Introduction Neck pain has become one of the most common problems in our society. In fact, neck pain is so prevalent that we have come to accept it as a normal part of a busy fife. Neck pain can affect anyone -- office workers, computer scientists, writers, athletes, and manual laborers. Because you are reading this book, either you or someone you know probably has neck pain and may be frustrated by the lack of good information available. But help is at hand. Although there are some gaps in our scientific understanding of neck pain, we have sufficient knowledge to make useful recommendations about diagnosis and treatment to help most people.
We do not know exactly how many people suffer from neck pain, but the number is in the tens of millions. One study estimated that in any year, at least one-third of adults has an episode of neck pain! Even worse, approximately 15 percent of those people have chronic or recurrent neck pain. The goal of this book is to help you understand the causes of neck pain, and to provide you with effective and safe techniques to relieve it. Another goal is to provide you with guidelines to determine when or if you need professional care. And if you need help, the facts in this book should enable you to communicate better with your doctor, chiropractor, or physical therapist in order to optimize your care, and to become an active participant in it.
Neck pain is usually due to mechanical problems with one or more parts of the neck. It is rare for neck pain to be due to a serious illness like cancer or infection, but that said, the consequences of chronic and severe neck pain can be very serious. Some people are unable to work and may lose their jobs. Others cannot enjoy a social life, travel, or sports. Others may become irritable or depressed and develop marital and family problems. The financial consequences can also be dire: large amounts of money are spent on health care and disability payments each year because of neck pain.
Fortunately, there is hope for neck pain sufferers. There are highly qualified physicians, chiropractors, and physical therapists who specialize in spine problems. However, much of the upto-date knowledge needed to help patients has not yet filtered down to the general orthopedist, family practitioner, or neurologist. Therefore, it is the responsibility of the person with neck pain to be informed. Even more important, the information and techniques in this book will help most people with neck pain get better without professional care.
People with chronic neck pain may initially try massage therapists, chiropractors, or acupuncturists. If they don't get better, they will see physical therapists, physicians, and finally surgeons. Frequently the initial treatment works and their condition improves. However, too often, pain recurs and the patient seeks help elsewhere.
In my practice, I see this pattern all the time and have learned that there are no quick and easy solutions to neck pain. It takes work and time to get better, and the patient must be an active participant. Treatment must be both aggressive and active. Too often, patients have had only passive treatment. They have been treated with massage and manual therapy, heat packs and cold packs, and vitamins and herbs, but they have not been given the skills, knowledge, and training to play an active role in getting better. Fortunately, most people will respond to good conservative care that is scientifically based and sensitive to the needs of each patient.
However, even with excellent care, a small number of people still do not get better. Then the patient will need more aggressive forms of treatment that require the expertise of a spine specialist. Some patients will need spinal injections; some may even need surgery. Because each person is different, we need individualized treatment options. It is best to start simple and get more complex if necessary.
I never tell people to learn to live with the pain. Instead, I teach people how to overcome the pain. In this book, I will offer active and safe treatments that usually lead to improvement, or even total relief. I will offer advice based on my own extensive experience, coupled with the best scientific information available. However, I do not have any secrets or miracles. My treatment plan requires hard work and a commitment of time and energy. No single treatment works for everyone, so I will provide several treatment options. I will start with the fundamentals of strength training and body mechanics. If done correctly and diligently, these methods will often be effective treatment for most people. If not, these basic elements will provide the background necessary for the more aggressive treatments that I will recommend, most of which require professional care.
The premise of this book is simple. A person with neck pain must understand the anatomy and function of the neck. It is also very useful to know how our bodies transmit pain messages from the neck or other site of injury to the brain. Knowledge is power -- power over pain. When you know the cause of the pain, you can develop treatment strategies that are specific for you. Some will be simple, such as rearranging your desk, workstation, and computer height or using your chair properly. Other strategies will be more complex, and will require a daily exercise routine and perhaps a few changes in lifestyle.
Most patients with long-standing neck pain will have flareups, despite being faithful to their programs. There are ways to help alleviate these intermittent flares, which I call "neck first aid." I will discuss the posture of the neck rest position, use of over-the-counter medications, proper use of ice, and a series of pain neutralization exercises, all geared to relieving the pain of flares.
In the remainder of this introductory chapter, I will present an overview of the problem of neck pain. I will introduce the subjects that I will discuss in detail later in the book. I recommend that you initially read or scan the book from beginning to end, and then return to the specific chapters that seem most important for you. This is especially true for the reader who is not familiar with medical or anatomic words and terms.
NECK PAIN IN THE GENERAL POPULATION Almost everybody has had pain or stiffness in the neck at one time or another. In fact, we tend to accept neck pain as a normal part of life, and usually it goes away in a day or two without treatment. To try and determine the prevalence of neck pain in the general population, a group of medical researchers sent questionnaires to 10,000 people and asked if they had troublesome neck pain in the previous year, and, if so, how long it lasted. They found that 34 percent of those who answered the questionnaires had troublesome neck pain in the past year, and 14 percent had pain that lasted for more than six months!
Another survey found that at any one time, 22 percent of people have neck pain that is bothersome and two-thirds of people have had significant neck pain at some time in their lives. These studies make it clear that neck pain is a major health problem.
THE CAUSES OF NECK PAIN: WHAT HURTS AND WHY The neck serves two basic functions. It is a pipeline for blood, nerves, food, and air, and it is a pedestal to hold up and support the head. Most of the problems that cause neck pain are due to damage to the pedestal and involve injuries to discs or joints. In addition, neck muscles may tire out and fatigue because of poor posture or overuse, contributing to the pain, but rarely being the underlying problem. When a person keeps his or her head in one position all day, there are stresses placed on the discs, joints, and/or muscles, resulting in pain.
WHEN TO SEE A DOCTOR Many people are reluctant to go to a medical doctor for neck pain, partly because it seems like such a trivial problem, and are more likely to go to a massage therapist or chiropractor. However, if the pain persists, is very severe, or does not respond to chiropractic care or over-the-counter medications, it is time to see a physician.
There are also situations when you should go to a physician directly, rather than seeing another kind of health care provider first. If the neck pain is mild or absent, but there is severe pain in one or both arms, there may be pressure on a nerve in the neck, usually due to a disc herniation. This requires the evaluation of a doctor. If one or both arms become weak and you drop things or have difficulty lifting light objects, it is time to see a physician. The same is true if the neck pain becomes so severe that you are not able to go to work or do even simple household tasks. If there is a loss of bowel or bladder control, you should go to an emergency room immediately. None of these symptoms necessarily means that there is an emergency or that surgery is necessary, but they do mean that medical evaluation is required.
In other instances, it is optional to see a physician, and I make specific recommendations in chapter 11. However, if you are not getting better after three to six weeks of alternative health care, it is time to see a doctor. The doctor may need to order tests such as X-rays or an MRI scan. In addition, the doctor may be able to offer short-term relief by prescribing antiinflammatory medications or other medications for pain. If the condition still does not improve, it may be necessary to do spinal injections, which can be very effective.
It is rare to need surgery for neck problems, but occasionally surgery is the best answer. Only a spine specialist can help you make this decision.
NECK-RELATED HEADACHES It is estimated that about 16 percent of people suffer from headaches that occur sufficiently often to interfere with their lives. There are many types of headaches, including migraine headache, tension headache, cluster headache, and headache due to neck problems. A headache that occurs as a result of a disorder of the neck is properly called cervicogenic headache, but I use the term "n...
