Neck pain is a problem that almost everyone experiences.This is the most mobile and fragile part of the spine, and pain syndromes of different intensity can arise for completely different reasons.Neck pain rarely indicates a serious illness.However, recurring and persistent neck pain will be a signal to look for the cause of this condition.
Usually these are muscle pain;The cause can also be spinal degeneration, trauma and other causes (not causing vertebral disease): angina, infection, endocrine, rheumatism, cancer, lymph node pathology, etc.
Neck pain can 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 cervical pain:
- According to the duration, 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, people distinguish between aching pain, dull pain, and aching pain.
- According to location, pain is distinguished in the front, back and side of the neck.When the pain spreads to the head, people talk about cervical pain, and to the shoulders - cervical pain.
- Due to their appearance, all neck pain can be divided into 2 large groups - vertebral and non-vertebral:
- Vertebrogenic: occurs due to disease or injury to the spine.This is the most common group of causes of cervical pain.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial syndrome, myotonic syndrome, myositis, cervical myelopathy, poor posture, etc.
- Nonvertebrogenic: caused by other reasons (myocardial ischemia, infectious diseases, endocrine, cancer, lymph node damage, rheumatism, etc.).
Let's look at individual reasons in more detail.
Causes of neck pain
Trauma (fractures, spinal injuries)
The mechanism of whiplash injury involves a strong bending of the neck forward or backward and a stronger jerk in the opposite direction.This type of damage is typical of an accident.In this case, tension of the ligamentous and muscular apparatus occurs, destruction of the vertebrae (compression fractures) and intervertebral discs, subluxation and dislocation of the cervical vertebrae and hernia formation.
There are signs of pain in the neck, spreading to the shoulders, head and inter-scapular area;movement restrictions;dizzy;nausea.M.b.impaired vision, swallowing (difficulty swallowing).
Other possible injuries include bruises, wounds, and neck strains.The consequences of injury can be neck pain, migraines, muscle spasms, reduced neck mobility, fatigue and impaired vision.
Degenerative disease of the spine
Osteoarthritis is characterized by age-related degenerative-dystrophic changes in the spinal joints that occur due to reduced elasticity, flattening and destruction of the intervertebral discs.
The shock absorption function of the disc gradually declines.This leads to an increase in the load on the intervertebral (facet) joints, arthropathy, radiculopathy - pain syndrome due to bone growth (osteoporosis) compression of nerve roots and muscle tension in the neck.When the vertebral artery is compressed, there will be ringing in the ears, flashing spots in front of the eyes, blurred vision, and dizziness.
Gradually, the discs lose their elasticity.When they are compressed, a protrusion (protrusion) occurs into the spinal canal leading to further hernia formation.This leads to compression and the development of pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome worsens, the sensitivity of the arms, legs and scalp is impaired with the development of numbness and paresthesia.Hand weakness appears, tendon reflexes change.
The pain is unidirectional, shooting, and increases when tilting to the painful side or tilting the head back, so the patient intuitively bends the head forward and to the side opposite the pain location.Osteochondrosis may be accompanied by brachial neck pain;cervical pain.
Spondylosis is often accompanied by osteoarthritis.With this pathology, bone growths (osteoporosis) form at the edges of the vertebral bodies.At the same time, the size of the intervertebral discs is reduced.When adjacent vertebrae fuse, neck mobility is limited.
In spondylolisthesis, displacement (slip) of the vertebra above occurs relative to the vertebra below.This pathology is manifested by pain in the area.Diagnosis is confirmed by X-ray.
Muscle syndrome
Myalgia - myofascial syndrome
Long-term overextension of the neck muscles, sprained ligaments, and local hypothermia lead to muscle pain.They are accompanied by limited mobility and neck muscle spasms.When palpated (palpation), the muscles feel tense and sore.
The pain syndrome in myofascial syndrome is moderate in intensity, short-lived, intensifies with neck movement, and resolves spontaneously if left untreated.
Myotonic syndrome (muscle spasms in the neck and chest area)
Clinical manifestations are prolonged and persistent muscle tension, their reflex contraction - muscle spasms.The muscles become dense to the touch, swollen and painful.
Trigger points are formed - the most pronounced pain area.Neck pain intensifies when turning the head, bending, and extending the cervical spine.It may be accompanied by numbness of the fourth and fifth fingers.
Mosite
With neck myositis, inflammation of the muscle fibers develops.The disease most often occurs in the setting of hypothermia.It is manifested by severe pain when moving and impaired muscle tone.Due to differences in muscle tone, the head tilts to one side and secondary torticollis forms.
Cervical myelopathy
Myopathy or degenerative pathology of muscle tissue is characterized by a decrease in the contractility of muscle fibers, progressive muscle weakness, limitation of movement, hypotonia and the development of muscle atrophy followed by replacement of muscle fibers by adipose or connective tissue.
Cervical plexus inflammation
Cervical plexitis is a disorder of the cervical plexus.Most often, it develops against the background of trauma or hypothermia.The pain is localized in the front of the neck and spreads to the ears, chest and back of the head.The pain increases when coughing, talking and is accompanied by a crawling feeling, paresthesia - sensitivity disorders in the form of numbness, burning, tingling.
Bad posture
Posture is disrupted when a person spends long periods of time in front of a computer or in another monotonous position.Risk 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 a stoop forms.
Other reasons
Neck pain can also be caused by other non-vertebral causes, for example coronary artery disease (coronary heart disease. In atypical forms, the pain can radiate to the neck, left arm, shoulder. This disease is characterized by changes in the electrocardiogram. Clinical symptoms include chest heaviness, shortness of breath, weakness with minimal physical activity.
With meningitis (leptic meningitis), pain in the neck and head is accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed in meningeal disease.To differentiate these conditions, a lumbar puncture is performed.
Cervical lymphadenitis, or swelling of the cervical lymph nodes, is the most common cause of cervical pain (about 50% of all cases) in children.This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis media, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathologies.The pain increases when swallowing, palpation (palpation) of the lymph nodes.
Neck pain may accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease appears before age 16 years and is characterized by joint damage and extra-articular manifestations.
Other types of systemic collagenose 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 and skin tissue, similar to photodermatitis, primarily in exposed areas of the body.
- Scleroderma includes sclerotic changes in the skin, muscles, joints, blood vessels, and internal organs.
Cervical pain is observed with torticollis, an orthopedic condition in which the neck deviates from its vertical axis.This birth defect is diagnosed in young children and is more common in girls.
Neck pain accompanies tumor diseases; purulent inflammatory process: abscess (limited soft tissue inflammation), phlegm (soft tissue inflammation without clear boundaries); pathology of the thyroid gland; salivary glands; plexus; osteoporosis; tracheitis (inflammation of the lining of the trachea); esophagitis (inflammation of the lining of the esophagus); atherosclerosis; Reiter's syndrome; foreign object.
With pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), pain syndrome is associated with increased body temperature, feeling of heat, excessive sweating, increased heart rate, increased irritability, and tearing.
Sialadenitis is an inflammation of the salivary glands.The pain increases when chewing and swallowing.Swollen salivary glands, dry mouth, weakness, chills and fever.
With mineral (mainly calcium, phosphorus) and vitamin (D 3) deficiencies, bone loss develops (osteoporosis). 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.
With atherosclerosis (damage to the walls of large arteries leading to the formation of atherosclerotic plaques that interfere with 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.The most common cause is mycoplasma infection and has a chronic course.
Locating neck pain - what problem do they indicate?
Pain localization helps determine the exact cause of neck pain and take necessary measures promptly.
The main causes of anterior neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.Pain in the neck increases when swallowing, accompanied by redness of the skin on the front of the neck, temperature increases to fever (38-39°).
- Cervical plexus inflammation.
- Systemic connective tissue disease (dermatomyositis, scleroderma).The pain is painful, lasting, spreading to the neck and spine.
- Cervical lymphadenitis.
- Atypical form of myocardial ischemia.
- Tracheitis, esophagitis.
- Compression fracture of the cervical vertebrae.
Causes of pain in the back of the neck:
- Spondylosis, disc protrusion, spinal herniation, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Tuberculosis of the spine.
- Osteomyelitis.
- Reiter syndrome.
- Compression fractures of the cervical vertebral bodies, fractures of the arch and vertebral processes.
Pain on one side of the neck can occur due to atherosclerosis;myofascial syndrome;foreign object;Tumor processes in the pharynx, larynx, thyroid gland.Neck pain on one side can lead to secondary torticollis, because the patient always tries to tilt the head to the painful side.
Who should I contact for neck pain?
A therapist, pediatrician or neurologist will help relieve neck pain.If your neck pain is caused by an injury, you should contact a traumatologist or surgeon.Depending on the cause of pain, therapists and pediatricians may also refer patients to specialists such as rheumatologists, infectious disease specialists, cardiologists, oncologists, or otolaryngologists.
Disease diagnosis, testing and examination
To determine the cause of neck pain, the doctor examines the patient, asks him about existing complaints, clarifies the duration of the symptoms, the nature of the pain, location, irradiation, association with other symptoms and performs palpation.Determining the cause of cervical pain is important for appropriate treatment.
If necessary, the following are prescribed:
- consultation of narrow experts;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectric activity of muscles and neuromuscular transmission), electromyography (determination of the speed of transmission of nerve impulses along peripheral nerve fibers).
- Cervical spine X-ray, CT, MRI;
- myelography - contrast x-ray of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound) of salivary glands, thyroid gland;duplex scan (to assess vascular condition and blood flow).
Treatment methods
Treatment of cervical pain must be comprehensive.There are conservative treatments aimed at relieving muscle pain, spasms, stopping the inflammatory process, and surgical intervention is performed to stabilize the spine and ensure pus drains out.
Conservative treatment methods:
- Treatment with medication.Prescribed only by a specialist, self-medication is unacceptable!For myofascial syndrome, this may be local therapy (using anesthetic ointments or gels) or the use of systemic medications to relieve muscle pain and spasms.
- Impact physical therapy methods.These include magnetotherapy, electrophoresis, electrophoresis with drugs, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated current), 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 pain.Exercise therapy helps strengthen neck and back muscles and develop correct posture.
- Massage.It can be performed alone or in combination with exercise therapy and manual therapy.Improves blood circulation, reduces muscle spasms, normalizes muscle tone.
- Manual therapy.Allows you to relieve muscle tension, pain and remove blocks.
Important: exercise, massage, manual therapy are contraindicated during the period of acute pain, as well as in case of injury!
- Acupressure or impacting acupuncture points with needles, electrocautery, or hirud therapy.The combination of points, time and number of procedures will be different for different pathologies.
- Orthopedic techniques.This is the immobilization method using tape or a Chance collar.It is performed for compression fractures of the cervical vertebrae, in the acute phase of myofascial syndromes, osteoarthritis.
- Kinesio taping or taping is the application of special patches (bandages) 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 recover from injuries and surgery.There are different taping options for different pathologies.Depending on the method of application, the bandage improves lymphatic drainage, has anti-inflammatory and analgesic effects, normalizes muscle tone and stabilizes joints.
Surgical treatment is performed for spinal hernias (if conservative therapy is ineffective), tumors, abscesses, cellulitis, and foreign bodies in the neck.
What medicine to treat?
Extravertebral syndromes are treated by specialists;Each group of causes has its own treatment.To relieve muscle pain in the neck, the following groups of drugs are used:
- NSAIDs (nonsteroidal 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 reducing pain and other signs of inflammation.To reduce the risk of side effects, NSAIDs with selective COX 2 effects should be used.
- Local anesthetic.They are injected into the area where the nerve exits (block).
- Muscle relaxants.Helps reduce muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Reduces inflammation, tissue swelling, and pain.Often 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 bone fractures.
- Chondroprotectors.Improves nutrition (nutrition) of cartilage tissue, promotes cartilage regeneration.
- Anticonvulsants.Prescribed for convulsions and muscle spasms.
Medical treatment is indicated only after a complete examination and determination of the cause of neck pain.
Prevent neck pain
To prevent neck pain, simple rules should be followed:
- Properly organize your workplace (lighting, screen level, distance from screen to eyes and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid drafts and hypothermia;Do not allow sudden bowing or tilting of the head, etc.
- Pay attention to your posture, even when working in front of a computer.
- During your breaks, do calisthenics to strengthen your neck and shoulder muscles.
- Optimize physical activity.
- For sleeping, it is better to use not a high orthopedic pillow, but a regular orthopedic pillow, or even better.
- Correct body weight.
- Go see a doctor promptly.
Taking the following precautions will help maintain health and well-being for many years.Seeing a doctor at the first signs of illness and getting timely treatment will help avoid the condition becoming chronic and the development of complications.