Let's Talk about Our Most Common Back and Neck Pain Problems

Cervical Strain or Sprain: Understanding and Managing a Common Injury

I want to provide you with the general information you need to get good care for these 10 common spine problems, the ones that patients most often inquire about.  Specific medical advice should be sought directly from a healthcare professional.  Here are ten common spine problems that my patients ask about, and I will be addressing each one individually
 

1. Cervical Spine Strain and Whiplash: Pain caused by injury to the muscles and ligaments supporting the neck and facet joints that connect the vertebrae.

2.                   Lower Sprain: Often caused by muscle strain, injury, or poor posture.

1. Herniated Disc: When the soft center of a spinal disc pushes through a crack in the tough outer layer.
2. Sciatica: Pain that radiates along the sciatic nerve, typically caused by compression or irritation.
3. Scoliosis: An abnormal curvature of the spine, often diagnosed during adolescence.
4. Spinal Stenosis: Narrowing of the spinal canal, leading to pressure on the spinal cord or nerves.
5. Degenerative Disc Disease: Wear and tear on the spinal discs over time, causing pain and discomfort.
6. Tumors and Infections of the Spine: A rare but very serious cause of damage to the spine, often seen as late complication during primary cancer therapy.
7. Spinal Fractures: Breaks or cracks in the bones of the spine, usually caused by trauma or osteoporosis.
8. Failed Back Surgery of the Spine: Persistent or worsening pain after a spine surgery treatment.  Did the patient FAIL to get better, or did the surgery FAIL to fix the problem?.

If you have specific concerns about your spine health, it's recommended to consult with a healthcare professional for a thorough evaluation and personalized advice.  Let's start with one of the most common...

Cervical Strain or Sprain: Understanding and Managing a Common Injury
Cervical strain or sprain refers to an injury affecting the muscles, tendons, or ligaments in the neck, often caused by sudden movements or trauma. This paper provides an overview of the symptoms, treatment options, and healthcare professionals involved in managing cervical strain or sprain.

Introduction:
​Cervical strain is a common condition that can result from various activities, including whiplash injuries, improper lifting, or sudden movements. The five most common causes that my patients run into are:

1. Whiplash Injuries: Sudden acceleration or deceleration of the head - which is heavy relative to the neck -commonly associated with car accidents, and some sports injuries, can lead to a severe cervical sprain or strain, often referred to as whiplash. The forceful movement of the head strains and sometimes tears the neck muscles and ligaments.
2. Poor Posture: Prolonged periods maintaining the neck and head in an incorrect position, such as slouching while sitting at your desk or spending too much time looking down at your phone, can contribute to cervical strain over time.
3. Repetitive Strain: Activities that involve repetitive neck movements or sustained positions, such as long hours of computer work, painting, or other manual tasks, can strain the neck muscles and lead to discomfort.  Likewise, repeated and prolonged exposure to low-grade impacts or vibration, as seen in construction vehicles, can result in a chronic strain situation.
4. Lifting Heavy Objects Incorrectly: Lifting heavy objects with improper technique or with sudden, jerky movements can strain the neck and upper back muscles and cause injury.
5. Sleeping Position: Sleeping in an awkward or unsupportive position can lead to neck strain. Using an unsuitable pillow or sleeping in an uncomfortable posture may contribute to waking up with neck pain (Check out my post on Proper Pillow Selection)..

 While most cases can be effectively managed with conservative (nonsurgical) treatments, severe cases may require surgical intervention.

Symptoms:
Symptoms of cervical strain include intense neck pain, muscle spasms, limited range of motion, headaches, tenderness, and swelling. In severe cases, individuals may experience arm pain or numbness, indicating potential nerve compression or a herniated disc. 
Treatment:
Conservative Measures:
Treated well with non-operative methods symptoms may resolve over a period of a few weeks or 2 -3 months.  However, it is not uncommon for some symptoms, such as stiffness and headache, to linger for a year or more before completely resolving.

1. Rest: Allow the neck muscles time to heal by avoiding activities that worsen the strain.
2. Ice and Heat Therapy: Apply ice in the first 48 hours to reduce swelling, followed by episodic heat to relax muscles.
3. Pain Medications: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain by reducing the inflammation within the injured muscles and ligaments.
4. Physical Therapy: Exercises and stretches to improve flexibility and strengthen neck muscles can usually be started in two to three weeks when the initial muscle spasm calms down.
5. Neck Brace or Collar: In some cases, a neck brace may be recommended to limit movement and provide support.
6. Massage and Relaxation Techniques: Alleviate muscle tension and promote healing.

Surgical Intervention:
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Surgery is considered when conservative measures fail or when there is an underlying structural issue, such as:

• Severe herniated disc.
• Persistent nerve compression.
• Trauma or instability requiring stabilization.

Common surgical procedures include discectomy, cervical fusion, foraminotomy, and artificial disc replacement.  Approximately one patient in 10 or 20 will need surgery for an acute strain, and some additional patients may later require surgery to address late disc degeneration of instability caused by the initial strain.

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Healthcare Professionals:
There are several healthcare professionals that may be consulted during the evaluation and treatment process:

1. Primary Care Physician: Initial assessment, treatment, and referral to specialists if needed.
2. Orthopedic Surgeon: Specialist in musculoskeletal conditions for both non-operative and surgical interventions.
3. Neurologist: Consulted for evaluation and management of neurological symptoms of arm pain, numbness, or weakness, and for any evidence of a more severe neurological problem such as dizziness or loss of balance.
4. Physical Therapist: Designs rehabilitation exercises for improved neck strength and flexibility and provides some modalities that can relieve spasm and improve function.
5. Pain Management Specialist: Manages pain through medications, specialized injections, or other interventions.
6. Chiropractor: Utilizes manual adjustments for musculoskeletal issues.
7. Rheumatologist: Involved in cases related to inflammatory conditions or autoimmune disorders.
8. Emergency Room or Urgent Care Physicians/Nurse Practitioners: Address acute trauma or severe symptoms; often obtain the first imaging studies of the injured tissues and may be the first to see fractures or other problems that will need surgery.

Conclusion:
Cervical strain or sprain is a common yet manageable condition. The pain and stiffness associated with this muscle injury can be remarkably intense and limiting, early on.  If arm pain or weakness is part of it, the situation needs to be carefully assessed and imaging obtained by a specialist.  Conservative measures are often effective, but surgical intervention may be necessary in severe cases. Collaboration among healthcare professionals is crucial for accurate diagnosis and tailored treatment plans, ensuring optimal recovery for individuals with neck and back injuries.

I hope you find this helpful.  In the coming weeks I'm going to address each of the common problems I listed above.  If there's something you think I need to address that you don't see, just let me know!!