Neck pain is a problem that almost everyone faces.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.Nevertheless, periodically recurring cervicalgia, which is persistent, should be a signal to look for the cause of this condition.
Most often these are muscle pains;Degenerative changes in 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, pain and stiffness in the hands, etc.
Classification, types and nature of pain syndromes
There are several classifications of cervicalgia:
- Depending on the duration, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (longer than 4 months).
- According to the nature of the pain syndrome, painful, dull, shooting pain is distinguished.
- According to localization, the pain differs in the front, back and side of the neck.When the pain radiates to the head, they speak of cervicocranialgia, and in the shoulder, cervicobrachialgia.
- Due to their appearance, all neck pains can be divided into 2 large groups - vertebrogenic and non-vertebrogenic:
- Vertebrogenic: they arise as a result of diseases, injuries of the spinal column.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, muscle-tonic 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 take a closer look at the individual reasons.
Causes of neck pain
Injuries (fractures, neck sprain)
The mechanism of whiplash injury is associated with a sharp forward or backward bending of the neck with a further jerk in the opposite direction.This type of damage is typical of an accident.In this case, there is stretching of the tendon-ligament 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, radiating to the shoulders, head and interscapular area;restriction of movement;dizziness;nausea.M.b.impaired vision, swallowing (dysphagia).
Other injuries they can cause include bruises, sores and strained neck muscles.The consequences of a traumatic injury can be cervicalgia, migraine, muscle spasm, reduced mobility of the neck, fatigue and visual impairment.
Dystrophic diseases of the spinal column
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the joints of the spine caused by reduced elasticity, flattening and destruction of the intervertebral discs.
The function of shock absorption discs gradually decreases.This leads to an increase in the load on the intervertebral (facet) joints, arthrosis, radiculopathy - a 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, ringing in the ears, flickering spots before the eyes, blurred vision and dizziness occur.
Gradually, the intervertebral discs lose their elasticity.When they are compressed, there is a protrusion (protrusion) into the spinal canal with further herniation.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 hands, 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, of a shooting character, intensifies when leaning on the painful side, throwing the head back, so the patient intuitively bends the head forward and to the side opposite to the place of pain.Osteochondrosis can be accompanied by cervicobrachialgia;cervicocranialgia.
Osteochondrosis usually accompanies spondylosis.With this pathology, bony growths (osteophytes) are formed on the edges of the vertebral bodies.At the same time, there is a decrease in the size of the intervertebral discs.When adjacent vertebrae are fused, neck mobility is limited.
In spondylolisthesis, the upper vertebra moves (slips) in relation to the lower one.This pathology manifests itself as pain in the area of location.The diagnosis is confirmed by an X-ray.
Muscular syndromes
Muscle pain - myofascial syndrome
Long-term overstrain of neck muscles, stretching of ligaments and local hypothermia lead to muscle pain.They are accompanied by limited mobility and neck muscle spasm.When palpating the muscles, they feel tight and painful.
The pain syndrome in myofascial syndrome is of moderate intensity, short-lived, aggravated by neck movements and goes away on its own if not treated.
Muscle-tonic syndrome (muscle spasm of the cervicothoracic region)
Clinically, it is manifested by long-term and persistent muscle tension, their reflex contraction - muscle spasm.The muscles become thick 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.
Please
In myositis of the neck, inflammation of the muscle fibers develops.The disease most often occurs against the background of hypothermia.It is manifested by severe pain during movement 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 contractility of myofibrils, progressive muscle weakness, limitation of movement, reduced tone and the development of muscle atrophy with subsequent replacement of muscle fibers by fat or connective tissue.
Cervical plexitis
Cervical plexitis is a disorder of the cervical nerve plexus.It develops more often 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 back of the head.The pain intensifies when coughing, talking, is accompanied by a crawling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Bad posture
Posture is disturbed 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 to sleep on.With bad posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a slouch is formed.
Other reasons
Neck pain can be caused by other, non-vertebrogenic causes, for example, coronary disease (coronary heart disease. In an atypical form, the pain can radiate to the neck, left arm, shoulder. This disease is characterized by changes on the ECG. Clinical symptoms include heaviness in the chest, difficulty breathing, weakness with minimal physical activity.
With meningitis (inflammation of the soft brain membranes), pain in the neck and head is accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed in meningism.In order to differentiate between these conditions, a spinal puncture is performed.
Cervical lymphadenitis, i.e. 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, flu, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathologies.Pain intensifies when swallowing, palpation (palpation) of 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:
- 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 on exposed parts of the body.
- Scleroderma includes fibro-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Cervicalgia is observed in 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 lining of the trachea); esophagitis (inflammation of the lining of the esophagus); 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, feeling hot, increased sweating, increased heart rate, increased irritability and tearfulness.
Sialadenitis is an inflammation of the salivary glands.The pain intensifies when chewing and swallowing.Swelling in the area of the salivary glands, dry mouth, weakness, chills and elevated temperature appear.
A lack of minerals (primarily calcium, phosphorus) and vitamins (D 3) leads to loss of bone mass (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 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.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 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 intensifies when swallowing, accompanied by reddening of the skin on the front surface of the neck, a rise 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 back pain:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Tuberculosis of the spine.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of the body of the cervical vertebrae, fracture of the arches and growths 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, because the patient always tries to tilt the 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 an injury, you should consult 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 otorhinolaryngologist.
Disease diagnosis, tests and examinations
In order to determine the cause of cervicalgia, the doctor examines the patient, questions him about existing complaints, clarifies the duration of the symptoms, the nature of the pain, its localization, radiation, combination with other symptoms, and performs palpation.Determining the cause of cervicalgia is important for proper treatment.
If necessary, the following is prescribed:
- consultations of narrow specialists;
- instrumental examination methods: EKG, Holter monitoring, EMG - electromyography (determination of bioelectric 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 salivary glands, thyroid gland;duplex scan (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, as well as surgical intervention that is performed to stabilize the spine and ensure drainage of pus.
Conservative treatment methods:
- Drug therapy.Only a specialist prescribes, self-medication is unacceptable!For muscle syndromes, it can be either local therapy (use of anesthetic ointments, gels) or the use of systemic drugs to alleviate pain and muscle spasms.
- Physiotherapy methods of influence.These include magnetotherapy, phonophoresis, electrophoresis with medical substances, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidally modulated current), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite applications and others.
- Exercise therapy.A set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps in strengthening neck and back muscles and forming proper posture.
- Massage.It can be carried out separately or in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.It allows you to relieve muscle tension, pain and remove blockages.
Important: physical therapy, massage, manual therapy are contraindicated in 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, osteochondrosis.
- Taping or kinesio taping is the application of special patches (tapes) to the skin of the neck.It is used to relieve pain, swelling, relieve muscle spasms and pinched nerve endings, improve circulation and lymph flow, and restore after injuries and operations.Banding schemes differ for different pathologies.Depending on the method of application, the strips improve lymphatic drainage, have an anti-inflammatory and analgesic effect, normalize muscle tone and stabilize 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
Nonvertebral syndrome is treated by specialists;each group of causes has its own therapy.The following groups of drugs are used to relieve muscle pain in the neck:
- 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.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 are injected into 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).Relieves inflammation, tissue swelling, 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-mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.They improve cartilage tissue trophism, stimulate cartilage regeneration.
- Anticonvulsants.It is prescribed for convulsions and muscle spasms.
Drug therapy is prescribed only after a complete examination and determination of the cause of cervicalgia.
Preventing neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (illumination, monitor level, monitor distance from eyes and other parameters must be in accordance 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 when working at the computer.
- During the breaks, do exercises to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleeping, it is better to use not a high one, but an ordinary one, or even better, an orthopedic pillow.
- Correct body weight.
- Have a medical examination in a timely manner.
Following preventive measures will help maintain health and well-being for many years.A visit to the doctor when the first signs of pathological symptoms appear and timely treatment will help to avoid the chronicity of the process and the development of complications.