Anatomy, Pathology and Treatment of the Neck

The neck is the bridge between the head and the rest of the body and is made up of a number of vital structures including bones, vessels, organs, fascia and muscles. The head sits on top of the neck, with the average head weighing approximately 5kg (or 11lbs) – that’s a fair amount of weight to support.

The bones whose function it is to do this are the 7 vertebrae of the cervical spine. These are the top most vertebrae of the entire human spine:

What causes neck pain?

Neck and spine pain is a very common complaint. The spine is a complex area and pain can be caused by a number of different structures. There are a variety of possible reasons for a person to experience pain in this region. Pain can be caused by inflammation or structural changes in the vertebral joints caused by arthritis and other degenerative conditions. It could also be from an injury to the local muscles, or due to problems or irritations of the nerves that 'feed' off this section of the spine. These nerve irritations could include disc prolapses or be from a flare-up of degenerative disc disease. Pain emanating from the neck and spine also doesn't always have to be structural in nature - 'mechanical' neck pain caused by poor posture or muscle instability is often more common. The onset of the pain can be a good indicator of what structures might be at fault and a thorough assessment is usually required to examine this region.

Head and neck pain is an extremely common condition and there are many symptoms associated with it including headaches and referred pain down the arm.

The pathology within the neck can be broken down into 4 simplified conditions:

• Mechanical neck pain (including Headaches)
• Chronic Neck Pain
• Radicular neck pain
• Specific cervical pathology

Mechanical neck pain

Mechanical neck pain is the most common condition, often arises insidiously and is generally multifactorial in origin, including one or more of the following: poor posture, anxiety, depression, muscle strain, ligament sprains and repetitive sporting or occupational activities (Journal of Manual & Manipulative Therapy. 2008)

Headaches

The cause of headaches is often difficult to ascertain. Some headaches are associated with referred pain from the neck and are related to joint stiffness, muscle pain and posture. Physiotherapists are able to assess to see if neck problems are linked to your headaches, and offer appropriate treatment if any dysfunction is identified.

Chronic Neck Pain

Chronic pain is when neck pain lasts more than 12 weeks or keeps coming back over several months/years. It is typically due to spinal degeneration (e.g. osteoarthritis/ degenerative disc disease) which is the natural aging process of our bones and joints.

Radicular Neck pain

Pain can be caused by irritation, traction or compression at the nerve root in the neck. The causes of this can be due to a herniated disc, arthritic bone, tight muscles, lesions, or infection. The symptoms involve pain down the arm or pins and needles or weakness in the arm. The symptoms are usually unilateral.

Pathological neck conditions

This includes conditions such as: Cervical myelopathy, Cervical Arterial Dysfunction, Cervical fractures. These types of cervical conditions are very rare but serious and require urgent medical attention. Your physiotherapists number one priority is to assess and rule out these conditions.

Risk factors

There are many different risk factors for neck pain which have been suggested in the medical literature (J Epidemiol Community Health. 2010).  The most common risk factors are:

• Poor posture
• Reduced neck muscle strength
• Repetitive movements / labour intensive occupation
• Previous neck trauma
• Psychosocial factors such as anxiety/depression

Treatment for neck pain

Here at the White House we are able to assess your neck pain and determine a treatment plan that most suitable for you and your condition.

Physiotherapy treatment could include: Exercise prescription, Manual therapies (joint mobilisation / manipulation), Soft tissue release & Acupuncture.

We have gym-based facilities and Pilates classes if we feel these would benefit your rehabilitation.

We can assess your ergonomics, workspace and posture to advise the best setup for your working day to aid rehabilitation and prevent the risk of reoccurrence.

On some occasion’s patients would benefit from further investigations or orthopaedic reviews. We are able to determine and advise whether this would be appropriate for you. We have long standing professional relationships with the top orthopaedic consultants in the area and we can refer swiftly and directly if necessary.

What exercises can I try?

Due to the complexity of the spine, and the variety of possible problems, it is very difficult to prescribe exercises that will help recovery from a problem in this area without seeing and assessing a patient in clinic.

We recommend seeing one of our Physiotherapist's who will be able to show you the correct exercises for your individual needs. Often, a few simple exercises done correctly can go a long way to alleviate neck and spine problems. Exercises can help to improve muscle strength, range of motion and posture. We use online exercise programmes to email your specific exercises to you, and they are even accessible through our exercise app.

Our Physiotherapy team can assess for and treat all of the above, often without the need for surgical intervention.

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