Neck pain is a problem that almost everyone has encountered.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.However, periodically recurring and persistent neck pain should be a signal to look for the cause of this condition.
Most of the time they are muscle pain;the cause can also be degenerative changes in the spine, injuries and other (non-vertebrogenic) causes: angina pectoris, infectious, endocrine, rheumatic, oncological diseases, 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 neck pain:
- 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 and sharp pain are distinguished.
- According to location, the pain differs 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: occurs as a result of diseases and injuries to the spine.This is the most common group of causes of neck pain.According to statistics, it is> 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial syndromes, 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 look at the individual reasons in more detail.
Causes that cause neck pain
Injuries (fractures, whiplash)
The mechanism of neck injury is associated with a sharp bend of the neck forward or backward, with further recoil in the opposite direction.This type of damage is typical of an accident.In this case, there is stretching of the tendon-ligamentous 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 region;restriction of movements;dizziness;nausea.M.b.impaired vision, swallowing (dysphagia).
Other injuries they can cause include bruising, sores, and strain on the neck muscles.The consequences of traumatic injury can be neck pain, migraines, muscle spasm, difficulty with 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, which occur due to a decrease in 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 compression of the nerve roots by bone growths (osteophytes) and tension in the neck muscles.When the vertebral arteries are compressed, noises in the ears, flickering spots before the eyes, blurred vision and dizziness occur.
Gradually, the intervertebral discs lose elasticity.When they are compressed, a protrusion (bulge) occurs in 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, sharp in nature, increases when tilting to the painful side, throwing the head back, so the patient intuitively tilts the head forward and to the side opposite to the place of pain.Osteochondrosis can be accompanied by cervicobrachialgia;cervicocranialgia.
Spondylosis often accompanies osteochondrosis.With this pathology, bone growths (osteophytes) form 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 fuse, neck mobility is limited.
In spondylolisthesis, there is displacement (slipping) of the overlying vertebra in relation to the underlying vertebra.This pathology manifests itself as pain in the localization area.The diagnosis is confirmed by radiography.
Muscle syndromes
Muscle pain - myofascial syndrome
Prolonged excessive tension of the neck muscles, torsion of 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 become tense and painful.
The pain syndrome in myofascial syndrome is of moderate intensity, of short duration, intensifies with neck movements and disappears spontaneously if not treated.
Musculotonic syndrome (muscle spasm of the cervicothoracic region)
It is clinically manifested by prolonged and persistent muscle tension, its reflex contraction - muscle spasm.The muscles feel dense to the touch, swollen and painful.
Trigger points are formed - areas of more pronounced pain.Neck pain intensifies when turning the head, flexion and extension of the cervical spine.It may be accompanied by numbness of the fourth and fifth fingers.
Maissite
In cervical myositis, inflammation of muscle fibers occurs.The disease most often occurs against the background of hypothermia.It manifests as intense pain during movements and impaired muscle tone.Due to the difference in muscle tone, the head tilts to one side and secondary torticollis forms.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by decreased contractility of myofibrils, progressive muscle weakness, limitation of movement, decreased tone and development of muscle atrophy with subsequent replacement of muscle fibers by adipose or connective tissue.
Cervical plesitis
Cervical plexitis is a disorder of the cervical nerve plexus.More often it develops against the background of injury or hypothermia.The pain is located in the anterolateral region of the neck and radiates to the ear, chest and back of the head.The pain intensifies when coughing, talking and is accompanied by a tingling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Bad posture
Posture suffers when a person spends a lot of time at a 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 an incorrect posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a tilt is formed.
Other reasons
Neck pain can also be caused by other non-vertebrogenic causes, for example, coronary artery disease (coronary artery disease. In 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.
In 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 neck pain (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 may accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease appears before the age of 16 and is characterized by joint lesions 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 can fuse together.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in exposed areas of the body.
- Scleroderma includes fibro-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Neck pain 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); thyroid gland pathology; 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), pain syndrome is combined with an increase in 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 (mainly calcium, phosphorus) and vitamins (D 3), bone loss (osteoporosis) occurs. 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.
In 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 complex of symptoms that is 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.
Location of neck pain - what problems does it indicate?
The location of the pain helps to correctly determine the cause of neck pain and take the necessary measures in time.
The main causes of frontal 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 plesitis.
- 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 neck pain:
- 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 on the side of the neck can occur with atherosclerosis;myofascial syndrome;foreign body;tumor process in the pharynx, larynx, thyroid gland.Lateral neck pain can lead to secondary torticollis, as 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 your neck pain is caused by an injury, contact a traumatologist or surgeon.Depending on the cause of the pain, the therapist and pediatrician may also refer the patient to specialists such as a rheumatologist, infectious disease specialist, cardiologist, oncologist or otolaryngologist.
Diagnosis of the disease, examinations and examinations
To determine the cause of neck pain, the doctor examines the patient, questions him about existing complaints, clarifies the duration of the symptom, the nature of the pain, its location, radiation, combination with other symptoms and performs palpation.Determining the cause of neck pain is important for appropriate treatment.
If necessary, the following is prescribed:
- consultation of restricted specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectrical activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of nerve impulse transmission along peripheral nerve fibers).
- Cervical spine radiography, computed tomography, magnetic resonance imaging;
- myelography – contrast x-ray 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
Neck pain treatment should be comprehensive.There are conservative treatments that aim to relieve muscle pain, spasms, interrupt the inflammatory process and surgical interventions carried out to stabilize the spine and ensure the exit of pus.
Conservative treatment methods:
- Drug therapy.Prescribed only by a specialist doctor, self-medication is unacceptable!For muscle syndromes, it can be local therapy (use of anesthetic ointments, gels) or the use of systemic medications aimed at relieving pain and muscle 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 to strengthen the muscles of the neck, back and form correct posture.
- Massage.It can be performed 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 blockages.
Important: exercise therapy, massage, manual therapy are contraindicated in the acute period of pain, as well as in case of injuries!
- Reflexology or influence on acupuncture points with needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will be different for different pathologies.
- Orthopedic techniques.This involves immobilization with a Chance bandage or collar.It is performed in compression fractures of the cervical vertebrae, in the acute period in muscular syndromes, osteochondosis.
- Taping or kinesio taping is the application of special adhesives (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.Taping schemes differ for different pathologies.Depending on the method of application, the tapes improve lymphatic drainage, have anti-inflammatory and analgesic effects, 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 medications 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 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.To reduce the risk of side effects, the use of NSAIDs with selective action on COX 2 is recommended.
- Local anesthetics.They are injected into the area where the nerves exit (block).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling and pain.Generally 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 the trophism (nutrition) of cartilage tissue, promote cartilage regeneration.
- Anticonvulsants.Prescribed for convulsions and muscle spasms.
Drug therapy is prescribed only after a complete examination and identification of the cause of neck pain.
Preventing neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (lighting, monitor level, distance from 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 exercises to strengthen the muscles in your neck and shoulder girdle.
- Optimize physical activity.
- For sleeping, it is better to use not a high pillow, but a regular orthopedic pillow, or even better.
- Correct body weight.
- Undergo a medical examination in a timely manner.
Following preventive measures will help maintain health and well-being for years to come.Consulting a doctor when the first signs of pathological symptoms appear and timely treatment will help avoid the chronicity of the process and the development of complications.