Mechanical Neck Pain
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Original Editor - Rachael Lowe
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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 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 tangential 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]
Neck pain persisting since 12 weeks or more comes under the heading of Chronic Neck Pain.
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].
Epidemiology[edit | edit source]
Rate of recurrence is high for neck pain along with its chronicity. The economic burden to neck pain is also high. Highest incidence of neck pain is found in computer workers. Prevalence is high among women, high income countries and high in urban report. The prevalence in overall population is 16.7% to 75.1%.[4]
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.[5]Poor posture is considered the greatest cause of mechanical neck pain when there is no trauma or major injury.[6]Measuring the Craniovertebral (CV) angle is one of the method used to measure the forward head posture.[7]
The therapist's role is to provide appropriate office ergonomics to reduce the chances of recurrence. For more information on this click on Office Ergonomics and Neck Pain
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) occurring 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 dysfunction at the thoracic spine will create associated effect on the cervical spine.[8]
Classification (Neck Pain Task Force Classification)[edit | edit source]
Level 1 : There are no evident physical examination findings which suggest of any structural pathology and minimal or no involvement of activities of daily living. Neck pain is present.
Level 2 : Patient is not able to activities of daily living properly and there are no signs and symptoms of any structural involvement.
Level 3 :Presence of neurologic signs(sensory deficits/ reduced DTR/weakness). No signs/symptoms of any major structural pathology
Level 4: Signs/symptoms of a major structural pathology like fracture/dislocation/spinal cord injury/metastasis/neoplasm or any systemic disease.[9]
Red Flags[edit | edit source]
Congenital Basilar Impression/Basilar Invagination[edit | edit source]
Neck pain may mask a serious pathology. It is possible to encounter life threatening condition such as craniovertebral anomalies. Basilar invagination is an abnormality where the odontoid process projects above the foramen magnum. The prevalence is 1%.This is the most common malformation of the craniocervical junction.[10]
Congenital basilar impression may not be recognized till adulthood if it is asymptomatic.
The patient of mechanical neck pain might complain of dizziness on neck movements, headache, facial numbness specially on prolong postures or even drop attacks. All these features are an indication of a red flag which are to be ruled out by the physiotherapist refer to the neurosurgeon when necessary. [11]
Angina[edit | edit source]
The patient can have pain on weight lifting in the gym, which doesn't alleviate after positional or postural changes and the pain is ceased once the activity is stopped. This is an indication of a red flag and further investigations are needed.[12]
Fracture[edit | edit source]
Prolonged use of corticosteroids, osteoporosis, history of trauma or old age are the corresponding red flags to be ruled out.
Spinal Cord Injury /Cervical Myelopathy[edit | edit source]
The therapist has to look for signs of radiculopathy like sensory issues in arms and legs ,loss of muscle strength in limbs or bladder-bowel dysfunction. Cervical spondylotic myelopathy is the most common myelopathy detected after 55 years of age usually. The early symptoms are similar to those of mechanical neck pain.[13]
Malignancy[edit | edit source]
History of tumor/neoplasm, Unexplained weight loss, sudden loss of appetite, dysphagia, headache, failure to improve after the treatment of one month.
Infection[edit | edit source]
The therapist has to look for signs of infection like fever /night sweats.[9]
Differential Diagnosis[edit | edit source]
Cervical Spondylosis[edit | edit source]
It is a degenerative disease which is progressive in nature. It affects IV disc, facet joints, ligamentum flavum and joints of Luschka. It is natural aging process which happens after fifth decade of life. Symptoms include neck pain , neck stiffness and can have radicular symptoms.
Long term mechanical neck pain can lead to Cervical spondylosis.
Cervical Nerve Root Lesion[edit | edit source]
The cause of cervical nerve root lesion is disc herniation ,stenosis ,osteophytes /swelling with trauma. Affected nerve root may have depressed DTR. Numbness , pins, needles in affected dermatomes (paresthesia). Cervical traction reduces the symptoms.
Brachial Plexus Lesion[edit | edit source]
It can occur due to stretching of cervical spine , compression of cervical spine or depression of shoulder. Contributing factor can be thoracic outlet syndrome. There is pain over trapezius along with sharp burning sensation.[14]
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 management[edit | edit source]
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. You can find the information on Evidence Based Interventions for Neck Pain
Physiotherapy treatment:
- Pain management :
Transcutaneous electrical nerve stimulation (TENS) , IFT (interferential therapy) depending on the radicular symptoms.
Ultrasound therapy: Can be applied on trigger points over the trapezius muscle.
Neck mobilization/ Thoracic mobilization: Central Maitland Mobilization or Sustained Natural Apophyseal Glide on cervical spine.
Active neck range of motion exercises.
Home program
Ergonomic advice: It has to be given based on the job/work of the patient.
Also refer to Evidence Based Interventions for Neck Pain and Treatment‐based classification approach to neck pain
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.
- ↑ Genebra CV, Maciel NM, Bento TP, Simeão SF, De Vitta A. Prevalence and factors associated with neck pain: a population-based study. Brazilian journal of physical therapy. 2017 Jul 1;21(4):274-80.
- ↑ 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
- ↑ 9.0 9.1 Bier JD, Scholten-Peeters WG, Staal JB, Pool J, van Tulder MW, Beekman E, Knoop J, Meerhoff G, Verhagen AP. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Physical therapy. 2018 Mar 1;98(3):162-71.
- ↑ Donnally III CJ, Munakomi S, Varacallo M. Basilar invagination.
- ↑ 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.
- ↑ Mathers JJ. Differential diagnosis of a patient referred to physical therapy with neck pain: a case study of a patient with an atypical presentation of angina. Journal of Manual & Manipulative Therapy. 2012 Nov 1;20(4):214-8.
- ↑ Smith BE, Diver CJ, Taylor AJ. Cervical Spondylotic Myelopathy presenting as mechanical neck pain: A case report. Manual therapy. 2014 Aug 1;19(4):360-4.
- ↑ Magee DJ. Orthopedic physical assessment-E-Book. Elsevier Health Sciences; 2019 Mar 25.
