Posts tagged neck pain
The Neck's Impact On Recovery From Concussion
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Concussions have received significant media and medical research attention over the last decade due to in part to the incidence of chronic traumatic encephalopathy (CTE) among former football athletes. This increase in attention to brain injuries has led to improved medical training and early recognition of concussion symptoms leading to improved care of athletes and patients suffering from post concussion symptoms. Authors estimate an incidence of 750 cases of mild traumatic brain injury per 100,000 person years and close to half of all of these individuals will experience post concussion symptoms including headaches, neck pain, dizziness, balance impairments, and fatigue. Experts in concussion report a large percentage of these symptoms may not be due to the brain but instead concurrent injury to the neck, specifically the upper neck bones.

Kennedy and colleagues examined a cohort of patients with persistent post concussion symptoms (median 5 weeks post concussion) to determine the coexistence of associated neck impairments (JOSPT. 2019). Authors examined patients both before and after treatment of their necks. Consistent with prior research impairments of the upper joints and musculature were found among this cohort including neck pain, limited range of motion, muscle and joint tenderness. These impairments are consistent with findings from patients with cervicogenic headaches and likely help explain the positive benefits of treating the neck in patients with concussion.

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Physical Therapy Headache Solutions
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Headaches remain a significant source of pain and disability for patients in our country costing over $30 billion dollars each year. Symptoms can be driven by different types of headache including tension, migraine, and cervicogenic (driven from the neck). Cervicogenic headaches can be found in 4% of the general population, 20% of all patients with headaches, and up to 50% of patients with headaches after a whiplash mechanism of injury.

The upper neck vertebrae are most commonly associated with these symptoms with the 2nd and 3rd vertebral joint driving 70% of headaches. The clinical diagnosis can be made based on the following criteria

  1. Pain that originates in the neck and radiates to the frontal and temporal regions

  2. Unilateral symptoms (may be bilateral but never together)

  3. Radiates to ipsilateral shoulder and arm

  4. Provocation of symptoms with neck movement

  5. History of neck pain

Physical Therapy remains a first line treatment for cervicogenic headaches. Researchers advocate for a mulitimodal approach including spinal manipulation, neck and upper back strengthening (see videos). These interventions have received the highest grade (A) of evidence for treatment of this condition. Specifically, evidence supports the use of manual therapy and exercise over primary care management, manual therapy or exercise alone in patients with neck pain and headache. These benefits are sustained at 1 and 2 year follow up time periods. Finally, the number needed to treat (NNT) is 2 for patients with neck pain treated with manual physical therapy and exercise to achieve one additional successful outcome than would have occurred if patients received an alternative treatment.

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Benefits Of Manipulation For Patients With Neck And Arm Pain
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Thoracic manipulation by Physical Therapists has previously been shown to improve pain and function in patients with elbow, shoulder, and neck pain. Authors continue to research the mechanisms behind its’ effectiveness including a beneficial cascade of events in the peripheral and central nervous system, as well as, a possible biomechanical change in the spinal joints. Clinically, thoracic manipulation is also utilized in patients with neck and arm pain (cervical radicular pain or cervical radiculopathy). This painful condition is secondary to encroachment of the spinal nerves in the neck as they pass through their respective vertebrae. Patient’s with this condition can experience pain, numbness, and/or pins and needles into their shoulder blade, arm, and hand. If left untreated patients may also notice weakness in their hands. Physical Therapy treatments including manual therapy and exercise aim to improve spacing within the bony neck canals that contain the neck nerves, as well as, optimize movement in the body regions adjacent to the neck to reduce the demands in the affected neck vertebrae. A new recent study highlights the benefits of thoracic manipulation in this patient population.

A randomized controlled trial in the Journal of Orthopedic and Sports Physical Therapy was conducted by Young and colleagues to determine the effectiveness of thoracic manipulation in patients with neck and arm pain (2019). Authors randomized patients to one of two treatment groups including a single session of thoracic manipulation or sham (placebo) manipulation. They assessed immediate and short term (48-72 hours) changes in pain, pain location (centralization), function, neck range of motion and strength. As expected, patients provided with thoracic manipulation reported decreased pain, improved function, and demonstrated improved range of motion at both time points compared to the sham manipulation group.

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How Does Needle Depth Impact Treatment Effects From Dry Needling?
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Dry needling is a treatment provided by Physical Therapists to relieve a patient’s muscular pain and associated symptoms. This intervention can be performed in both extremity and spinal regions within the body. Current research continues to investigate the mechanisms behind its’ effectiveness, as well as, the most appropriate patient populations and diagnoses for its’ utilization. In addition, authors are trying to determine which parameters of the treatment such as needle placement, needle number, duration of treatment, utilization of electrical stimulation and needle depth may be modified for optimal treatment effects.

Griswold and colleagues reviewed the available evidence behind needle interventions for spinal pain to determine if depth of needle placement influences treatment effects (JMMT. 2019). Authors included 12 studies in the systematic review and 10 studies in the meta analysis. They reported both superficial and deep dry needling improved pain but significantly better outcomes on pain were found for utilization of deep dry needling. In addition, there was a greater effect when needles were placed in the area of pain compared to a distal site on the body.

Contact the experts at MEND to learn more on how dry needling can improve your current symptoms

Higher Amounts Of Exercise Correlated With Greater Reductions In Neck Pain
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With the hypervigilance in abstaining from opioid prescriptions due to the opioid crisis, there has been an effort in determining alternate ways of providing analgesic effects for those in chronic pain. One of the most consistent modalities to help benefit with treatment is exercise. There has been many studies exploring the analgesic effect of exercise on pain and dysfunction as compared to pharmacological treatment. However, there has not been any literature supporting the appropriate dosage and intensity of exercise.

A recent study (Polaski, AM et al. PLoS One. 2019) performed a meta-analysis of many studies using exercise to help treat and manage chronic pain. The studies ranged from many different durations and intensities with different populations, all experiencing chronic pain. The researchers found a positive correlation between duration of exercise and decrease in neck pain. Duration could be constituted for amount of time during exercise, and/or number times exercising throughout the week.

If you are experiencing chronic pain, please seek counsel with your health provider to help guide you in designing a exercises program with the appropriate duration.

The Importance Of Neck Strengthening In Patients With Neck Pain
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Neck pain is a common source of musculoskeletal pain with up to 70% of Americans experiencing neck pain at some point in their lives. In the early or acute phases of pain, hands on treatment including spinal manipulation and joint mobilization have been shown to reduce pain and disability due to neck symptoms. If left untreated, neck pain begins to create muscles imbalances including weakness and tightness of the upper quarter muscles. Specifically, research has shown poor performance of the deep neck muscles along the front of the spine. The deep neck flexors provide strength and stability to the skull on the spine as well as the spinal vertebrae. Normally these muscles have a feed forward response where they fire before bigger movements of the neck, but in patients with neck pain these muscles fire late or may not fire perpetuating muscle imbalances and movement impairments at the neck. A new systematic review highlights the importance of the deep neck flexors for patients with neck pain.

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Blomgren and colleagues examined the available evidence behind the utilization of deep neck flexor strengthening in patients with neck pain (BMC Musculoskeletal Disorders. 2018). Authors included 12 randomized controlled trials in their final analysis to determine the impact of these exercises on aspects of muscle performance including strength, endurance, coordination, and function. They reported strong evidence was found for the effectiveness of these exercises on coordination, but smaller effects were found for deep cervical strengthening on strength or endurance measurements. In addition, deep cervical flexor strengthening exercises were found to improve neck and head posture.

In our physical therapy practice in Boulder we commonly start with these exercises before rapidly progressing patients toward a higher level strength training program. In our practice experience, higher level strength training of the neck and shoulders is the most effective way to restore function and prevent recurrence in patients with neck pain.

To learn more on how to develop your neck strength contact the experts at MEND