Treatment of Neck Pain
Treatment depends on the nature and severity of the condition. Physical therapy is frequently recommended and is a valuable tool in assessing the pain. Treatment suggested by Dr. Schnitzer typically include a diagnostic and therapeutic exercise program, modalities (such as heat, ice, electrical stimulation, etc) postural techniques and a home exercise program. The length of the program depends on the particular condition. Other treatment options may include in-office trigger point (muscle ) injections or joint injections, as well as referral to other providers for other injections such as epidural or facet blocks.
Early evaluation and treatment on neck pain is important in order to prevent further worsening of symptoms. There are many causes of neck pain, many of which are managed fairly easily. However, there are other disorders which may require a more aggressive treatment options. Following is a list of some of the common conditions which may produce neck pain:
- Cervical (neck) strain – typically caused by trauma (such as ‘whiplash’ from a motor vehicle accident) or chronic overuse of the neck muscles (such as sitting for hours working on a computer.) Patients usually feel a stiffness in the neck with reduced range of motion. Headaches may also occur.
- Myofascial (muscle) pain – typically an aching pain which is usually associated with overuse and may occur in any muscle group. At times, the site of origin of the pain may cause a sensation of “referred pain” or spread of the pain to another location (ie. myofascial pain from the shoulder blade may “run” up to the neck or down the arm.)
- Cervical disc herniation (slipped disc) – typically caused by trauma to the head or neck, but may also be associated with wear and tear of the spine over time (degenerative disc disease.) This pain may be burning or sharp and may cause radiation of pain down the arm, sometimes felt as an electrical sensation. The radiating pain (called radiculopathy) is caused by a pinched nerve from the disc herniation.
- Cervical spinal stenosis – narrowing of the spinal canal from either arthritis of the neck bones, congenitally small spinal canal (ie. from birth), a disc herniation, or a combination of more than one of these factors. The pain may be similar to that caused by a disc herniation, and may also cause weakness of the arms or legs.
- Tendon/Ligament sprain or tear – these are known as soft tissue injuries and are usually caused by trauma and/or overuse. The pain is aching and is also associated with local tenderness in the area involved.
- Cervical fracture/dislocation – caused by injury to the neck. This condition may be associated with instability of the cervical spine, and typically causes sharp or aching pain, as well as swelling in the area. There may also be radiation of pain into the arms.
Treatment of Low Back Pain
Low back pain is a very common condition involving the lumbar spine, and it is one of the most common causes of missed days at work. Diagnosis and treatment of low back pain depends on the nature and severity of symptoms. A thorough and focused physical examination is critical to making the right diagnostic decisions. Testing after exam may include xrays, mri scan, electrodiagnostic evaluation, and other exams, as needed.
Treatment may include physical therapy, injections such as trigger point or joint injections. In addition, it may be appropriate to refer the patient for other procedures such as epidural or facet injections. If necessary, surgical consultation is available if the patient’s symptoms warrant it.
As is the case with the neck, the treatment depends on the cause. Some causes of low back pain are listed below:
- Lumbar (low back) strain – frequently caused by an acute injury or physical activity (motor vehicle accident, lifting, bending, twisting, or maintaining one position for an extended period of time.) The pain involves muscles in the back and may be mild or severe, and sometimes a person may feel that he/she “cannot move” or feel “stuck.” Though the pain may be severe, it typically improves and resolves over a period of days, or at most, a few weeks.
- Lumbar disc herniation (slipped disc) – similar to the neck, a herniated lumbar disc is most often caused by some form of trauma involving the low back, but may also be associated with arthritic (degenerative) changes in the lumbar spine or disc. The pain is burning or sharp and may be associated with radiation of electrical type pain down one or both legs, if there is a pinched nerve. Sometimes the leg pain may be more severe than the back pain.
- Lumbar stenosis – narrowing of the spinal canal, which is due to congenital factors, disc herniation, and/or arthritic changes in the lumbar spine. The pain is typically aching, sharp or throbbing, and is associated with burning or shooting radiation down the legs. Patients may also notice weakness of the legs.
- Soft tissue injuries – typically localized aching/sharp pain with tenderness noted in the area involved. These are usually caused by overuse/repetitive type injuries.
- Non-spinal causes of low back pain – Because there are many other structures present near the lumbar spine, problems in these areas may produce “back pain.” Some of these causes include sacroiliac dysfunction, hip pain (from arthritis or fracture,) some gynecological disorders, kidney disease.