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 varying intensity can arise for completely different reasons.Neck pain rarely indicates a serious illness.Nevertheless, periodically recurring cervicalgia, which is persistent, should be a signal to search for the cause of this condition.
Most often these are muscle pains; the cause can also be degenerative changes in the spine, injuries and other (non-vertebrogenic) causes: angina pectoris, infectious, endocrine, rheumatic, oncological diseases, pathology of the lymph nodes, 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 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 location, pain is distinguished in the anterior, posterior and lateral parts of the neck.When the pain radiates to the head, they speak of cervicocranialgia, and to the shoulder - of cervicobrachialgia.
- Due to their occurrence, 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 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, poor posture, etc.
- Nonvertebrogenic: caused by other reasons (myocardial ischemia, infectious, endocrine, oncological diseases, damage to the lymph nodes, rheumatism, etc.).
Let's look at individual reasons in more detail.
Causes that cause neck pain
Injuries (fractures, whiplash)
The mechanism of whiplash injury is associated with a sharp bend of the neck forward or backward with further recoil in the opposite direction.This kind of damage is typical for an accident.In this case, stretching of the tendon-ligamentous apparatus and muscles occurs, 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, radiating to the shoulders, head, and interscapular area;restriction of movements;dizziness;nausea.M.b.impaired vision, swallowing (dysphagia).
Other injuries that can cause include bruises, wounds, and strained neck muscles.The consequences of traumatic injury can be cervicalgia, migraine, muscle spasm, 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 decreased elasticity, flattening and destruction of intervertebral discs.
The shock-absorbing function of the discs is gradually impaired.This leads to an increase in the 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, noise in the ears, flickering of spots before the eyes, blurred vision, and dizziness occur.
Gradually, 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 one-sided, shooting in nature, increases when tilting to the painful side, throwing back the head, so the patient intuitively bends his head forward and to the side opposite to the location of the pain.Osteochondrosis may be accompanied by cervicobrachialgia;cervicocranialgia.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) form at the edges of the vertebral bodies.At the same time, there is a decrease in intervertebral discs in size.When adjacent vertebrae fuse, the mobility of the neck is limited.
With spondylolisthesis, displacement (slipping) of the overlying vertebra occurs in relation to the underlying one.This pathology manifests itself as pain in the area of location.The diagnosis is confirmed by x-ray.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term overstrain of the neck muscles, sprained ligaments, and local hypothermia lead to muscle pain.They are accompanied by limited mobility and spasm of the neck muscles.When palpating (feeling) 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 left untreated.
Muscular-tonic syndrome (muscle spasm of the cervicothoracic region)
Clinically manifested by prolonged and persistent muscle tension, their reflex contraction - muscle spasm.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, flexion and extension of 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 against the background of hypothermia.It manifests itself as severe pain during movements and impaired muscle tone.Due to the difference 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 subsequent replacement of muscle fibers by fatty 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 in the area of the anterolateral surface of the neck, and it radiates to the ear, chest, and back of the head.The pain intensifies when coughing, talking, and is accompanied by a crawling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Poor posture
Posture is disrupted 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 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
Pain in the neck can also be caused by other, non-vertebrogenic causes, for example, coronary artery disease (coronary heart disease. In the atypical form, 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 stiff 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 cervicalgia (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 years 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 may fuse together.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in exposed areas of the body.
- Scleroderma includes fibrous-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), 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), 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 deficiency of minerals (primarily calcium, phosphorus) and vitamins (D 3), bone loss develops (osteoporosis). The risk of its occurrence increases in women during menopause.Osteoporosis of the cervical spine is accompanied by 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 impede normal blood flow) and other vascular pathologies, neck pain is combined with dizziness and tinnitus.
Reiter's syndrome is a symptom complex 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 to correctly determine the cause of cervicalgia and take the necessary measures in time.
The main causes of front 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 intensifies when swallowing, accompanied by redness of the skin on the front surface of the neck, an increase in temperature to febrile levels (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain is aching, pulling, radiating 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 back of the neck:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Spinal tuberculosis.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of the cervical vertebral bodies, fracture of the arches and processes of the vertebrae.
Pain in the side of the neck may occur with atherosclerosis;myofascial syndrome;foreign body;tumor process in the pharynx, larynx, thyroid gland.Cervicalgia on the side can lead to secondary torticollis, as the patient always tries to tilt his 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 can 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 cervicalgia, the doctor examines the patient, questions him 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 cervicalgia is important for proper treatment.
If necessary, the following is prescribed:
- consultation of narrow specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determining the bioelectrical activity of muscles and neuromuscular transmission), electroneurography (determining 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, 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 treatment aimed at relieving muscle pain, spasm, stopping the inflammatory process, and surgical intervention carried out to stabilize the spine and ensure the outflow 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 (use of anesthetic ointments, gels) or the use of systemic drugs aimed at relieving muscle pain and spasms.
- Physiotherapeutic 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.The set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps strengthen the muscles of the neck, back, and the formation of correct posture.
- Massage.It can be carried out either separately or in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.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 influencing acupuncture points using needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will differ 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 for muscle syndromes, osteochondosis.
- Taping 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.Schemes for applying tapes differ for different pathologies.Depending on the application method, tapes improve lymphatic drainage, have an anti-inflammatory and analgesic effect, normalize muscle tone, and stabilize joints.
Surgical treatment is carried out 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 medications are used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the enzyme cycloxygenase (COX).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, it is recommended to use NSAIDs with selective action on COX 2.
- Local anesthetics.They are injected into the area where the nerves exit (blockade).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling, pain.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 convulsions and muscle spasms.
Drug therapy is prescribed only after a full examination and identification of the cause of cervicalgia.
Preventing neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (lighting, level of the monitor, distance of the monitor to the eyes and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia;do not allow sudden bending or tilting of the head, etc.
- Watch your posture, including while working at the computer.
- During breaks, do exercise therapy to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleeping, it is better to use not a high, but a regular, or even better, orthopedic pillow.
- Correct body weight.
- Undergo medical examination in a timely manner.
Following preventative 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 avoid chronicity of the process and the development of complications.