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Physiotherapists, chiropractors and osteopaths are all trained to treat neck problems. Manual treatments carried to out by one of these therapists are often all that is needed. Sometimes manipulation is uncomfortable at the time, so it is important that you understand what is involved. Make sure you talk to your therapist about the treatments before they start.
If pain lasts for more than a few days, or if pain spreads into the arm, then you should see your doctor (GP). S/He will examine your neck and many arrange physical treatments.
Most cases of neck pain can be confidently diagnosed and treated without any special tests. Very occasionally your GP may ask for an x-ray out other important causes of neck pain, such as ankylosing spondylitis or an infection.
If your pain is very bad, or if it spreads into your arm or have dizzy spells, your GP may send you to see a specialist. The specialist may be a rheumatologist, orthopaedic surgeon or neurosurgeon, depending on the problem, further tests may be needed, such as x-rays, blood tests, An MRI scan will only be done if there is a suggestion that there is a nerve (or nerves) being pinched in the neck, and if further treatment is being considered. A specialist may recommend injections into certain parts of the neck, but only once is it clear exactly where the pain is coming from. Surgery is very rarely needed-only in severe cases or nerve or spinal cord involement.
Pain and stiffness can be caused by poor standing posture or by too soft a bed or the wrong thickness of pillow. If your desk is too low, so that your head is bent forward for long periods, then the neck may be stretched and you may develop muscle pain. Check your desk height and chair design at work and in the home-this is important to prevent problems. Similarly, if you work at a computer screen it is important to have screen, desk and chair set at the correct heights. Many firms employ people to check that their employees are sitting properly-check with your line manager or occupational health nurse.
Stress can make neck pain worse. One way of reducing the effects of stress is to learn how to relax the neck muscles. Relaxation and exercises are not mutually exclusive they complement each other. You can sometimes get audiotapes to help with relaxation from your doctor or a physiotherapist. They can also be bought from the pain relief foundation.
Simple exercises can help to restore your range of movement, promote strength, ease localised stiffness and help get your neck back yo normal. You should start by exercising very gently and gradually up. You can expect to feel some slight discomfort at first.
Figure 4 shows some simple stretching and strengthening exercises. Gently tense your neck muscles for a few seconds in each position. It you do this every day, the neck movements with increase your muscles strength.
Gentle massage of the neck muscles, particularly with aromatic oils, often helps. Please note, however, that some oils can be poisonous (toxic) in large quantities and can be harmfil during pregnancy or with conditions such as epilepsy. Rubbing the area with liniments can also help - these produce a feeling of warmth and reduce pain. Some liniments available over the counter contain capsaicin (an extract of the capsicum, or pepper, plant), and a similar stronger preparation is available on prescription.
Most attacks of neck pain settle down within a few days and do not need medical treatment. Resting for a few days is often all you need.
Painkillers
You can take simple painkillers such as paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, available at chemists, often help but can sometimes cause indigestion, so be careful if you have a history of stomach upsets. As an alternative you can rub anti-inflammatory gels or ctreams onto tender areas with less risk to the digestion.
In some cases of persistent pain the cause of the pain (such as a facet joint or a disc) can be identified. How ever. it is important to realise that pain can sometimes continue even after the original cause (whiplash, facet or disc) has long since settled down. Pain may at first cause to avoid normal activities and movement. If your initial spell of neck pain lasts a long time, lack or activity can cause the neck muscles to become weak, and this reduces the ability of the cervical spine to take further knocks. You may also lose confidence in your ability to reksume your normal activities. This may affect your work, your social life and your personal relationships. Naturally, you may feel depressed and anxious in this situation and this could lead to further loss of confidence, frustration and anger, particularly if family members and the medical profession appear unhelpful or unsympathetic. If you are anxious or depressed as a result of the pain, you may not feel like exercising, so your muscles become weaker still, and so it goes on.This can happen to anyone, and the longer it continues the harder it will be for you to recover your movement and confidence. The sections that follow explain what can be done to prevent or break this cycle of pain.
If you have long-lasting neck pain and stiffness, particularly if your sleep is disturbed, then you may feel excessively tired and this can cause depression.
Sometimes if you have neck pain you may also have muscle spasms that turn the head to one side. This is called torticollis. Although not very common, it is an unpleasant side-effect of neck pain. It usually lasts only a few hours or days, although rarely it may cuntinue for several weeks.
These can sometimes happen when body changes in cervical apondylosis cause pinching of the the vertebral artery. You may feel dizzy when looking up, or you may occasionally have blackouts.
Torticollis.
Sometimes if you have neck pain you may also have muscle spasms that turn the head to one side. This is called torticollis. Although not very common, it is an unpleasant side-effect of neck pain. It useally lasts only a few hours or days, although rarely it may continue for several weeks.
