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Here at Elementary health, we are fully aware of the large number of people who suffer from neck pain. We have an osteopath for neck pain, as our work in the Cambridge clinic, working with a vast range of physical capabilities, and our athlete work in London, allows us to have very positive contact with such symptom sufferers.

In fact, Neck pain (cervical spine pain) is currently one of the most common musculoskeletal illnesses for people to suffer from. Musculoskeletal illnesses are believed to generate some of the highest costs to society.

Diagnosis

The most commonly ‘diagnosed’ issues leading to an episode, or multiple episodes, of neck pain, with or without ‘radiculopathy’ (nerve irritation often causing symptoms into the shoulder or down the arm) are:-

Spinal functional instability, wry neck / torticollis,  motor control imbalances, facet joint irritation / dysfunction / locking, discal strain / sprain, muscle strains, muscle spasms, over use syndromes, degeneration, arthritis, ‘slipped discs’, ‘neuralgia’, ‘trapped nerve’, ligament sprain, inflammation, ‘cervical pain’, ‘nerve root impingement’, ‘trapped / pinched nerve’, cervical radiculopathy, ‘non-specific neck pain’, cervical spondylosis, ‘wear and tear’, ‘stiff neck’, mechanical neck pain….The list goes on!

The quality of some of these diagnosis concepts, and the actual correlation to your pain, are even more fascinating!

How This May Affect People

When this doesn’t go well, it often leads to a very dissatisfying outcome. This can manifest itself as: deconditioning, disability development, depression, loss of confidence in yourself and your body, which ultimately often leads to a dependency on pain altering medications, and poorer physical health.

So, what are we to do? Are we to:- be immobile?, be mobile?, be active?, or minimally active?, train into pain (‘no pain no gain’)?, or train avoiding pain?, use medication management?, use massage?, use spinal manipulation?, Osteopathy or chiropractic or physiotherapy?, use prescriptive exercise?, stretch the neck, or not stretch the neck?, regular treatments or minimal treatments?, have imaging or not to have imaging?, should we focus on structure or function?, or is it just age?!!!

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In the past I have seen different people regarding my back and neck problems. I was getting weekly treatments to try and solve my problems but had to keep these sessions up to ease the pain, it was a very frustrating process. I saw Michael for 3 sessions and he got to the root cause of my problem straight away, he even gave me great strength exercises to reduce the problem from happening again.

Investigations

Sometimes additional investigations are needed. However, for ‘non-specific neck pain’, they are rarely needed as a primary input into your assessment and treatment.

Imaging

Imaging was originally seen by most, as a tool to rule out pathology or disease states, and less to diagnose specific musculoskeletal causes. Often this was due to a poor correlation of images and symptoms.

New imaging approaches have developed, and our dependency on them increased!

However, recent studies show that by performing a thorough clinical case history and physical examination you can often, very effectively decide if MRI or additional imaging or other investigations are needed.

General Imaging

Studies show as well as x-ray images, MRI investigations are also poor methods at assessing causal patterns of pain. This is due to the large number of asymptomatic findings.

There are also recent studies that show that MR Imaging (MRI), may actually increase the patient’s likelihood of continuing in pain or disability status, and elongate their symptom picture.

Degeneration and Osteoarthritis

Then there are studies showing that degeneration changes, are just a part of function and use. These however, have no correlation with pain, or perceptions of illness, or illness behaviour i.e. age and degenerative changes have no clear causal link with pain.

In fact studies on some of the most athletic, show neck changes in images, with degeneration. All had no symptoms of neck pain. With poor positive predictive value, and a large number of false positive cases.

 

Physical Assessment

Physical assessment by a clinician is vital in all cases of neck pain.

Degeneration and Osteoarthritis

 

Does This Apply To You?

Ah yes, but these are not average people!?!!
Well we also have imaging studies of the average person on the street, with no neck pain. Interestingly, of this average adult population many will also have degenerative discs, or disc bulge present. Yet no pain!

What Can Help

For neck injury, ‘Prevention of injury remains an important goal for clinicians and researchers’.

Osteopathic Treatment

Osteopathy and the use of osteopathic manipulative medicine has research data that shows that neck pain is a common presenting issue, for people seeking osteopathic assistance, showing very positive outcomes and satisfaction levels.

Exercise Therapy

Exercise therapy has been shown in research to reduce neck pain symptoms, and help restore normal daily activity. More importantly, it seems to have a preventative role.

Also, there is evidence indicating that ‘neck specific exercises’ are significantly better for quality of life, than an untreated person. With improved symptoms, and more positive outcomes than those placed on waiting lists for assessments and treatment. However, stretching alone, without exercises, is not effective.

Perhaps showing why whole body assessment and treatment, is reported anecdotally in clinic to be so effective.

These positive effects from manual therapy and exercise, may be due to the increasing body of evidence, that pain is a brain interpretation of data, and the local structure itself, cannot consistently be linked with pain or general function.

Interestingly, you can also help reduce neck pain by treatment of other areas of the body. If this helped reduce the neck pain…. Maybe the next pain was secondary to another problem, seemingly ‘unrelated’?!

Additionally, manual therapy of the neck by an osteopath including the use mobilization and manipulation, and prescription exercise therapy, are all safer than long, or even short term medication treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs).

The point here is that there are many opinions and many solutions, to neck pain (cervical pain). Perhaps some, in our opinion, are more rational than others and some statistically safer than others, and some more empowering than others.

Whole Body Integration

Then we can start to look at a more global pattern, and treatment plan. People with neck dysfunction, have less balance, and alterations in core control, compared to healthy individuals. Diminished core stability measurements correlate with the extent of neck dysfunction. This indicates that, balance and core stability training, may be a successful rehabilitation protocol for spinal dysfunction.

Training the control of motion and stability, in the presence of change, plus training core stability, may help spinal mechanics and normal low back function, in relationship with the body’s trunk.

A session of respiratory muscle training  in athletes with chronic low back pain performing overhead squats. Reduced the activities of some ankle joint muscles, including tibialis anterior and peroneus longus, with resultant changes to the angle to reach peak activity in tibialis anterior and peroneus longus, in different phases of movement. The study concluded that ‘respiratory muscle training prevented excessive ankle joint muscle activity through stimulating local muscles’, ‘indicated an improved postural control and multi-sectional proprioception to maintain postural stability and stimulated the local muscles of the core area’.

Also this is suggestive that when a person suffers neck pain, their core control, breathing mechanics, and limb controls are all compromised, and that these can also be re-educated.

Many neck pain presentations can be treated with osteopathy and dynamic exercise therapy effectively. It does not matter whether the issue is of a primary or secondary origin, both will have significant improvement.

Perhaps this shows why whole body assessment and treatment, is reported anecdotally in clinic to be so effective. These positive effects from manual therapy and exercise, may be linked to the increasing body of evidence, that pain is a brain interpretation of data, and that the local structure itself, cannot consistently be linked with pain or general function.

Additionally, manual therapy by an osteopath including the use mobilization and manipulation, and prescription exercise therapy, are all safer than long, or even short term medication treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs).

There are many opinions and many solutions, to neck pain (upper spine pain / cervical spine pain). Perhaps some, in our opinion, are more rational than others and some statistically safer than others, and some more empowering than others.

With all treatments, it’s important to get the diagnosis, advice, and treatment programme from people who are trained, skilled and prepared to aid your musculoskeletal needs.

 

Treatment Options

The NICE guideline for ‘non-specific neck pain’, includes the guidance to remain as active as normal, seek support and advice at a specialist clinic, for education, management advice, manual therapy including spinal manipulation, mobilisation and soft tissue treatment by an osteopath, hydrotherapy application, increase in muscle strength and specialist exercise therapy for rehabilitation.

At Elementary Health we provide a seamlessly layered combination approach, of education and therapeutic application. This includes diagnosis, education of anatomy and pain theories, manual therapy, osteopathy, posture advice and training, lifestyle advice, hydrotherapy guidance, dietary overviews, and dynamic exercise therapy with motor control training rehabilitation. All of these work together to provide a uniquely structured approach, towards the aim of restoring your brain’s interpretation, or ‘mapping’ of your healthy functioning body, giving you back the control!

Next Steps

If there are any other questions, or, you wish to book a consultation with Michael Parr the consulting osteopath in Cambridge, based at Elementary Health. Please don’t hesitate to call or email.

Cambridge Osteopathy
& Rehabilitation Clinic

8c Romsey Terrace
Cambridge
CB1 3NH