbness of the fourth and fifth fingers.
mosita
With myositis of the neck, inflammation of the muscle fibers develops.The disease most often occurs against the background of hypothermia.It manifests itself as intense pain during movements and altered 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 the contractility of myofibrils, progressive muscle weakness, limitation of movement, decreased tone and development of muscle atrophy with subsequent replacement of muscle fibers by 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 nape of the neck.The pain intensifies when coughing, talking and is accompanied by a tingling sensation, paresthesia, a violation of sensitivity in the form of numbness, burning and tingling.
bad posture
Posture is altered when a person spends a lot of time in front of the computer or is in another monotonous position.Predisposing factors also include using a pillow that is too soft or too high for sleeping.With poor posture, the load on the ligaments and muscles of the neck increases, the head moves forward and slouches.
Other reasons
Pain in the neck can also be caused by other non-vertebrogenic causes, for example, coronary artery disease (coronary artery disease. In the atypical form, the pain can radiate to the neck, left arm and shoulder. This disease is characterized by changes in the ECG. Clinical symptoms include heaviness in the chest, shortness of breath and weakness with minimal physical activity.
With meningitis (inflammation of the soft meninges), pain in the neck and head is accompanied by stiffness in the neck, fever and vomiting.A similar clinical picture is observed with meningism.To differentiate 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 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 debuts 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.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in exposed areas of the body.
- Scleroderma includes fibrosclerotic 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), phlegmons (inflammation of soft tissues without clear boundaries); pathology of the thyroid gland; salivary glands; plexites; osteoporosis; tracheitis (inflammation of the tracheal mucosa); esophagitis (inflammation of the esophageal mucosa); atherosclerosis; Reiter's syndrome; foreign bodies.
With pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), pain syndrome is combined with increased body temperature, feeling of heat, increased sweating, increased heart rate, increased irritability and crying.
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 (osteoporosis) develops. The risk of its 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.
In 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 symptom complex that is manifested by the classic triad: damage to the genitourinary system (urethritis + prostatitis), joints, conjunctivitis.Most often it is caused by mycoplasma infection and has a chronic course.
Location of neck pain: what problems do they indicate?
Localization of pain helps to correctly determine the cause of neck pain and take the necessary measures in time.
The main causes of frontal neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.The pain in the neck intensifies when swallowing, accompanied by redness of the skin on the front surface 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, and radiates 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 neck:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondyloarthritis.
- Spinal tuberculosis.
- Osteomyelitis.
- Reiter syndrome.
- Compression fracture of the cervical vertebral bodies, 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 neck pain can cause secondary torticollis, as the patient always tries to tilt the head towards the painful side.
Who to contact for neck pain
A therapist, pediatrician, or neurologist will help you with neck pain.If your neck pain is caused by an injury, 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, 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 neck pain is important for proper treatment.
If necessary, the following is prescribed:
- limited specialist consultation;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determining the bioelectric activity of muscles and neuromuscular transmission), electroneurography (determining the speed of transmission of nerve impulses along peripheral nerve fibers).
- Cervical spine x-ray, computed tomography, magnetic resonance imaging;
- myelography: contrast x-ray of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound examination) of the salivary glands, thyroid gland;duplex scanning (to assess the condition of blood vessels and blood flow).
Treatment methods
The treatment of neck pain must be comprehensive.There are conservative treatments aimed at relieving muscle pain, spasms, stopping the inflammatory process and a surgical intervention that is performed to stabilize the spine and ensure the drainage of pus.
Conservative treatment methods:
- Drug therapy.Self-medication, prescribed only by a specialist doctor, is unacceptable!For muscle syndromes, it can be local therapy (use of anesthetic ointments, gels) or the use of systemic medications aimed at relieving muscle pain and spasms.
- Physiotherapeutic influence methods.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 done separately or in combination with physical therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.It allows you to relieve muscle tension, pain and eliminate blockages.
Important: physiotherapy, massage and manual therapy are contraindicated during the acute period of pain, as well as in case of injuries!
- Reflexology or influence on acupuncture points using needles, cautery, hirudotherapy.The combination of points, duration and number of procedures will differ for different pathologies.
- Orthopedic techniques.This is immobilization using a bandage or a Chance collar.It is performed for compression fractures of the cervical vertebrae, in the acute period for muscle syndromes, osteochondosis.
- Bandage or kinesio taping is the application of special patches (tapes) to 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, and restore after injuries and operations.Tape application schemes differ according to different pathologies.Depending on the method of application, the tapes improve lymphatic drainage, have anti-inflammatory and analgesic effects, normalize muscle tone and stabilize the 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.To relieve muscle pain in the neck, the following groups of drugs are used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the enzyme cyclooxygenase (COX).There are 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 (block).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling and 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 and mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.Improve trophism (nutrition) of cartilage tissue, promote cartilage regeneration.
- Anticonvulsants.Prescribed for seizures and muscle spasms.
Drug therapy is prescribed only after a complete examination and identification of the cause of neck pain.
Prevent neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (lighting, monitor level, distance of the monitor from the eyes and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia;do not allow the head to bend or tilt suddenly, etc.
- Watch your posture, even while working at the computer.
- During breaks, do exercise therapy to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleep, it is better to use not a high pillow, but a regular or even better orthopedic pillow.
- Correct body weight.
- Undergo a medical examination in a timely manner.
Following preventative measures will help maintain health and well-being for many years.Consulting a doctor when the first signs of pathological symptoms appear and timely treatment will help avoid the chronicity of the process and the development of complications.