There is nothing worse than a pain in the neck.  We depend on our necks so much during regular activities that when they are painful and not moving freely, our lives become more limited very quickly.

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So where does neck pain come from?  And how do we get rid of it?...

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Neck pain usually comes from:

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• Nerve compression- Nerve compression occurs when bones apply direct pressure to a nerve, trapping it and squeezing it.  The spinal nerves come out of the spine through openings called foramen.  Usually the foramen provides enough space to allow free movement of the vertebrae and the nerve independent of each other.  If the vertebra change there relationship to one another in space, the shape or size of the foramen alters.  Usually this happens in one of a few situations:

  • Spinal misalignment - If the vertebra move significantly (due to injury, soft tissue restrictions, etc.), then the foramen's shape can effectively be made smaller such that the nerve is pinched by the bone where it leaves the spine.  To determine the best course of treatment, one needs to know the specific cause for the spinal misalignment.  If the misalignment was caused by an injury and the soft tissue is not involved, then a chiropractic visit is likely to be in order.  If soft tissue is involved, then some manual therapy (massage or structural work) is also needed.  There are also other situations where no injury has happened, and the spinal misalignment has occurred over a period of time.  In these cases, the soft tissue has tightened and pulled the bones out of alignment.  As such, manual therapy to release the restricted tissue provides the best results.

  • Ruptured disc - Each vertebral disc acts as a spacer between two consecutive vertebra.  If the disc is ruptured then the space between the two vertebra becomes smaller, and again the foramen that the nerve runs through also gets smaller causing the bones to pinch the nerve.  Usually if a disc is ruptured, it typically calls for surgery.  There are artificial replacement discs, but these currently don't seem to be highly successful, and fusion of the vertebra is the usual procedure.

  • Herniated disc - When a vertebral disc herniates, part of the inside of the disc pushes out of the more tough and fibrous outside "shell" of the disc.  Sometimes the herniated tissue pushes out and it isn't a big deal... most people don't know they have a herniated disc.  In other cases however, the herniated tissue pushes directly into a spinal nerve, and that means pain.  Though a herniated disc might technically be nerve entrapment instead of nerve compression, I'm including it here along with the other "bony/spine" issues.  Herniated discs are treated with a variety of injections, and various surgeries.  People also find inversion tables and massage therapy helpful to lengthen out the spine and help relieve some of the pressure in the injured area.  For many people, these methods allow them to manage their symptoms and avoid surgery and drugs.

• Nerve compression can also occur in other areas of the body, such as the elbow or shoulder, though it is most common in the spine.

• Nerve entrapment - Nerve entrapment occurs when soft tissue (muscle, fascia, ligament, etc.) applies direct pressure to a nerve, trapping it and squeezing it.  Usually this occurs when muscles and fascia become thickened or tight.  In the case of neck pain, the tight or thick tissue will usually be in the neck although the condition causing it often comes from lower down in the body.  Nerve entrapment is most successfully treated with massage/manual therapy to release the tissue and correct the source of the problem.

• Soft tissue restrictions- In addition to the possibility of nerve entrapment by soft tissue, the soft tissue itself can be very painful if there was:

  • local tissue damage

  • increased tissue thickness

  • adhesions (i.e. tissue sticking together)

  • inflammation

  • constantly contracted muscle

  • tissue that is over stretched

  • etc.

 

The many ways in which these situations can come about are too numerous to list, but many times it is from an overuse type of injury.  Sometimes the overuse injury is very apparent (e.g. "I lifted a heavy weight and now my shoulder and neck hurt"), while other times it is not apparent at all (e.g. "I didn't do anything out of the ordinary, and all of a sudden my neck hurts like crazy!").  In the latter case, usually the trouble slowly builds over a long period of time until it is beyond a certain threshold, at which time you become aware of it.  Soft tissue restrictions are most successfully treated with massage/manual therapy directed and dealing with the specific issue at the source, and correcting any imbalances in the body that support the problem.

 

Usually all three of these problems (nerve compression, nerve entrapment, and soft tissue restrictions) have a soft tissue imbalance as either the source or a component of the issue.  For long term success, the imbalances in the soft tissue must be addressed with manual therapy of some kind.  The manual therapy must focus on correcting the imbalance, creating space and softness in the tissue, and bringing the body back to neutral position.