Cervical Pain Treatment by Physiotherapy
by Jonathan Blood-Smyth
Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be
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.
Many diseases and conditions could mimic neck, shoulder or arm pain so physios exclude serious underlying conditions by checking the patients medical history, how well they sleep, any change in their appetite or weight, control of their bladder and bowel function, general health and use of drugs. Once cleared the physiotherapist will start the examination by looking at the postural shape of the cervical spine, trunk, arms and shoulders. Typical poor posture is a slumped trunk, poking head and round shoulders, often seen at a computer and which leads to problems.
Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physio understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.
To narrow down the area responsible for the pain the physiotherapist will employ mobilization techniques in assessment of cervical spine lesions as well as treatment. The individual joint levels can be assessed for movement dysfunctions in a systematic manner, palpating the neck in lying when the spine is relaxed. If the symptoms are brought on by pressure on the spinal joints at a certain level then the physio can infer that the changes at that level are important in the diagnosis and subsequent treatment.
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.
Other treatment techniques commonly employed by physiotherapists are strengthening exercises for the deep neck flexor muscles, generalized exercise to get fitter, neural exercises to ease nerve related problems, mobilization of the thoracic spine, postural correction and pacing activities to prevent overdoing one position or function for too long at one time. In severe cases of nerve root pain in the arm, which is similar to sciatica in the leg, manual traction of the neck may be used to reduce the pressure around the sensitive nerve or autotraction kits can be used, allowing patients to give themselves traction regularly.
Jonathan Blood-Smyth is a senior physiotherapist at a large NHS teaching hospital. He publishes physiotherapy advice widely in books and on the web. He is also editor of a website which assists patients in the UK find local physiotherapists throughout Scotland, England, Wales and Northern Ireland
