The (Basic) Anatomy:The neck or the “cervical” (C-Spine) spine consists of seven vertebra, ligaments, muscles, tendons, discs that cushion (between) the vertebra, and a variety of nerves.The spinal cord, part of your “central nervous system” runs down the center (the spinal canal), the individual spinal (peripheral) nerves either travel up into your head or down into your shoulder and arm (“cervical or brachial plexus”), and finally, the sympathetic nerve chain (part of the autonomic nervous system) runs just in front and to the side of the spine.
The cervical spine is incredibly interesting, complicated, and delicate.When trouble arises in the cervical spine, it can effect literally everywhere else in the body.The neck provides the housing to the lower two inches of the brain (the medulla oblongata) within the upper two vertebra (C1 and C2) and then transfers the energy down the spinal cord through the spine.There are small but essential exit holes of approximately 3/8 inch in diameter(the intervertebral foramen) or small “port holes” between each vertebra, that allow the nerves of the spine to carry nerve pulses to and from the spinal cord (efferents and afferents).The peripheral nerves of the spine carry information to and from the head, the shoulders, and into the arms, wrists, and hands. And finally, there are direct communications from the spine and cranial nerves that communicate with the autonomic nervous system (automatic system that controls the physiology of the body) that controls or at least affects things like dizziness, nausea, heart rate, blood pressure, and light sensitivity.
As you can see, by far, the most interesting aspect of the cervical spine is its vital connection with the nervous system.So one might ask, why is the neck so commonly stiff and painful?Why do I wake up with headaches and neck stiffness or pain? And, why is the neck so prone to injury and degeneration? Let’s start with a couple concepts of the genesis of injury.
By and large, tissue damage, or “injury”, comes when the mechanical forces exceed the integrity of the tissue involved.That might be muscle, discs, tendons, nerves, or sometimes even bone.These forces can be either be created from a specific blow or blunt force, i.e., macrotrauma or, continued breakdown of the mechanics of a joint or region over an extended period of time, sometimes called a“repetitive- use injury”, “microtrauma”, or “stress” injury.In the cervical spine, after twenty four years of treating spine injuries, I would say that the most common causes of neck pain that I see is from wear and tear, improper sleep pillows, and stress.So although there are a lot of whiplash accidents, sports injuries, and other types of accidents that injure the cervical spine, for the last part of this article, I will focus on what approximately 80-90 percent of the injures coming into our clinic, disc compression syndromes with associated joint and muscle pain and dysfunction.
Disc compression is exactly what it sounds like; compression of the discs between the vertebra.The most common symptom is pain into the neck, down the shoulder, and if bad enough, into the arm, wrist, or hand.Pain may also be accompanied by “paresthesia” (para, abnormal + aisthesis, sensation, abnormal sensation such as pricking or tingling; heightened sensitivity) or sensory loss of sensation in a dermatomal (consistent with the nerve tract) distribution.And in the most severe cases, one may have strength loss into the shoulder, arm, or wrist/hand. In younger individuals, usually between 16 and 40, the discs are very well hydrated (high water content) due to the proteoglycan (water loving or phylic protein) concentration being so high.As we age into our middles forty’s,fifty’s and above , this protein decreases and so does the water, decreasing the shock absorbing capability and often times creating what is called “desiccation” or common degeneration of the discs.Now if there is a high enough compressional force-usually coupled with rotation or extension in the cervical spine, there is potential for a disc tear or strain.A good example of this is a “whiplash type” injury which oftentimes creates a disc tear or even ruptures.In simple terms, the disc is like a radial tire of your car with hundreds of concentric rings supporting it.These rings get torn and create bulges due to the internal pressure.If the force or injury is significant enough, it can create bugles/ protrusions, or even “herniations” which are usually classified whereby the front to back (AP) diameter is greater than the side to side (coronal) diameter.Generally in the cervical spine, this is usually considered herniated at 3-4 mm or more.
In summary, neck pain and its symptoms can come on with the slightest of movements, upon awakening, or can be caused by trauma.Neck tightness, stiffness, or pain are common, generally treatable symptoms that present when your body is telling you that there is abnormal pressure, biomechanics, or stress .Your nervous system then translates this information to your muscles and joints for protection to slow down your movement and activity.Pain, stiffness, or tension in the spine are not normal especially for prolonged periods (greater than 5-10 minutes) or at a high frequency (i.e., greater than once a month.You should not ignore the signs.It is important to seek a Health care professional that will look carefully at your spine to diagnosis your condition properly, usually with X-rays and a thorough neurological and orthopaedic examination.For good neck health, start with good exercise at least three times per week, do gentle stretches of your C-spine to maintain the essential movement, eat nutritionally, and get the proper neck support when you sleep.
Dr. Hall is a Sports Medicine Chiropractor and is affiliated with Santa Monica Orthopaedic and Sports Medicine Group. More information can be found at: www.ChiroPlusMD.com