The Human Neck-Part Three



Posted: Wednesday, September 02, 2009

by Jonathan Blood Smyth

The reduction in neck mobility exposes the capsules, fibrous bags around the joints, of the facet joints to traumatic stretching events. Turning the neck suddenly without conscious thought can push the joints to the limits of their movements, injuring the fibres of the capsular ligamentous tissues. This produces joint pain and scarring with increased capsular tightness as the healing process proceeds, making the joints tighter and less willing again to tolerate stresses. As the tight joints can occur in several parts of the neck this can cause a limitation of joint motion which doesn't become apparent until one day you find you can't turn your neck as you expect to.

The pain sources from facet joint arthropathy are due to various reasons: the local musculature responds to pain by developing muscle spasm; the local facet joint is suffering from pathological changes and there is referred pain. Localised neck pain, the centre of which is often identifiable by feeling with the fingers, comes from the irritated facet itself while the referred pain is much less clear in nature, expressing itself as a vaguer general feeling of ache in the arm or shoulder. As the neck problems increase it can interfere with important abilities such as sleeping which can lead to side effects such as depression and anxiety.

The facet joint can suffer a sudden, painful and relatively minor injury resulting in what is called an acute wry neck, perhaps from vigorous hair drying with a towel, jarring oneself or looking suddenly round to one side. If we sleep in an odd position for a while we can also wake up with this neck pain problem. The onset is usually quick and unexpected as our facet joint locks as the movement surprises our controlling muscular systems, perhaps spraining the easily irritated facet joint capsule or pinching the synovial membrane between the surfaces. Sudden, intense neck pain from this induces strong spasm of the neck muscles and secondary pain.

An acute wry neck is an unpleasant experience with acute pain on one side of the neck and a loss of neck movement. There may be very strong muscle spasm holding the neck in an odd posture to one side. Careful guarding of movements and avoidance of jarring or sudden motions is evident to avoid any sudden movement which might increase the muscular spasm and the forces of neck compression. It can be a challenge merely to get into and out of, with holding of the head typically needed as the movement down or up is performed to minimise muscle activity in the neck.

A locked neck joint can be unlocked, sometimes very quickly and with complete relief, by cervical manipulation from a manipulative physiotherapist, chiropractor or osteopath, with the mechanism thought to be un-trapping of the nipped tissues by gapping which could also allow the joint to realign itself. This is less common that the normal recovery which takes place over a few days with painkilling and anti-inflammatory drugs until the neck begins to move more normally again. Therapists can also employ a repeated therapy called joint mobilisations which helps to restore normal movements to the joint and prevent recurrence.

A sudden onset of neck pain, or more commonly a slower onset over a few days, can be an indication not of a facet joint problem but a nerve root irritation perhaps secondary to inflammatory changes or a disc protrusion. If a facet joint injury does not settle early or well an inflammatory exudate can form around the nerve root as it exits the spinal cord through the narrow channel, gradually developing into scar tissue as it heals. Nerve react particularly badly to stretch out of all possible mechanical inputs, and if a sudden stretch is put on the tethered nerve this can set off an inflammatory process resulting in severe and very unpleasant neck, shoulder and arm pain.

Although neck pain may not be the major presenting part of the problem, patients often indicate there were some warning signs from their neck previously, with the neck or arm being less predictable and reliable on various activities. The precipitating reason for the full syndrome may be something small, just in the right direction to stress the nerve.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Oxford visit his website.
This Article has been viewed 867 times. (Not updated in real-time.)
No comments yet.
We want your comments! If you can read this, you don't have javascript enabled, so you can't use this comment system. Please enable javascript.