Neck Pain – Treatment Overview

March 30th, 2009

Treatment Overview

Treatment for neck pain consists of reducing the pain with ice and medication, improving neck movement and flexibility with exercises or physical therapy, and avoiding further neck injury by changing activities and body mechanics, such as how you sit or sleep. The specific treatment may depend on whether your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain.

Because most neck pain is caused by repeated or prolonged movements to the neck’s muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain caused by activities resolve within 4 to 6 weeks.

Acute neck pain

For sudden (acute) neck pain:

  • Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
  • Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
  • Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after a neck-strain injury helps resolve some symptoms faster than taking time off from work and using neck immobilization.2
  • Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
  • Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For severe pain or muscle spasm, your doctor also may prescribe:

  • Muscle relaxants, which treat severe pain spasms when neck pain begins. They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
  • Narcotic pain relievers, which are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).

The treatment that is right for you may be different from the treatment for someone else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven’t been very well researched, even if they are used a lot. A review of multiple studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain.

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. See an illustration of a cervical collar.

Chronic neck pain

For long-lasting (chronic) neck pain, you can use the same treatment used for acute pain, although you do not have to worry about swelling. Your health professional may prescribe other medications, such as antidepressants. These include doxepin (Sinequan) and amitriptyline (Elavil, Endep).

You can aid healing and prevent further injury by:

  • Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness.
  • Changing or avoiding any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
  • Maintaining good health habits. If possible, reduce stress and tension at work and home. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.
  • Trying manual therapy. A trained practitioner may use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as “mobilization.” Avoid rapid, forceful movements, which are known as “manipulation.” Talk to your doctor before trying manual therapy.

Surgery

Surgery is rarely required for neck pain. It may be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include:

  • Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
  • Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
  • Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

What To Think About

A review of studies reports that:

  • Exercise reduced pain better than medication for muscle pain or spasm, stress management, or no exercise.
  • There is not enough evidence to determine whether medications, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain.

In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for 1 year. Compared with people who had chronic neck pain and were not using the exercises, the exercise group had less pain and disability.

Keeping your neck moving improves its function and helps it heal. In general, cervical collars are only used after a surgery or for a day or two after a neck sprain.

People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling in addition to medical treatment may help in recovery.

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Neck Pain – Home Treatment

March 20th, 2009

Even if you need medical treatment such as prescription medications for your neck pain, the following home treatment measures will help speed your recovery.

For sudden (acute) neck pain:

  • Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
  • Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
  • Return to your normal daily activities as soon as possible. One study found some evidence that continuing normal activities after an acute whiplash injury helps heal some symptoms faster than taking time off from work and using neck immobilization.
  • Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
  • Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Motrin), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For long-lasting (chronic) pain, you can use the same pain relief measures used for acute pain, but you do not have to worry about swelling.

You can aid healing in both acute and chronic neck pain and prevent further injury by:

  • Doing stretching and strengthening exercises for your neck to keep your neck flexible and strong and prevent stiffness.
  • Avoiding or modifying any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
  • Maintaining good health habits. Try to reduce stress and tension at work and home. Practice muscle relaxation exercises and consider getting a massage. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.

You can help prevent future neck pain by paying attention to how you move and hold yourself (body mechanics). This includes:

  • Avoiding slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Avoid sitting for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
  • Adjusting your workstation if you work at the computer. Keep the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. For more information, see the topic Office Ergonomics.
  • Using a headset or speaker phone if you use the telephone a lot. Do not cradle the phone on your shoulder.
  • Adjusting your car seat to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
  • Using a pillow that keeps your neck straight, neither too high nor too flat. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 4 in. (10 cm) wide, wrap it around your neck, and pin it in position for good support. Avoid sleeping on your stomach with your neck twisted or bent. See an illustration of proper sleeping positions.
  • Having the right posture when reading in bed. Prop the book up so you are not using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.
  • Using proper lifting techniques. Lifting with your knees, not your back, can also help prevent neck pain.

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. Once the pain begins to get better, start doing gentle neck exercises. See an illustration of a cervical collar.

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Stop Back Pain Instantly!

March 9th, 2009

By Julie A. Evans, Prevention

When Heather Chapman, 34, was two months pregnant, she suffered excruciating back pain caused by a herniated disk. Her doctor prescribed anti-inflammatory drugs and muscle relaxants. She was concerned that the drugs might harm her baby, so she reduced the amount of medication she was taking.

Heather’s pain continued, so she began to search for natural alternatives and found a book about acupressure, a needle-free form of acupuncture. Using the book as her guide, Heather pressed her thumb onto a point just above her anklebone, which the book said would relieve her pain.

“I was amazed,” says Heather. “I felt better within minutes.”

Sound miraculous? It’s not. In fact, the next time your back goes SPROING!—even if you’re so debilitated you can’t get up from your bed—try some of these easy, natural techniques. Not only can they provide instant temporary relief, but done regularly, some can even help keep your back from ever getting out of whack again.

When Backs Go Bad
Back pain—which affects an estimated 80 percent of all Americans at some time or another—can have many causes. Since your pain can be triggered by anything from muscle strain after lifting something heavy to a spinal fracture caused by osteoporosis, it’s always wise to see your doctor. Fortunately, most back pain isn’t serious, despite how it feels.

Most often, it’s due to strained muscles, which could result from performing any number of activities when your muscles are tight—such as lifting, bending, or twisting—or inactivity, which allows your back muscles to weaken and become stiff. Stress can also contribute to back pain.

As long as yours falls into the nonserious category, you can safely try these techniques the next time your back is killing you.

That’s Why It Hurts So Much
Back pain can be serious torture because most of the pain receptors in your back are found in the muscle tissues. And back muscles are approximately 20 times more painful than any other muscles in the body because they’re complex and located so close to the spinal cord, says Art Brownstein, MD, author of Healing Back Pain Naturally (Harbor Press, 1998). “If you were a champion basket weaver, you couldn’t weave a basket so sophisticated with all the different angles and fibers as your back muscles, which orchestrate the many joints in your back.”

Stretch Those Strained Muscles
Stretching—that thing you may do involuntarily when you wake up every morning—can directly relieve the back pain that emanates from strained or sore muscles, says Art Brownstein, MD, author of Healing Back Pain Naturally (Harbor Press, 1998) and assistant clinical professor of medicine at the University of Hawaii in Manoa.

Stretching elongates muscle tissues, improves blood flow, and speeds delivery of oxygen and nutrients to the back. It also helps decompress the vertebrae (the 24 movable bones that make up your spine), which press on the disks, the cushionlike pads between them.

Here is a simple stretch you might want to try: Lie on your back. Slowly bring your right leg, bent, in toward your chest, only as far as comfortable. With your hands on your shin, hold this position for 10 to 20 seconds, then slowly release and repeat with your other leg. Repeat five or six times in the morning before you rise and in the evening before you go to sleep.

This can help even if your pain is so severe that you can’t get out of bed—or off the floor. Start slowly and gently, gradually increasing the stretch as your back begins to loosen up and heal.

Remember to breathe deeply and fully, adds Dr. Brownstein. “Your breath is the link between your mind and body,” he says. “When you’re mentally agitated and upset, you can hyperventilate and not get enough oxygen. When you breathe slowly and deeply, your mind calms down, your nerves calm down, and your muscles stop contracting and start to lengthen. With this, blood flow is restored, and healing can occur.”

Relax Spasms With Yoga
During acute lower back strain, the muscles on either side of your spine at your waist, known as the paraspinal muscles, will go into spasm and feel tender and tight. As the muscles contract continuously, they squeeze off their own blood supply and deprive themselves of oxygen, explains Mary Pullig Schatz, MD, author of Back Care Basics: A Doctor’s Gentle Yoga Program for Back and Neck Pain Relief (Rodmell Press, 1992).

“You can get into a vicious circle, where the reaction of the muscles to continuous spasm and oxygen deprivation causes more spasm and thereby more pain,” says Dr. Schatz. To relieve back spasms, Dr. Schatz recommends the following yoga pose:

  • Lie on your back on the floor. Place a rolled-up towel under your neck and towels under your head.
  • Place the back of your calves on a chair so that your thighs and calves form a 90-degree angle. For extra relief, place a 2-pound bag of dried beans on your belly. Your arms should be outstretched at your sides, palms facing up, at a slight distance from your body. Remain in this pose for 5 to 10 minutes. As you’re doing this pose, use what Dr. Schatz calls the “relaxation breath.”
  • Inhale through your nose, then exhale, also through your nose.
  • Near the end of the exhalation, count silently to yourself—1,001…1,002…1,003—allowing the air to gently escape and the exhalation to come to a natural pause. Then begin the next breath.
  • Continue breathing this way for 2 to 3 minutes. Then return to normal, relaxed breathing for the remainder of your time in the pose.
  • When you’re ready to get back on your feet, roll onto one side and rest there for 1 minute before you push up into a sitting position. If you get up too quickly, you could prompt the spasms to return.

    • Acupressure: Fast Relief
    It sounds too good to be true: You can make your back pain subside, or even disappear, by applying pressure to a particular point on your body. That’s a simplified description of acupressure, a traditional Chinese technique that brings almost instant relief to back-pain sufferers.

    By placing pressure on certain points on your body-points used in acupuncture—the Chinese believe that you unblock the flow of vital energy, or qi (pronounced chee). Those blockages, they say, create an imbalance of qi in the body, which can make you more susceptible to pain and illness. (Western scientists who have studied acupuncture, however, believe it may work by increasing the production of endorphins, hormonelike pain relievers your body makes in response to injury. The same may be true of acupressure.)

    However, if it works—and it apparently does—acupressure brings only partial relief from back pain, says Christina Stemmler, MD, a Houston-based physician who uses both acupuncture and acupressure in her practice. Depending on the source of the problem, acupressure could lower pain by 50 to 75 percent, although acupuncture tends to bring instant and complete relief for acute back pain, she says.But if back pain strikes suddenly, you’re probably not going to be anywhere near an acupuncturist, so acupressure is best for a quick fix. Dr. Stemmler recommends the following acupressure points for back pain. Press these points with the tip of a mechanical pencil with the lead retracted or with the fingernail on your index finger:

  • Center the pencil tip between your nose and upper lip. Apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times until the pain begins to release.
  • Place the pencil tip between your inner anklebone and Achilles tendon, the large tendon running from your heel bone to the calf muscle. Apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times.
  • Make a fist. On the outside of your hand, next to the pinky finger, locate the spot where the skin folds and bulges. That’s your acupressure point. Place the pencil tip there, apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times.

    • Quick Fix for “Sitting Strain”
    You think of it as resting, but your back regards sitting as a real strain. Too much time on your duff for any reason can lead to back pain, says Jerome McAndrews, DC, national spokesperson for the American Chiropractic Association in Arlington, VA.

    Here’s why: When you sit for long periods of time, the muscles in the back of your legs shorten and contract abnormally from lack of activity. When you stand up, these muscles resist returning to their normal length and “yank” on the back of the pelvis. In turn, the muscles in your lower back, which are attached to the top of the pelvis, also get pulled. This pulling and tugging can lead to back pain, says Dr. McAndrews.

    Here’s how to loosen the muscles in the back of your legs:

  • Lie on the floor with your knees bent, feet flat on the floor.
  • Grasping your hands around your right thigh, gently pull one leg in toward your chest, keeping your other leg slightly bent. Only go as far as is comfortable.
  • Hold for 10 to 20 seconds and release. Repeat with the other leg. If your pain becomes worse, stop doing the exercise.

    • When you can easily do this exercise, try doing it with your inactive leg straight, but not locked. Hold a towel or rope around your leg to gently pull it toward you. Only go as far as is comfortable.

    As a variation, stand on the balls of your feet on the bottom stair. To keep your balance, hold the railing with one hand. Now, let your weight carry your heels down below the level of the step to stretch out the calf muscles in the back of your legs. Hold for 1 minute. Repeat several times until you feel the calf muscles relax or “let go,” says Dr. McAndrews.

    Get Herbal Relief
    When back pain strikes, you can reach for a nonprescription pain reliever such as acetaminophen, ibuprofen, or even aspirin. And why not? They work. But some people can’t tolerate their side effects, including stomach upset.

    Herbs provide a natural alternative to over-the-counter pain relievers without the undesirable side effects, says Douglas Schar, DipPhyt, MCPP, a medically trained herbalist in London and editor of the British Journal of Phytotherapy.

    “Back pain is an ongoing problem for many people. They often have to use medicine off and on for long periods of time. That’s where herbal medicines make a big contribution. They’re milder, and they don’t have the same side effects as some of the over-the-counter preparations,” Schar says.

    If you know what’s causing your back pain, try one of the following herbal remedies:

    Cramp Bark
    For back pain caused by strain and overuse of muscles, Schar recommends cramp bark, a muscle relaxant that soothes spasms. Cramp bark is available as bark or as a tincture.

    Tea: Add 1 teaspoon of the bark to 1 cup of boiling water. Steep for 10 minutes. Strain and drink the tea three times daily.

    Tincture: 1 teaspoon three times daily. You should feel some relief immediately. Continue to use cramp bark for up to two weeks, until the pain completely disappears.

    Valerian Root
    Back pain caused by tension and stress can be eased with valerian root, which blocks the transmission of stress from the brain to the body. Valerian root is especially helpful when used preventively because it calms you in stressful situations, Schar says. “Some people get a backache during stressful periods. The smartest plan is to start using valerian root at the onset of the difficult time—before the backache sets in,” he says.

    Look for valerian root capsules or tablets. Follow the instructions on the product label, and use it for the duration of the stressful period.

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    Patellar Tracking Disorder

    February 27th, 2009

    Knee pain can be a slow and frustrating condition to heal. But most people with patella-related knee pain gain relief with a few months of nonsurgical treatment. Generally, the longer you have had a patellar tracking disorder, the longer you can expect to be in treatment.

    Unless your knee is swollen, dislocated, giving way, or causing you severe pain, try the measures described in the Home Treatment section for a week or two before deciding whether to see your doctor. With rest from aggravating activity, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs), you can expect your pain to decrease. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome, a rare but serious disease.

    As your pain starts to subside, begin stretching and strengthening exercises to loosen tight connective tissue that can pull the patella off track, and to help stabilize the patella in the femoral groove as you bend and straighten your knee.

    Medical treatment

    If home treatment isn’t enough to reduce your knee problems, or if your knee is swollen, dislocated, giving way, or causing you severe pain, see your doctor for evaluation. Knee problems are often difficult to distinguish from one another, so a thorough exam and accurate diagnosis are essential for you to receive proper treatment.

    After confirming that you have a patellar problem, your doctor will review your home treatment measures and make further recommendations. You may be advised to have physical therapy, use a custom brace or shoe inserts (orthotics), stabilize your knee with tape or a neoprene brace, or lose excess weight.

    Surgery is not commonly done for patellar tracking disorders. But surgery is recommended in cases of repeated patellar dislocation, displaced or damaged cartilage following a dislocation, loose bodies (such as small pieces of bone or cartilage) in the knee following a dislocation, repeated subluxations caused by a structural deformity, or failed nonsurgical therapy.

    What To Think About

    Nonsurgical treatment—including stretching and strengthening exercises, temporary use of nonsteroidal anti-inflammatory drugs, and sometimes bracing or orthotics—usually eases the pain of a patellar tracking disorder and makes surgery unnecessary. Keeping your knee strong and flexible will help to prevent further problems. Staying at a healthy weight to decrease stress around your knees may also help.

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    Patellar Tracking Disorder – Home Treatment

    February 16th, 2009

    Home Treatment

    If you have achy knee pain on or around your kneecap and have not yet been diagnosed with a patellar tracking disorder, first use the following home treatment measures:

    • Take a break from activities that cause knee pain, particularly squatting, kneeling, running, and jumping. Swimming and cycling are good aerobic alternatives.
    • Ice your knee regularly, particularly before and after activity.
    • Use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling.

    You may also want to try:

    • Wearing a neoprene brace with a patellar cutout, if you feel that your kneecap is shifting enough to need stabilizing.
    • Using supportive shoe inserts (orthotics). You can buy good-quality inserts from a shoe store or drugstore.

    As your knee pain starts to subside, begin stretching and strengthening your leg. Stretching can loosen tight muscle and connective tissue that have been pulling the patella off track. Strengthening your thigh muscles can help stabilize the patella in the femoral groove as you bend and straighten your knee.

    • Stretch your thigh muscles (quadriceps), hamstrings, iliotibial (IT) band, and Achilles tendon daily, particularly before and after activity.
    • Begin thigh strengthening with isometric exercise and straight leg raises only. Progress to exercises such as quarter squats and leg presses, in which your feet are pushing against something (closed-chain exercises). Avoid knee-extension exercises in which you are raising and lowering your foot, which may further damage your unstable knee.
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