Cervical Pain Treatment by Physiotherapy

Neck pain is a very common symptom and one for which many people consult a physiotherapist. Initially in the subjective examination the physio will want to know how the pain came on and how long ago. Some people can recall a particular event such as cricking their neck or injuring themselves in some way, but many neck pains come on gradually with no precipitating factor.

The first investigation of the physiotherapist will be into the location and kind of pain. It is vital to understand if the pain is specific to one spot or whether it also affects other parts of the body. For example, if the pain is intense and specific the physiotherapist would surmise that the cause may be poor posture or a kind of degenerative problem; on the other hand, a referred pain may suggest a pinched nerve or a problem elsewhere.

Because neck pain could be an indicator of various pathologies the physio will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.

The neck has typical ranges of motion which are disturbed in pain conditions and the abnormalities give useful evidence about the underlying joint mechanics. The physio goes through cervical flexion, cervical extension, cervical rotations, cervical retraction and cervical side flexions to check which movements are limited and which are unaffected. Nerve conduction to the arms is then tested by investigating the sensation, muscle strength and reflex response.

Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain.