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Neck Pain

Neck pain is a very common symptom that affects nearly 2/3 of all individuals during their lifetime. Neck pain can range from mild to severe depending on the injury and source of pain. It can be acute in nature and resolve within a few days or weeks, but it can also linger and become chronic.

There can be many causes neck pain that can result from an abnormal movement, traumatic incident, poor posture, or can develop over time without cause.

Neck pain that persists is mainly a sign that treatment is needed. An orthopedic injury, disease, congenital malformation, or age-related changes may be responsible for more significant pain. A trained medical professional must determine the underlying cause of such neck pain. Examination, diagnosis, and treatment by a physical therapist will help to relieve your pain in the short-term and in the long-term will help to prevent recurrence.

How can Physical Therapy Help?

Once your neck pain has been examined or physical therapist may determine that you have an orthopedic injury. This means the source of your pain is coming from your muscles, joints, or nerves. You may have pain locally at your neck, but your neck can also refer pain into your shoulders, shoulder blades, arms, and hands. Symptoms can include pain, numbness, or tingling. These can all be treated by a physical therapist!

Once you have gone through a full physical therapy examination, your therapist will determine the exact treatment that is going to relieve your pain. Treatments in physical therapy include the following:

  • Massage and soft tissue mobilization
  • Modalities to relieve acute pain
  • Neck traction to relieve nerve pain
  • Joint mobilization
  • Strengthening and flexibility exercises
  • Functional exercises to help you return to your daily life or work activities

Your treatment will be determined by your symptoms and is specifically designed for YOU!

Whiplash Associated Disorder

Whiplash or Whiplash Associated Disorder (WAD) describes the sudden forward and backward movement of the head and neck, most commonly occurring during a motor vehicle accident. It can also occur during a variety of other activities such as recreational and competitive sports. Note that a whiplash could also occur with rapid side-to-side movement as well.

WADs are estimated to cost consumers and the insurance industry billions of dollars each year. With a WAD there can be soft tissue injury, bone fracture, and nerve damage. Because of the considerable number of structures (bone, spinal cord, brain, ligament, intervertebral disc, muscle, joint capsule, and tendon) involved, recover can take months or years. However, most cases of whiplash resolve themselves of severity in a few months or less.

A classification of whiplash was offered by the Quebec Task Force (a group that did extensive study on Whiplash) :

  • No complaints about the neck, no physical signs.
  • Neck complaints of pain, stiffness, or tenderness only No physical signs.
  • Neck complaint AND Musculoskeletal signs (decreased range of motion and point tenderness).
  • Neck complaint AND neurological signs (decreased or absent deep tendon reflexes, weakness, and sensory deficits).
  • Neck complaints AND fracture or dislocation.

X-rays and other diagnostics may be performed by your physician to rule out fractures.

How can physical therapy help with Whiplash Associated Disorders?

Physical therapy can be very helpful with the recovery of range of motion, strength, endurance, and the management of pain. Soft collars are of little benefit but rigid collars may be helpful in the acute stages of recovery. Early on, treatment will be gentle and focused on pain relief and gaining mobility. As you progress, treatment will focus more on strengthening and return to function and daily activities. Sometimes these injuries can be more challenging than other cases of neck pain and symptoms, so seeing a physical therapist to help you recover is even more important!

Additional Resources

Temporomandibular Disorders (TMD)

Temporomandibular disorder (TMD), is a term that describes an entire group of disorders involving the temporomandibular joint or joints (TMJ).

The TMJs are the jaw joints. There is one on each side of your head just in front of your ear canals. Like many other joints in the body, they consist of:

  • muscles that control joint movement,
  • ligaments that hold the bones together,
  • cartilage that provides a smooth surface for the bones to move on,
  • a disc that helps with proper movement, of the bones,
  • elastic tissue that helps hold the disc in place.

One or more of the above tissues can cause symptoms. In fact, studies suggest that one third of the population at any one time experiences TMJ symptoms such as pain with chewing, yawning, or jaw opening. Women seem to have TMJ problems much more often than men and it is estimated that 3-6% of the population might benefit from treatment.

There are a variety of temporomandibular disorders. The muscles (myogenous), joint(s) (arthrogenous), or a combination of the two may cause pain.

Since physical therapists treat muscle and joint problems, they are ideally suited to address a TMD. Moreover, a majority of patients diagnosed with TMD, also have associated neck pain. Both respond well to treatment provided by a physical therapist. No other healthcare practitioner is better suited to address both the TMD and neck pain.

TMD may appear to be a complex condition and it shouldn't be. This website and your physical therapist can help to insure the following:

  • You are properly educated,
  • that your treatment is conservative, cost-effective, and reversible,
  • goals are realistic,
  • your examination is brief and meant to identify your source(s) of pain.

When a physical therapist performs the examination, they will be able to classify you as having one or more of the following:

  • An inflammatory condition
  • Limited jaw range of motion
  • Excessive jaw range of motion
  • Arthrogenous Disc Displacement
  • Jaw muscle pain
  • Neck pain causing related headaches (sometimes mistaken as TMD)

Once the involved structures are identified, the therapist will be able to provide you with the appropriate treatment.

Additional Resources

BPPV and Physical Therapy

Epley Maneuver is Helpful for Vertigo

Vertigo, in particular "benign paroxysmal positional vertigo (BPPV)", is a common disorder in which the patient complains of spinning and dizziness with rapid changes in head positions. BPPV is typically idiopathic (of unknown cause) in nature. Other reported causes are head trauma, vestibular neuritis (inflamed vestibulo-cochlear nerve), vertebrobasilar ischemia (inadequate blood flow to the brain), and inner ear infection.

It is hypothesized that small particles, (called otoconia) in the semi-circular canals, over-stimulate the sense organs (hair cells and cupula). This results in patient complaints of dizziness and the observation of nystagmus in the direction of head rotation. The dizziness may last anywhere from a few seconds to a minute and there may be associated nausea.

Brandt-Daroff and canalith repositioning movements (Epley Maneuver) are the most common therapeutic interventions. The goal of these treatments is to move the small particles within the semicircular canal to the utricle where they no longer are able to stimulate the sense organs within the canal.

Hi-quality research studies show significant numbers of patients that experience a resolution of symptoms and negative diagnostic tests for BPPV after treatment intervention as compared to the control groups.

While BPPV is a common diagnosis for those suffering from dizziness, there are other causes of vertigo (both central and peripheral). It is important to consult your doctor and physical therapist regarding proper diagnosis and treatment of vertigo.

More on Vertigo at the Mayo Clinic