Care for the Neck
The reason we hold our heads high, why we are able to move our head around and scan the surroundings not just for sensorial pleasure but even for survival in the neck. It is crucial for balance, aids in swallowing and even helps expand the rib cage during inhalation.
A narrow conduit, the cervical spine connects the skull to the torso and enables communication between the two. It is the most flexible part of the spine where bones, muscles, nerves, blood vessels, lymphatics and other connective tissues are woven together in a complex pattern.
The cervical spine consists of 7 vertebrae that can together enable bending the head forward, bending it backward, turning to the sides, tilting the head. Each individual cervical joint also has a primary motion. Cervical vertebrae C1 and C2 are composed of special bony structures that support and move the skull and are known as “atypical” vertebrae. The upper portion of C3 to C7, the “typical” cervical vertebrae are primarily used for rotation while that of the lower portion is side-bending.
Apart from movement related functions, the vertebral bodies in the neck protect the spinal cord and vertebral arteries while the muscles protect neurovascular structures that sustain life. Therefore, taking proper function of the neck is essential even for survival.
Fortunately, the most common problems people face are pain, stiffness, sprain, stress and other injuries that can make movement difficult, though if it is very severe, it can impact functionalities and even prove fatal at times.
Self-Care for Pain Management
Pain in the neck caused by exertion and stress, if it is not debilitating and not caused by trauma, can be managed with some self-care measures such as:
- Resting for short periods and avoiding strenuous activities and movements that can aggravate the pain.
- Hot or cold fomentation can help relax the muscles. Begin by applying ice to reduce swelling and pain and then apply heat to relax the muscles and improve blood circulation. Use fomentation for 15 or 20 minutes and give a gap of two-hours in between to allow the skin time to recover.
- Some gentle stretches can provide relief from pain or muscle tightness.
Lifestyle changes that play can help reduce neck pain include:
- Being physically active
- Using proper posture through the day
- Using ergonomic furniture
- Not smoking
- Lifting heavy things using the correct posture
- Balancing weight on both shoulders to reduce overexerting one side
For Severe Pain
If the pain persists, physical therapy may be needed to improve neck strength and flexibility. Consult an expert who can decide on the duration and the specific program required based on diagnosis. It may require several sessions spread across weeks with a trained physical therapist to find relief. You may also be required to practice some of the exercises at home.
There are two common types of physical therapy, passive and active. In passive, the patient does not need to make any effort. Fomentation, massage, ultrasound, electrotherapy, and other similar techniques are used to decrease pain and swelling. In the initial stages of treatment, this may be used more.
In active physical therapy, the patient actively participates through exercises and stretches to strengthen the neck muscles and make them flexible.
The two common therapy procedures include:
- The McKenzie approach for centralizing and providing relied to pain symptoms
- Dynamic lumbar stabilization exercises reduce motion at the injury location to control pain and train muscles to provide protective support during activity automatically
Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are over-the-counter (OTC) pain relief medications that may be prescribed to reduce neck pain. If it does not have the desired effect, then stronger medications maybe prescribed such as prescription-strength NSAIDs, muscle relaxants, or opioids for a brief period. To avoid complications, follow doctor’s advice and read directions on use.
Some extreme situations may need injections for the cervical spine:
- Cervical epidural steroid injection: Disc herniation or other spinal degeneration may cause inflammation of nerve roots and tissues in the region. Cortisone steroid solution may be injected into the outer layer of the spinal canal, called the cervical epidural space, using contrast-enhanced fluoroscopy (x-ray guidance), for pain relief.
- Radiofrequency ablation (RFA): RFA is administered using fluoroscopy when there is pain in the facet joint for lasting relief. Heat lesion is created by placing a special needle near the facet joint’s sensory nerve to prevent pain signals from reaching the brain.
- Trigger point injection. Needle similar to the one used for acupuncture is injected without any solution or a trace of local anaesthetic to soothe the trigger point.
Injections provide only temporary relief and need to be supplemented with therapeutic exercises and lifestyle changes for efficacy. As injections also can cause grave side effects, it is used only in extreme cases, and as a step to avoid surgery, if possible.
Surgery—The Last Resort
Surgery may be prescribed if other treatments do not provide relief and symptoms persist, or in case of compression of the spinal cord or nerve roots. Two common surgery options for neck pain are:
Cervical Discectomy and Fusion: A very common surgery for neck pain, discectomy involves removing a problematic disc through the front of the neck, called anterior cervical discectomy. For spinal stability, this procedure is done along with a cervical spinal fusion.
An alternative is to perform the posterior cervical decompression or microdiscectomy through the back of the neck, where only a part of the disc is removed without spinal fusion. The location of the cervical disc herniation must be accessible with minimal manipulation of the spinal cord. If the location is too central, it is safer to use the ACDF approach.
Cervical artificial disc replacement (ADR): This is a fairly recent procedure where damaged disc is removed and replaced with an artificial disc, rather than a fusion. This preserves greater neck mobility than discectomy but is not a common practice yet due to its newness.
Posterior Cervical Laminectomy: Lamina, the back part of the vertebra, is removed through the back of the neck. This retains the flexibility of the neck if spinal fusion is not required. Sometimes, however, a spinal fusion is required with the procedure.
Posterior Cervical Laminoplasty: Similar to laminectomy, in this the lamina is not completely removed but rather, cut and restructured to provide more space in the spinal canal.
Posterior Cervical Foraminotomy: A small part of the foramen is removed through the back of the neck and it does not require spinal fusion. In case of a nerve irritation due to a herniated disc, a part of the disc may be removed. If a bone spur is causing the irritation, the bone spur may be chiselled away.
Anterior Cervical Corpectomy: This is a rare surgery, needed in case of a spinal cord compression at multiple spinal levels. At least one vertebral body–the cylindrical bone at the front of a vertebra—is removed along with the discs above and below that vertebra. The space created is filled with a bone graft and/or cage, inducing the fusion of the bones into one solid segment.
While some injuries may make neck surgery inevitable, it can be avoided with timely care and regular exercises, which Chennai Ortho strongly recommends for we believe ‘Movement is Life’.