The cervical spine starts from the base of the head down to the upper back. It is made up of seven vertebrae that act as support for the neck and eight nerves that start in the neck and descend into the upper extremities. The job of the cervical spine is to support the head, allow movement of the head, and protect the spinal cord. In recent time, stress to the neck has increased due to constant use of computers and increased use of cell phones. These activities cause poor posture. Many different pains can originate from the neck including shoulder pain, radiating pain into the arm, and headaches.
There are many muscles that surround the neck that help in supporting the head. Some of these are big, strong muscles that move the head. Others are small muscles that are postural and act as stabilizers to the small joints in the neck. A cervical strain occurs when a big, strong muscle is overused and becomes overstretched with resultant spasm. When this happens it can cause pain with prolonged postures (especially sitting) and pain with moving the head in specific directions. Many patients describe this as “I slept funny one day and woke up like this.”
The goal of physical therapy is to reduce spasm around the neck and correct muscle imbalance. The bigger, stronger muscles tend to be overused while the small, postural muscles are weak and under used. This puts greater strain on the superficial muscles and results in pain and tightness. Physical therapists may use modalities like ultrasound and electrical stimulation to reduce pain and spasm. Other interventions are manual therapy to reduce pain, stabilization and strengthening to the neck and shoulder muscles, and ergonomic/postural assessment. >> top of page <<
The cervical spine is made up of seven vertebrae and the eight nerves that run between those bones. In between each bone is a disc that provides space and shock absorption for the spine. The disc is a viscous material that bends and conforms to the pressures placed on it by different postures and positions of the neck. These discs can herniate, meaning the fluid material pushes out away from their firmer encasing, and cause pain and irritation to the surrounding nerve. The symptoms for this can be neck pain and/or radiating pain from the neck down into the arm and hand.
Physical therapy will work to reduce pain, improve range of motion, and improve the strength of the shoulder and neck muscles. Mechanical traction, a device that places a gentle pull upward at the neck to take the weight and stress of the neck, may also be used. Another effective treatment approach is from the McKenzie method. The McKenzie method uses specific movements and positions of the spine to place pressure to the disc to reposition it (1). In the event physical therapy is not able to eliminate symptoms, steroid injections or surgery are the next interventions. >> top of page <<
Whiplash is a term that is used for symptoms after a car accident or traumatic, sudden starting and stopping movement. The distribution and severity of symptoms varies widely for people with whiplash. The most common symptoms are low back and neck pain as these are the most vulnerable for large movements during a car accident. Symptoms may not start right after the accident and often can take up to 2-3 days to become noticeable.
The mechanism for low back and neck pain are the same with whiplash. Whiplash causes a fast, large movement of the spine. The response of the muscles surrounding that area is to protect the joints by tightening around the joint. Pain occurs because of the intense tightening of the muscles with resultant poor range of motion. It is difficult to discern how long pain will last although there are certain risk factors for prolonged symptoms. People who are fearful of movement, feel like they can’t help their own pain, and/or use passive coping strategies are all predictors for prolonged symptoms (2). Physical therapists will provide the tools and strategies to enable you to help yourself and get back to your daily routine.
Specific physical therapy goals will focus on increasing tolerance to activity, improving range of motion, strengthening weakened muscles, and decreasing pain. It is important to begin physical therapy as soon as possible. Physical therapy may utilize modalities like ultrasound and electrical stimulation, manual therapy to increase range of motion, and progressive resistance exercise for whiplash pain. >> top of page <<
Headaches are a very common problem with a multitude of possible sources. There are many different types of headaches ranging from tension headaches, to migraines, to cervicogenic headaches. Working with your primary care physician or specialist is important to identify the type of headache and rule out non-musculoskeletal issues. Physical therapists work with tension type headaches, cervicogenic headaches, as well as migraines.
Tension headaches are a result of overused muscles that support the neck and jaw. When these muscles are overused they become tight and can spasm. Characteristics of tension type headaches are symptoms on both sides of the head or neck, worsened with prolonged postures, improved with activity, and no throbbing or pulsing (3). Posture plays a large role in tension headaches because poor posture results in increased muscle use around the neck and jaw. Strengthening the muscles of the shoulder and upper back is a main focus on improving posture and decreasing tension headaches. Manual therapy and massage may also be used to reduce muscle spasm.
Cervicogenic headaches are a result of poor mobility and posture of the upper cervical spine. The neck gets 50% of it’s motion from the first 2 joints of the spine (3). These joints can become less mobile and stiff for a variety of reasons. The headache pain is a referred pain from the neck joints. Characteristics of cervicogenic headaches are unilateral symptoms, migrating from the back of the head to the front, and exacerbated with certain neck postures (3). Physical therapy works on improving the mobility of the cervical spine, decreasing associated muscle spasm, and improving the strength of postural muscles. >> top of page <<
- Dunsford A, Kumar S, Clarke S. Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain. J Multidiscip Healthc. 2011; 4: 393-402. doi: 10.2147/JMDH.S24733
- Williamson E, et al. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms.
Physiotherapy. 2015; 101(1): 34-43.
- International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24:1–160.