Neck Pain - Causes

Neck pain can result from several causes, including:

• Muscle strains. Overuse, such as too much time spent hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
• Worn joints. Like the other joints in your body, your neck joints experience wear and tear with age, which can cause osteoarthritis in your neck. Neck (cervical) osteoarthritis can cause pain and stiffness in your neck.
• Disk disorders. As you age, the cushioning disks between your vertebrae become dry and stiff, narrowing the spaces in your spinal column where the nerves come out. The disks in your neck also can herniate. This means the inner gelatinous cartilage material of a disk protrudes through the disk's tougher cartilage covering. Neck pain may occur or nearby nerves can be irritated. Other tissues and bony growths (spurs) also can press on your nerves as they exit your spinal cord, causing pain.
• Injuries. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits.

Neck Pain

Most people will experience neck pain at some point in their lives. Neck pain can be acute (meaning it lasts a few hours to a few weeks), or it can be chronic (lasts several weeks or longer).

Most causes of neck pain aren't serious. Poor posture at work, such as leaning into your computer, and during hobbies, such as hunching over your workbench, are common causes of neck pain.

But sometimes neck pain can signify something more serious. If your neck pain is so severe that you can't touch your chin to your chest despite a few days of self-care, seek immediate medical attention.

Neck pain takes many forms. Signs and symptoms of neck pain may include:

• Pain in your neck that may feel sharp or dull
• Stiffness in your neck
• Difficulty going about your daily tasks because of pain or stiffness in your neck
• Shoulder pain in addition to neck pain, in some cases
• Back pain in addition to neck pain, in some cases

Spinal Decompression Therapy

Research indicates the discs may be responsible for a significant percent of lumbar/leg, and neck/arm pain. Simply stated, compression (and flexion) increase end-plate, disc (and facet) stress and can lead to inflammatory responses from damage including annular compromise (circumferential and radial tear) protrusions and possible extrusion of nuclear material. Research also indicates not all disc pain can be diagnosed by static imaging (MR) nor do the majority of those with MR findings have pain (as many as 29% of prolapsed discs are not generating pain at the time of the MRI).

In theory many mechanical discogenic pathologies causing pain can be treated sucessfully with DTS axial decompression. (For our purposes decompression refers to a reduction of intradiscal pressure and a centripetal effect that improves osmotic exchange, circulation and thus healing). Since the disc is an avascular structure, it doesn't receive fresh blood and oxygen with every beat of the heart. Bogduk reports nutrient supply to the disc is barely adequate for normal requirements and the disc's inner portion has the most precarious nutrient supply. Discs require diffusion created by motion and pressure reducing positions to restore nutrients and enhance healing.

Typically back pain with referral pain is an indication for decompression and reduction of those referral symptoms an excellent clinical sign it is working. However studies suggest some prolapsed and severely degenerated discs may have negative IDP due to a disturbed hydrostatic mechanism. In these cases creating negative IDP by traction to gain a centripetal effect becomes more nebulous (but as long as no increase of symptoms occurs treatment is still warranted for a test period of a few weeks.). Generally in cases with a patent annulus (the disc's outer annulus is still intact) centralization of pain can be an excellent clinical indication the treatment is viable.

Centralization is a recognized prognosticator of good clinical outcomes in disc cases. Patients often report centralization during or soon after a DTS treatment thus giving the clinician a viable indicator for a good outcome and reducing the likelihood of surgical intervention.

Recumbent positions (both prone and supine) decrease intradiscal pressures in comparison to standing and sitting. However, focused, mechanical Y-axis traction improves the discs healing response via decompression more quickly and with fewer disuse side-effects than prolonged bed rest.

There is a suggestion in the literature that extruded nuclear material may be drawn in by the reduction of intradiscal pressures and /or the tightening of the posterior longitudinal ligament. This concept however is not uniformly accepted due to the limited number of studies able to differentiate the natural history of disc herniation vs. the direct effect of treatment. Of course whether the disc is the sole source or just a component of the pain is often impossible to prove in many cases.

Many authorities conclude it is not so much something is structurally improved, but an inflammatory response to injury or foreign matter is reduced. We must keep in mind also that many studies suggest less than 5% of patients are good surgical candidates and many back surgeries (and injection procedures) fail to show any long-term value. Thus passive non-surgical procedures that limit side effects and allow progression to active care should be the focus of treatment in that population of patients who fail to improve on their own. As a passive therapy decompression has definite limitations in curing chronic musculoskeletal conditions. Its value is most specifically in helping discogenic back/neck and referral pain, not acute muscular back pain or those related to posture etc. (other types of therapeutic intervention may be more appropriate).

Loss of local muscle control & endurance, abnormal posture, cyclical flexion with compression (not to mention genetic influences) are the probable source of most disc damage and degeneration. A passive therapy therefore has little effect truly fixing the underlying problem.

However, a temporary reduction in intradiscal pressure through cyclical stretching can apparently have a profound effect on the healing process via increased eontact with the blood/nutrient supply and cellular migration (so called phasic, non-linear effects) as well as neurological changes generated by soft tissue stretch. Treatment outcomes are basically of three types.

1. Treatment rapidly and completely eliminated pain (cure response).
2. Pain becomes manageable and/or intermittent (management response).
3. No response.

Typically there is a slightly higher proportion of type 1 vs. 2 and fewer type 3 in a typical Chiropractic practic. Decompressive traction of a compressive disc lesion matches treatment to diagnosis and as such is a very reasonable passive therapy.