What a Pain in the Neck!
2021 is the IASP (International Association for the Study of Pain- yes, there is a whole international organisation, whose sole purpose is to research and further the understanding of pain!) year for back pain, and so with 2021 quickly drawing to a close, I think it important that we take a closer look at back and neck pain, and the evidence that is guiding our management. As with all research, it keeps changing and some of the beliefs that we hold on to may be outdated and in need of change!
A big finding that is shaking the foundations of what we have always believed, is that degenerative changes seen on x-rays and MRI’s in people with neck pain are the same compared to people with NO pain. What this means is that degenerative changes progress over time without being related to the development of, or worsening of neck pain. This is significant for two reason:
Changes in your spine is a normal process of ageing- think of the changes as wrinkle on the inside.
And because of this we need to look at more than the physical changes in the neck when looking at the cause of pain and therefore its management needs to follow suit.
I want to just re-emphasise this, and say it again, because it this finding may be counterintuitive to our previous understanding of back and neck pain: if I take an x-ray or MRI of your neck, I will not be able to tell if you have pain based on the changes that I see. And you and I may have the same amount of change on an x-ray or MRI, but you might be in pain, and I may not be. Why is this? Pain is your brains way of warning you that there is something wrong, but what informs your brain that there is something wrong is more than just the physical look, shape and age of the joints and muscles. Have a read of the previous blog post: “What is Pain?”, for more on this.
Another commonly held belief is that a bad posture means pain, and that fixing the posture should relieve the pain. The evidence is shifting from this idea of one perfect posture to “your next posture is your best posture”. In other words, humans were not meant to sit or stand still in front of a PC for hours at a time. We were made to MOVE! So rather than teaching and encouraging one perfect posture, we have moved (pun definitely intended) towards, well, movement! Sit for a while, slouch for a while, stand for a while, do a couple of somersaults, lunges and squats. Research shows that it doesn’t need to be any specific movement or exercise, its just movement that we are after! So move, move, move!
There are also a couple of other important things about neck pain:
Headaches are commonly associated with neck pain, so if headaches are your main complaint, it’s important to have your neck assessed.
Neck pain is associated with reduced movement variability (so the number of different ways that you move your head and neck) and increased trunk stiffness- so getting your trunk moving and increasing the number of different ways that you move your neck can help for your pain.
Like other painful conditions, negative emotions, mental health, and problems with sleep can all contribute to your neck pain, and can also facilitate the pain to becoming more persistent or chronic. So a holistic approach to managing these are important in effectively managing your neck pain.
So if you have neck pain, what should or could you do about it?
Surprise, surprise the current evidence is pointing more and more to the effectiveness of exercise for reducing not only your pain, but the disability related to your neck pain, and restoring muscle function.
Education, so knowing more about pain and identifying what the inputs into your pain experience are is important. I always say: knowing your enemy and its tactics will always give you the upper hand!
There is also evidence for the use of manual physiotherapy as an addition to exercise for managing neck pain and disability.
If you are worried or concerned about your pain, seeking out help and getting a detailed assessment from your health care provider is an important first step. Your physiotherapist will be able to guide your exercises and help give you management tools that will not only help manage your pain, but will also help prevent future injury, pain and disability.
