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neck pain

It is important to try and identify precisely where on your neck or shoulder you are experiencing your pain. The rule of thumb is always that diffuse pains origin is somewhere else than the area you are experiencing that pain in. Pain that you can localize under your fingers is usually an indication that the pain originates from the underlying structure. In addition, you can have multiple pathologies co-existing, i.e. a neck condition and a shoulder condition that will due to the location, affect each other.

Your neck and shoulders contain soft tissue and bone tissue. Soft tissue is made up of muscles, nerves, arteries, veins, ligaments, capsules and fascia. Many conditions can cause pain in the neck and shoulder area. Some can be life-threatening (such as heart attack and major trauma), and others are not so dangerous (such as simple strains or contusions), but can lead to severe dysfunction if left untreated. Patients with severe dysfunction of the cervical spine may well end up having surgery performed to correct the dysfunction, and this will necessitate a prolonged period of recovery and rehabilitation.


Causes of Neck Pain:

Your neck and shoulders contain soft tissue and bone tissue. Soft tissue is made up of muscles, nerves, arteries, veins, ligaments, capsules and fascia. Many conditions can cause pain in the neck and shoulder area. Some can be life-threatening (such as heart attack and major trauma), and others are not so dangerous (such as simple strains or contusions), but can lead to severe dysfunction if left untreated.

The most common cause of shoulder pain and neck pain is injury to the soft tissues. This can occur from trauma such as a whiplash or other injury to these areas. We are all getting older, and therefore degenerative conditions such as arthritis of the cervical spine can cause local pain, or nerve root impinchment that can cause both neck pain and shoulder pain. Degenerative disc disease in the neck (cervical spondylosis) can cause local neck pain or referred pain into the shoulder and arm, sometimes down into the hand.

Abnormal conditions involving the spinal cord, heart, lungs, and some abdominal organs also can cause neck and shoulder pain:

Gallbladder Disease:  This can cause a pain referred to the right shoulder.

Inflammation:  Inflammation under the diaphragm can also cause referred pain in the shoulder

Rotator Cuff Injuries:  The rotator cuff is a group of tendons that support the shoulder especially during rotational movements. These tendons can be injured during a fall on the shoulder, lifting, playing sports that involve a lot of overhead throwing, or after repetitive use over a long time. These injuries will be described in more detail under shoulder pain.

Bursitis:  A bursa is a sac over the joints to provide a cushion to the joints and muscles. These bursae can become swollen and painful after injuries. This can also lead to referred pain into the neck, shoulder blade area and upper arm. These will also be described in more detail under shoulder pain.

Whiplash Injury:  Injury to the ligamentous and muscular structures of the neck and shoulder can be caused by sudden acceleration or deceleration, as in a car accident.


Shoulder and Neck Pain Symptoms:

Pain:  Patients describe neck and shoulder pain as being sharp, a dull toothache, burning, crampy, shooting pains, or stabbing. Pain can cause patients to keep their necks still and this can lead to a stiff neck or shoulder and loss of range of motion. This can lead to constant or intermittent headaches. The character of each symptom is important because the particular features can be clues to the cause of your pain.

Weakness:  Weakness can be due to severe pain from muscle or bone resulting in loss of movement and ultimately atrophy. The nerves that supply the muscles, however, also could be injured. It is important to distinguish true weakness (muscle or nerve damage) from inability or reluctance to move because of pain or inflammation.

Numbness:  If the nerves are pinched, bruised, or cut, you may not be able to feel things normally. This may cause a burning sensation, a loss of sensation, or an altered sensation similar to having your arm "fall asleep."The picture of the man falling asleep on his arm after having too much to drink and not be able to move his arm and hand when waking up comes to mind.

Coolness:  A cool arm or hand suggests that the arteries, veins, or both have been injured or blocked. This may mean that not enough blood is getting into the arm.

Colour Changes:  A blue or white tinge to the skin of your arm or shoulder could suggest that the arteries or veins have been injured. Redness can indicate infection or inflammation. Skin rash might also be present. Bruising may be evident.

Swelling:  This may be generalized to the whole arm or may be localized over the involved structures (a fracture area or an inflamed bursa, for example). Muscle spasms or tightness may simulate actual swelling. Dislocation or deformity may cause a swollen appearance or, paradoxically, a sunken area.

Deformity:  A deformity may be present if you have a fracture or a dislocation. Certain ligament tears can cause an abnormal positioning of the bony structures. These will be identified with x-rays or the applicable stability tests.




Self-Care at Home

Minor injuries that have only slight pain can be treated at home. If the source of the pain and the cause of the pain are not known, or if symptoms suggest you might have a more serious condition, you should contact your doctor while initiating basic care measures.

Rest: Use the injured area as little as possible for the first two to three days, and then slowly begin to exercise the injured area. This speeds recovery. You might benefit from immobilizing the neck in a soft collar. 

Ice: An ice pack applied to the neck area for 15-20 minutes every 3-4 hours will result in decreased pain and inflammation. Directly applying ice can damage the skin, so put your ice in a damp towel before applying to the affected area. 

Pain Control: Use what normally works for you. Do not use non-steroidal anti-inflammatories during the acute phase (first 24-72 hours) as this might affect the bodys normal healing response. 

Heat: Do not apply heat during the acute phase as it might increase the swelling and bleeding in the injured area and worsen your pain. 


Physiotherapy Treatments
A treatment plan will be developed after a complete history and physical examination (and any tests, if indicated). Treatment options vary for each condition. Clearly, a simple strain is treated far differently than a severe whiplash injury or disc derangement.
Patients with severe dysfunction of the cervical spine, whom wont benefit from physiotherapy treatment, will be referred to a specialist for further investigations.
The ultimate goal is to treat, rehabilitate, prevent and pre-habilitate for the future.

Posture Correction
Most people think that to "stand up straight" means tensing your back to heave your chest 'in and up', and pulling your head back in to your chest. This is not so. The spine has three natural curves that you need to maintain called the lumbar and cervical lordosis, and the thoracic kyphosis. These are the curves found from the base of your head to your shoulders and the curve from the upper back to the lower back and from the lower back to the base of the spine. The amount of ankle overpronation and supination also influences posture and this can result in various lower limb pathologies.
We assess patients through the Posturepro programme to identify structural changes, excessive forces working in on the different spinal areas, and where the patients centre of gravity falls. Relevant treatment and rehabilitation programmes are then prescribed in an attempt to treat the cause of a patients problem and not merely the symptoms.


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