Neck Pain Treatment

Severe neck pain with pain radiation into the arm and hand is usually the result of a herniated disc or a traumatic injury causing the nerve exit to be compromised, compressing the nerve. Most commonly affected are the C6 nerve in 25% of cases and the C7 nerve in 60%. About 25% of arm pains are from an acute prolapsed disc. In older people the cause is more likely to be narrowing of the exit channel from bony outgrowths, disc bulging, ligament infolding and arthritic enlargement of the facet joints. Chiropractors routinely assess and treat this kind of neck pain.

Factors making nerve root pain more likely are routine lifting of weights above 25 pounds (12 kilograms), driving or operating vibrating machinery and smoking. Cervical radiculopathy is not common and occurs much less frequently than lumbar root lesions such as sciatica.

There can be many reasons for the onset of nerve root neck pain or it can come on slowly without clear reason. If the neck is moved backwards, tipped to one side and rotated to the same side this can sharply narrow the nerve exit space and injure the nerve, occurring in a traumatic accident or a sporting injury. The opposite can occur with a quick side bend, combined with flexion or extension, tractioning the nerve and causing injury. Sudden loading of the neck in any posture can cause disc prolapse. There may be degenerative changes in an older group and with repetitive or sustained neck postures an osteophyte can impinge the nerve and give a slower development of arm pain.

The chiropractor will take a detailed history to establish the diagnosis is clearly that of cervical radiculopathy. The exact location and nature of the pain, numbness or weakness, aggravating or easing factors, mechanism of injury, previous occurrences, lower limb symptoms, bladder or bowel dysfunction and medical or other treatments are all noted.

People with root pain look tired due to poor sleep, don't find anything funny and guard their arm in a protective posture against the abdomen or hold it out to the side with their hand on the back of their neck or the other side of the head. This may reduce the forces through the inflamed nerve root and so reduce pain.

A postural abnormality is often present with the neck held side flexed or rotated away from the painful side. Examination by the chiropractors includes recording any muscle spasm, checking reflexes, sensibility and muscle power, any combined movements which might aggravate the pain and any easing factors such as manual traction. Acupuncture and cervical epidural injections of steroids may be useful if chiropractors cannot reduce the pain sufficiently.

Posture is usually abnormal with the head tilted away from the painful side and the neck held stiffly with reduced ranges of movement. The chiropractor notes the muscle spasm and tests the muscle power to determine which nerve root is affected, looks for sensory and reflex loss and notes which combination of movements are provocative and if manual traction reduces symptoms.

Initially the chiropractor concentrates on reduction of the pain and potential inflammation, using ice, non-steroidal anti-inflammatory drugs and other analgesia, avoiding aggravating postures and activities, manual or mechanical traction. The aim of treatment is to reduce the forces going through the nerve root and to allow it to settle. A collar for support and to reduce movement, especially at night, can be useful. Manual traction is a chiropractors skill which needs to be carefully applied if it is not to worsen the condition. Once the acute phase is over the chiro turns to restoring range of movement and neck and overall muscle power, beginning with isometric exercises and progressing. Patients should keep up strengthening, stretching and cardiovascular fitness over the long term.

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