Painful neck can be due to many reasons

PHOTO: Painful neck can be due to many reasons

Neck pain can be a disabling condition, with a life time course marked by periods of well being and worsening of symptoms.

The estimated incidence of neck pain ranges from 10-21 per cent. There is a higher incidence noted in office and computer workers. The prevalence is higher in women, in high-income countries and in urban areas.

The cause of neck pain can be divided into two main groups - those arising from joints, ligaments and muscles of the neck, and those involving the cervical nerve roots or spinal cord.

Neck pain may be caused by the following:

*Injury or degeneration affecting muscles or ligaments and soft-tissue strain.

*Inflammation due to rheumatoid arthritis and ankylosing spondylitis.

*Infection due to discitis, epidural abscess and meningitis.

*Infiltration by tumours.

There are some risk factors which can contribute to the onset of acute neck pain, such as the nature of occupation, stress at work, psychosocial nature of the work environment and smoking.

Involvement in a motor vehicle accident is not a risk factor for developing neck pain, but those who develop neck pain soon after such an accident are at greater risk of developing chronic neck pain.

Finding the cause of neck pain begins with a detailed history, physical examination and the use of several diagnostic tests. These tests are used to find out the cause of your pain and not to make your pain better.

X-rays of the neck are usually the first step and will help determine if more tests are needed. The MRI is commonly used to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. It is done to find tumours, herniated discs, or other soft-tissue disorders.

The CT scan is most useful when a condition that only affects the bones of the spine is suspected. A bone scan is used to help locate the affected area of the spine. Blood tests are done to look for infection or arthritis. Problems originating in areas other than the spine may also cause neck pain. These include cardiac pain, complex regional pain syndrome, entrapment syndromes, rotator cuff pathology and thoracic outlet syndrome.

You should seek medical advice and treatment when there is:

*Continuous and persistent neck pain.

*Severe intractable or increasing pain.

*Radiating pain down the arms.

*Pain accompanied by headaches, numbness, tingling, or weakness.

*New symptoms before the age of 20 years or after 55 years.

*Weakness involving more than one area or loss of sensation involving more than one dermatome.

Multimodal treatments include passive mobilisation or manipulation in combination with either exercise alone or exercise with thermal modalities and education. These are more effective than single modality approaches.

In an acute injury, lie down on your back with a thin pillow. This will relieve the pressure and relax any tight muscles. Ice will help decrease swelling and muscle spasms.

After an injury, your neck will become stiff. Initiating gentle movements as soon as possible will help to regain full range of motion, reduce pain from swelling and muscle spasms, and prevent your muscles from becoming weak.

Stretching exercises can help to relax the neck muscles and restore range of motion. Strengthening and stabilising exercises help to regain good posture as your neck needs the support of the neck, shoulder, and trunk musculature.

Maintain proper postural alignment throughout the day in order to decrease any strain created on your neck.

Diagnostic and therapeutic injections of local anaesthetics and steroids can help in severe acute cases. When non-operative methods have failed, surgery can be carried out to remove the pain generator and correct any pathological condition.

This can be done in a minimally invasive fashion with the use of microscopes and endoscopes.

Relieving the pressure on the spinal cord and nerve roots can help alleviate pain. Motion-preserving surgery can reduce the wearing out of adjacent neck levels. Fusion becomes necessary in cases of neck instability.

Some preventive measures can be undertaken to prevent worsening or onset of neck pain. Maintain a good posture by holding your head up and keeping your shoulders back and down. Use the chair arm rests to keep the arms supported.

Avoid sitting in the same position for prolonged periods of time.

Take periodic 10 minute breaks from the desk. Avoid looking up or down at a computer monitor - adjust it to eye level.

Sleep with your neck in a neutral position by using a small pillow under the nape of your neck.

Relax yourself as stress, tension and worry can tighten muscles and cause more pain. Stay at work or return to work as soon as possible even if the pain hasn't completely gone.

And expect the neck pain to get better by staying positive!