Physical Therapy Services

Neck Pain

The neck, or cervical spine, is a complex structure that has great bearing on one’s health and vitality. It is comprised of seven bones (vertebrae) that have the distinction of being the most flexible in the human spine. The topmost vertebra, called the atlas, is shaped like a hoop. The atlas rests on the second vertebra, called the axis, and pivots around a post-like structure called the dens, on the axis. There is no disc between the atlas and axis; this is where the majority of neck movement occurs when you turn your neck. The last five vertebrae, and the rest, are connected with discs.

The neck supports the weight of the head and contains part of the brain stem and the uppermost part of the spinal cord. Nerve roots branch out from between the neck vertebrae and converge to form the peripheral nerves that control the upper extremities (shoulder, upper arm, lower arm, wrist, and hand). Vertebral arteries run through the edges of the neck vertebrae and supply blood to the cerebellum- the part of the brain that is involved with balance and coordination. The esophagus (leads to the stomach) and larynx (throat, leads to the lungs) are situated in front of the cervical spine. Finally, several sets of muscles envelop the cervical spine and control precision movement. With all these delicate structures in one small area, it is easy to understand the neck’s potential to cause numerous kinds of problems if everything isn’t in working order.

Neck pain can arise from the following:

Old injuries – Injuries like those that occur from whiplash (rear-end car collisions) or falls on the head can lie dormant for years. Vertebrae can shift out of normal position, resulting in sub-optimal joint movement. Eventually, degenerative changes follow, leading to pain and dysfunction. A good analogy is a car’s wheel alignment being knocked off center after hitting a curb: the wheel’s mechanics are disturbed, and pretty soon the tire tread thins unevenly and the brake starts making noises. Pain is your neck’s way of telling you that there is something mechanically wrong that you should get checked out.

Disc herniations – Discs are the tough ligaments that hold vertebrae together while allowing them to move in unison. A disc is comprised of two main parts: an outer annulus and an inner, jelly-like structure called the nucleus pulposus. When healthy, the tight rings of the annulus keep the nucleus inside. When weakened, the nucleus can punch though the annulus, making it to the outside. This usually occurs from trauma, lifting a heavy load, or in rare cases, simply coughing or sneezing. The condition is called a herniated nucleus pulposus, or HNP for short. Being that the outer layer of the annulus has a high density of nerve endings, HNPs can be very painful. If the nucleus presses against a nerve root, it may cause radiating pain down into the arm.

Stenosis – Degenerative joint disease can cause bony projections to narrow the canal where the spinal cord resides. As a result, the spinal cord can get compressed. This can lead to local pain and bilateral (both sides) numbness and weakness below the compression site.

Chiropractic adjustments and manual therapy techniques can help some cases of neck pain by gently moving the joint through its physiological range of motion, which improves disc hydration and facet movement. Adjustments also help to prevent the soft tissues surrounding the spine from shortening and calcifying.