Neck Pain is Fairly Common
Your neck, also called the cervical spine, begins at the base of the skull and contains seven small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury.
The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have a variety of causes. Here are some of the most typical causes of neck pain:
Injury and Accidents
A sudden forced movement of the head or neck in any direction and the resulting “rebound” in the opposite direction is known as whiplash. The sudden “whipping” motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.
Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.
- Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
- Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
- Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Over time, a disc may bulge or herniate, causing tingling, numbness, and pain that runs into the arm.
Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.
Chiropractic Care of Neck Pain
During your visit, your doctor of chiropractic will perform exams to locate the source of your pain. They will also ask you questions about your current symptoms and remedies you may have already tried. For example:
- When did the pain start?
- What have you done for your neck pain?
- Does the pain radiate or travel to other parts of your body?
- Does anything reduce the pain or make it worse?
Your chiropractor will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting any movement that causes pain. They will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.
In some instances, your chiropractor might order tests to help diagnose your condition. For example, an X-ray can show narrowed disc space, fractures, bone spurs or arthritis. If nerve damage is suspected, your doctor may order a special test called electromyography (an EMG) to measure how quickly your nerves respond.
Chiropractors are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, they will refer you to the appropriate medical physician or specialist. The doctor may also ask for permission to inform your family physician of the care you are receiving to ensure that your chiropractic care and medical care are properly coordinated.
Treatment: Neck Adjustments
A neck adjustment (also known as a cervical manipulation) is a precise procedure applied to the joints of the neck, usually by hand. A neck adjustment works to improve the mobility of the spine and to restore range of motion; it can also increase movement of the adjoining muscles. Patients typically notice an improved ability to turn and tilt the head, as well as a reduction of pain, soreness and stiffness.
Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.
All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The chiropractic profession takes the issue of stroke and the safety of patients very seriously and engages in training and postgraduate education courses to recognize risk factors in patients, and to continue rendering treatment in the most effective and responsible manner.
A comprehensive review of scientific evidence related to neck pain treatments found at least as much evidence supporting the safety and effectiveness of common chiropractic treatments, including manipulation, as for other treatments such as prescription and nonprescription drugs and surgery.9 9. Hurwitz E, et al. Treatment of neck pain: noninvasive interventions. Spine 2008;33(4S):S123-S152.
Neck manipulation is a remarkably safe procedure. While some reports have associated high-velocity, upper-neck manipulation with a certain kind of stroke, or vertebral artery dissection, research suggests that patients are no more likely to suffer a stroke following a chiropractic neck treatment than they are after visiting their primary care medical doctor’s office. It was also concluded that vertebrobasilar artery (VBA) stroke is a very rare event, and that this type of arterial injury often takes place spontaneously, or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon.4 4. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33:S176–S183.
Patients with this condition may experience neck pain and headache that leads them to seek professional care —often at the office of a doctor of chiropractic or medical doctor—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity, upper neck manipulation is extremely rare – about 1 case in 5.85 million manipulations.5 5. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.