Neck pain is a problem that almost everyone has faced.It is the most mobile and fragile part of the spine, and painful syndromes of different intensity can arise for completely different reasons.Neck pain rarely indicates a serious illness.Nevertheless, periodically recurring cervicalgia that is permanent should be a signal to look for the cause of this condition.
Most often it is muscle pain;The cause can also be degenerative changes of the spine, injuries and other (non-vertebral) causes: angina pectoris, infectious, endocrine, rheumatic, oncological diseases, pathology of lymph nodes, etc.
Neck pain can be accompanied by dizziness, weakness, headache, muscle spasm, pain and numbness in hands, etc.
Classification, types and nature of pain syndromes
There are several classifications of cervicalgia:
- Depending on the duration of the course, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- Painful, dull, shooting pain is distinguished according to the nature of the pain syndrome.
- According to the location, pain is distinguished in the front, back and side parts of the neck.When the pain radiates to the head, they talk about cervicocranialgia, and when the pain radiates to the shoulder - cervicobrachialgia.
- Due to their occurrence, all neck pain can be divided into 2 large groups - vertebral and non-vertebral:
- Vertebrogenic: occurs as a result of diseases, spinal injuries.This is the most common group of causes of cervicalgia.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial, muscle tone syndromes, myositis, cervical myopathy, poor posture, etc.
- Non-vertebral: caused by other causes (myocardial ischemia, infectious, endocrine, oncological diseases, damage to lymph nodes, rheumatism, etc.).
Let's consider individual reasons in more detail.
Causes that cause neck pain
Injuries (fractures, whiplash)
The mechanism of whiplash injury is associated with a sharp bending of the neck forward or backward with subsequent recoil in the opposite direction.Such damage is characteristic of an accident.In this case, tendon-ligament apparatus and muscles are stretched, the spine (compression fractures) and intervertebral discs are destroyed, cervical spine subluxations and dislocations and hernias are formed.
Complaints are pain in the neck radiating to the shoulders, head and interscapular area;restriction of movements;dizziness;nauseaM.B.Impaired vision, swallowing (dysphagia).
Other injuries that can result include bruises, lacerations, and strained neck muscles.Consequences of traumatic injury may include cervicalgia, migraine, muscle spasms, impaired neck mobility, fatigue, and impaired vision.
Dystrophic diseases of the spine
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the vertebral joints, which occur due to a decrease in elasticity, flattening and destruction of the intervertebral discs.
The impact absorption function of the discs is gradually impaired.This leads to an increase in the load on the intervertebral (facet) joints, arthrosis, radiculopathy - a pain syndrome due to the stretching of the nerve roots by bone formations (osteophytes) and tension in the neck muscles.When the spinal arteries are compressed, there is noise in the ears, flashes of spots in front of the eyes, blurred vision and dizziness.
Gradually, the intervertebral discs lose their elasticity.When they are compressed, a protrusion (protrusion) appears in the spinal canal with the subsequent formation of a hernia.This leads to compression and the development of pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome intensifies, the sensitivity of the arms, legs and scalp decreases with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is unilateral, shooting in nature, increases when bending to the painful side, throwing the head back, so the patient intuitively bends his head forward and on the opposite side of the pain site.Osteochondrosis may be accompanied by cervicobrachialgia;Cervicocranialgia.
Spondylosis is usually accompanied by osteochondrosis.With this pathology, bone formations (osteophytes) are formed on the edges of the vertebral bodies.At the same time, the intervertebral discs are reduced in size.The mobility of the neck is limited when adjacent vertebrae are fused.
During spondylolisthesis, the spine moves (slips) from above to below.This pathology is manifested in the form of pain in the location.The diagnosis is confirmed by X-ray.
Muscle syndromes
Muscle pain - myofascial syndrome
Long-term overload of neck muscles, stretching of ligaments and local hypothermia cause muscle pain.They are accompanied by limitation of mobility and spasm of neck muscles.When palpating (feeling) the muscles, they feel tension and pain.
The pain syndrome in myofascial syndrome is moderate in intensity, short-lived, aggravated by neck movements, and disappears on its own if left untreated.
Muscle-tonic syndrome (muscle spasm of the cervicothoracic region)
It is clinically manifested by prolonged and constant muscle tension, their reflex contraction - muscle spasm.The muscles become firm, swollen and painful to the touch.
Trigger points are formed - areas of the most pronounced pain.Cervicalgia intensifies when turning the head, flexing and extending the neck spine.It may be accompanied by numbness of the fourth and fifth fingers.
Mosit
Myositis of the neck develops inflammation of muscle fibers.The disease most often occurs against the background of hypothermia.It is manifested by severe pain during movement and decreased muscle tone.Due to the difference in muscle tone, the head tilts to one side and secondary torticollis occurs.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by decreased contractility of myofibrils, progressive muscle weakness, limitation of movements, decreased tone, and development of muscle atrophy with subsequent replacement of muscle fibers with fatty or connective tissue.
Cervical plexitis
Cervical plexitis is a disorder of the cervical nerve plexus.More often it develops against the background of trauma or hypothermia.The pain is localized in the area of the anterolateral surface of the neck and radiates to the ear, chest and back of the head.The pain intensifies when coughing, talking and is accompanied by a crawling sensation, paresthesia - sensitivity disturbance in the form of numbness, burning, tingling.
bad posture
The posture is disturbed when a person spends a lot of time at the computer or is in another monotonous position.Predisposing factors also include using a pillow that is too soft or too high for sleeping.During bad posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a tilt is created.
other reasons
Neck pain can be caused by other, non-vertebral causes, for example, coronary artery disease (coronary heart disease. In an atypical form, pain can spread to the neck, left arm, shoulder. This disease is characterized by ECG changes. Clinical symptoms include heaviness in the chest, shortness of breath, weakness with minimal activity.
In meningitis (inflammation of the soft meninges), pain in the neck and head is accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed with meningism.Spinal puncture is performed to differentiate these conditions.
Cervical lymphadenitis, or enlargement of the cervical lymph nodes, is the most common cause of cervicalgia (about 50% of all cases) in children.This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, flu, rhinosinusitis, measles, mononucleosis, tuberculosis) and in oncological pathology.Pain intensifies when swallowing, palpation of lymph nodes (palpation).
Neck pain can accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease begins before the age of 16 and is characterized by joint damage and articular manifestations.
Other systemic collagenoses that can cause neck pain include:
- Ankylosing spondylitis is a connective tissue disease that affects the spine.With this disease, individual vertebrae can fuse together.
- Dermatomyositis is characterized by inflammation of muscle tissue and skin, similar to photodermatosis, mainly in open areas of the body.
- Scleroderma includes fibrotic-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Cervicalgia is characterized by torticollis, an orthopedic disease with deviation of the neck from the vertical axis.This congenital malformation is diagnosed in early childhood and is more common in girls.
neck pain accompanies cancer 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 mucous membrane of the trachea); Esophagitis (inflammation of the mucous membrane of the esophagus); atherosclerosis; Reiter's syndrome; foreign bodies.
With 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 heat, sweating, increased heart rate, irritability and tearfulness.
Sialadenitis is an inflammation of the salivary glands.Pain intensifies during chewing and swallowing.Swelling of salivary glands, dry mouth, weakness, chills and fever are observed.
Bone loss (osteoporosis) develops with a deficiency of minerals (mainly calcium, phosphorus) and vitamins (D 3). 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 - during eating.
With atherosclerosis (damage to the walls of large arteries with the formation of atherosclerotic plaques that obstruct normal blood flow) and other vascular pathologies, neck pain is combined with dizziness and ringing in the ears.
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 mycoplasmal infection and has a chronic course.
Localization of neck pain - what problems do they indicate?
Localization of pain helps to correctly determine the cause of cervicalgia and take the necessary measures in time.
The main causes of anterior neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A retropharyngeal abscess is an inflammation of the tissue located in the retropharyngeal space.Pain in the neck increases when swallowing, accompanied by redness of the skin on the front surface of the neck, temperature rise to febrile level (38-39°).
- Cervical plexitis.
- Systemic connective tissue diseases (dermatomyositis, scleroderma).The pain aches, lies, radiates to the neck and spine.
- Cervical lymphadenitis.
- Atypical form of ischemic heart disease.
- Tracheitis, esophagitis.
- Compression fractures of the cervical spine.
Causes of back pain in the neck:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Spinal tuberculosis.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fractures of cervical spine organs, fractures of arches and vertebral processes.
Atherosclerosis may cause pain in the neck;myofascial syndrome;foreign bodyTumor 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 to contact for neck pain
A therapist, pediatrician or neurologist can help with neck pain.If neck pain is caused by trauma, then you should consult a traumatologist or surgeon.Depending on the cause of the pain, the therapist and pediatrician can also refer the patient to specialists such as rheumatologist, infectious disease specialist, cardiologist, oncologist or otolaryngologist.
Disease diagnosis, tests and investigations
To determine the cause of cervicalgia, the doctor examines the patient, asks him about the existing complaints, explains the duration of the symptom, the nature of the pain, its localization, irradiation, combination with other symptoms, and conducts palpation.It is important to determine the cause of cervicalgia for proper treatment.
If necessary, the following is prescribed:
- Consultation of narrow specialists;
- Instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectrical activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of transmission of nerve impulses 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 scan (to assess the state 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 drainage of pus.
Conservative treatment methods:
- drug therapy.Only with a doctor's prescription, self-medication is not allowed!For muscle syndromes, it can be local therapy (use of anesthetic ointments, gels) or the use of systemic drugs aimed at relieving muscle pain and spasms.
- Physiotherapy methods of influence.These are magnetotherapy, phonophoresis, electrophoresis with medicinal substances, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite use and others.
- Exercise therapy.The set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps to strengthen the muscles of the neck and back and to establish a correct posture.
- Massage.It can be performed both separately and together with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasm, normalizes muscle tone.
- manual therapy.Allows you to release muscle tension, pain and remove blocks.
Important: exercise therapy, massage, manual therapy are contraindicated during acute pain, as well as during injuries!
- Reflexology or impact on acupuncture points using needles, cauterization, hirudotherapy.The combination of points, duration and number of procedures will be different for different pathologies.
- Orthopedic technique.This is immobilization using a bandage or chance collar.It is carried out in the case of compression fractures of the cervical spine, in the acute period during muscle syndromes, osteochondrosis.
- Taping or kinesio taping is the use of special spots (tapes) on the skin of the neck.It is used to relieve pain, swelling, muscle spasms and nerve endings, improve blood circulation and lymph flow, and recovery after injuries and surgeries.Schemes of tape use differ for different pathologies.Depending on the method of use, tapes improve lymphatic drainage, have anti-inflammatory and pain-relieving effects, normalize muscle tone and stabilize joints.
Surgical treatment is performed for spinal hernia (if conservative therapy is ineffective), neoplasms, abscesses, cellulitis, and foreign bodies on the neck.
What drugs to treat?
Non-vertebral syndrome is treated by specialists;Each group of causes has its own therapy.The following groups of drugs are used to relieve pain in the neck muscles:
- Non-steroidal anti-inflammatory drugs (NSAIDs).They inhibit the enzyme cyclooxygenase (COX).There is COX 1 and COX 2. The use of NSAIDs is a symptomatic therapy aimed at relieving pain and other signs of inflammation.To reduce the risk of side effects, it is recommended to use non-steroidal anti-inflammatory drugs with selective action on COX 2.
- Local anesthetics.They are inserted into the place where the nerves exit (blockade).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Drugs that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling, pain.It is usually used when non-steroidal anti-inflammatory drugs are ineffective or in combination with them.
- Vitamins B, C (ascorbic acid), D and minerals: calcium, phosphorus, potassium, magnesium.Calcium is a vitamin and mineral complex recommended for the treatment and prevention of osteoporosis and fractures.
- Chondroprotectors.Improvement of cartilage tissue trophic (nutrition), promotion of 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 avoid neck pain, it is recommended to follow simple rules:
- Arrange your workplace correctly (illumination, monitor level, distance of the monitor from the eyes and other settings must comply with generally accepted standards).
- Minimizing risk factors: avoid scratches, hypothermia;Do not allow sudden bending or tilting of the head, etc.
- Watch your posture, including when working at the computer.
- During the break, do exercise therapy to strengthen the muscles of the neck and shoulder girdle.
- Optimizing physical activity.
- For sleep, it is better to use not high, but ordinary, or even better, orthopedic pillow.
- Correct body weight.
- to undergo a medical examination on time.
Adherence to preventive measures will help maintain health and well-being for many years.At the first signs of pathological symptoms, a visit to the doctor and timely treatment will help prevent the chronicity of the process and the development of complications.