Mechanical Neck Pain
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Introduction[edit | edit source]
Neck pain is a common musculoskeletal problem, worldwide. Just like low back pain, neck pain is episodic in nature.
It is defined as pain between superior nuchal line and imaginary transverse line through the tip of the first thoracic spinous process and laterally by sagittal planes tangenital to lateral borders of the neck.[1]
Individuals with neck pain that lack an identifiable pathoanatomic cause for their symptoms are usually classified as having mechanical neck pain. Direct pathoanatomic cause of mechanical neck pain is rarely identifiable[2]. Although the cause of neck pain may be associated with degenerative processes or pathology identified during diagnostic imaging, the tissue that is causing a patient’s neck pain is most often unknown[2]
Mechanical neck pain commonly arises insidiously and is generally multifactorial in origin, including one or more of the following: poor posture, anxiety, depression, neck strain, and sporting or occupational activities[3].
Causes[edit | edit source]
Poor posture/Muscle imbalance[edit | edit source]
Most common abnormal posture seen in the region of neck is forward head posture. There is shortening(tightness) of the postural muscles like upper trapezius, levator scapulae and pectoral muscles and weakness in deep neck flexors, rhomboids and serratus anterior. This leads to restricted neck mobility. Such kind of muscle imbalance and abormal posture is found in the population who work on laptops/computers for long hours. This creates stress and pain in the cervical region.[4]Poor posture is considered the greatest cause of mechanical neck pain when there is no trauma or major injury.[5]
Measuring the Craniovertebral (CV) angle is one of the method used to measure the forward head posture.[6]
Alteration in thoracic alignment[edit | edit source]
The cervical ,thoracic and the lumbar spine are interrelated biomechanically. There has to be proper motion (concomitant motion) occuring at the thoracic spine inorder to get full ROM at the cervical spine. Thoracic spine acts as the supporting base for the cervical spine and it has an influence on cervical joint kinematics via the cervicothoracic junction. Because of the close kinetic link, any mechanical dysfuntion at the thoracic spine will create associated effect on the cervical spine.[7]
Red flags[edit | edit source]
Congenital Basillar impression/Basillar invagination[edit | edit source]
Neck pain may mask a serious pathology. It is possible to encounter life threatening condition such as craniovertebral anomalies. Basillar invagination is an abnormality where the odointoid process projects above the foreamen magnum. The prevalence is 1%.This is the most common malformation of the craniocervical junction.
Congenital basillar impression may not be recognized till adulthood if it is asymptomatic.
There was one case when the client was a soccer player (age 37 years) and his chief complain was intermittent neck pain and had no history of trauma. His NPRS score was 3/10 and his highest score in last 24 hours was 6/10.He had a drop attack recently while playing soccer. After this episode he suffered from facial numbness during prolonged postures. He even reported restriction of right rotation of neck and headache episode. He even had dizziness during neck extension. No radiating symptoms were present. He was referred to the neurosurgeon and MRI of cervical spine was prescribed in which basillar impression was revealed.[8]
Management[edit | edit source]
Despite the prevalence, less-than optimal prognosis, associated risk of disability, and economic consequences of individuals suffering from mechanical neck pain, there remains a significant gap in the literature, which fails to provide sufficient, high-quality evidence to effectively guide the conservative treatment of this patient population[3]. Heintz et al[3] suggest that this lack of quality evidence largely stems from the poorly understood clinical course of neck pain in conjunction with the inconclusive results related to the efficacy of commonly used interventions.
Physiotherapy approach the management of mechanical neck pain is with a plethora of interventions such as manual therapy, therapeutic exercises, modalities, massage, and functional training.
References[edit | edit source]
- ↑ Cleland JA, Dommerholt J, Oostendorp RA, Vleeming A. Manual therapy for musculoskeletal pain syndromes: an evidence-and clinical-informed approach. Elsevier,; 2016.
- ↑ 2.0 2.1 Childs, J.D., Cleland, J.A., Elliott, J.M., Teyhen, D.S., Wainner, R.S., Whitman, J.M., Sopky, B.J., Godges, J.J., Flynn, T.W., Delitto, A. and Dyriw, G.M., 2008. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 38(9), pp.A1-A34.
- ↑ 3.0 3.1 3.2 Heintz MM, Hegedus EJ. Multimodal management of mechanical neck pain using a treatment based classification system. Journal of Manual & Manipulative Therapy. 2008 Oct 1;16(4):217-24.
- ↑ Richa Mahajan, Chitra Kataria, Kshitija Bansal. .2012.Comparative Effectiveness of Muscle Energy Technique and Static Stretching for Treatment of Subacute Mechanical Neck Pain. International Journal of Health and Rehabilitation Sciences. 1 (1)
- ↑ Jasmita Kaur Chaudhery, Ajit Dabholkar. Efficacy of Spinal Mobilization with Arm movements (SMWAMS) in Mechanical Neck pain patients: Case-Controlled Trial. International Journal of Therapies & Rehabilitation Research. IJTRR 2017; 6 (1): 18-23
- ↑ Contractor ES, Shah SS, Shah SJ. To study correlation between neck pain and cranio-vertebral angle in young adults. Int Arch Integr Med. 2018;5(4):81-6.
- ↑ Shriya Joshi, Ganesh Balthillaya, Y. V. Raghava Neelapala. Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature .Asian Spine J 2019;13(5):849-860
- ↑ Mourad F, Giovannico G, Maselli F, Bonetti F, de las Peñas CF, Dunning J. Basilar impression presenting as intermittent mechanical neck pain: a rare case report. BMC musculoskeletal disorders. 2016 Dec;17(1):1-5.
