NECK

NECK

The cervical region is made up of 7 vertebrae.

This part of the spine should have a curve similar to the lumbar region (lordosis), but unlike the lumbar region, it does not bear as much load. However, it is subjected to constant stress due to the continuous movements of the head.

Cervical pain can have multiple causes: excessive stress, injuries, degenerative conditions, dislocations, fractures, etc. Conditions at this level must be taken seriously as they can involve the roots of the cervical nerves.

Contents

• common conditions
  • whiplash
  • cervical vertebrae fracture
  • cervical discopathy
• chronic conditions
  • cervical spondylosis
• surgical interventions
  • surgical intervention for disc hernias

Common Conditions

• whiplash

  

  This is one of the most common traumatic conditions at the cervical spine level, caused by a sudden movement that involves a very rapid displacement of the head. It can be caused by various factors, the most common being car accidents. Other causes include injuries from contact sports or work-related injuries.

  During the initial consultation, the doctor may recommend an X-ray of the neck to check for fractures. If the X-ray is inconclusive, an MRI or CT scan may be requested.

  Immediate treatment involves using a semi-rigid cervical collar to immobilize the neck and keep it decompressed. This conservative treatment can be accompanied by medication to control pain and inflammation.

  After stabilizing the situation and balancing the area, physical therapy is recommended, which may include manual treatments and specific exercises for the area.

• cervical vertebrae fracture

  

  There are several types of fractures associated with the cervical region. Clinically, these are divided into two categories: fractures without neurological implications (stable fractures) and fractures with neurological implications (unstable fractures).

  Stable fractures (without neurological involvement) are associated with localized pain, restricted movement, and postural changes of the cervical spine. Depending on the severity of the fracture, kyphotic or scoliotic compensations may appear at this level.

  X-rays are usually sufficient to detect a fracture at this level, but if in doubt, an MRI or CT scan may be requested to exclude any possibility.

• cervical discopathy

  

  Intervertebral discs are made up of a fibrous ring and a gelatinous nucleus and act as shock absorbers for the movements and impacts they encounter. Movements at the spinal level cause constant changes in the pressures inside the disc and continuous movement of the gelatinous nucleus. For example, when we bend the head forward (flexion), the nucleus pulposus will migrate posteriorly, and when we bend it backward (extension), it will migrate anteriorly, etc.

  This normal functioning is disrupted by adopting poor postures that create abnormal pressures throughout the spine. In such cases, the disc begins to wear prematurely, and the nucleus has increasing freedom of movement.

  When it is pushed towards the exterior of the disc without the fibrous ring breaking, it creates a protrusion. If the problem persists, the fibrous ring will give way and allow the nucleus to migrate outside the disc, forming a hernia. The hernia can appear in any direction, but when the nucleus migrates posteriorly, it comes into conflict with the spinal cord or nerve roots, creating significant discomfort.

  The discomfort can become throbbing pain, numbness, or tingling (paresthesia), and the range of motion of the spine is significantly diminished and becomes painful.

  The clinical diagnosis can be made based on the path and intensity of the pain and can be confirmed by imaging through X-rays, MRI, or CT. In most cases, conservative treatment is recommended. In the initial stages, a cervical collar and medication for pain and inflammation management may be recommended. Manual therapy is recommended at the beginning of physical therapy sessions (osteopathy, therapeutic massage, mobilizations of the area, stretching), followed by therapeutic exercises to regain maximum range of motion. Maintenance programs are also very important to help patients maintain muscle strength, but poor postures that can worsen the condition of the affected discs should be avoided.

Chronic Conditions

• cervical spondylosis

  

  Cervical pain is usually associated with cervical spondylosis. This can have many causes and actually represents a deterioration of the cervical joint surfaces. Among the most common causes are poor postures, using pillows that are too high during sleep, a sedentary lifestyle, practicing contact sports, a disc protrusion, arthritis, or trauma that affected this region.

  The pain is not only localized at the neck level (cervicalgia); it can radiate down the arms (cervicobrachialgia) or cause sharp pains in the scapula area, shoulders, or down the arms to the fingers.

  It is very important to have an accurate diagnosis to create a tailored physical therapy program. Spondylosis is highlighted radiologically, and MRI or CT can be used to see the impact of the problem on the spinal cord and cervical nerve roots.

  In most cases, the treatment is conservative, and manual therapies aimed at decontracting the cervical muscles and ligaments are recommended. They are very useful for regaining range of motion and are supported by therapeutic exercises for this level.

  To manage the treatment, the lifestyle must be modified.

Surgical Interventions

• surgical intervention for disc hernias

  

  Surgical treatment is indicated only in cases where conservative treatment has not been effective or in cases where there is a possibility of worsening the neurological problem.

  Today, surgical interventions are less aggressive, such as microsurgery or endoscopic intervention. Problems that can follow a surgical intervention can be caused by recurrences or the way scar tissue (fibrous tissue) forms.

  Physical therapy is essential post-surgery to recover as much range of motion as possible.