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Physical Therapy

Acute Neck Pain: A literal pain in the neck

September 8, 2020
By Health Loft

Acute Neck Pain: What is it, and how to manage it?

Acute neck pain (cervicalgia) is pain in the neck that arises suddenly that may or may not have been from an injury. The term “acute” indicates that the pain has been present anywhere from a couple seconds to a few months. Neck pain is a common ailment and we as physical therapists see it amongst many people. Approximately 54% of people have experienced neck pain in the last 6 months and 67-70% of adults will experience in their lives. Frankly there is never an ideal time to experience it. Neck pain is often associated with a decrease in activity, decreased productivity, decreased ability, and increased fear. The fear typically stems from the unknown, and many people ask  “will I have neck pain forever?”. Whether your neck pain arose after a recent fender bender or you slept “wrong”, the good news is there are physical therapists that can help you. There are also things you can be doing to take back control of your physical health and well-being to improve your neck pain

As mentioned above a recent onset of neck pain can be counterproductive to your daily routine and personal goals. In the event you experienced a recent trauma such as a fender bender on the way to work or a fall, it would be of benefit to be evaluated by a trained physical therapist. In the event you recently started up a new exercise routine or you fell asleep on the couch in an unusual position, this might be something easily managed at home on your own before you seek professional care. Your physical therapist is trained to evaluate either scenario and respond appropriately with a referral for medical evaluation or recommendation for continued treatment under their care.

What to expect when you see a Physical Therapist for Neck Pain

In the event you choose to seek care from a licensed physical therapist, here is what you can and should expect from that appointment. After you’ve checked in and filled out your medical history, the physical therapist will do a thorough review of your history and get started. The examination process starts off with an interview individualized to you. This is your chance to discuss what is going on with your body and how it is affecting your daily life. In this instance the majority of the symptoms you discuss will likely be related to your neck. Don’t write something off as unrelated if it is not in your neck (ex. numbness and tingling down your arm or pain in-between your shoulder blades). If it is bothersome for you, let your physical therapist know. Physical therapists are trained to decipher what is pertinent information and what might not be, and every detail matters.

Your physical therapist will conduct a physical examination after spending some time getting to know you, your condition, and what is important to you. This is where they apply their knowledge of musculoskeletal function to assess your condition based on the symptoms and limitations you previously reported. With any musculoskeletal condition there are always primary factors, secondary factors, and tertiary factors. What does that mean? In simple terms it means, “Where is the angry bear?”, “What is poking/poked the bear?”, and “What kind of environment is the bear in?” Let’s put that into an example using acute neck pain.

Example: 55-year-old accountant wakes up on the couch with pain on the left side of the neck that increases when looking to the left

  • Left sided neck pain when looking to the left (primary factor; “angry bear”),
  • Stiff upper back and decreased shoulder mobility (secondary factors; poking the “bear”),
  • Working long hours at a desk, often falls asleep on the couch watching TV after dinner, sedentary lifestyle, poor sleep hygiene (tertiary factors; the “bear’s” environment)

After completing the subjective interview and physical examination, your physical therapist will assess the information obtained from you and the exam. During this time your physical therapist will be able to determine the severity of the condition and determine whether you need to be referred to a physician. The irritability of your condition will also be established. This is the determination of how much activity it takes to flare up your condition and how much work it takes to calm down your condition. The nature, stage (acute, sub-acute, or chronic), and the status (stable, getting better, or getting worse) will also be established.

When to Get Imaging for Neck Pain

As mentioned earlier, the common fears associated with acute neck pain, especially neck pain after a recent trauma, can lead you to believe that you must have imaging before you do anything else. That isn’t always true and sometimes unnecessary imaging can be more detrimental to your overall recovery prognosis.  A set of “rules” have been developed and validated by research to help health care providers determine whether x-rays are needed or if it is safe to proceed without.

These rules have been referred to as the “Canadian C-spine Rules.” Imaging of the neck or back should always be paired with a proper and thorough examination. Otherwise it can be analogous to taking a picture of the sun and asking someone whether the sun is setting or rising. Without contextual factors (i.e. a thorough examination) the information obtained from the image can be misleading or inaccurate. It is common to see findings on an magnetic resonance image (MRI) report such as a disc bulge, C5-6 (or C6-7) degenerative changes, facet joint arthropathy, spondylosis, etc. These findings are often present in people without any pain or limitation. They may not be related to the symptoms you are experiencing, especially with non-traumatic neck pain. In simpler terms, it can be like telling an elderly person that they have a wrinkle on their skin or a gray hair. Does that sound concerning? It would be considered normal to notice a few wrinkles or gray hairs on an elderly person and it is not a cause for concern. The same is often the case for these common findings seen on imaging. This isn’t permission to tell your grandma that she has wrinkly skin or gray hair.

If you fall into imaging category based on the Canadian C-Spine Rules or you have signs of decreased nervous system function such as a sudden onset of true numbness or fatiguing weakness, rest assured. Your physical therapist will refer you to your physician to order the appropriate imaging to rule out any physical examination concerns.

Physical Therapy Treatment for Neck Pain

Conservative care is the gold-standard approach to treat acute neck pain after serious medical concerns have been ruled out. Conservative care is the use of non-surgical treatment methods such as consultation with a physical therapist, medication, and injections. Working with a physical therapist is very effective and efficient, often times leading to a reduction in total healthcare costs.

Treatment should consist of education on your condition in a way in which you can understand it. The education should be focused on the findings from your examination, what can be done to improve your symptoms/impairments (neck pain), what can be done for treatment, and the prognosis for recovery. The main stay of your treatment should be activity and movement based. However, there are ways to facilitate improved tolerance to movement and activity faster than treatment with exercise and activity alone. For example, performing hands-on manual therapy techniques applied by a physical therapist, paired with exercise has been shown to lead to a faster recovery. There are also treatment options such as electric stimulation, ice, heat, and trigger point dry needling that may be used in the short term to help manage pain.

As your pain and limitations become less severe and less irritable, you become more independent. Once you become more independent, the treatment focuses on optimizing exercise and activity important to you along with education on what you should continue to do on your own. Remember though, physical therapy isn’t a treatment, it is a profession. You are welcome to consult with your physical therapist as needed even if you’ve been previously released from care.

How to Treat Neck Pain at home

We live busy lives and often don’t know how to find an extra hour in our day to seek formal supervised care from a physical therapist. The good news, as mentioned earlier, is that movement and exercise are the primary focus of treatment. There are things you can try at home first. If you are having trouble figuring out where to start, consult with one of our licensed physical therapists. A specific exercise isn’t usually the problem. More often than not, it is the intolerance of exercise is the problem.

A good place to start with acute neck pain to decrease pain and regain range of motion is with isometric resistance. Once your range of motion begins to improve, working on strengthening the muscles in the front of the neck is the next step. Often times the upper back will feel stiff. Working on decreasing the stiff sensation in your upper back can often be performed simultaneously while working on neck range of motion. These exercise principles can be found on the internet. Try to source your information from a reputable and reliable source. If in doubt, consult with one of our physical therapists for an exercise routine specifically for you that can be sent to your phone with videos and explanations.

Long term, you want to make sure you are incorporating strengthening exercises targeted to the muscles in your shoulders and upper back into your normal exercise routine. Periodically you should put your neck through range of motion exercises as a way to “check-up” on yourself and ensure that you’re able to move through a full range of motion without limitation.

Wearables/Durable Medical Equipment (DME):

There are a host of products that have been developed and marketed to help treat neck pain. This can range from home TENS units, home traction units, braces, and postural awareness wearable devices among others. There is no simple way to determine what will be effective for you or what will be an inefficient use of time and resources. A thorough evaluation can help bridge this gap. There is still room for trial and error. The best general advice is, if you think it will help and you can afford it, try it. If it is working for you feel free to continue use. If the product is not working or making things worse don’t feel like you have to continue using it. All of these products are intended to help, but it is not a one size fits all approach.

A few questions to consider when exploring different products:
  1. “Does the use of this make things better or worse?”
  2. “Can I afford this?”
  3. “Will I be reliant on this device long term if I don’t get professional help?”

Injections and Surgery:

As mentioned earlier, the gold standard approach for the care of acute neck pain once serious medical concerns have been ruled out is conservative care. Injections can be helpful in certain cases but should not be used alone. The injection will be targeted towards the primary factor, but we previously discussed the presence of secondary and tertiary factors that need to be addressed. The secondary and tertiary factors won’t be affected by the injection. The use of injections should be paired with education and guidance from a licensed physical therapist to maximize outcomes, minimize recurrence, and mitigate further unnecessary costs.6

Surgery is also an option for treatment. In the absence of serious medical pathology (such as a fracture or loss of function in the nervous system) surgical intervention should be considered a last resort. Surgery does not come without risks, even if the word “minor” is used in the description. If you are considering surgical intervention be sure to ask questions. Your physical therapist is also available to help answer questions as well while you navigate this difficult decision.

If you have neck pain, numbness and tingling down your arm, numbness and tingling into your shoulder blade, or other symptoms; consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. Remember to also check out our FacebookInstagram, and Twitter pages for more articles on nutrition, physical therapy, and exercise!

 

 

Written by Michael Bagwell
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES

 

 

 

References:

  1. Brinjikji W et al. (2014) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol, 36(4):811-816
  2. Campbell SM and Roland MO (1996). Why do people consult the doctor? Family Practice, 13:75-83
  3. Cote P et al. (2008). The burden and determinants of neck pain in workers: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders, Spine (Phila Pa 1976) ,33(4 suppl):S60-74
  4. Flynn TW, Smith B, Chou R (2011). Appropriate use of diagnostic imaging in low back pain: A reminder that unnecessary imaging may do as much harm as good. JOSPT. 41(11):838-846
  5. Nakashima H et al. (2015) Abnormal findings on magnetic resonance images of the cervical spine in 1211 asymptomatic subjects. Spine (Phila Pa 1976), 40(6):392-8
  6. Horn ME and Fritz JM (2018). Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort. BMC Health Services Research, 18,887 https://doi.org/10.1186/s12913-018-3699-0
  7. Miller J et al. (2010). Manual therapy and exercise for neck pain: A systematic review, Manual Therapy, 15:334-354
  8. Moser N et al (2018). Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) collaboration. Eur Spine J 27(8):1219-1233
  9. Safdari M et al. (2018). Cervical magnetic resonance imaging (MRI) findings in patients with neck pain a cross sectional study of southeast Iran. Int J Med Invest, 7(3):25-31
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