Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be
The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.
Because neck pain could be an indicator of various pathologies the physio will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.
The neck has typical ranges of motion which are disturbed in pain conditions and the abnormalities give useful evidence about the underlying joint mechanics. The physio goes through cervical flexion, cervical extension, cervical rotations, cervical retraction and cervical side flexions to check which movements are limited and which are unaffected. Nerve conduction to the arms is then tested by investigating the sensation, muscle strength and reflex response.
To narrow down the area responsible for the pain the physiotherapist will employ mobilization techniques in assessment of cervical spine lesions as well as treatment. The individual joint levels can be assessed for movement dysfunctions in a systematic manner, palpating the neck in lying when the spine is relaxed. If the symptoms are brought on by pressure on the spinal joints at a certain level then the physio can infer that the changes at that level are important in the diagnosis and subsequent treatment.
Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.
Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain.