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Every year thousands of people consult a physiotherapist for neck pain and related symptoms. The first part of the examination is determining when the pain came on and what reason there was for it. There may have been an injury or some obvious reason for the pain onset, but often the patient cannot recall a specific event which might have been responsible for the neck pain.
The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.
Many illnesses and conditions can be associated with cervical problems so the physios review the past medical history, general health, loss of weight, normal control of the bowel and bladder, normal appetite, drugs use and quality of sleep. The physio will then ask the patient to disrobe and examine the posture of the thoracic spine, cervical spine, arms and shoulders. Poor posture is very common, with a rounded trunk, rounded shoulders and a poking chin being the most common combination.
Next the physiotherapist will check the movements of the neck, going through neck rotation, neck flexion, neck extension, neck side flexion and retraction. The restriction in range of motion and the level and type of pain elicited on certain movements gives valuable information about the nature of the problem and the likely successful therapy. Further testing involves the reflexes, muscle power and sensibility in the arms to check that the nerves going to the arms are conducting normally.
Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.
Mobilization techniques are a core manual skill for physiotherapists and abnormal joint mechanics, known as dysfunctions, can be identified by palpation of the main spinal and facet joints by the physio. Treatment can use repetitive small movements to relieve pain an encourage normal motion, to more forceful manipulations which take the joints beyond their typical ranges and restore movement. Any increases in movement gained by treatment is maintained by home exercises.
Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain.
