by Othon Molina, Ph.d.c, LMT
The following information is for educational purposes only and is meant to complement any medical treatment not to prescribe or diagnose any condition. Please consult with your doctor before starting any medical, or nutritional program.
The neck and its functions, are very important, which is why I always start my therapy there. If the neck is blocked and out of alignment, it cuts the brain off from the rest of the body. It still could be a secondary problem area. None the less the neck muscles are for stabilizing the head and movement. They are not for holding the head up, remember if you are doing that gravity will win. The bones when we are properly aligned are what hold us up. The head weighs from ten to fifteen pounds depending on your size. The muscles of the neck at the front (anterior) or flexors are weaker than at the back side, or the extensors (posterior).
Turning the neck involves the muscles at the side such as the sternocleidomastoid and others working together. There are usually several muscle groups working together to make a movement, as well as antagonists (Muscles that work against or stabilize).
We wake up with a pain in the neck. This can sometimes happen from sleeping in a bad position. This is the hardest type of injury to treat with massage. As the damage has been happening all-night and there may be quite a bit of irritation. A doctor can give some anti-inflammatory medication, or just plain aspirin may help. We may pinch a nerve or stress the disc in the neck which can cause the pain. Of course that old saying I just turned my neck and threw it out, is usually the last straw that broke the camel’s back. It had been working his way to being out of place or bulging the disk to the level where it presses on the nerve.
The most common neck injury apart from waking up with a stiff neck, is a strain of the neck muscles. This could be from a minor tear of a muscle tissue to an actual sprain of the ligaments. This is caused by many factors, any sudden motion can injured pre-disposed tense areas. Take for instance that you have a stressful job, and you sit all day at a desk, about half of the population. Then you were invited to play a nice friendly game of softball at the company pick nick. At some point you turned your head hard and further than your muscles where prepared for and wham! You hurt your neck. Anther common injury to the neck of course are auto accidents, now we know there could be severe injury to the muscles as well as ligaments in that situation.
The muscle spasms that come from all these type of injuries are secondary protective reactions. Working on them may help, however as in all healing you have to get to the cause. If it’s happened over a period of time, which this is how the body gets to a susceptible condition. Then it takes more long-term correction than a quick manipulation. However even a manipulation sometimes can work to turn the problem around. You still need to determine the cause, torn muscles and ligaments don t like being stretched further or quick movements. However misaligned vertebrae or discs that could be relieved by a manipulation respond well in the right circumstances.
Test for Neck injuries
Passive movements first, have patient look to one side then the other, notice pain in the movement or limitation. If it hurts with the motion, it could be a ligamentous injury. Full flexion of the neck, pain (looking down) could be a ligament as well. Then complete extension (looking up) pain in extension could be a disc.
If these don t hurt, then we start with resistive movements these determine if it’s a muscle injury.
Last if there is limited motion in one direction as you move it, may cause the pain or referred pain then once again, it could be a disc. The final test would be to compress the neck, into the side that you feel has the protruding disc, this too will duplicate the pain they are having.
Treatment for ligament or muscle tear
For any injury involving muscle or ligament, we use RICE (Rest Ice Compression and Elevation) since it s in the neck elevation is relative. I would lay them down. The manual treatment is DTF (deep transverse friction massage). Careful to apply at the patients tolerance level of pain; DTF can aid in the healing of strained muscles and sprained ligaments.
Traction would not be a good idea at this point, just as deep longitudinal massage on the lesion would also not be a good approach. Massage on the other muscles in the holding pattern or that are compensating for the pain would always help, but remember, we need to get to the cause to get the best results. During the acute phase, is not the time to do structural alignment or traction to increase mobility. That needs to be done in the second phase of treatments.
Diathermy (electronic heat) and ultrasound (sound waves that create heat) have some significant use in this situation, because they increase the blood flow that helps the body to heal. I prefer ice during the acute stage at least for four or five days. Use of ice in the neck requires some patience and experience. The DTF with the ice cube is my preferred method. These are common traditional treatments. Even acupuncture helps during this stage, to accelerate healing.
The next level of severity with this injury may require seeing a doctor, for an injection. Sometimes a steroid injection into a muscle or swollen area can help break the cycle of pain. There are also proliferant injections (Glucose and Lidocaine) sometimes called sclorosing, that help create scar tissue on ligaments, to help bind the tear and accelerate healing. Very few doctors are skilled or use this type of treatment, and it can be very effective.
Traction or manipulations at this stage is not very productive, although I have seen improvement, at the later stages with these therapies.
A disc injury to the neck
Injuring a disk in the neck hurts severely, and sometimes no matter what you do it all hurts. Just holding the head up can be difficult. Of course this type of injury can happen just as easy with a sudden twist as in sports or a car accident. It can also come on over a period of years. We don t really know what causes this type of injury. We can only guess that improper posture is a possible cause and that over a period of time we have put unusual stress and pressure on certain discs. Because the ligaments are stressed by misalignments, they can exert more pressure on the whole structure; until one day it presses on the nerve severely enough to cause us the pain. Which can happen at the turn of the head or even sleeping on it wrong. Often this pain shoots down the shoulder, or down the arm. It can seem to come on fast, but may have taken a long time.
The tests above show us whether it’s a disc or a ligament, however if you’re not experienced in these methods of diagnosis, it’s easy to get confused, always consult with a doctor if you have any doubts.
Treatment for disc injuries
There is very little most people can do for these type of injuries, unless they are informed. RICE helps, resting may do more than you think. By rest we mean laying down for a few days. Taking aspirin helps reduce the inflammation which can help (according to most doctors). First you can avoid the positions that hurt and minimize the motion. Then there’s a neck brace. It’s a great tool to assist the muscles in holding the head with less effort. Much like using a back brace, it takes some pressure off the disc. These devices are only available through doctors. Other medical treatments are injections for discs. They are tricky but can be done, as well as manipulations. You have to be extremely well trained and be very careful. The wrong move or an injection not well placed can hurt the patient worse, or not help at all. We are not always sure why manipulations work at this stage sometimes and other times don t work at all. Trigger point therapy relieves the pain, and so does working on the muscles that are involved. The key is to not make it worse, some traction may help during the second level of treatment as well as corrective exercises.
James Cyriax MD Orthopedic Medicine Volume I , II Wilkins Co. Baltimore MD 1977
Paul Vinger MD. Sports injuries , PSG Publishing : Littleton MA 1981
Stanley Hopperfield- Physical Examination of the spine and extremities
Ben Benjamin Listen to your pain Penguin Books 1984
For any questions please call:
Othon Molina Ph.D. c LMT