Neck pain is a problem that almost everyone has experienced.This is the most mobile and fragile part of the spine, and painful syndromes of varying intensity can occur for completely different reasons.Neck pain rarely indicates a serious illness.However, periodically recurring neck pain, which is persistent, should be a signal to look for the cause of this condition.
Most of the time these are muscle pains.the cause can also be degenerative changes in the spine, injuries and other (non-spinalogenic) causes: angina, infectious, endocrine, rheumatic, oncological diseases, lymph node pathology, etc.
Neck pain can be accompanied by dizziness, weakness, headaches, muscle spasms, pain and numbness in the hands, etc.
Classification, types and nature of pain syndromes
There are several classifications of neck pain:
- Depending on the duration of its course, it can be acute (less than 4 weeks), subacute (1-4 months) and chronic (more than 4 months).
- Depending on the nature of the pain syndrome, pain, dull, shooting pain is distinguished.
- Depending on the location, the pain is distinguished in the anterior, posterior and lateral part of the neck.When the pain radiates to the head, they talk about cervical cranial pain, and to the shoulder - about cervicobrachial pain.
- Due to their appearance, all neck pains can be divided into 2 large groups - vertebral and non-vertebral:
- Spinal cords: appear as a result of diseases, injuries of the spine.This is the most common group of causes of neck pain.According to statistics, it is > 70%.The most common cause is muscle pain.It can be caused by conditions such as myofascial, myotonic syndromes, myositis, cervical myopathy, poor posture, etc.
- Non-vertebral: caused by other reasons (myocardial ischemia, infectious, endocrine, oncological diseases, damage to the lymph nodes, rheumatism, etc.).
Let's look at the individual reasons in more detail.
Causes of neck pain
Injuries (fractures, whiplash)
The mechanism of whiplash injury is associated with a sharp forward or backward bending of the neck with further recoil in the opposite direction.This type of damage is typical for an accident.In this case, stretching of the tendon-connective apparatus and muscles, destruction of the vertebrae (compression fractures) and intervertebral discs, subluxations and dislocations of the cervical vertebrae and the formation of hernias occur.
There are complaints of pain in the neck, radiating to the shoulders, head and scapular region.restriction of movements;dizziness;nausea.M.b.impaired vision, swallowing (dysphagia).
Other injuries they can cause include bruises, sores and strained neck muscles.The consequences of a traumatic injury can be neck pain, migraine, muscle spasm, reduced neck mobility, fatigue and reduced vision.
Dystrophic diseases of the spine
Osteochondrosis is characterized by age-related degenerative-dystrophic changes in the joints of the spine that occur due to reduced elasticity, flattening and destruction of the intervertebral discs.
The shock-absorbing function of the discs gradually weakens.This leads to an increase in the load on the intervertebral (facet) joints, joints, radiculopathy - a pain syndrome due to pinching of the nerve roots by bone growths (osteophytes) and tension in the neck muscles.When the vertebral arteries are compressed, ringing in the ears, flickering spots in front of the eyes, blurred vision and dizziness occur.
Gradually, the intervertebral discs lose their elasticity.When they are compressed, a protrusion (protrusion) appears in the spinal canal with the further formation of a hernia.This leads to compression and development of pathological changes in the spinal cord (myelopathy).As a result, the pain syndrome intensifies, the sensitivity of the hands, feet and scalp decreases with the development of numbness and paresthesia.Weakness appears in the hands, tendon reflexes change.
The pain is unilateral, shooting, increases when leaning to the painful side, throws back the head, so the patient intuitively bends his head forward and to the opposite side from the location of pain.Osteochondrosis can be accompanied by cervical brachial pain.cervical cranial pain.
Spondylosis usually accompanies osteochondrosis.With this pathology, bone growths (osteophytes) are formed at the edges of the vertebral bodies.At the same time, a reduction in the size of the intervertebral discs is observed.When adjacent vertebrae are fused, neck mobility is limited.
With spondylolisthesis, displacement (slippage) of the overlying vertebra occurs relative to the underlying one.This pathology manifests itself as pain in the area of the location.The diagnosis is confirmed by X-ray.
Muscle syndromes
Muscle pain – myofascial syndrome
Long-term neck muscle strain, ligament sprains and local hypothermia lead to muscle pain.They are accompanied by limited mobility and spasm of the neck muscles.When the muscles are palpated (felt), they feel tight and sore.
The pain syndrome in myofascial syndrome is moderate in intensity, short-lived, intensifies with neck movements, and resolves on its own if left untreated.
Myotonic syndrome (muscle spasm of the neck region)
Clinically it is manifested by prolonged and persistent muscle tension, their reflex contraction - muscle spasm.The muscles become dense to the touch, swollen and painful.
Trigger points are formed - areas with the most intense pain.Neck pain intensifies when turning the head, bending and extending the cervical spine.It may be accompanied by numbness of the fourth and fifth toes.
Mosite
With myositis of the neck, inflammation of the muscle fibers develops.The disease occurs more often against the background of hypothermia.It manifests as severe pain during movements and reduced muscle tone.Due to the difference in muscle tone, the head tilts to one side and secondary torticollis is formed.
Cervical myopathy
Myopathy or degenerative pathology of muscle tissue is characterized by a decrease in the contractility of myofibrils, progressive muscle weakness, limitation of movements, decreased tone and the development of muscle atrophy with subsequent replacement of muscle fibers by adipose or connective tissue.
Cervical plexitis
Cervical plexus is a disorder of the cervical nerve plexus.More often it develops against a background of injury or hypothermia.The pain is located in the area of the anterolateral surface of the neck and radiates to the ear, chest and back of the head.The pain intensifies when you cough, talk and is accompanied by a crawling sensation, paresthesia - a violation of sensitivity in the form of numbness, burning, tingling.
Bad posture
Posture is disturbed when a person spends too much time at the computer or is in another monotonous position.Predisposing factors also include using a pillow that is too soft or too high to sleep on.With bad posture, the load on the ligaments and muscles of the neck increases, the head moves forward and a stoop is formed.
Other reasons
Neck pain can also be caused by other, non-vertebral causes, for example, coronary artery disease (coronary artery disease. In the atypical form, the pain can radiate to the neck, left arm, shoulder. This disease is characterized by changes in the ECG. Clinical symptoms include heaviness in the chest, shortness of breath, weakness with minimal physical activity.
With meningitis (inflammation of the soft meninges), neck and head pain is accompanied by neck stiffness, fever and vomiting.A similar clinical picture is observed with meningism.To differentiate these conditions, a spinal tap is performed.
Cervical lymphadenitis, or enlarged cervical lymph nodes, is the most common cause of neck pain (about 50% of all cases) in children.This symptom occurs in various infectious and inflammatory diseases (tonsillitis, pharyngitis, otitis, stomatitis, ARVI, influenza, rhinosinusitis, measles, mononucleosis, tuberculosis) and oncological pathology.The pain intensifies when swallowing, palpation (palpation) of the lymph nodes.
Neck pain can accompany juvenile rheumatoid arthritis.This autoimmune connective tissue disease appears before the age of 16 and is characterized by joint damage and extra-articular manifestations.
Other systemic collagenosis that can cause neck pain:
- Ankylosing spondylitis is a connective tissue disease that affects the spine.With this disease, individual vertebrae may fuse together.
- Dermatomyositis is characterized by inflammation of the muscle tissue and skin, similar to photodermatitis, mainly in exposed areas of the body.
- Scleroderma involves fibro-sclerotic changes in the skin, muscles, joints, blood vessels and internal organs.
Neck pain is seen with torticollis, an orthopedic disease with deviation of the neck from the vertical axis.This congenital malformation is diagnosed in early childhood and is more common in girls.
Neck pain accompanies tumor diseases. purulent-inflammatory processes: abscesses (limited inflammation of soft tissues), inflammations (inflammation of soft tissues without clear boundaries). pathology of the thyroid gland; salivary glands; braids; osteoporosis; tracheitis (inflammation of the lining of the trachea). esophagitis (inflammation of the lining of the esophagus). atherosclerosis; Reiter's syndrome? foreign bodies.
With the pathology of the thyroid gland (diffuse toxic goiter, Hashimoto's thyroiditis), the pain syndrome is combined with increased body temperature, feeling of heat, increased sweating, increased heart rate, increased irritability and lacrimation.
Sialadenitis is an inflammation of the salivary glands.The pain intensifies when chewing and swallowing.There is swelling in the area where the salivary glands are located, dry mouth, weakness, chills and fever.
With a deficiency of minerals (mainly calcium, phosphorus) and vitamins (D 3), bone loss (osteoporosis) develops. The risk of its occurrence increases in women during menopause.Osteoporosis of the cervical spine is accompanied by neck pain.
Tracheitis is characterized by increased pain when coughing, while esophagitis is characterized by increased pain when eating.
With atherosclerosis (damage to the walls of large arteries with the formation of atheromatous plaques that prevent normal blood flow) and other vascular pathologies, neck pain is combined with dizziness and tinnitus.
Reiter's syndrome is a complex of symptoms manifested by the classic triad: damage to the genitourinary system (urethritis + prostatitis), joints, conjunctivitis.It is most often caused by a mycoplasma infection and has a chronic course.
Identifying neck pain - what problems do they indicate?
Identifying pain helps to correctly determine the cause of neck pain and take the necessary measures in time.
The main causes of front neck pain are:
- Pathology of the thyroid gland.
- Sialadenitis.
- A post-pharyngeal abscess is an inflammation of the tissue located in the post-pharyngeal space.The pain in the neck intensifies when swallowing, accompanied by redness of the skin on the front surface of the neck, an increase in temperature to feverish levels (38-39°).
- Cervical plexitis.
- Systemic diseases of the connective tissue (dermatomyositis, scleroderma).The pain is aching, pulling, radiating to the neck and spine.
- Cervical lymphadenitis.
- Atypical form of ischemic heart disease.
- Tracheitis, esophagitis.
- Compression fractures of the cervical vertebrae.
Causes of pain in the back of the neck:
- Osteochondrosis, disc protrusion, spinal hernia, spondylosis, spondylolisthesis.
- Myofascial syndrome.
- Ankylosing spondylitis.
- Tuberculosis of the spine.
- Osteomyelitis.
- Reiter's syndrome.
- Compression fracture of the cervical vertebral bodies, fracture of the arches and dislocations of the vertebrae.
Pain in the side of the neck can occur with atherosclerosis.myofascial syndrome;foreign body;tumor process in the pharynx, larynx, thyroid gland.Neck pain on the side can lead to secondary torticollis, as the patient always tries to tilt his head to the painful side.
Who to contact for neck pain
A therapist, pediatrician or neurologist will help with neck pain.If the neck pain is caused by an injury, then you should contact a traumatologist or surgeon.Depending on the cause of the pain, the therapist and pediatrician may also refer the patient to specialists such as a rheumatologist, infectious disease specialist, cardiologist, oncologist, or otolaryngologist.
Diagnosis of the disease, tests and examinations
To determine the cause of neck pain, the doctor examines the patient, asks him about existing complaints, clarifies the duration of the symptom, the nature of the pain, its localization, radiation, combination with other symptoms, and conducts palpation.Determining the cause of neck pain is important for proper treatment.
If necessary, the following are prescribed:
- close specialist consultation;
- instrumental examination methods: ECG, Holter monitoring, EMG - electromyography (determination of bioelectrical activity of muscles and neuromuscular transmission), electroneurography (determination of the speed of transmission of nerve impulses along peripheral nerve fibers).
- X-ray of the cervical spine, CT, MRI?
- myelography – contrast X-ray of the subarachnoid (subarachnoid) space of the spinal cord.
- Ultrasound (ultrasound examination) of the salivary glands, thyroid gland?duplex scan (to assess the condition of blood vessels and blood flow);
Treatment methods
The treatment of neck pain must be comprehensive.There are conservative treatments aimed at relieving muscle pain, spasm, stopping the inflammatory process, and surgery performed to stabilize the spine and ensure pus drainage.
Conservative treatment methods:
- Pharmacotherapy.Prescribed only by a specialist doctor, self-medication is unacceptable!For muscle syndromes, this can be either local treatment (use of anesthetic ointments, gels) or use of systemic drugs aimed at relieving muscle pain and spasms.
- Physiotherapy methods of influence.These include magnetotherapy, phonophoresis, medicated electrophoresis, ultrasound, laser, UHF (thermal procedure), cryotherapy (cold exposure), SMT (sinusoidal modulated currents), UVT (shock wave therapy), MLT (magnetic field + laser exposure), paraffin/ozokerite application and others.
- Exercise therapy.The set of exercises is selected individually depending on the cause of the pain.Exercise therapy helps to strengthen the muscles of the neck, back and to form the correct body posture.
- Massage.It can be performed either alone or in combination with exercise therapy and manual therapy.Improves blood circulation, relieves muscle spasms, normalizes muscle tone.
- Manual therapy.It allows you to relieve muscle tension, pain and remove blocks.
Important: gymnastics, massage, manual therapy are contraindicated during the acute period of pain, as well as in case of injuries!
- Reflexology or influencing acupuncture points using needles, cautery, irudotherapy.The combination of signs, duration and number of procedures will differ for different pathologies.
- Orthopedic techniques.This is immobilization using a bandage or Chance collar.It is performed for compression fractures of the cervical vertebrae, in the acute period for muscular syndromes, osteochondrosis.
- Taping or kinesio taping is the application of special patches (tapes) to the skin of the neck.It is used to relieve pain, swelling, eliminate muscle spasms and pinched nerve endings, improve blood circulation and lymph flow, and recovery after injuries and operations.Schemes for applying tapes differ for different pathologies.Depending on the method of application, the tapes improve lymphatic drainage, have anti-inflammatory and analgesic effects, normalize muscle tone and stabilize joints.
Surgical treatment is performed for spinal hernias (if conservative treatment is ineffective), neoplasms, abscesses, cellulitis and foreign bodies in the neck.
What drugs to treat
Non-spinal syndrome is treated by specialists.each group of causes has its own treatment.To relieve muscle pain in the neck, the following groups of drugs are used:
- NSAIDs (non-steroidal anti-inflammatory drugs).They inhibit the cyclooxygenase (COX) enzyme.There are COX 1 and COX 2. The use of NSAIDs is symptomatic treatment aimed at relieving pain and other signs of inflammation.To reduce the risk of side effects, the use of NSAIDs with selective action on COX 2 is recommended.
- Local anesthetics.They are injected into the area where the nerves exit (blockage).
- Muscle relaxants.Helps relieve muscle spasms and relax muscles.
- Preparations that improve tissue microcirculation.
- Steroid hormones (glucocorticoids).Relieves inflammation, tissue swelling, pain.It is usually used when NSAIDs are ineffective or in combination with them.
- Vitamins B, C (ascorbic acid), D and minerals: calcium, phosphorus, potassium, magnesium.Calcium is a complex of vitamins and minerals recommended for the treatment and prevention of osteoporosis and fractures.
- Carboprotectors.Improve the nutrition (nutrition) of cartilaginous tissue, promote the regeneration of cartilage.
- Anticonvulsants.It is prescribed for spasms and muscle spasms.
Medication is prescribed only after a complete examination and identification of the cause of neck pain.
Prevention of neck pain
To prevent neck pain, it is recommended to follow simple rules:
- Properly organize your workplace (lighting, screen level, distance of the screen from the eyes and other parameters must comply with generally accepted standards).
- Minimize risk factors: avoid drafts, hypothermia.do not allow sharp bending or tilting of the head, etc.
- Watch your posture, even when working at the computer.
- During breaks, do exercises to strengthen the muscles of the neck and shoulder girdle.
- Optimize physical activity.
- For sleep, it is better to use not a high, but a regular, or even better, orthopedic pillow.
- Correct body weight.
- Get a medical examination on time.
Taking preventive measures will help maintain health and well-being for many years.Visiting a doctor when the first signs of pathological symptoms appear and timely treatment will help prevent the chronicity of the process and the development of complications.