Neck pain and Headaches are a very common issue in our society, and understanding the causes and prevention of them will go a long way to leading a healthy and pain free life. In this educational summary, we discuss some of the most common conditions we see in our office. Below we will discuss the following neck-related pain conditions.

  1. Upper Crossed Syndrome
  2. Headaches
  3. Neck Sprain/Strain
  4. Disc Pain
  5. Cervical Radiculopathy
  6. TMJ Dysfunction

Upper Crossed Syndrome

Upper Crossed Syndrome describes a type of common muscle imbalance. This occurs when the muscles at the front of the neck and the muscles at the mid back become weak. The chest muscles and muscles at the base of your skull become tight as part of your body adapting to the new “posture” you have acquired. This produces a familiar pain pattern at the base of the neck and the shoulders, as well as joint dysfunction at the base of the skull and shoulders.

The main physical causes of this condition are:

  • Desk job
  • Sitting for too long
  • Driving long hours
  • Poor posture

However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often have poor posture while sitting at a desk for most of the day. A compounding factor is a sedentary lifestyle with little or no physical activity. This newly acquired posture that is causing pain can lead to prolonged dysfunction/pain along with decrease in productivity while working.

The best way to combat this problem is, of course, to prevent it before it starts. If possible, minimize sitting for long periods of time and take frequent work breaks to take short walks around the office to reset your posture. I personally recommend taking a 5 minute walk OUTSIDE as the fresh air can re-energize your productivity flow as well.

If the problem has already begun, we at Align To Health can teach you proper ergonomics and posture to prevent this problem in the future so that you are more mindful of the positions that promote this problem.

We are also trained in soft tissue techniques that will be able to relax your tight muscles, restore motion and reduce pain levels. There are also methods of rehabilitative exercise that can be taught to you to reverse any noticeable change in your current posture and prevent a progression of this condition. Indirect bonus, it will start some healthy habits for you to employ for the rest of your life.

Headaches

Headaches come in many varieties, and nearly everyone experiences this type of pain at some point in their lives. The common symptom of all headaches is of course characterized by pain. Different types of headaches cause pain in different regions of the head and have unique pain sensations. Some portion of people experiencing headaches can be characterized as migraines. Migraines often feature symptoms such as nausea, vomiting or sensitivity to lights.

The physical causes of this condition are extremely numerous, but some of them are:

  • Stress
  • Poor posture
  • Diet & exercise habits
  • Hormonal imbalance
  • Smoking
  • Allergies

Since there are so many different types of headaches, as well as causes and symptoms, it is important to get a proper diagnosis so that you can better treat the cause. An assessment of your lifestyle habits is an effective way to diagnose common contributing factors that may be causing your headaches.

A good place to start can be to address your sleeping habits, making sure you get the proper amount of sleep and making sure you are getting restful sleep. A proper, healthy, balanced diet that is free of any substances that you may have a sensitivity to or may be a trigger for headaches is important for managing this condition as well.

Posture and body habits can be huge contributing factors and may be some of the simplest to diagnose and manage.

Treatment such as soft tissue modalities coupled with chiropractic adjustments and very simple rehab tools can be a simple and effective way of managing headaches of this type.

Neck Strain/Sprains

Cervical strains and sprains are some of the most common injuries sustained to the cervical spine. A cervical strain is when an injury occurs to the muscles of the cervical spine. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. Patients suffering from this diagnosis often have pain when attempting to move the head and neck, especially at end ranges of motion. Another symptom that sufferers’ may experience is frequent headaches, which may not seem directly evident to the patient that the source of the headaches may be caused by their cervical strain or sprain.

The main physical causes of this condition are:

  • Automobile accidents
  • Whiplash
  • Contact sports injuries
  • Repetitive overuse injury
  • Abnormal positions for prolonged periods of time

Some of the time these injuries are impossible to avoid, such as traumatic automobile accidents and whiplash injuries. At this point there are no steps for prevention and your next course of action is to seek treatment, usually with ice in the days immediately following the injury as well as therapeutic modalities such as Muscle Release Technique, spine mobilization, light rehab exercises and massage.

In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction in ergonomics in the workplace, fixing posture and instilling healthy habits, as well as receiving the proper knowledge in exercising can help build a better foundation for a healthy spine for life.

Neck Disc Pain

Discogenic Pain Syndrome is a condition that results from soft tissue damage and associated irritation of the fibers of intervertebral discs. Intervertebral discs are cushions found between each vertebra of the spine that work as shock absorbers to protect the vertebrae by helping dissipate the forces applied to the spine and to help facilitate movement. Intervertebral discs consist of an outer annulus fibrous, made up of tough, fibrous connective tissue, which surrounds a gel-like center called the nucleus pulposus. The outer third of the annulus fibrous is innervated by nerves and contain pain and mechanical receptors which mediate pain transmission from structural damage to the intervertebral discs or indirectly through chemically mediated inflammation.

Cervical disc pain can arise from a variety of reasons, whether by injury or a degenerative condition. In most cases, the condition can be treated to allow the person to continue his/hers active lifestyle.

Potential causes of Cervical Discogenic Pain Syndrome

  • Direct trauma - falls, motor vehicle accident, whiplash, sports injury
  • Overuse, fatigue, repetitive microtrauma - over hours, days, months of the same position
  • Sudden unguarded movement.

Symptoms of Cervical Discogenic Pain Syndrome

The symptoms will vary because of the complexity of the injury. With a herniated disc, pain can result in some of these or all of these symptoms: pain in the neck, radiating pain (anywhere from neck to fingers), tingling, and numbness down the arm or around the shoulder blade due to pressure put on the nerve root. Discogenic pain due to an injury can result in immediate pain or pain shortly after the injury. Headaches (usually cervicogenic) can also result from cervical disc pain.

Treatment of Cervical Discogenic Pain Syndrome

Treatment for cervical discogenic pain will depend on the clinical presentation. Conservative treatment can successfully manage many cervical disc herniations. Initial treatment will focus on controlling pain and dysfunction. Once pain and inflammation have decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft tissue therapy, activity as tolerated, and pain-free range of motion exercises. Late rehabilitation will be administered as the condition improves and will include stabilization exercises, patient education, and postural training. Education in proper training, biomechanics, and a home exercise program will help strengthen the spine and decreases the likelihood of future injury. A high percentage of discogenic pain cases are resolved with conservative care such as those described earlier. If for any reason you fail to respond to conservative treatment, we believe in team work with other medical professionals. We would refer out to another professional for their expertise in imaging (MRI, CT scan, or X-Ray) or an orthopedic consult can be warranted.

Cervical Radiculopathy

Cervical Radiculopathy is a dysfunction of the cervical nerve roots resulting in various neurologic findings. The cervical spine consists of seven cervical vertebrae and eight cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or weakness and though the problem occurs at the nerve root of the cervical spine, these symptoms will often radiate to parts of the body controlled by that nerve. The seventh (C7) and sixth (C6) cervical nerve roots are most commonly affected.

In younger patients, cervical radiculopathy is usually the result of a disc herniation or an acute injury causing foraminal impingement of the exiting nerve. In the older population, cervical radiculopathy is usually due to foraminal narrowing from osteophyte formation, decreased disc height, or degenerative changes. In elderly patients with osteophyte formation, repetitive neck movements may result in a more insidious injury. Cervical radiculopathy due to sports injuries can result from several mechanisms. Typical injuries occur from forced extension, side bending, or a rotational mechanism, which closes the foramen and results in the exiting nerve root being injured.                                

Risk Factors for Cervical Radiculopathy (not limited to these)

  • Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
  • Driving or operating vibrating equipment
  • Smoking
  • Collision sports (e.g. football, hockey)
  • Prior injuries

History and Symptoms of Cervical Radiculopathy

The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain. The pain may range from deep aching to severe burning neck pain. Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation, or a cold feeling”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved. Occasionally, a motor weakness may develop to the shoulder or arm muscles. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.

Treatment of Cervical Radiculopathy

Initial treatment will focus on reducing pain and inflammation and prevention of further neurological loss. The focus will also be on centralizing (reducing) any radicular symptoms by decreasing nerve root compression and pressure within the cervical spine. This will consist of manual traction and pain-free ranges of motion while avoiding positions that increase neck and arm symptoms. A cervical pillow at night can be helpful in maintaining the neck in a neutral position and limiting head positions that cause foraminal narrowing. Once pain and inflammation have decreased, therapy will progress to restore full range of motion and mobility of the neck and shoulder. This will include muscle stretching, strengthening and proprioceptive training, and corrective exercises as tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and as long as it does not cause an increase in symptoms. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a secondary consultation with a neurologist or neurosurgeon will be recommended.

TMJ Dysfunction

“I’ve got TMJ”  It’s a pretty common statement which is a bit of a misnomer.  Everyone has TMJ.  Why?  The TMJ is the tempo-mandibular joint(TMJ).  We all have it.  What people are probably trying to say is that they have TMJ disorder, aka pain and dysfunction of the jaw while opening or closing your mouth.

What happens is the mandible (your jaw) connects to the rest of your head at the temporal bone.  It’s a complex joint that is usually misunderstood. It can move up and down, side to side, and you can rotate it. Within the joint there is a small cartilaginous disc that keeps the bone from your skull and the bone from your jaw from rubbing against each other. Kind’ve like your knee joint and the meniscus. Unfortunately, it’s a common place for joint dysfunction After that, you can get overuse and degeneration of that joint.  One way to tell if you have this disorder is to go to a mirror, open your mouth and watch + feel the way it opens. Normally, your jaw should open straight down. Sometimes when people have TMJ dysfunction, the jaw opens like a C (opens on one side), an S curve (opens on one side first and then the other side opens after), or it opens not smoothly.

The main physical causes of this condition are:

  • trauma
  • overuse from a commonly chewing on one side of your mouth
  • keeping the mouth open for extended periods of time (like at the dentist)
  • improper bite

From a physical standpoint, the best way to prevent TMJ disorder is to wear proper mouthpieces while playing sports, wearing mouth guards while sleeping, making sure to chew food evenly on both sides of your mouth, cutting tough meats and other foods into small pieces and minimizing gum chewing.

Treatment for this can include intra-oral muscle release to relax any tightness, joint manipulation, and a dentist referral to follow up with teeth alignment in relation to your jaw.

Dr. Mueen Ghoury

Chiropractor

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