That Pain in the neck
By Dr. Mark Amerasinghe
[This article was first published on 21 February, 2010 in the Sunday Times Sri Lanka]
Neck pain, like backache, is a common problem, particularly among the over forties. The spine in the neck, the cervical spine, is made up of seven blocks of bone -the cervical vertebrae. It projects to the front, as is evidenced by the hollow of the neck at the back. As a result, when the spine is subjected to stress along its length, this stress is borne more by the back part of the vertebrae.
Each vertebra consists of a strong block of bone, the body, and a weaker portion behind, consisting of an arch of bone enclosing a hollow. From the upper and lower margins of the arch are, on either side, two little projections of bone known as the facets. The back surface of the upper facet and the front surface of the lower facet are polished and smooth, so that one vertebra can sit comfortably on the vertebra below, coming into contact at the facets, forming a joint (the facet joint) where movement can occur between the vertebrae.
The bodies of neighbouring vertebrae are connected to each other by a strong but compressible disc of tissue (the intervertebral disc) which binds the bodies firmly to each other, while, because it is compressible, allowing movement between them. The vertebrae are also bound to each other by bands of tissue –the ligaments passing between the arches.
When the vertebrae are piled one on top of each other, the hollows enclosed by the arches form one continuous canal (the spinal or vertebral canal) which lodges the spinal cord running down from the brain above. From the spinal cord arise the spinal nerves on either side.
These nerves leave the spine through little spaces on the sides. An important anatomical fact is that part of the front wall of this space (foramen) is made up of the outer portion of an intervertebral disc and the back wall is formed by a facet joint. A slight bulge (protrusion) of the outer part of the disc – something which can occur in a disc that has undergone changes with age - can irritate the nerve.
In like manner, a swelling of a facet joint lying behind the nerve can do so. Just as when you twist (sprain) your knee or ankle the joint can swell up and needs rest, in similar manner, a twisting strain of a facet joint can give rise to a tiny, not easily demonstrable, yet painful swelling which needs to be rested. The forward curvature of the spine in the neck tends to throw a greater strain on the back part of a vertebra. Thus, our daily activities, looking up, down, bending and turning our heads, can without much difficulty cause a strain of the facet joints and the ligaments joining the arches, apart from pressing more on the weaker back portion of the disc, leading to a slight bulge (protrusion). Depending on the particular nerve/s irritated, pain can occur in the shoulder blades (a common site) or even down the arm or going up to the back of the head.
These facts help us to understand the distribution of pain arising from disturbances of the cervical spine and place us in a better position to take action to prevent these disturbances and also to handle them effectively when they do occur.
When you lie on your back, you can easily pass your hand under your neck, which, because of the hollow, is unsupported and thus under strain. There are two ways you can provide this support.
Using a ‘bole’ pillow
The long cylindrical type of pillow (used for babies) which can be tucked easily into the hollow, provides support to the spine. Supporting the neck in this manner is very useful in reducing and relieving neck pain.
The butterfly pillow
• Use two pillows, the softer one being on top.
• Tie the top pillow in the middle so that it looks like a butterfly.
• When you lie down rest your head on the bottom pillow, while your neck rests on the ‘waist’ of the butterfly.
• The position of your head will depend on the size of the bottom pillow. You can start off with your neck being straight. If you use a thinner bottom pillow, your head will fall backwards, while a thicker pillow or a rolled up towel tucked under the pillow will push your head forwards. You will have to find out the position that suits you best, by trial and error.
I have personally found a butterfly pillow most useful. If you are too lazy to be tying up pillows, just push a crushed up very soft pillow into the hollow of the neck, and you will note the difference it makes!
Once you have found the desirable position on the butterfly pillow, you do not have to sleep staring at the ceiling; you can turn towards one or other side ‘wing’ while your neck still rests on the waist of the butterfly.
Use of a collar
A well fitting collar helps to reduce pain. It does so, by preventing sudden, jerky and twisting movements and thus resting the small facet joints. It is important that the collar is properly selected. Your head should be in a neutral position with the eyes looking straight ahead.
This is the position of least strain on the spine. It is the vertical height of the collar which determines this. The collar should rest on the two bony prominences at the inner ends of the collar bones and run up to the level of the chin, with the head held in the neutral position.
Those who have had a bout of neck pain should always use the collar when travelling in a vehicle, even if they are pain-free at that moment.
Neck relaxation exercise
When you have a neck pain you often find that the muscles at the back of the neck and/or over the shoulder blades are tense and tight. They are in spasm, due to the irritation of the nerves that supply them
• Sit in a comfortable position with head in the neutral position, looking straight ahead.
Let your head drop down very slowly as if you are dropping off to sleep. Let it go as far as possible without forcing it. Now come up, again very slowly to the starting position.
• Turn your head first to one side, then to the other and get back to the starting point.
• Let your head drop backwards and get back to the starting position.
It is important that the head be allowed to drop under its own weight and very slowly. Just let go. Do this exercise daily, before you get out of bed, and again, just before you drop off to sleep i.e. at ‘nodding time’
If you do this exercise daily, you will find that the range of movement possible progressively and slowly increases. But do not concentrate on the degree of movement. Just relax.
Attention to certain activities of daily living
• In your pantry cupboards, items used infrequently should be on the top shelf while items used regularly should be at or around eye level.
• Avoid looking up for long periods of time. It increases the stain on the weak part of the discs and the facet joints.
• In like fashion avoid looking down for long periods. It strains the ligaments. Hairdressers in particular should try to do most of their work at or around eye level. I presume that their clients sit on a chair, the height of which is adjustable. The relaxation exercise can be particularly helpful for hairdressers.
• Ensure that the monitor of you computer is so placed that again you are working, most of the time, at around eye-level. If you are looking at a document when working, see that it is as the same level as the monitor, so that you do not have to be looking down and to the side, frequently.
• At all times avoid sudden jerky movements.
• People having neck pain and those over 40yrs, in my opinion, should avoid ‘head stands’
Paying attention to these matters can pay dividends by sparing you that neck pain if you are fortunate not to have suffered from it, and if you have, it can help relieve the pain and prevent a recurrence. One final word. Do not get alarmed by reading reports of radiological examinations and scans.
They often sound more terrifying than the reality of your condition., because they are written in a special language that can be understood only by those qualified to interpret them. Remember that, there are many people going around with ‘horrible’ looking X-rays of the neck, but who have no complaints!