Neck pain is a problem that almost everyone faces.This is the most mobile and fragile part of the spine, and painful syndromes of different intensity can arise from completely different reasons.Neck pain rarely indicates a serious illness.Nevertheless, periodic recurrent cervicalgia that is persistent should be a signal to look for the cause of this condition.
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, lymph node pathology, etc.
Neck pain is accompanied by dizziness, weakness, headaches, muscle spasms, pain and numbness in the arms, etc.can be accompanied by
Classification, types and nature of pain syndromes
There are several classifications of cervicalgia:
- According to the duration of the course, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- Depending on the nature of the pain syndrome, painful, dull, shooting pains are distinguished.
- Depending on the location, the pain differs in the front, back and sides of the neck.When the pain spreads to the head, they talk about cervicocranialgia, and to the shoulder, cervicobrachialgia.
- According to their occurrence, all neck pain can be divided into 2 large groups - vertebrogenic and non-vertebrogenic:
- Vertebrogenic: diseases caused by damage to 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.This includes myofascial, muscle-tonic syndromes, myositis, cervical myopathy, poor posture, etc.can be caused by conditions such as
- Non-vertebrogenic: caused by other causes (myocardial ischemia, infectious, endocrine, oncological diseases, damage to lymph nodes, rheumatism, etc.).
Let's consider the individual reasons in more detail.
Causes of neck pain
Injuries (fractures, whiplash)
The mechanism of whiplash injury is associated with a sharp forward or backward bending of the neck with further pulling back in the opposite direction.This type of damage is typical of an accident.At this time, stretching of the tendon-ligament apparatus and muscles, destruction of vertebrae (compression fractures) and intervertebral discs, subluxation and dislocation of cervical vertebrae, and the formation of hernias occur.
There are complaints of pain spreading to the neck, shoulders, head and interscapular region;restriction of movements;dizziness;nauseaM.b.visual impairment, swallowing (dysphagia).
Other injuries that can be caused include bruises, cuts and strained neck muscles.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 that occur as a result of a decrease in flexibility in the joints of the spine, flattening and destruction of the 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 spinal veins are compressed, there is noise in the ears, flickering of spots in front of the eyes, blurred vision, dizziness.
Gradually, the intervertebral discs lose their elasticity.When they are compressed, a protrusion (protrusion) is formed in the spinal canal with the further formation of a hernia.This causes compression and the development of pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome intensifies, with the development of numbness and paresthesia, the sensitivity of the arms, legs, and scalp is impaired.Weakness appears in the hands, tendon reflexes change.
The pain is one-sided, shooting in nature, increases when bending to the painful side, throwing back the head, so the patient intuitively tilts his head forward and to the opposite side to the location of the pain.Osteochondrosis can be accompanied by cervicobrachialgia;cervicocranialgia.
Spondylosis is usually accompanied by osteochondrosis.With this pathology, bone growths (osteophytes) occur 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.
With spondylolisthesis, displacement (slippage) of the upper vertebra occurs relative to the main one.This pathology manifests itself as pain in the area where it is located.The diagnosis is confirmed by radiography.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term overstrain of neck muscles, stretching of ligaments and local hypothermia cause muscle pain.They are accompanied by limited mobility and neck muscle spasm.When palpating (feeling) the muscles, they are tight and painful.
The pain syndrome in myofascial syndrome is of moderate intensity, short-term, 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 and continuous muscle tension, their reflex contraction - muscle spasm.Muscles become tight, swollen and painful to the touch.
Trigger points are formed - the most expressed areas of pain.Cervicalgia is aggravated 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 muscle fibers develops.The disease most often occurs against the background of hypothermia.It manifests itself as severe pain during movements and a violation of muscle tone.Due to the difference in muscle tone, the head is tilted to one side and secondary torticollis is formed.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by the development of muscle atrophy with decreased contractility of myofibrils, progressive muscle weakness, limitation of movements, decreased tone, and subsequent replacement of muscle fibers with 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 on the anterolateral surface of the neck and spreads to the ear, chest and back of the head.The pain intensifies when coughing, talking and is accompanied by a crawling sensation, paresthesia - a disturbance of sensitivity in the form of numbness, burning, tingling.
Poor posture
Posture is disturbed when a person stays at the computer for a long time or is in another monotonous position.The use of a pillow that is too soft or too high for sleeping is also a predisposing factor.With poor posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a bend occurs.
Other reasons
Pain in the neck can also arise from other, non-vertebrogenic causes, for example, coronary artery disease (ischemic heart disease. In an atypical form, pain can spread to the neck, left arm, shoulder region. This disease is characterized by changes in the ECG. Clinical symptoms include heaviness in the chest, shortness of breath, weakness with minimal physical activity.
Meningitis (inflammation of the soft meninges) causes neck pain and headache accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed with meningism.A spinal tap is performed to differentiate these conditions.
Cervical lymphadenitis or enlarged cervical lymph nodes is the most common cause of cervicalgia in children (about 50% of all cases).This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathology.Pain intensifies during swallowing, palpation (palpation) of lymph nodes.
Neck pain can accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease makes its debut 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.Individual vertebrae can fuse with this disease.
- Dermatomyositis is mainly characterized by photodermatosis-like muscle tissue and skin inflammation in exposed areas of the body.
- Scleroderma involves 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 birth defect is diagnosed in early childhood and is more common in girls.
Neck pain is accompanied by 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 esophageal mucosa); atherosclerosis; Reiter's syndrome; foreign bodies.
With the pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is combined with an increase in body temperature, a feeling of warmth, increased sweating, increased heart rate, increased irritability and tearfulness.
Sialadenitis is an inflammation of the salivary glands.Pain intensifies during chewing and swallowing.There is swelling in the area where the salivary glands are located, dry mouth, weakness, tremors, and fever.
With a lack of minerals (primarily calcium, phosphorus) and vitamins (D 3), bone loss develops (osteoporosis). During menopause, the risk of its occurrence increases in women.Osteoporosis of the cervical spine is accompanied by cervicalgia.
Tracheitis is characterized by increased pain during coughing, and esophagitis is characterized by increased pain during eating.
Atherosclerosis (damage to the walls of large vessels with the formation of atherosclerotic plaques that prevent 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 does it indicate?
Localization of pain helps to correctly identify the cause of cervicalgia and take the necessary measures in time.
The main causes of anterior neck pain:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal cavity.Pains in the neck region intensify during swallowing, accompanied by reddening of the skin on the front surface of the neck, temperature rising to fever level (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain aches, pulls, spreads 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 cervical vertebral bodies, fracture of arches and processes of vertebrae.
Pain in the neck can occur with atherosclerosis;myofascial syndrome;foreign body;tumor process in pharynx, larynx, thyroid gland.Cervicalgia on the side can cause secondary torticollis, because the patient always tries to tilt the head to the painful side.
Who should you contact for neck pain?
A therapist, pediatrician or neurologist will help with neck pain.If neck pain is caused by an injury, then you should 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 rheumatologist, infectious disease specialist, cardiologist, oncologist or otolaryngologist.
Disease diagnosis, tests and examinations
To determine the cause of cervicalgia, the doctor examines the patient, asks him questions about the existing complaints, clarifies the duration of the symptom, the nature of the pain, localization, radiation, combination with other symptoms, and conducts palpation.Determining the cause of cervicalgia is important for proper treatment.
If necessary, the following are prescribed:
- consultation of narrow specialists;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (to determine the bioelectric activity of muscles and neuromuscular transmission), electroneurography (to determine 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 of salivary glands, thyroid gland (ultrasound examination);duplex scanning (to evaluate the condition of blood vessels and blood flow).
Treatment methods
Treatment of cervicalgia should be comprehensive.There is conservative treatment aimed at relieving muscle pain, spasm, stopping the inflammatory process, and surgical intervention to stabilize the spine and ensure the flow of pus.
Conservative treatment methods:
- Drug therapy.It is prescribed only by a medical specialist, self-treatment is unacceptable!For muscle syndromes, it can be local therapy (use of anesthetic ointments, gels) or use of systemic drugs aimed at relieving muscle pain and spasms.
- Methods of physiotherapeutic effect.These include magnetotherapy, phonophoresis, electrophoresis with drugs, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozocer applications, etc.
- Exercise therapy.The set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps to strengthen neck and back muscles and to 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.It allows you to relieve muscle tension, pain and remove blocks.
Important: exercise therapy, massage, manual therapy are contraindicated during acute pain, as well as during injuries!
- Effect on acupuncture points using reflexology or needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will be different for different pathologies.
- Orthopedic methods.This is immobilization using a bandage or Chance collar.It is performed in the acute period for compression fractures of cervical vertebrae, muscle syndromes, osteochondrosis.
- Banding 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 blood circulation and lymph flow, and recover after injuries and operations.Application schemes of tapes differ for different pathologies.Depending on the method of application, the tapes 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 for treatment
Non-vertebral syndrome is treated by specialists;each group of causes has its own therapy.The following drug groups are used to relieve muscle pain in the neck:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit cyclooxygenase (COX) enzyme.There are COX 1 and COX 2.The use of NSAIDs is a symptomatic therapy aimed at relieving pain and other inflammatory symptoms.To reduce the risk of side effects, it is recommended to use NSAIDs with a selective effect on COX 2.
- Local anesthetics.They are injected into the area where the nerves exit (blockade).
- Muscle relaxants.It helps to relieve muscle spasms and relax the muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Eliminates inflammation, tissue swelling, pain.It is usually used when NSAIDs are ineffective or in combination with them.
- B, C (ascorbic acid), D vitamins 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 cartilage tissue trophism (nutrition), promote 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.
Prevention of neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Arrange your workplace correctly (lighting, monitor level, monitor distance from the eyes and other settings should comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia;do not allow sudden tilting or tilting of the head, etc.
- Pay attention to your posture, including when 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 an ordinary, or even better, orthopedic pillow, not a high one.
- Correct body weight.
- Get a medical examination on time.
Taking preventive measures will help protect your health and well-being for many years.When the first signs of pathological symptoms appear, consulting a doctor and timely treatment will help prevent the process from becoming chronic and developing complications.