Chiropractic & Neck Pain

Chiropractic & Neck Pain

Neck Pain

Neck pain is a common pain symptom experienced by most of us. Most neck pain begins with some kind of trauma, but sometimes the origin is difficult to identify.

With all neck pain—no matter what the cause—the pain itself tells us that there is some kind of problem in the functioning of the different parts of the spine.

Browse our articles to learn more about neck pain.

 

Additional Neck Pain Sections

Neck Pain Treatments

 

Articles:

Title
TMJ and Neck Pain
The Relationship Between Cervical Radiographic Findings and Pain
The Neck Pain Disability Index
Study Shows Connection Between Neck Pain, Arm Position
Shoulder-Neck Pain and Total Body Pain
Retropharyngeal Tendinitis
Predictors of Neck Disorders
Neck Pain Risk Factors
Manipulation, Mobilization and the Cervical Spine
Neck and Back Pain in Schoolchildren - The Role of Backpacks
Headache Type and Neck Mobility

Chiropractic & Neck Pain

Neck pain is a common pain symptom experienced by most of us. Most neck pain begins with some kind of trauma, but sometimes the origin is difficult to identify.

With all neck pain—no matter what the cause—the pain itself tells us that there is some kind of problem in the functioning of the different parts of the spine.

Browse our articles to learn more about neck pain.

 

Additional Neck Pain Sections

Neck Pain Treatments

 

Articles:

Title
TMJ and Neck Pain
The Relationship Between Cervical Radiographic Findings and Pain
The Neck Pain Disability Index
Study Shows Connection Between Neck Pain, Arm Position
Shoulder-Neck Pain and Total Body Pain
Retropharyngeal Tendinitis
Predictors of Neck Disorders
Neck Pain Risk Factors
Manipulation, Mobilization and the Cervical Spine
Neck and Back Pain in Schoolchildren - The Role of Backpacks
Headache Type and Neck Mobility

TMJ and Neck Pain

The relationship between temporomandibular joint dysfunction (TMD) and whiplash is an area of strong debate in medical and engineering circles. Clinically, a great number of patients suffering from whiplash injuries report TMD problems; biomechanically, engineers have been unable to show what happens during a rear end collision that causes injury to the temporomandibular joint.

Part of the problem may very well be that TMD pain may simply be an integral part of neck pain, rather than a separate, unrelated lesion caused by the collision itself. This theory is given credence by a new study that looked specifically at the interrelationship between neck pain and TMD symptoms in the general population.

The goal of this study was to find associations between TMD and neck pain. The researchers used a standard questionnaire that focused on symptomatology of both neck pain and TMD. The authors evaluated TMD by the patient's experience of any joint sounds (such as clicking), stiffness or fatigue in jaws, difficulty with opening mouth wide or it locking in, and any facial or jaw pain. Neck pain was defined as, "a troublesome pain experienced within the last year in the neck area between the occipital bone and the spinous process of the seventh cervical vertebra." 438 subjects completed the questionnaire.

188 patients (38.9%) had "troublesome" neck pain. The authors noted that this rate increased with age, and affected females more than males. A history of trauma did not correlate to troublesome neck pain. 266 subjects (55.1%) were identified with TMD pain.

When the results of the study were analyzed statistically, the authors found that there is indeed a significant association between neck pain and TMD pain. In particular, the strongest relationship exists between neck pain and facial and jaw pain.

The authors also suggest some anatomical reasons why the two conditions are so closely linked:

  • The authors refer to experimental studies that show that some neurologic circuits converge in the trigeminal nerve, showing that jaw functioning is inextricably linked with the cervical spine.
  • Biomechanically, "the masticatory muscles enter into a synergic or antagonistic relationship with cervical muscles acting as extensors or flexors of the cervical spine. Variations of length and of tonic response in cervical muscles might influence the activity of masticatory muscles."

The authors conclude that future research should investigate not only the role of direct trauma on the TMJ, but also the general "topography of pain and related structures" of the head, face, and spine.

Ciancaglini R, Testa M, Radaelli G. Association of neck pain with symptoms of temporomandibular dysfunction in the general adult population. Scandinavian Journal of Rehabilitation Medicine 1999;31:17-22.

The Relationship Between Cervical Radiographic Findings and Pain

What is the relationship between radiographic findings and neck pain and disability? This study took the cervical radiographic findings from 675 patients, and compared this information to self-reported pain and disability ratings to try to find an answer to this question.

The researchers examined the cervical spine radiographs, and recorded all evidence of degenerative findings; the study reported that most degeneration was found at C5, C6, and C4—in order of decreasing frequency. Interestingly, the authors found that spinal degeneration was not related to a history of neck trauma—although patients with a history of trauma reported more pain and disability than non-trauma patients.

The study also reported that those patients with spinal degeneration were more likely to experience chronic neck pain.

Marchiori DM, Henderson CNR. A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine 1996;21(23):2747-2752.

The Neck Pain Disability Index

This article summarizes a new questionnaire developed by Dr. Howard Vernon, DC, designed to assess whiplash patients. The survey is a modification of the Oswestry Low Back Disability Index. Each category contains 6 possible answers, scored from 0 to 5. Scores are totaled, and a rating is determined: 0-4 = No disability; 5-14 = Mild disability; 15-24 = Moderate disability; 25-34 = Severe Disability; 35-50 = Complete disability. The test has been studied a number of times and has been found to be a reliable and accurate assessment of neck pain disability. The following is a copy of the survey, as the article states that, "its duplication and use is encouraged."

This survey provides a simply tool for quantifying neck pain disability, and the author suggests using it to evaluate a patient's progress and to determine severity of disability. Please feel free to copy the following page and use this survey in your practice.

 


 

This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the ONE box which applies to you. We realize you may consider that two of the statements in any one section relate to you, but just mark the one box which most clearly describes your problem.

Section 1 — Pain Intensity

    • I have no pain at the moment.
    • The pain is very mild at the moment.
    • The pain is moderate at the moment.
    • The pain is fairly severe at the moment.
    • The pain is the worst imaginable at the moment.

Section 2 — Personal Care

    • I can look after myself normally without causing extra pain.
    • I can look after myself normally but it causes extra pain.
    • It is painful to look after myself and I am slow and careful.
    • I need some help but manage most of my personal care.
    • I need help every day in most aspects of self care.
    • I do not get dressed, I wash with difficulty and stay in bed.

Section 3 — Lifting

    • I can lift heavy weights without extra pain.
    • I can lift heavy weights but it gives me extra pain.
    • Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, for example on a table.
    • I can lift very light weights.
    • I cannot lift or carry anything at all.

Section 4 — Reading

    • I can read as much as I want to with no pain in my neck.
    • I can read as much as I want to with slight pain in my neck.
    • I can read as much as I want with moderate pain in my neck.
    • I can't read as much as I want because of moderate pain in my neck.
    • I can hardly read at all because of severe pain in my neck.
    • I cannot read at all.

Section 5 — Headaches

    • I have no headaches at all.
    • I have slight headaches which come infrequently.
    • I have moderate headaches which come infrequently.
    • I have moderate headaches which come frequently.
    • I have severe headaches which come frequently.
    • I have headaches almost all the time.

Section 6 — Concentration

    • I can concentrate fully when I want to with no difficulty.
    • I can concentrate fully when I want to with slight difficulty.
    • I have a fair degree of difficulty in concentrating when I want to.
    • I have a lot of difficulty in concentrating when I want to.
    • I have a great deal of difficulty in concentrating when I want to.
    • I cannot concentrate at all.

Section 7 — Work

    • I can do as much work as I want to.
    • I can only do my usual work, but no more.
    • I can do most of my usual work, but no more.
    • I cannot do my usual work.
    • I can hardly do any work at all.
    • I can't do any work at all.

Section 8 — Driving

    • I can drive my car without any neck pain.
    • I can drive my car as long as I want with slight pain in my neck. I can drive my car as long as I want with moderate pain in my neck.
    • I can't drive my car as long as I want because of moderate pain in my neck.
    • I can hardly drive at all because of severe pain in my neck.
    • I can't drive my car at all.

Section 9 — Sleeping

    • I have no trouble sleeping.
    • My sleep is slightly disturbed (less than 1 hour sleepless).
    • My sleep is mildly disturbed (1-2 hours sleepless).
    • My sleep is moderately disturbed (2-3 hours sleepless).
    • My sleep is greatly disturbed (3-5 hours sleepless).
    • My sleep is completely disturbed (5-7 hours sleepless).

Section 10 — Recreation

    • I am able to engage in all my recreation activities with no neck pain at all.
    • I am able to engage in all my recreation activities, with some pain in my neck.
    • I am able to engage in most, but not all, of my usual recreation activities because of pain in my neck.
    • I am able to engage in a few of my usual recreation activities because of pain in my neck.
    • I can't do any recreation activities at all.

Vernon H. The neck disability index: patient assessment and outcome monitoring in whiplash. Journal of Musculoskeletal Pain 1996;4(4):95-104. (Reprints of this article are available from Haworth Medical Press, 1-800-342-9678.)

Study Shows Connection Between Neck Pain, Arm Position

Neck pain is a common pain condition, and one frequently treated by chiropractors. While patients who suffer from neck pain as a result of whiplash or other injury often are most concerned with recovering the full range of function in their neck, researchers are beginning to uncover how neck pain may impact other areas of the body, including the upper body and arms. A number of studies have shown that spinal misalignment can affect the neurological pathways that create proprioception, the body’s ability to sense the relative position of its parts.

In a recent study published in the Journal of Manipulative and Physiological Therapeutics, researchers based at the New Zealand College of Chiropractic investigated the neurophysiologic connections between neck and arms, and how misalignment in the neck might interfere with this connection. They also explored whether spinal manipulation, as performed by a chiropractor, might restore some of the communication between the neck and arms.

The study participants included 25 volunteers with a history of untreated neck pain or stiffness and a control group of 18 volunteers with no such pain history. Among the 25 participants in the treatment group, 14 had experienced whiplash or other head injury. Most of the participants were recruited from a local university and college area, and the average age of volunteers ranged from 23 to 25. Image of participant position during joint experiment

Each volunteer received an initial assessment from a licensed chiropractor who noted any apparent spinal dysfunctions that might limit the patient's range of motion. The researchers then measured each patient’s ability to accurately position his or her elbow, using the following method (see image A): As the participant lay on his back with eyes closed, the researcher positioned his right arm pointing up at an 80° angle, identified this as the target angle, then repositioned the participant's arm to a new resting angle between 70° and 110°. This experiment was repeated with the participant's neck in different positions (facing front, turned to each side, and pointing down, see images B-D). The participant would then be asked to move his arm back to the original position. Arm positions were measured through sensors attached to an electrogoniometer. The researchers found that the group of patients who reported past neck pain were far less accurate in repositioning their elbows than those with no history of neck problems.

The patients in the treatment group then received a session of spinal manipulation that consisted of high-velocity, low-amplitude thrusts, while participants in the control group took a 5-minute rest period. After these treatments, all the volunteers went through another round of positioning and repositioning their elbows.

Participants with a history of neck pain, who had as a group performed poorly in the initial tests, significantly improved their ability to accurately position their elbow joints after the chiropractic treatments, while patients who had instead rested were less accurate in their joint positioning during the second round.

These findings suggest that spinal dysfunctions may impact the body’s proprioception, especially of the upper limbs. More importantly, the researchers found that this disability could be improved with just a single chiropractic adjustment session. The study lends credence to the notion that chiropractic treatment can be helpful not only in reducing immediate pain symptoms, but in restoring neurophysiological connections throughout the upper body.


Haavik H, Murphy B. Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense. Journal of Manipulative and Physiological Therapeutics. February 2011. 34: 2, 88-97.

Shoulder-Neck Pain and Total Body Pain

Work-related musculoskeletal pain is a huge expense, and recently OSHA has taken some steps in making the workplace easier for workers. This study examined one aspect of worker pain by evaluating the relationship between shoulder-neck (SN) pain and total body pain (TBP). The authors also wanted to evaluate the effect of nonspecific pain on a patient's report of mental distress and self-experienced health. The study looked at 8,116 people in the general population. The authors organized their data according to work status (employed or retired) and age to see if total body pain was related to working status as well.

The analysis was performed mainly through questionnaires. Body aching was assessed by the Standardized Nordic Questionnaire (SNQ), in which 4 regions of the body were illustrated on a body map. The General Health Questionnaire assessed mental health, and a seven-point scale was used to measure self-reported health.

72% of those reporting shoulder-neck pain had more than one painful body area. Total body pain scores were higher as shoulder/neck pain scores increased, and self-experienced health scores were significantly affected. Yet men and women scored quite differently in the remainder of the findings:

  • Women had higher TBP scores than men, but the scores decreased in the 60 year old age group—their condition improved when out of work.
  • The relationship between TBP and SN pain was more pronounced in the female group than the male group.
  • Men who were not working had the lowest reported health scores in relation to their pain status.
  • Women showed higher mental stress and distress in relation to their degree of shoulder-neck pain.
  • Emotional distress was found in 30.9% of women and 23.3% in men.
  • 42.3% of employed women had SN pain, and 55.7% had widespread pain.

 These findings show that the amount of pain experienced in the shoulder/neck area is dependent on the total burden of body pain. "The findings suggest that a majority of a middle aged general population could be sensitized to develop pain when subjected to repeated musculoskeletal strain in a particular part of the body, e.g. work situations demanding repetitive shoulder movements." They also mention that mental stress is often overlooked with chronic musculoskeletal pain patients. The authors make the following recommendations for handling these cases:

"Our results emphasize the need for assessment of the number of pain locations as well as the primary pain location when investigating possible causal relationship between repetitive low force musculoskeletal load and the development of localized pain...In the treatment and rehabilitation of patients reporting chronic musculoskeletal pain, a multidisciplinary approach focusing also on mental distress, is important already before work capacity is lost."

Ektor-Andersen J, Isacsson S, Lindgren A, et al. The experience of pain from the shoulder neck area related to the total body pain, self experienced health and mental distress. Pain 1999;82:289-295.

Retropharyngeal Tendinitis

This interesting case study illustrates the potential relationship between neck trauma, delayed onset of neck pain, and dysphagia.

"A 42 year old secretary in excellent health fell, in the sitting position, into a stream. She had minor abrasions of the limbs but did not hurt her neck or head. Ten days later she developed a stiff neck. Turning the neck to the left side was painful, making driving difficult. After two days pain increased; prescribed methocarbamol failed to provide relief. On day 3 she had painful difficulty in swallowing, not in the throat but in the right side of the neck 'as if the muscles and ligaments were strained,' and painful movement was relieved when flexing her neck."

The dysphagia increased to the point where the patient could swallow only sips of water. "She held her neck to ease swallowing. She also took to holding her head with both hands to enable her to lay her head on the pillow, and to sit up when getting out of bed." Her symptoms gradually improved, and by day 12 they had resolved.

"The unusual combination of such distinctive symptoms suggests a lesion in the retropharyngeal space involving the prevertebral muscles...The salient features are: (1) The curious location of pain, mainly in the side of the neck. This is quite different from that experienced in common neck sprains of whiplash injury, which are maximal in the posterior neck muscles with radiation to the shoulders, occiput, and interscapular regions. (2) Pain aggravated by movement... (3) Pain is dramatically increased by swallowing. (4) Painful dysphagia is felt not in the throat, but in the side of the neck. Patients may be obliged to hold their necks to allow swallowing. (5) The illness is unaccompanied by fever or systemic disturbance and is self-limiting."

The author attributes the symptoms to damage of the longus cervicis colli.

Pearce JMS. Longus cervicis colli "myositis" (syn: retropharyngeal tendinitis). Journal of Neurology, Neurosurgery, and Psychiatry 1996;61:324.

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