Neck pain has many causes. Mechanical neck pain comes from injury or inflammation in the soft tissues of the neck. This is much different and less concerning than symptoms that come from pressure on the nerve roots as they exit the spinal column. People sometimes refer to this problem as a pinched nerve. Health providers call it cervical radiculopathy.
This guide will help you understand:
How the problem develops
How doctors diagnose the condition
What treatment options are available
The chiropractic approach is to help restore a more normal motion and position of affected spinal joints and bones by specific chiropractic adjustments or manipulation. This is often combined with ice, traction, soft tissue massage, electrical muscle stimulation, ultrasound, traction, exercise and stretching. Please see the treatments section for descriptions of each of these procedures. We do not always adjust or manipulate the spine in the presence of certain disc and nerve problems in the neck. Depending on your exam findings, more conservative techniques can sometimes be used. Traction can help de-compress the pressure on the discs of your neck. Sometimes, keeping the neck still for a couple of days can help calm the irritated nerves. This is prescribed only when clinically indicated and you should not start wearing a collar prior to being examined by one of the chiropractic doctors. Wearing the collar longer than a couple of days can actually slow the healing process and prolong disability. Electrical muscle stimulation and ice are commonly used to help reduce the inflammation in the muscles and nerves. A thorough exam and history will help in identifying the appropriate treatment for you.
What part of the neck is involved?
The spine is made of a column of bones. Each bone, or vertebra, is formed by a round block of bone, called a vertebral body. A bony ring attaches to the back of the vertebral body. When the vertebra bones are stacked on top of each other, the bony rings forms a long bony tube that surrounds and protects the spinal cord as it passes through the spine.
Travelling from the brain down through the spinal column, the spinal cord sends out nerve branches through openings on both sides of each vertebra.
The intervertebral disc sits directly in front of the opening. A bulge or herniated disc can narrow the opening and put pressure on the nerve. A facet joint sits in back of the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve.
An intervertebral disc fits between each vertebral body and provides a space between the spine bones. The disc normally works like a shock absorber. An intervertebral disc is made of two parts. The center, called the nucleus, is spongy. It provides most of the shock absorption. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.
Why do I have this problem?
Cervical radiculopathy is caused by any condition that puts pressure on the nerves where they leave the spinal column. This is much different than mechanical neck pain. Mechanical neck pain is caused by injury or inflammation in the soft tissues of the neck–the disc, the facet joints, the ligaments, or the muscles of the neck.
The main causes of cervical radiculopathy include degeneration, disc herniation, and spinal instability.
As the spine ages, several changes occur in the bones and soft tissues. The disc loses its water content and begins to collapse, causing the space between the vertebrae to narrow. The added pressure may irritate and inflame the facet joints, causing them to become enlarged. When this happens, the enlarged joints can press against the nerves going to the arm as they try to squeeze through the neural foramina. Degeneration can also cause bone spurs to develop. Bone spurs may put pressure on nerves and produce symptoms of cervical radiculopathy.
Heavy, repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc. A blow to the head and neck can also cause extra pressure on the nucleus. If great enough, this increased pressure can injure the annulus (the tough, outer ring of the disc). If the annulus ruptures, or tears, the material in the nucleus can squeeze out of the disc. This is called a herniation.
Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand these pressures. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. Over time, the annulus becomes weakened, and the disc can more easily herniate through the damaged annulus. If the herniated disc material presses against a nerve root it can cause pain, numbness and weakness in the area the nerve supplies.
Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine (the neck) can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissue may also have spinal instability. Spinal instability also includes conditions in which a vertebral body slips over the one just below it. When the vertebral body slips too far forward, the condition is called spondylolisthesis. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms of cervical radiculopathy.
What does the condition feel like?
The symptoms from cervical radiculopathy are from pressure on an irritated nerve. These symptoms are not the same as those that come from mechanical neck pain. Mechanical neck pain usually starts in the neck and may spread to include the upper back or shoulder. It rarely extends below the shoulder. Headaches are also a common complaint of both radiculopathy and mechanical neck pain.
The pain from cervical radiculopathy usually spreads further down the arm than mechanical neck pain. And unlike mechanical pain, radiculopathy also usually involves other changes in how the nerves work such as numbness, tingling, and weakness in the muscles of the shoulder, arm, or hand. With cervical radiculopathy, the reflexes in the muscles of the upper arm are usually affected. This is why doctors check reflexes when people have symptoms of cervical radiculopathy.