Neck Pain

Musculoskeletal neck pain results from irritation of musculoskeletal structures which make up the neck (or cervical spine) including joints, muscles, ligaments, discs and nerves.  Oftentimes, the source of neck pain is a combination of the above listed structures-as our body relies on proper function of all these components to ensure smooth movement throughout our daily activities.  If one area of the spine isn’t moving properly or not moving at all, the body will recruit other areas to compensate for this dysfunction.  This places extra burden or biomechanical stress on the otherwise “healthy” structures and can thereby result in pain and irritation.

                Three major causes or triggers for neck injury (with symptoms including pain, stiffness and/or loss of range of motion) include:

1) Postural Imbalance/Repetitive Microtrauma-this type of injury occurs when common, everyday tasks (sitting, driving, computer/desk work, etc.) are performed when using improper biomechanics (poor posture) for extended periods of time.  These types of injuries usually appear gradually over time and the symptoms are often worse during periods of fatigue and emotional/mental stress.  Over time, when these imbalances and poor postures are not corrected, the result is degenerative change or arthritis.  Chiropractors are experts in identifying and correcting these postural imbalances and biomechanical stressors which can cause neck, upper shoulder and back pain and eventually lead to arthritis.

2) Trauma-Involvement in a fall or motor vehicle accident may injure the surrounding structures of our spine, such as in a whiplash syndrome.  Sprains to joints, ligaments and discs as well as muscle strains are common because of a trauma .  Careful examination by a chiropractor or other qualified health care provider is required to rule out injury to the spinal cord or other potentially serious or life threatening injuries.  Once this has been ruled out, a chiropractor is specially trained to diagnose and treat the musculoskeletal injuries caused by motor vehicle accidents.

3) Arthritis/Degenerative Change- Degenerative changes include many conditions affecting different regions of the spine and include terms such as arthritis, degenerative disc disease, spondylosis, osteoarthritis, spurs, osteophytes, stenosis, facet hypertrophy, arthropathy, etc.  Many different terms may be used to describe a  specific issue or a general issue and the terms used often become a point of confusion. 

The role of degenerative arthritis can be summarized as follows:

Arthritic or degenerative change is our body’s natural response to abnormal loads (mechanical stress) placed upon a particular region of the affected joint.  Let me explain this by illustrating a process called Wolff’s Law.  Wolff’s Law states that when increased loading on a bone occurs, the bone will remodel itself by laying down more bone mass and will become stronger over time to adapt to the increased load forces.  This occurs as a natural metabolic process in our body and in fact, our skeleton is replaced every few years as a result of this process.  With degenerative change, the same phenomena is true-however, the joint affected by arthritis allows abnormal forces to be placed upon the bone.  The bone is then remodeled in an abnormal pattern in an attempt to provide support or buttress the joint.  This is why arthritic joints can become painful, stiff, achy and have decreased ranges of motion.

Causes of arthritis or degeneration of the spine include trauma to the affected region earlier in life (see #2 above) and poor biomechanics over an extended period of time (see #1 above).

Chiropractic care can gently and safely restore the natural movement patterns in joints affected by arthritis and degenerative change.  By restoring these lost ranges of motion and correcting the mechanics, the degenerative process can be slowed, maintained or reversed in some cases.  Improved biomechanics also enhances your body’s healing ability by providing improved circulation and hence, nutrition and oxygen supply to the surrounding joint structures while waste products and inflammation are released from the area.  In this way, the techniques used by a chiropractor help to aid your body’s own natural healing process and prevent the degenerative process.

Whiplash or Whiplash Syndrome is a term used to describe an event in which the cervical spine (your neck) has undergone a rapid acceleration/deceleration which causes damage to the various tissues of the cervical spine. As in a car accident, the forces involved often include an abrupt stop or change in direction. Our head has no support above it and therefore acts as a weighted pendulum, allowing for ranges of motion in our neck to exceed their normal limit.

Unfortunately, the term “whiplash” does not describe the degree or severity of the injuries sustained which may include anything from a minor strain to even death. For this reason, emergency room follow up after involvement in a car accident is the first step to rule out potentially life threatening injuries. Even at low impact speeds, there is a potential for serious injury or death and may even be accompanied by no symptoms at all.

Various structures in our neck (cervical spine) have the potential for injury in this type of accident. Strained muscles and sprained joints and ligaments are very common injuries in motor vehicle accidents. Injury to the spinal cord and/or nerve root(s) are also common features in a whiplash syndrome.

Common symptoms of whiplash may include:

• neck pain,
• neck stiffness,
• neck tightness,
• loss of range of motion,
• neck to upper shoulder soreness.

Common accompanying symptoms of whiplash may include:

• arm pain,
• numbness and/or tingling into the arm/hand/finger(s),
• headache,
• dizziness,
• fatigue.

Common signs of whiplash include:

• tenderness along the muscles of the cervical spine,
• muscle spasm (your body’s natural defense response to help “guard” the injury),
• loss of range of motion,
• forward head posture,
• elevated shoulder positioning (of one or both shoulders),
• head tilted or rotated.

Once the risk of life threatening injury is ruled out for whiplash, the next step is to rule out fracture, instability and/or neurologic involvement (injury to nerves, nerve roots, discs, spinal cord). Along with orthopedic and neurologic tests, chiropractors often use x-ray, CT scan or MRI to rule out these possibilities.

Here are 7 steps that you can take to avoid and reduce lower back pain:

1. Avoid prolonged sitting
2. Get regular sleep
3. Participate in regular aerobic exercise
4. Maintain a healthy weight with a balanced diet
5. When lifting, keep loads close to your torso
6. Don’t smoke
7. See your chiropractor to identify risks that may be unique to you

What are some of the causes for lower back pain?

Although the causes of low back pain are varied, the causes of such chronic back pain can put into 3 major categories.  To “triage” low back pain into one of these categories is the first step taken by a chiropractor.

1) Non-musculoskeletal low back pain.  This accounts for <1% of all patients with low back pain presenting to all health care professionals, but has the most serious potential health risks.  Viscera (or simply the organs in our body) can produce pain that we feel in our back.  For example, the aorta (the largest vessel that comes from the heart) can dilate (or expand abnormally) and put pressure on the spine causing pain.  This is also called an aneurysm and can be potentially life threatening.  Other examples of non-musculoskeletal low back pain may include infection, tumor, cancer, and visceral referred pain.

With non-musculoskeletal pain (<1% of all low back pain), a referral to the appropriate specialist or primary care physician is made.

2) Neurogenic pain comprises about 10% of patients with low back pain.  This type of pain is caused from irritation of nerves that supply the low back and lower extremities (legs).

Neurogenic low back pain (~10% of all low back pain) is also commonly managed by chiropractors and oftentimes includes co-management with other specialists (ie. neurologists, physiatrists, orthopedic surgeons,  primary care, etc.).

3) Musculoskeletal low back pain.  90% of all cases of low back pain are considered to be musculoskeletal (pain that comes from irritated joints, muscles, ligaments, discs, tendons, and bone).  Pain may be just in the low back or may radiate into the buttocks, legs and/or feet.

Musculoskeletal low back pain (90% of all low back pain) is the primary area in which chiropractors specialize.  Research shows that chiropractic care is the most effective back pain treatment when treating musculoskeletal low back pain.

Just as any other physician, a chiropractor is trained to diagnose your low back pain.  In addition to taking a detailed history, chiropractors may use various orthopedic tests , neurologic tests, imaging (x-ray, MRI, etc.), blood work, etc. to diagnose a patient’s condition into one of the above categories.

Chiropractors commonly work together with other medical specialists to help treat painful conditions.  It is a misconception that you have to choose either a chiropractor or a medical specialist to help with your condition.  Rather, by working together and maintaining open communication between the chiropractor, the specialist and the patient make for the best results.

Given the range of conditions outlined above, it is easy to see why if low back pain that lasts for more than a few days should be evaluated by a qualified health care professional.  Remember, only a qualified health care professional can diagnose your condition.

The practice of Chiropractic is a specialized health care approach that is based upon the relationship between how your body is structured and how it functions; with a greater focus on the role of the spine. A Chiropractic practitioner is called a Chiropractor.

Some Chiropractors use a wide variety of approaches for treatment but the primary focus would be to perform spinal adjustments, or adjustments to other areas of the body that would help correctly align the spine, thus supporting the natural ability of the body to heal itself.

Main Points

• Many people choose chiropractic care for back and neck related pains as well as for headaches.
• Inherent with any such treatment, there are side effects and risks that depend largely upon the particular chiropractic treatment applied. Your chiropractor can explain these before treatment.
• In the United States, a Doctor of Chiropratic (DC) degree is required from a college that is accredited to confer such a degree.
• Research continues on chiropractic treatment and its effects on conditions and diseases that could benefit from such treatment.
• Be sure to always inform your regular health provider of any alternative and complimentary practices or treatments that you receive or use. Doing so will best allow them to manage your overall health and provided for safe and coordinated health care.

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Dr. John Herner is a licensed NH Chiropractor and available to discuss any additional questions or concerns you may have, with offices located at 60 Main Street, Nashua, NH 03060.