David T. Turdy

Your neck and back are made up of a column of bones stacked one on top of the other (the spinal column). The bones that make up your spinal column are called vertebrae. They help to support your head and protect the spinal cord – the main nerve that links nerves throughout your body to the brain.

The top seven bones of the spinal column are called the cervical vertebrae, and these form your neck. They’re linked together by facet joints, which, together with your neck muscles, allow you to move your head in any direction.

Between the bones are discs of cartilage known as intervertebral discs. At the level of each disc, nerve roots branch out from your spinal cord, passing through an opening in the side of the spine. The nerve roots in the neck join to form the nerve trunks that run into your arms. Impulses travel along these nerves, sending sensations such as touch and pain to your brain and messages from your brain to your muscles.

Four arteries carry blood from your heart to your brain. Two of these run inside the bones of your spine and supply the part of the brain that controls your balance (the cerebellum). All four arteries connect to your brain.

 

The most common symptoms people with neck problems experience are:

You may feel pain in the middle or on either side of you neck, but it may also extend to the shoulder and shoulder blade, or to the upper chest.

If you have tension headaches, the pain often travels to the back of your head, and sometimes behind your eye or even into your ear.

It may be painful to move and your muscles may feel tight, especially if you’ve been sitting in one position for a long time. You may notice your neck doesn’t turn as far as it normally does, for example when you try to look over your shoulder while reversing the car.

If a nerve root is being pinched you may have numbness, tingling or pins and needles down your arm, sometimes right down to the fingers.

You may hear or feel clicking or grating as you move your head – this is called crepitus, and is caused by bony surfaces moving against each other or by ligaments moving over bone. Other joints often do this too but noises from your neck usually seem louder because they’re happening closer to your ears. You may also find they’re more noticeable at night. This is quite common and can sound alarming but it’s not serious.

If you feel dizzy when looking up or turning your head, this may be caused by the vertebral arteries being pinched. This sometimes happens as a result of changes in the bones of the spine. Pinching of these arteries can sometimes cause blackouts as the blood flow is temporarily reduced. However, this kind of dizziness can have other causes (for example, problems in the ear) so it’s best to see your doctor if the problem continues.

Sometimes if you have neck pain you may also have muscle spasms that turn your head to one side. This is called torticollis, cervical dystonia or acute wry neck. This isn’t very common but is unpleasant. The problem usually only lasts a few hours or days, but rarely may continue for several weeks.

Cervical spondylosis

Spondylosis happens when the discs and the facet joints in the spine age. It’s caused by everyday use over many years and is quite normal as you get older.

The discs between the bones become thinner and the spaces between the bones narrower. Spurs of bone called osteophytes sometimes form at the edges of the bones and the facet joints. These changes can be seen in x-rays and are very similar to osteoarthritis , but in the neck they’re known as cervical spondylosis. These changes are part of a repair process where the body adapts to the wear that occurs as we age.

Spondylosis doesn’t always cause pain, but it may increase the risk of having spells of neck pain. Because neck pain tends to come and go, it’s not usually possible to identify spondylosis as a driect cause.

Occasionally when people have spondylosis:

• the nerve roots may be irritated or pinched, either by bulging discs or osteophytes, sometimes causing pain or numbness
• if the vertebral artery is pinched it can affect the blood supply to the brain, causing dizziness or blackouts.

Whiplash

Whiplash is caused by your body being carried forward, causing your head to flip back. As your body stops, your head is thrown forwards. This happens most commonly in car accidents and sports injuries. It’s thought that the pain is caused by the capsule around the facet joints and the ligaments stretching, along with muscle spasm as your body tries to splint the injury. There’s often a delay before you feel any pain or stiffness from whiplash.

Although whiplash can badly strain your neck, seat belts and properly adjusted headrests in cars help greatly to prevent serious injuries. Most whiplash improves within a few weeks or months. Gentle exercises to keep your neck moving will help to prevent longer-term problems and get you back to normal as soon as possible.

Tension

Most muscles relax completely when they’re not being used, but some (known as anti-gravity muscles) have to work all the time in order to keep your body upright. Muscles at the back of your neck must always be tensed, otherwise your head would fall forwards when you’re sitting or standing. When we’re worried or stressed we often tighten these muscles even more, which can cause neck pain and tension headaches. Tension headaches are very common and are often wrongly called migraines.

Slipped discs

A slipped or bulging disc in your neck can cause neck pain which is usually associated with pain radiating down one arm, numbness, pins and needles, or weakness. This will often settle by itself or following physiotherapy, but occasionally you may need further treatment.

Stenosis and myelopathy

Rarely, disc bulges and osteophytes can cause narrowing of the spinal cord (stenosis) which can affect the spinal cord and cause weakness in arms and legs (myelopathy).

Most neck and shoulder problems will benefit from acupuncture and tui na treatment. we will assess your condition and put together a tailored treatment programme.

The aim of our treatment is to improve symptoms and restore function. The approach will depend on whether you have a short-term (acute) problem or a long-standing (chronic) condition. Almost everyone will benefit from our programme, which might include:

• heat therapy
• needling with electro-stimulation
• Cupping and Moxa
• Tui Na massage to ease stiffness and break up the adhesive soft tissues
• advice on improving shoulder, neck and spine posture exercises to  increase the range of joint movement
• applying herbal tape to improve pain

 

Exercises as these can help the muscles and ligaments to relax and ease your pain and stiffness.

 

Pain and stiffness can be caused by a number of factors:

• poor standing posture
• staying in the same position for too long
• a bed that’s too soft
• a pillow that’s uncomfortably hard or soft
• poor posture at work.

 

When you’re sitting, your hips and knees should be at right angles, and you should have good support for your lower back. Hardback, upright chairs or straight-backed rocking chairs are better for your posture than low, soft, upholstered chairs or sofas. Using back supports can help your posture when sitting at home, at work or in the car.

If your desk is too low, so that your head is bent forward for long periods, then your neck may be stretched and you may develop muscle pain. Check the height of your desk and the design of your chair at work and at home. Many employers have occupational health specialists who can check that workstations are set up according to your needs.