Tuesday, January 23, 2018

What A Pain In the Neck (Literally)!

A Strengthening Approach to Non-Specific Neck Pain

Neck pain is something that affects approximately 30% to 50% of the general population and causes extensive issues in an individual’s personal and professional lives. The complexity and sheer number of the structures located in this area contribute to its widespread effects and make it difficult to effectively apply a standardized and generalized treatment; potential pain generators include nerves, bones, discs, fascia, ligaments, and muscles. Mechanism of injury is an additional factor to consider; pain will present differently if caused by trauma (i.e. whiplash stemming from a car accident) or if by degeneration (normal wear and tear). In this blog, we will briefly discuss nonspecific mechanical neck pain, which first needs to be defined.

In short, nonspecific mechanical pain refers to a source of pain other than a nerve issue (with radiating pain down into the arm), fractures, rheumatological disease, tumors, or systemic disease. Essentially, when an individual has been screened for red flag symptoms (tumors, arterial insufficiency, fractures, instability, etc.) they are left with a number of mechanical drivers of pain that lies with one or more of the structures listed above. What this means is that after you are cleared from having anything like a cervical fracture, spinal cord compression, etc, there are a number of ways to identify the culprits and treat your pain.

Often times, we ignore our pain and simply assume it will go away on its own. A study by Ylinen et al, JAMA 2003 set up 3 groups in an experiment: a home stretching program without skilled physical therapy, a supervised strengthening program, and a supervised endurance program. The strengthening and endurance program both had significant changes in pain and (not surprisingly) strength measurements as compared to the non-supervised home stretching program (the people who hope it will go away). Perhaps the most exciting thing about this study was that these changes were still significant at the 3 year follow up.

Celenay et al. discovered that manual therapy (when physical therapists put their hands on you to help mobilize joints and tissues) was additionally helpful. In fact, the group in this study that received manual therapy in addition to neck stabilization exercises had greater outcomes than just the stabilization group in relation to improving disability, pain intensity at night, rotation motion (think driving!), and quality of life.

Another study looked at EMG activation of different cervical musculature, and what they found is significant. In those without neck pain, there was less activation of the superficial neck muscles (the ones you can see in the mirror when you move your neck) and greater activation of the deep neck flexor muscles, longus colli and longus capitus (these muscles are deep and cannot be felt).The reverse was also true: in those who had neck pain, they tended to have greater activation of their superficial muscles and did not activate their deep neck flexors effectively. What this means is that in those with mechanical neck pain, it is potentially helpful to learn how to activate those deep neck muscles: longus colli and longus capitus.

One test to assess a patient’s ability to recruit their deep neck muscles is the aptly named Deep Neck Flexor Endurance Test. This test is completed with the patient in supine and knees bent. They then tuck their chin and lift their head 1 inch from the table. Any dropping of the head or substitution from those superficial muscles is the end of the test. Normative data suggests that in those without neck pain, men scored 38.9 seconds and women scored 29.4 seconds. However, those with neck pain were found to have significantly decreased deep neck flexor endurance, average of 21.4 seconds. Weakness of the deep neck muscles and over-activation of the superficial ones commonly leads to a position of forward head postures, as we often see in those who work with computers.

In short, there are ways that physical therapists can help identify the pain-causing structures in your neck and apply an evidence-based effective treatment to get you back to living life without that nagging injury.

Matthew J. Brennan PT, DPT
The Physical Therapy & Wellness Institute

PTW’s Matt Brennan, DPT is a staff physical therapist at our West Norriton location. For an initial evaluation, call Matt at 610 630 0101 today! 

Celenay, Seyda et al. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients with Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. Journal of Orthopedic and Sports Physical Therapy. 46:2.2016
Domenech MA, Sizer PS, Dedrick GS, McGalliard MK, Brismee JM. "The Deep Neck Flexor Endurance Test: normative data scores in healthy adults." PM R. 2011 Feb. Web. 08/18/2012.
Fall et al. Spine 2004
Kay et al. Cochrane Database. 2005.

Ylinen et al, JAMA 2003