Neck Pain Support Blog

Cervical Radiculopathy?? How Your Doctor Will Determine the Nature of your Neck and Arm Pain

Susan is a homemaker who was involved in a rear end car collision. She is having moderate neck pain and numbness and tingling into her left middle finger. It is affecting all of her activities at home including her her ability to carry her son and do simple household activities at home. Even turning her head is bothersome. The pain is relentless and after one week of suffering she decides to go to her Doctors office. What does this patient have? Well if you have been following the Neck Pain Support Blog, you may guess a cervical radiculopathy. A cervical radiculopathy is often present when patients present with neck pain, radiation of pain into the arms and hands, numbness and tingling into the fingers, and weakness of the upper extremity muscles. How would your Doctor diagnose this problem if you walked in with the same symptoms?

Your doctor will do a thorough consultation and examination on you to determine what is going on. Simply prescribing medication such as muscle relaxers or pain pills will only provide you with temporary relief. Your doctor will first ask you specific questions about your symptoms. For example, how this neck pain started- was it due to a trauma? What is the level of pain? How does the pain travel? Does it hurt when you cough or sneeze? Do you have radiation into your arms and hands? Does the pain affect your activities of daily living? All these answers are helping the Doctor to determine what nerve root level is affected.

They may do orthopedic tests. Your neck range of motion will also be tested. Other tests that your Doctor can do are more neurological in nature. Your doctor may refer you to a neurologist or a chiropractor for this further testing. This neurological testing often involves looking at the motor, sensory and reflex portions of each nerve root in the neck.

• Motor: Looking at the strength of the muscles. For example to test C6 nerve root, the Dr may have test the strength of your biceps. To test C7 nerve root, the dr may test the strength of your wrist flexors.
  
  
• Sensory: Looking at your sensitivity for feeling. In this neurological portion, the Doctor will often use an instrument called a “pinwheel”- the Doctor will ask you to close your eyes and roll this pin wheel along the dermatomes of the cervical nerve roots. The pinwheel will be rolled on the right and left side and you will be asked- does this feel the same or different on the right side compared to the left side? For example it will be rolled on the upper arm on both sides, and then on the lower arms including the thumb and index finger etc. This will help to determine what nerve roots are affected. Although this sensory testing with a pinwheel can be a little uncomfortable (it can feel ticklish at times), it is not painful
  
  
• Reflex: A check of the upper extremity reflexes is also important - The Doctor may look to see if you have a normal response, look at the intensity of the reflex (you may show a hyper or hypo reflex) and also look to see if the reflex is symmetrical on both sides. For example they will check biceps, brachioradialis and triceps reflex.

Your Doctor may order a cervical x-ray. The x-ray may come back and show degeneration of the bones in the neck. It may also show misalignments in the cervical vertebra, which could definitely cause pressure to be put on the cervical nerves. But one the best ways to diagnose a radiculopathy (and your Doctor may not send you out for this immediately) is a cervical MRI. An MRI using magnetic waves and has the ability to show you what is going on by looking at slices of the area your doctor is interested in. The test does not require any special dye or needles and is painless. Most importantly it can show you what is going on at the disc level. For example, it may show a disc bulge at C5/C6 or a disc herniation at C4/5. Not only will the MRI show the discs, it will also highlight the soft tissues and muscles surrounding the area . If you are claustrophobic and have a fear of enclosed spaces, request an OPEN MRI center to make your exam more comfortable for you.

It is not always clearly understood where exactly the nerve root is being affected. The nerve may be affected at a different location along its path. For example, the median nerve runs along the outside of your arm. If pressure is applied to the median nerve it can cause symptoms related to carpal tunnel syndrome. The pressure on the median nerve root is at the wrist area, not in the neck. The Doctor may order additional electrical studies and do different orthopedic tests to determine the diagnosis.

Electrical studies look at how well the nerves are functioning and are called an EMG (electromyography) This test measures how long it takes a muscle to work once a nerve signals it to move. The time it takes will be slower if nerve pressure from radiculopathy has affected the strength of the muscle.

Another electrical test that may be used instead of EMG is cervical root stimulation (CRS). In this diagnostic test, the Doctor puts a small needle through the back of the cervical spine into the nerve where it leaves the spinal column. Readings of muscle action are then taken of the muscles on the front and back of the upper arm and along the inside of the lower arm. Doctors use the readings to determine which nerve is having problems.

Don’t ignore the symptoms of a cervical radiculopathy. It is very painful and will affect your activities of daily living, just like Susan's case. It is best to get this diagnosed right away to see what and where the issue is. Once you get it diagnosed you can make an informed decision about treatment and get onto the path of relief.

Additional Reading Resources:

• Part I: Neck Pain Resulting from a C5, C6, C7 or C8 Radiculopathy
• Part II: Are Your Severe Neck Pain Symptoms the Result of a Cervical Radiculopathy?
• Part III: The Causes of Severe Neck Pain Resulting from a Cervical Radiculopathy
• Part IV: Severe Neck Pain From a Herniated Disc: What are Your Treatment Options?
• Understanding your Disc Problem Like a Jelly Donut
• The Normal Cervical Curve in the Neck
• How to End Neck Pain Naturally by Doing A Cervical Traction Program at Home

Visit Arc4life.com for your online selection of cervical supports and cervical traction products for relief of stiff neck, and neck pain Bookmark this on Delicious Stumble It!

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Natural Treatments for Headaches and Neck Pain

I get a lot of emails from patients who suffer from neck pain- and more usually than not, they also suffer from headaches. This connection between headaches and neck pain is real and is often referred to as “cervicogenic headaches”. Anatomically speaking, internal connections between cranial nerves and the muscles of the head and neck play a major role when someone suffers with neck pain and headaches. Specifically, C1, C2 and C3 nerves that exit the cervical spine go directly into the head. They innervate the muscles at the top of the neck, near the attachments of the skull. Hence any pressure put on these nerves or spinal joints will cause irritation and pain. Here are some examples of these muscles:

• The semispinalis capitus muscle is innervated by nerves C1-C5- the function of this muscle is to rotate the head and pull the head backward
• The Longus Capitus muscle is innervated by nerves C1-C3 and flexes the head (brings the head forward)
• The Rectus Capitus Lateralis is innervated by C2 and C3- its job it is bend the head laterally

The 5th cranial nerve** called the Trigeminal nerve innervates the sensation to the face and is located in the upper neck region. Another cranial nerve, cranial nerve #2 innervates the sensation to the back of the head up to the top. Problems located in the upper neck region will often result in pain radiating up from the base of the skull/upper neck to the eyes and/or face.

The 11th cranial nerve called the spinal accessory nerve innervates two muscles called the sternocleidomastoid and the trapezius muscles, 2 muscles in the neck. The sternocleidomastoid muscle tilts and rotates the head, while the trapezius muscle has several actions on the scapula, including shoulder elevation and adduction of the scapula. Injury anywhere in the neck can cause spasm and pain in these large muscle groups.

As we can see there is definitely a connection between the muscles of the upper neck and cervical spinal nerves and cranial nerves. Understanding where your headache is coming from is important – and your exam should include a check of the neck, upper back and cranial nerves. A chiropractor will often note spinal misalignments in the upper cervical spine as well as trigger points in the upper neck muscles.

What type of treatments will help with headaches and neck pain?

• Traction, or stretching of the cervical spine will help to ease pressure off of the cervical nerves. Traction can be done in the office or even using a home unit such as the pronex cervical traction unit.
• Chiropractic adjustments will help to align the cervical spine, thus removing pressure to the upper cervical nerves which directly innervate the muscles of the head and upper c spine
• Stretching exercises of the neck muscles will also help to decrease pain and maintain mobility in the cervical spine. These exercises should be done slowly and the stretch should be held for at least 10-15 seconds. Furthermore it is important to do strengthening exercises to prevent to make your muscles stronger and prevent recurrent headache occurrences.

Arc 4 life offers other natural headache remedies as well including:

• Headache Ice Pillow- This special "u" shaped neck pillow is made specifically for headache pain sufferers and has a special compact design. This neck pillow helps to relieve headaches by providing support to your neck while sleeping or resting in a seated position.
• Healthy Neck System- The Healthy Neck System was created to ease neck tension and upper back muscle spasms. It has 5 special contact points for your neck that you can use to decrease tension and reduce trigger points.
• Halo Rejuventor- The HALO Rejuvenator Pain Reliever works by simply increasing the blood supply to the affected areas, strengthening the neck muscles and naturally enhancing spinal alignment. When the body senses extra weight on the head, the spine reacts in a vertical way and lengthens by as much as ½ inch. In doing so, the three curves of the spine straighten and your posture becomes more erect, which in turn relieves abnormal tension of the muscles.
• The Cervical Traction Neck Pillow- The Cervical Linear Traction Neck Pillow is a great neck pillow for patients who suffer from headaches. The traction "V" side of the neck pillow will give you a gentle stretch in your cervical paraspinals, suboccipitals and upper trapezius.

** There are 12 cranial nerves- they are called “cranial” because they originate in the brain

Additional Resources:

• The Right Pillow for Headaches
• Treatment of Headaches: T.E.N.S vs Manipulation
• Neck Pain Relief Kit
• Neck Exercises for Pain Relief
• More Headache Remedies

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Neck Pain in Cyclists can be Prevented with Good Posture &Technique

I recently came accross a health article by Dr.Asplund- a medical Doctor in DC who is an avid cyclist. He discusses ways to prevent neck pain while cycling.

Dr.Asplund states that neck pain among cyclists in common- whether occasional or recurrent. Often times this neck pain is more common early in the cycling season. He suggests that in "to avoid early season overuse injuries, riders should initially ride at high cadence and low resistance and only increase training mileage by 10% weekly, gradually building to goal mileage".

Dr.Asplund notes that riding position technique can play a role in preventing Neck pain. He notes that the type of bike is a factor: For example, riding in drop handlebars for long periods increases the load on the arm and shoulders as well as hyperextension of the neck, leading to pain. If the virtual top tube length (top tube plus stem length) is too long for the rider, or if aero bars are used, hyperextension of the neck is further increased. Having a bike properly adjusted for your height, weight and frame are important for comfort.

Keeping your head extended (position of when you are looking up at the ceiling) for a long period of time can cause muscle spasm, especially trigger points. The muscles of the neck such as the suboccipitals and the cervical paraspinals may be affected. "Trigger points are small rubbery knots that form in muscle and adjacent muscle sheaths (fascia), which may send pain signals to the brain and contribute to a pain-spasm-pain cycle. Trigger points are frequently caused by direct blunt trauma, or by repetitive micro trauma, as is seen in overuse athletic injuries" Dr. Asplund stated.

Dr. Asplund goes on to give advice to prevent neck pain while cycling:

• One way to reduce neck hyperextension is by raising the handlebars, or using handlebars with a shallower drop.
  
• Reduce the virtual top tube length, by using a stem with a shorter extension. Moving the saddle forward would also reduce virtual top tube length, but the rider should be cautious as improper fore/aft saddle position can lead to knee pain.
• Changes to riding technique can also help with neck pain. Rigid riding position transmits more shock directly to the neck and shoulders.
• Riding with unlocked elbows and changing hand position (i.e. from drops to brake hoods) can alter neck posture minimizing pain.
  
• The rider may also alter his head position during the ride, in essence stretching the neck muscles while riding.

Riders whose neck or back pain is refractory to the above techniques should decrease their weekly mileage by 10% until the back pain disappears. During this period of mileage reduction, they should also avoid climbing and sprinting, and use a high cadence, low resistance spinning technique. Ice and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, may be used to provide pain relief. NSAIDs should be taken with food, and if the pain is not resolving within 1 week, medical evaluation is recommended. Medical management may include continuation of NSAIDs, trigger point injections, and possible a referral for physical therapy to improve core strength and flexibility.

In summary, although neck and back problems are very common, they can usually be managed by a combination of bicycle adjustment, technique change, and minor medical treatment.

Article Source: Neck Pain and Back pain with Cycling

Additional ReSources:

• Can Forward Head Posture Cause Neck Pain
• Your daily neck pain Free regime
• Neck Exercises for Neck Pain Releif
• Reasons for Neck Pain and How to Correct them
• Neck Pain Relief Kit

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Exercise For Neck Pain Works, Study Shows

Experts say exercise underutilized as treatment for back, neck pain Exercise has shown significant promise in improving physical function, decreasing symptoms and minimizing disability caused by chronic low back and neck pain. However, according to a study, exercise remains an underutilized treatment.

Researchers from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina conducted a survey of nearly 700 individuals with chronic back or neck pain who saw a physician, chiropractor and/or physical therapist during the previous 12 months. They asked participants whether they were prescribed exercise, the amount of supervision received, and the type, duration and frequency of the prescribed exercise.

Less than 50 percent of the subjects in our sample were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain, said Timothy S. Carey and Janet K. Freburger, lead researchers of the study.

Related Coverage Lost time injuries, musculoskeletal disorders decline in '07, study finds (12/01/08) Job creation must be accompanied by emphasis on safety, group says (04/02/09) National summit urges action to improve workforce health, productivity (12/01/08) Michigan: Senator introduces bill to block state-mandated ergonomics standard (03/23/09) Surgeons issue new treatment guidelines for carpal tunnel syndrome (12/01/08) According to the study, the type of provider played a major role in whether participants received a prescription. Of those who received an exercise prescription, 46 percent received the prescription from a physical therapist, 27 percent from a physician, and 21 percent from a chiropractor. The authors noted that these findings correlated with previous studies that have found that "who you see is what you get." The study, published in Arthritis Care & Research, found that for those who were prescribed exercise and the type of provider seen determined the amount of supervision and, to some extent, the types of exercises prescribed. Physical therapists were more likely to provide supervision and prescribe stretching and strengthening exercises, practices which the researchers said follow current guidelines and lead to better outcomes.

The authors suggested that future studies explore barriers to prescription of exercise treatments, such as practitioner knowledge, organizational aspects of the practice, and poor reimbursement for exercise instruction compared with other types of treatment.

Second study supports exercise. In a second unrelated study published in The Spine Journal, researchers found that exercise in the workplace is effective in preventing new episodes of low-back problems.

"Strong and consistent evidence finds many popular prevention methods fail while exercise has a significant impact, both in terms of preventing symptoms and reducing back pain-related work loss," said Dr. Stanley J. Bigos, University of Washington professor emeritus of orthopedic surgery and environmental health.

Chronic Pain Can Be Treated Better with Collaberative Treatments, study shows

Chronic pain affects 15% of the United States population. Often times chronic pain management consists of only treating the pain aspect and places little emphasis on how this pain affects patients day to day. Patients who suffer with chronic pain often turn to medications for treatment- chronic pain can lead to increased overall stress, anxiety and often depression. Unfortunately, depression is often not addressed when treated for chronic pain, and it can make it more difficult to follow through with recommended therapies.

A new March 2009 study published in Journal of the American Medical Association shows that when patients are treated with a team of Doctors approach, treatment can be more effective. This team approach includes psychotherapy to deal with depression. This was compared to how chronic pain is treated conventionally- by only medication, therapy or surgery sometimes

Dr. Steven K. Dobscha, of Portland VA Medical Center in Oregon, looked at 401 people with an average age of 61 or 62 who were in chronic pain for at least three months. (They excluded those diagnosed with chronic fatigue syndrome or fibromyalgia.) The study, which took place in the Department of main purpose was to determine if chronic pain can be treated more effectively if different types of treatment is used collaboratively. The 401 participants in this study has musculoskeletal pain of moderate or greater pain intensity and disability that lasted 3 months or longer.

There were two groups in this study. The first group was treated for chronic pain by a team of doctors using a variety of treatment methods, including a psychologist. Treatment included workshops for further education on pain treatment, patient assessment, education and activation, symptom monitoring, feedback and recommendations to clinicians, and facilitation of specialty care. In this particular group the psychologist talked to patients about their treatment and their goals for care, and the team came up with a treatment plan that was e-mailed to the patient's doctor or posted in an alert in the patient's medical record. People who needed more intensive care such as an an additional consultation with a mental health professional -- received it. Over the course of a year, patients with the pain-treatment team had an average of about 10 or 11 meetings or other contacts with their team members, unlike people with regular care.

The second group was treated as usual at the Veterans Affairs Medical center, no extra counseling or intervention.

The results were measured over 12 months by using questionnaires that asked patients their pain level and intensity and how it affected their activities of daily living. Also the participants were given a Depression health questionnaire. It was found that participants in the pain treatment team showed greater improvement in pain related disability and also a decrease in depression was seen.

"Overall, this study showed that a collaborative care intervention for chronic pain was significantly more effective than treatment as usual across a variety of outcome measures. Although many of the improvements were modest, they may be especially meaningful because patients in our sample were older, had long-standing pain, multiple medical problems, and reported high baseline rates of disability. Our results add to the growing body of literature suggesting that the collaborative care model is effective in improving clinical outcomes and adherence to treatment guidelines across a variety of chronic conditions. Patients in many health care systems and private group practices have limited access to specialty chronic pain services. A primary care–based intervention can have positive effects on pain disability and intensity, and on depressive symptoms," the authors concluded. Helping patients with chronic pain in a collaborative method with a team of doctors resulted in resulted in modest but statistically significant improvement in a variety of outcome measures.

What are the solutions for chronic pain? This study shows us that simply using one method such as medication or turning to surgery may not be the answer. There are a multiplicity of factors that play a role. Just taking medications can lead to an unhealthy dependence and unwanted side effects that may require more medications. Surgery itself can be a risky, require longer recovery and rehabilitation and again, require the patient to take more medications. Also both of these solutions (medications or surgeries) can cost more in the long term- to both the patient and the health

Chronic pain can easily lead people into depression. This type of pain affects your day to day activities- including your personal and work environment. Not being able to fully participate in family events can lead to anxiety, sadness and depression. Treatment needs to involve different health professionals including psychologists. Just talking to patients and understanding what is on their mind, what is causing them anxiety can make such a big difference in how chronic pain is dealt with. Family members are not trained to handle chronic pain- that is why talking to a professional can be of aid. Simple encouragement, reassurance, answers to why things are the way they are, and options avaialbe for chronic pain- can make a big difference in how chronic pain is dealt with and how effective the treatment is.

Article Source: Jama 2009;301(12):1242-1252. Collaborative Care for Chronic Pain in Primary Care

Additional Resources:

• Treatment of Chronic Pain Through Exercise
• The Emotional Impact of Neck Pain: Study Shows that Depression and Anxiety Play a Role
• The Relationship Between Stress and Neck Pain
• Chronic Pain Can cause shrinkage of the brain
• Neck Pain Relief Kit

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