A Pain in the Neck!

Neck pain is a common complaint amongst the general population affecting 70% of individuals at some time in their lives (Jull et al, 2008). Approximately one third of all adults will experience neck pain during the course of a year and between 5-10% of these patients will go on to develop chronic neck pain (Pool et al, 2010). This represents a significant group of people who rely on allied health practitioners for appropriate diagnosis and management.

Causes of neck pain

Most cases of neck pain are labelled as non-specific as no known cause can be established on radiological imaging. Examples of specific conditions include; cervical spondylosis (arthritis), prolapsed disc, spinal canal stenosis, facet joint syndrome and cervicogenic headaches (headaches from a neck origin).
Causes of neck pain can be multifactorial. It is my clinical experience that poor posture is often a contributing factor to non-specific neck pain. Patients often report increased pain levels with prolonged sitting leading to overload of the neck joints and muscles. Correction of posture leads to reduced pain levels and improved sitting tolerance. This has been confirmed by Falla et al (2007) who showed that patients with chronic neck pain demonstrate a reduced ability to maintain an upright sitting posture. They further showed that exercises targeted at re-training the deep neck muscles improved upright sitting posture.Treatment

Treatment for neck pain consists of postural re-training, manual therapy, exercise therapy, traction and soft tissue therapy. A recent systematic review conducted by the Cochrane Collaboration concluded that there is strong evidence in the literature to support the use of manual therapy if combined with exercise in treating neck pain patients. Further, a randomised controlled trial has shown that manipulative therapy and exercise can reduce the symptoms of cervicogenic headache and effects are maintained for 12 months (Jull et al, 2002).

Written By Chris Tubb

References

Falla, D., Jull, G., Russell, T., Vicenzino, B. & Hodges, P. (2007). Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical therapy 87: 408-417.

Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., Emberson, J., Marschner, I. & Richardson, C. (2002). A randomised controlled trial of exercise and manipulative therapy for cervicogenic headaches. Spine 27(17) 1835-1843.

Jull, G., Sterling, M., Falla, D., Treleaven, J. & O’Leary, S. (2008). Whiplash , headache and neck pain. Churchill Livingstone.

Pool, J., Ostelo, R., Knol, D., Vlaeyen, J., Bouter, L. & de Vet, H. (2010). Is a behavioural graded activity program more effective than manual therapy in patients with subacute neck pain. Spine 35(10) 1017-1024.