Neck pain is the equivalent of low back pain at the level of the cervical spine; the cause is the same and the consequences are similar. Both are due to a compression of the nerve structures inside the vertebral column by the intervertebral discs. However, there are many other structures that if activated by painful stimuli can produce symptoms related to cervicobrachialgia: the paracervical muscles, some joints, the ligaments, for which evaluation by a doctor skilled in the field is essential.

Usually the approach to this problem consists in advising the patient to rest, possibly wearing a soft collar to relieve the pressure on the column and taking analgesic drugs (so-called NSAIDs such as salicylated nimesulide or similar) and muscle relaxants. The exercises in which muscle relaxation is achieved are useful and must be given with precise indications.

Spinal manipulations can provide a fair benefit, as well as all techniques that reduce pressure on the intervertebral discs (pompages, tractions and physical therapy with analgesic currents). Very useful can be the injection of cortisone on the nerve root which has been crushed by the herniated disc.

Acute cervicobrachialgia if left untreated tends to heal on its own in 3 months. Postural correction and techniques that tend to induce disc protrusion (like Mc Kenzie) are very effective. Postbalance exercises are very useful especially if administered after medical evaluation

If the pain lasts for more than three months and does not benefit from any type of medical or physiotherapeutic approach, surgery may be necessary (this occurs in a very limited number of patients).

The clinical manifestations with which the disease occurs can be the most varied and are listed below.

 

Acute stiff neck

. Young patient (15-30 y.).

. Attacks with spontaneous healing in 7-10 days.

. We find an extreme partial articular scheme: the head is tilted laterally, a rotation and lateral flexion are completely blocked; the other movements are less limited but all painful.

Unilateral cervicoscapular pain

. The patient is usually over 25 years old.

. Pain is intermittent (several weeks) with painless periods between attacks; perhaps not always on the same side.


. Over the age of 50, pain can become constant.

Unilateral root pain

. The patient is certainly over 35 years old.

. The same anamnesis of the 2 previous cases.

The pain becomes very strong and continuous, difficult to control with drugs taken by mouth. Cortisone infiltration must be performed on the compressed nerve root; this quickly relieves pain. Otherwise you have to wait for the pain to subside after a few months.

Acroparesthesia

. Paresthesias in both hands and feet in a patient over 60 years old.

. The cause is a small bilateral protrusion, usually irreducible.

Bilateral scapular pain

. The patient is generally over 60 years old.

. Since it is a central protrusion, a particular manipulative approach is required (strong traction, lever traction).


Whiplash injury

The term whiplash does not constitute a diagnosis, it only indicates the type of trauma that has occurred. When a car is buffered from behind, the patient's head undergoes first hyperextension and then hyperflexion.

Various injuries are possible: ligament injury, muscle, fracture, central disc protrusion (in many cases).

The series of events is well known: the patient remains stunned for a moment, the radiography performed at the emergency room is usually negative. The cervical collar is usually recommended but it has been seen from all clinical research that its usefulness is only in the 2-3 days following the trauma.

The next day, the neck is very painful and rigid, fixed in flexion; coughing hurts.

Pain and limitation remain strong enough for a few weeks and gradually improve over a few months.

Manipulation and massage performed by an experienced person can be of great help.

 

In some cases, muscle tension and contracture in the trapezius and shoulder muscles are mainly observed. Neuroprolotherapy, with small injections of 5% glucose and lidocaine, manages to reduce the symptoms by 80-90% from the first sessions. The procedure is poorly painful and not very invasive.