Thursday, October 16, 2008

Neck Pain Treatment By Physiotherapists

By Jonathan Blood-Smyth

Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be

The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.

Many diseases and conditions could mimic neck, shoulder or arm pain so physios exclude serious underlying conditions by checking the patient's medical history, how well they sleep, any change in their appetite or weight, control of their bladder and bowel function, general health and use of drugs. Once cleared the physiotherapist will start the examination by looking at the postural shape of the cervical spine, trunk, arms and shoulders. Typical poor posture is a slumped trunk, poking head and round shoulders, often seen at a computer and which leads to problems.

Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physio understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.

Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain.

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