Neck Pain

We started our conversation about the mechanics and physiology of neck anatomy in a previous article here. Right now I am going to follow up a little bit by delving into the various interventions we use here at Capital District Vitality Center to treat neck pain. First and foremost, if you have either acute or chronic neck pain, we need to diagnose that. It is imperative if you have an injury that you go to a professional to evaluate the degree of dysfunction that you have.

When I see new patients, we begin with a complete orthopedic and neurological evaluation, including a case history, and then we sit down and have a conversation about things such as traumas, lifestyle, previous interventions, etc. It is important before a practitioner begins to treat you, that they first examine you. I really stress that to my clients and that sometimes interventions are quite cavalier – but they shouldn’t be. There are a lot of underlying issues that could be in the background creating a signal (pain) and it is important to address all of those contributing factors.

Once we have successfully identified why the problem is there to begin with and the extent of that problem, the intervention then becomes unique to that individual, as it always should be. When we look at creating a treatment program for someone with a neck issue, there is always a home exercise component, as well as implementing mobilization and addressing the physiology to quell pain and inflammation.

First and foremost, we look at the structure of the neck and then we try to determine what it is that we need to do in order to rehabilitate the structure.  Mobilization is the key to life. When you have an injury, resting the area is important, but unless it is an actual fracture that needs to be immobilized or some type of injury of that nature, it is still crucial to not allow that area to stop moving.

When joints in the spine or in the body in general stop moving, trouble is not far away. So when we stop moving an area, not only is the neurological stimulation from the joint to the brain itself is now modified, but also the mobilization of the range of motion of the joint becomes impaired.

Our brain has what is called the somatosensory area, which is a sensory area for perceiving motion. What drives the brain are muscle spindles, which are parts of the muscles themselves and joint mechanoreceptors. Joint mechanoreceptors are little filaments or signal mechanisms in the joint that tell the brain what is going on. There are a lot of different types of mechanoreceptors and sensors.

Passive range of motion, or somebody moving you, is also part of the healing process. Ultimately, the best resolve for any type of mechanical problem, whether it be neck, low back or shoulder is a gradual process beginning with passive range of motion, to active range of motion, to active range of motion with resistance. But it needs to be graded and it needs to be a coached transition. Part of that process is feedback from the patient to say “Yes, I feel better,” or “No, I do not.”

Exercise and motion are kind of like standing on the edge of a cliff hoping not to fall off.  If, in fact, you do too much like the three bears and the porridge and you go too far; you may not have a good resolve. The problem is most of the time you do not know until after the process is complete. So it is okay if it hurts for about an hour after a procedure – that is pretty normal, especially if you are pushing a little bit. If it hurts for a day or two, or a week, you did too much.

When we think about rehabilitation, in particular when discussing neck pain, motion, practical application and even manipulation are all really helpful. Manipulation resets what is called the gain to the muscles surrounding a joint.  Basically a joint has muscular stability coming from surrounding structures.  When a muscle is in spasm, those muscles then shorten and the gain of the muscle, which should be at a zero level, starts to heighten.

When we manipulate a joint, or perform a chiropractic adjustment, we reset the gain to the surrounding muscles themselves, some of which may be very tight. This process of resetting the gain is a neurological one. That is why manipulation is such an interesting tool. Your brain has a perception that this now is normal, if that is how you are holding yourself. If we were able to successfully and safely manipulate a joint, depending on the exam and the circumstances, the muscle tone surrounding the joint that is inflamed and irritated can be reset through a neurological reflex. This allows the neck to achieve a more normal status and that is why oftentimes manipulation is done repetitively.

When we talk about neck pain we always have to address pain and inflammation as part of the issue. There is always a lifestyle piece to everything. My approach to medicine requires my clients to acknowledge the importance of how their lifestyle affects their health. Muscles require hydration, rest, exercise, and deep, restful sleep to regain themselves. We have to have enough protein, hydration, stimulation, and then during deep, restful sleep we release something called human growth hormone (HGH) and this is what allows muscles to heal and also to get larger.

So if you are not sleeping well — and pain can also be a deterrent to that – if you are not hydrating well, if you are not getting enough protein, and you are not getting the appropriate energy sources from carbohydrates, vegetables in particular, there is certainly a discussion to be had surrounding the cause and effect of those issues on the body.

If you explore my website further and read other health articles I have written, you will hopefully begin to understand more about the importance of how food and lifestyle are so critical for repair.

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