Changes occur with chronic cervical pain

Original Editor - Mostafa Shahien

Top Contributors - Mostafa Shahien  

Introduction

Cervical pain is one of the most common complaints by patients represented to physiotherapy clinics.It disturbs the overall function and quality of life for most patients.it may occur because many different reasons and with many different forms so discussing the possible causes,changes occur with chronic pain and the best treatment modalities is very essential and mandatory .

Changes Occur With Chronic Cervical Pain.

1.Pain Centralization

Reduced pain thershold is one of the findings that resaearchers have found in patients with chronic neck pain[1].The decrease in pain thershold is recorded both locally and distally in upper and lower limbs and this suggest that central changes occur with chronic cervical pain.

2.proprioceptive changes

patients with chronic cervical disorders show deficit in the proprioceptive input which affect postural stability[2]

3.Neuromuscular dysfunction

researches shown that patients with chronic cervical pain exhibit up to 90%deficit in cervical spine muscles strength[3].

deep neck flexors have reduced emg activity and delayed activation when performing arm movement so the feedforward mechanism is diturbed[4]

neck flexor muscles(SCM and anterior scalene) have shown side-specific weakness in unilateral cervical pain.[5]

Assessment

assessment of chronic cervical pain should focus on different areas:

.posture assessement

done from three different positions:

from posterior:if you find elevated shoulder,it would be tightness of upper trapezius and levator scapula.

from lateral:you will find forward head posture.

from anterior:you will find cord like apperance at SCM .

.balance assessment

as explaind above,patients with chronic neck pain have impaired postural stability.

.gait assessment

in extreme cases of cervical dysfunction,gait pattern may be changed.

.flexibility and muscle strength assssment

physical therapy treatment

the main aim for physical therapy treatment is to restore the balance between the muscles by stretching the tight one and strength the weak and also to improve proprioception.and here are some examples of treatment.

.stretching for tight muscles

the most common tight muscles:

upper trapezius

streno cleido mastoid(SCM)

stretching alone is not suffecient to treat patients with chronic cervical pain,you should also work on deep neck flexor stabilization protocol as it is very important step in the rehabilitation program.

proprioceptive exercises.

as stated above,patients with chronic neck pain show deficit in proprioception which affect postural stability.any exercise that involve head and eye movement thought to imrprove proprioception as the vestibular,visual and prorioception is linked together as noted in researches[8] [9].

you may also look at Sensorimotor Impairment in Neck Pain to see the proprioceptive exercises.

References

  1. Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing. Journal of Musculoskeletal Pain. 2002 Jan 1;10(3):69-81.https://www.tandfonline.com/doi/abs/10.1300/J094v10n03_05
  2. Malmström EM, Fransson PA, Bruinen TJ, Facic S, Tjernström F. Disturbed cervical proprioception affects perception of spatial orientation while in motion. Experimental brain research. 2017 Sep 1;235(9):2755-66.https://www.ncbi.nlm.nih.gov/pubmed/28623390
  3. Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical Biomechanics. 2005 Oct 1;20(8):794-8.https://www.ncbi.nlm.nih.gov/pubmed/15996800
  4. Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental brain research. 2004https://www.ncbi.nlm.nih.gov/pubmed/14762639 Jul 1;157(1):43-8.
  5. Falla D, Jull G, Rainoldi A, Merletti R. Neck flexor muscle fatigue is side specific in patients with unilateral neck pain. European Journal of Pain. 2004 Feb;8(1):71-7.https://onlinelibrary.wiley.com/doi/full/10.1016/S1090-3801%2803%2900075-2
  6. https://backintelligence.com/sternocleidomastoid-stretch/
  7. https://backintelligence.com/sternocleidomastoid-stretch/
  8. Revel M, Minguet M, Gergoy P, Vaillant J, Manuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Archives of physical medicine and rehabilitation. 1994 Aug 1;75(8):895-9.
  9. Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. Journal of Orthopaedic Research. 2007 Mar;25(3):404-12.