Everyone, at one time or other, has had a stiff neck. How do you deal with it?
The cervical spine consists of 7 block-shaped bones called vertebrae. They are stacked, one upon the other forming the spinal column.
The neck vertebrae have two major functions
•To bear the weight of the head
•To protect the spinal cord or spinal nerve roots inside the spinal column
Each vertebra has bony projections called “processes” that are sites for the attachment of ligaments and muscles that help stabilize and move the spine.
Between each vertebra are cushions, called discs. Each disc has a soft jelly-like center called the nucleus pulposus, which is surrounded by a tough fibrous outer envelope called the annulus fibrosis.
Each vertebrae has areas for the attachment of muscles.
In the neck there are a series of ligaments that are important for stability of the vertebral column.
A stiff neck occurs when there is either a muscle strain or there is damage to the ligaments. Muscle strains can be due to injury or to prolonged abnormal positioning. An example of injury might be trauma to the muscles during athletic events.
Abnormal positioning is a more common occurrence. This happens when one holds their head in one position for too long a period of time. Sitting at the computer or driving long distances are two situations where this occurs. Another example is when a person wakes up with a stiff neck because of sleeping in a weird position.
The interspinous ligaments at C5-7 are also prone to tear following neck injuries. The interspinous ligaments are slack when the head and neck are in the upright position.
During hyperextension of the head (when the head is bent backward), the ligaments slacken
In hyperflexion (head is bent forward,) the cervical interspinous ligaments are tightened and they are vulnerable to tears at the tips of the spinous processes.
The classic injury to the interspinous ligaments occurs with rear-end automobile whiplash incidents.
The ligaments at the tips of the spinous processes are mixed with the fibers of the long ligaments of the neck, which are attached to the base of the skull.
Fibers of the trapezius muscle also blend with these ligaments. This is why neck injuries may produce symptoms of pain and tightness in the head and shoulder muscles.
If there is no history of trauma, a stiff neck is usually a result of muscle tightness. Moist heat applied for twenty minutes two to three times a day, neck support during sleep using a curved pillow, and a soft cervical collar worn for two to three days can be helpful. Non-steroidal-anti-inflammatory drugs and muscle relaxants can also be beneficial.
If symptoms don’t resolve, then a visit to the physician is advised. Physical therapy modalities such as electrical stimulation and ultrasound can help with pain resolution. Gentle stretches and range-of-motion exercises may be prescribed.
With a history of trauma, then the treatment approach is different. A visit to the doctor is recommended to make sure there is no significant damage to the neck. Imaging procedures such as MRI may be done before treatment is instituted. Pain resolution may take a long time with significant muscle injury or damage to the interspinous ligaments. This is particularly true if there is underlying osteoarthritis affecting the neck.
Helpful treatment modalities for more severe problems can include acupuncture, chiropractic, prolotherapy, Botox, and massage.
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