Cervicalgia

Neck pain is a widespread disorder: correcting incorrect lifestyle habits and practicing physical activity and targeted exercises regularly is the best way to prevent it.

Cervicalgia, or pain located in the back of the neck, at the level of the cervical vertebrae (technically referred to as C2-C7 and corresponding to the cervical spine, or the “high” part of the spine), is one of the most frequent osteoarticular disorders in adulthood in the Western world and can begin to cause problems as early as the age of 30.

Epidemiological data indicate that about 50% of the world’s population experiences a cervicalgia attack at least once in their life. The peak of onset is in the age group between 40 and 60 years and the disorder seems to prefer women over men and those who live in cities over those who live in rural areas.

According to the Global Burden of Disease 2010 Study, cervicalgia ranks fourth in the ranking of causes of years lost to disability, just after low back paindepression and joint pain.

What is it

In common language, we often refer to cervicalgia with the generic term “cervical” (used in expressions such as “it is the fault of the cervical”, “I suffer from cervical” etc.), thus improperly summarizing the typical neck pain, of musculoskeletal character, more or less intense and disabling, which can also radiate to a shoulder (more rarely both) and arms, making movement difficult due to the drop in muscle strength and associated sensory discomfort (localized tingling, numbness, changes in sensitivity, pinpricking sensation or changes in the temperature of the affected arm). In addition, cervicalgia can also induce to assume a posture that does not allow to adequately expand the ribcage, thus compromising proper breathing.

Cervicalgia appears, very often, as a consequence of the alteration of the intervertebral bone surfaces determined by osteoarthritis and the resulting inflammation, which can involve in a variable way the muscles and ligaments of the neck and shoulders and the cervical nerves (which branch off from the spinal cord contained in the vertebral canal to go to innervate numerous sensory and muscular structures of the neck, of the shoulders and arms).

On the other hand, ageneric neck pain can also appear due to a simple extemporaneous muscle contracture, cause of an equally significant malaise, but linked to a non-degenerative phenomenon and completely reversible at the end of the acute cervicalgia attack (unlike cervical osteoarthritis, which remains always present even in periods of well-being between subsequent acute attacks).

Symptoms of cervicalgia

In relation to the origin and distribution of pain and secondary symptoms, three variants of cervicalgia are recognized, namely cervicalgia itself, cervico-brachial syndrome and cervicocephalic syndrome. Let’s see what the differences are.

Form of cervicalgia Pain site Events
Real cervicalgia The pain mainly affects the neck, especially in the region of the nape, and the upper back, between the shoulder blades The pain is usually related to the presence of a contracture and/or inflammation muscle (in particular, affecting the splenium muscle of the head and of the neck, trapezius and levator shoulder muscle), in proportion varies from case to case. The resulting discomfort can be remarkable and can prevent all or only part from moving the neck for one or more days.
Cervicobrachial syndrome Neck and shoulder pain Neck and shoulder pain are added to sensory symptoms and loss of strength, which radiate from the cervical spine to the shoulders and to the arms, sometimes reaching up to the hands. The Events, in general, concern only one arm, in correspondence of the side most affected by inflammation, which in this Case also involves the cervical nerves markedly.
Cervicocephalic syndrome Neck and shoulder pain Distinctive neurological sensory symptoms such as headaches are present, dizziness and nausea, visual and hearing disorders, to which are added, sometimes, even swallowing disorders. These manifestations can be so intense and disabling that neck pain is completely overshadowed.

You may also be interested in the article Torticollis.

Causes of neck pain

Cervicalgia can arise for countless and very different reasons. However, in most cases, the appearance of neck and shoulder pain is linked to lifestyle errors that impose abnormal stress on this region of the spine, or to the presence of cervical osteoarthritis (a degenerative disease affecting cartilage, in turn favored by postural unfavorable factors, as well as genetic predisposition).

The main modifiable risk factors of cervicalgia include:

– psychoemotional tensions

– a sedentary lifestyle or lack of structured physical exercise

– extreme physical activity and excessive exertion, especially if performed in cold/humid environments

– repeated movements of the arms and shoulders (in recreational or professional contexts)

– maintaining an incorrect posture, both during the day and during sleep.

Correcting these behaviors appropriately is the best strategy to reduce the likelihood not only of suffering from cervicalgia, but also of developing cervical osteoarthritis that can further promote these disorders.

Even a dental malocclusion or an occasional acute traumatic event (such as whiplash or a sports accident) or continuous harmful micro-insults (such as those affecting those who practice contact sports such as boxing, rugby, American football or strenuous work such as bricklayer or porter) can be at the origin or, in any case, facilitate the onset of cervicalgia. In addition, if the muscles are already subjected to a contracture, even the so-called “cold strokes” can trigger an episode of cervicalgia.

In all cases, then, the presence of individual predisposing factors, such as alterations in the physiological curvatures of the spine (for example, scoliosis, dorsal kyphosis or lumbar hyperlordosis), can increase the likelihood of developing cervicalgia, both because of the improper mechanics and dynamics inevitably imposed by these conditions and as a consequence of the risk behaviors already mentioned, which in these cases become even more harmful.

Regardless of age, profession and individual characteristics, if you do not want to increase the likelihood of suffering from cervicalgia it is also advisable to avoid smoking, both active and passive, a result associated with a greater frequency of disorders in the neck, for reasons not well specified, but probably related to the increase in the degree of general inflammation of the body.

Additional risk factors, at least partly modifiable, which can favor the onset of soreness and muscle contractures in the neck concern the psychological sphere: clinical experience shows that removing tension and alleviating situations of depression, anxiety and stress can have a favorable impact on cervicalgia and surrounding symptoms, while their persistence can prevent their resolution, despite appropriate therapies.

Treatment of acute and chronic cervicalgia

As a rule, in the absence of serious structural alterations of the spine or specific underlying pathologies, neck pain and all other signs and symptoms of cervicalgia tend to improve spontaneously over a few days, especially if therapy with appropriate analgesic or anti-inflammatory drugs or a heat treatment with an overlapping effect is undertaken.

In general, the first therapeutic approach can be based on over-the-counter drugs and / or medical devices (for example, thermal bands), freely purchased in pharmacies without a prescription. However, if it is a pain that does not regress (or even worsens) within 2-3 days, it is necessary to contact the doctor for a competent evaluation and the possible prescription of appropriate instrumental investigations (x-rays, CT scans, magnetic resonance imaging, etc.).

The specific treatment to be undertaken must be chosen in relation to whether cervicalgia is in the acute phase (ie characterized by intense pain of recent and sudden onset), post-acute (corresponding to the natural evolution of the previous phase) or chronic (situation in which cervical pain of variable intensity is constantly present for long periods, generally due to an underlying pathology such as osteoarthritis cervical).

During the acute phase, the therapy aims to reduce the intensity of pain in the shortest possible time and restore the usual ability to move the neck, arms, shoulders and back, without further discomfort. To achieve these results, non-steroidal anti-inflammatory drugs (NSAIDs) can be used, to be applied topically in the form of creams, gels, gradual release patches or to be taken by mouth, or oral analgesics. In cases of particularly severe pain or not relieved by these remedies, the doctor may propose the infiltration of local anesthetics or corticosteroids.

If acute cervicalgia is induced by postural errors or repetitive movements and associated with significant muscle contracture, muscle relaxant medications may also play a role in calming pain, thanks to the reduction of abnormal muscle tension present. These medications should be taken with some caution by the elderly and people sensitive to their effects as they can result in transient muscle weakness and facilitate falls and trauma.

Alternatively, when muscle contracture is the primary cause of neck pain, self-heating adhesive bands can be applied to relax muscles and relieve pain, to be left in place for 8 hours. Studies and clinical experience indicate that this remedy is as effective as the pharmacological one on the analgesic level (ie pain reduction), but should not be used when cervicalgia has a prevalent inflammatory component. So, if the pain depends, for example, on the exacerbation of a cervical osteoarthritis, before applying the heat you will have to wait 2-3 days (post-acute phase).

When pain in the cervical tract is due to trauma such as whiplash, the use of the collar may be prescribed. This medical device, however, is often frowned upon by orthopedists and should be worn for a limited period of time to avoid “relaxing” too much and weakening the neck muscles, which should instead be kept active to facilitate rapid and efficient healing from trauma.

After the acute attack of acute cervicalgia, to eliminate residual symptoms, promote a full functional recovery of the patient and prevent new painful episodes, a rehabilitation path can be undertaken with physiotherapy, manipulations, electro-analgesia, massage therapy and thermotherapy. All these interventions must be planned by the doctor, in relation to the nature of the neck pain and any underlying pathologies and should be started only after the acute phase has been overcome (vice versa there is a risk of increasing inflammation and pain instead of reducing them).

In a minority of cases, surgery by a neurosurgeon or orthopedic surgeon could be used to resolve chronic cervicalgia, but these are extremely rare conditions. This possibility occurs especially in those suffering from cervical osteoarthritis that has led to the formation of “bony spines” on the vertebral surfaces that overlook the central foramen, ie the space where the spinal cord is present, or on the exit points of the spinal nerves, going to press on the spinal cord or on the nerves themselves, causing inflammation and / or causing an injury.

Another condition in which surgery can be proposed in case of cervicalgia is the formation of a herniated disc due to failure of the fibrous membrane (annulus) that surrounds the “heart” (nucleus pulposus) of the intervertebral discs. Disc herniation, as well as bone spines of arthrosis, also causes compression of the nerve roots, causing them to become inflamed.

The importance of lifestyle

In addition to all the pharmacological, physical and surgical interventions mentioned, to avoid new attacks of acute cervicalgia and the establishment of a chronic form it is essential to change life habits, learning to avoid assuming any incorrect position both during the activities of the day (at work, in the car, at the table, while watching television or using tablets and smartphones) and during night rest. To get used to a correct posture more easily, you can make use of ergonomic seats and shaped cushions specially designed to release tension from the muscles of the neck, shoulders and arms and to maintain an ideal orientation of the entire spine.

In addition, it is important to regularly practice both sports activities in general and specific exercises for the neck, shoulders and arms, ideally being supported at least in a first phase by a qualified physiotherapist or a competent instructor. In this regard, it should be remembered that physical exercise, stretching and muscle strengthening correctly performed represent real preventive treatments for most joint diseases and back pain, as well as a precious ally of global health.

When to consult your doctor

The family doctor and possibly the orthopedic specialist or neurosurgeon (preferably with specific expertise in disorders of the spine) should always be consulted when significant painful symptoms appear in the neck and shoulders and, again, if the treatment initially prescribed to combat cervicalgia has not had the desired effect within a reasonable time (7-14 days).

Other warning signs that should lead to avoidance or abandonment of do-it-yourself care and prompt diagnostic investigation include fever, severe headache, weakness, numbness, difficulty concentrating and tremors, as well as irradiation of significant neurological symptoms to the arms and/or legs.

The doctor (pediatrician) should then always be consulted when a child has neck pain of any origin, especially if the possible cause of the pain is not immediately recognizable. In this regard, it should be remembered that the onset of muscle stiffness in the neck in association with fever may indicate the presence of meningitis, a severe disease with potentially disabling or even lethal outcomes that requires immediate referral to the emergency room and the start of targeted treatment as quickly as possible.

Meningitis is an infrequent but serious pathology, which in the past mainly concerned the pediatric age, but which today tends to occur more often even among adults and that is why it is increasingly recommended to do vaccination prophylaxis.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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