Prognosis and cause of neck pain neck pain has lifetime
prevalence of 70%, the 20% of the Dutch population are suffering from neck pain
in a normal course the patient's pain reduces at least 45% in the first six
weeks after onset and he's able to gradually increase his level of activities
of daily living and the level of participation in an up normal course the pain
does not decrease or even increase in the first six weeks and the limitations
in activity and participation do not become less or even bigger it has to be
said that 50 to 85 percent of neck pain patients will suffer from recurring neck
pain.
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| Neck Pain Guideline |
Four different grades of neck pain number one neck pain
without symptoms of a serious structural pathology and no are hardly any influence
on activities of daily living number two neck pain without symptoms of a
serious structural pathology again and strong influence on activities of daily
living number three neck pain without symptoms of serious structural pathology
but with the presence of neurological signs and symptoms and the last category
number for neck pain with signs and symptoms. Which could be indicative of a
serious structural pathology like fracture dislocation spinal cord injury infections
tumors or systemic disease neck pain can further differentiated between
work-related neck pain and trauma related neck pain.
Signs and symptoms that could indicate a fracture are older
age trauma and patient history longer use of corticosteroids because they we
can connect the tissue and osteoporosis because obviously the weaker your bone structure
the more likely you are to fall victim to a fracture number two cervical artery
dysfunction typical symptoms are dizziness diplopia which is when you see
everything double malaise vomiting weakness in the extremities and papillary
changes number three damage to the spinal cord or cervical myelopathy in this case
your patient would present with neurological symptoms like for example
widespread weakness or changes in sensibility in both arms or legs or bowel and
bladder dysfunction number four infections including infections of the urinary
passage or skin infections those symptoms include fever maternal sweating and
other risk factors for infections such as an underlying cause of a disease the
use of immunosuppressive and open wound intravenous drug use or exposure to
contagious diseases number five malignity typical signs and symptoms here are a
history of cancer no improvement of the complaints within four weeks
unexplained weight loss an age above 50 and problems with swallowing headache and
vomiting and a last category of red flags are systemic diseases.
The fact that the treatment for grade 3 neck pain is
different from grade 1 or 2 your first step during physical examination is to
in or exclude neurological symptoms if you're patient mentioned any of them
during your patient history taking so the first thing you should do is to
examine your patients biceps and triceps reflex test different dermatomes of
the arm and hand for changes in sensibility and evaluate different minor films
in your patients arm and hand for diminished muscle strength to confirm your
hypothesis of grade 3 neck pain you should perform the spurning test and all
the traction or distraction tests if any of these two tests are positive you
can regard grade 3 neck pain as probable if there was no mentioning of neurological
symptoms during patient history taking and you found no signs during your
neurological examination you can choose to do the upper limb tension test for
the nervous marianas and the brachial plexus to exclude grade 3 neck pain.
Which grade of neck pain is your patient suffering from too
is the cause of complaints normal or abnormal 3 is your patient's neck pain
work or trauma related 4 are there prognostic factors psychosocial personal or
environmental factors that can explain an abnormal course and which can be influenced
by physiotherapy and 5 is there a connection between impairments in activities
and participation and the neck pain or other physical or anatomical properties
and can these be influenced by physiotherapy based on your answers to those
five questions you will be able to categorize your patient into four different
treatment profiles profile a is neck pain grade one or two with a normal course
profile B is neck pain grade one or two with an abnormal course and without the
dominance of psychosocial factors.
Neck pain grade three so neck pain with neurological signs
and symptoms these profiles are important as your management strategy.
The goal is to educate your patient to facilitate an active
coping style and to prevent him from slipping into an abnormal course usually
explained that the normal course of neck pain is favorable and that neck pain
is not damaging nor is a right and neck pain associated with the structural
damage advise the patient to stay active and motivated to gradually increase
his activity part of the patient and exercise level and to return back to work
at the same time avoid suggestions that might have your patient stay passive if
neck pain is work-related he should adjust his workspace accordingly on top of
that you should explain him how different work-related prognostic factors that
we mentioned in part 1 have a negative influence for the suffering from neck
pain in case your patient is not able to work you can suggest your patient to
contact a physiotherapist that is specialized in work-related issues let's look
at the management strategy for profile B this profile has an abnormal course
with neck pain grade one or two without dominant psychosocial factors therefore
your goal is to influence prognostic factors that are present in your patient
and that are related to the delayed recovery these can be physical or
non-physical so first of all you should educate your patient according to what was mentioned for
profile a then the additional therapy of choice consists of exercise therapy
with cervical and or thoracic mobilizations and manipulations the exercises
should be in line with the needs limitations and goals of your patient in case
this therapy does not have sufficient effect you can consider the following
additional measures a cervical pillow cognitive behavioral therapy kinesio
taping in case of trauma related neck pain to decrease pain in short term
massages in combination with other forms of therapy for short term pain reduction
heat and cryotherapy also in combination with other forms of therapy and
workspace adaptions in case of work-related neck pain the guideline this encourages
the use of dry needling electrotherapy ultrasound or laser therapy in case of
work-related neck pain the management is the same like for profile A+ motivate
the patient to get in touch with a physiotherapist to specialize in
work-related issues or the company's practitioner to evaluate treatment options
if you suspect work-related sectors that delay the recovery if your patient is
on sick leave or is less productive not longer than four weeks ask your patient
about arrangements being made with the company's physician or advise them to get
in touch with a physiotherapist specialized in work-related issues to coordinate
further management at last you should evaluate the content of your treatments
commitment to therapy and the results with an NP RS or PC skill terminate the
treatment as soon as your patient's goals have been reached or if there is no
improvement after six weeks of treatment if the treatment has not had any
effect after six weeks on pain or activity level contact the patient's general
practitioner to evaluate further treatment options.
In the morning you can take the heating pad now I just
microwave this make it you know it's warm tepid but not hot you're not gonna
burn yourself you put that on your neck and then as you put it there put a little
lavender in it because you want that aroma calming you and then just for 10
minutes a little bit more if you can just relax and let yourself meditate that'll
let those muscles come down and really allow your shoulders apparently you don't
live in my house know what there's not a lot of but I six something everyone's
screaming and trying to get themselves ready to get out the door see the thing
about this you can also throw this at people you're going to that was that was
delicious that smells really good it's a little lavender how we do that at home
actually it does work well second big issue a lot of times if your muscles
don't have the right electrolytes in them they'll spasm automatically you need
potassium you need magnesium so find some dishes that you like that naturally
have them so a good example if you have potassium and magnesium together yeah
that so the berries will have the magnesium and this yogurt has magnesium as
well and potassium and then the real trick is to find a nice way of actively
stretching the muscle ah so I'm gonna do I'll do it I'll teach this to you if
you don't mind take a little towel wrap it up and put it over the middle of
your head and your neck the middle of your heads everyone see that area there
not down here but up here and then gently let your hands relax and pull your
head forward.
Nice work
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