Below are the structures which cause neck pain and how to diagnose the problem.
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Arthritis is diagnosed based on the history, physical exam, and x-ray. Typical arthritis symptoms include increased pain in the morning, increased pain with lack of movement of the neck, decreased pain with movement or when “warmed up.”
Tenderness will be present over the joints of the neck. Anti-inflammatories decrease pain.
This diagnosis is confirmed with x-rays which will show bone spurs, decreased bone density, and decreased disc height.
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If you have been involved in an injury, the following areas of injury will be diagnosed as indicated. Injury is diagnosed by history.
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Inflammation is diagnosed in the physical examination. Movement of of the neck in certain positions will be painful when inflammation is present. Often, inflammation can be felt with the doctor’s fingers. Anti-inflammatories will also reduce pain and stiffness – another clue that inflammation is part of the source of pain.
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Disc bulges and disc herniations are suspected during the physical examination. Tingling/numbness and pain extending down into the shoulders, arms, and into the hands will be present. Often changes in muscle strength and reflexes are present.
MRI is ordered in order to properly visualize the discs. It is the gold standard for disc pathology diagnosis.
Treatment of neck pain is not a formula, it is different for each person. These guidelines are here to give you an idea of how this problem is corrected.
Injured body tissues require different types of treatment. Below, based on the body tissue, I will review the types of treatment which are appropriate based on medical literature.
Anti-inflammatory protocols, including ice, anti-inflammatory medications, rest, compression, and elevation of injured body part are appropriate. Next, return to normal range of motion by stretching and home stretching. Neuromuscular reeducation and therapeutic exercise are important to returning the muscle back to normal strength and coordination with other muscles. Muscles in the human body need to be balanced. This prevents return of problems in the future. I will no release you as discharged until you are balanced.
Disc bulges and herniations occur either with trauma or long-standing degenerative processes.
Disc herniations occur with trauma. They are directly related to an injury such as an automobile accident. Depending on the severity of the disc herniation, treatment can include surgical consult, epidural steroid injections, or physical therapy and chiropractic care.
If the disc herniation is nonsurgical, then a combination of therapeutic exercise, neuromuscular reeducation, and spinal manipulative therapy will decrease pain and inflammation and muscle spasms associated with the pain.
Disc bulges occur over a number of years and as a result of the degenerative process of the spine. This occurs when the entire disc circumferentially bulges outward beyond the borders of the vertebra above and below. Treatment involves stabilizing therapeutic exercises, spinal manipulation, and anti-inflammatory protocols. Home exercise and stretching are very important both for disc bulges and disc herniations as a key for prevention.
Torn ligaments often require surgery. If you have torn ligaments, you will be referred for co-management with an orthopedic specialist or neurosurgeon depending on your case.
However, sprained ligaments are very amenable to rehabilitation. Anti-inflammatory protocols are appropriate followed by gentle stretching. You must have a trained and experienced therapist to help you with this as you do not want to increase the damage to the ligaments. Muscular strengthening to take up the slack created by stretched ligaments is important.
Eventually with proper time, stretching, sometimes tissue massage, and muscle strengthening, the ligaments will heal properly.
One of the most overlooked causes of neck pain is that of vertebral subluxation or joint alignment issues. When the vertebra become misaligned due to trauma or lack of maintenance, pressure builds inside the joints causing damage to the cartilage and inflammation. The damage leads to arthritis, and the inflammation causes pain and stiffness. Inflammation then causes pressure on the nerves and reflexive muscle spasm.
Treatment for this condition focuses on the underlying lack of motion at the joint level and alignment. Chiropractic spinal manipulation is the first treatment used followed by stabilizing therapeutic exercise. If this condition has advanced, anti-inflammatory therapies may be needed as well during the acute or early phase.
With regular chiropractic treatment, this problem is nearly always resolved.
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