SPINAL CONDITIONS
Neck Pain & Whiplash
Neck pain
Cervical spondylosis is the medical term used to refer to general ‘wear and tear’ that occurs between the bones in the neck. The condition can also be referred to as disc degeneration or degenerative change. Cervical spondylosis can lead to episodes of stiffness and neck pain. Cervical spondylosis is common. In severe cases of cervical spondylosis, the spinal cord or the nerves in the neck can become compressed.
As we get older, we all will develop wear and tear in our spines, and in particular in our necks. It is estimated that by the age of 70, nearly 100% of all people will have some degree of cervical spondylosis.
The majority of people who suffer with cervical spondylosis will experience episodes of neck stiffness and pain. Neck pain arises when these worn joints and discs become inflamed. However, not everyone with cervical spondylosis develops symptoms.
Many people have neck pain which has got nothing to do with cervical spondylosis. The commonest cause of neck pain is muscle tension in the neck, shoulders and upper back. This can also extend into the head causing associated headaches. Poor posture and spending too long slumped over computers and hand-held devices are big factors in developing muscle tension in our necks and shoulders.
There are 2 common patterns of neck pain:
Constant neck pain or ache. This type of pain is generally aggravated after exercise and made worse by any prolonged activity such as reading or driving. This type of pain can be worse first thing in the morning and in the evening after a long day.
Repetitive episodes of acute neck pain. This type of pain generally waxes and wanes. A seemingly trivial activity can lead to an acute episode of severe and incapacitating neck pain developing over the course of a few hours. These episodes can last a few days, or a few weeks and people often experience a reduced range of neck movement. Over time the pain may fail to fully resolve between episodes leaving you with a constant neck pain or ache that continues to flare up on a regular basis.
With cervical spondylosis it is possible for the nerves or the spinal cord to become compressed. This is called cervical radiculopathy and cervical myelopathy.
Cervical radiculopathy – If the nerves are being compressed then this can cause arm pain, numbness, pins and needles and weakness.
Cervical myelopathy – If the spinal cord is being compressed then this can also lead to numbness, pins and needles, and weakness in the hands. It can also result in a loss of fine hand function making you clumsy with a tendency to drop things, a change in the way that you walk, and a loss of bladder and bowel control.
Tips for managing neck pain
Spinal specialists often use the term conservative management to describe any treatment option that does not involve surgery. Treatment for your neck may be as simple as reassuring you that you do not have a serious problem. However, anyone who has had a neck problem should consider some preventive measures to protect their neck from further problems in the future. Most patients will benefit from seeing a physiotherapist, an osteopath or a chiropractor.
Neck pain is common. However, there are a number of simple things that you can do to optimise the condition of your neck, which when combined can form an effective strategy allowing you to become more comfortable and active.
Stretching
The aim of stretching is to maintain the range of movement of your neck. You should stretch the rest of your body as well as your neck. A physiotherapist, osteopath or chiropractor will help you to develop a program of stretches that you can then perform two or three times a day on your own. The aim is to allow your neck to have freer movement so that you do not injure your neck when engaging in trivial activities.
Regular exercise
With the help of your physical therapist you should develop an exercise regimen to strengthen the muscles associated with the neck, shoulder girdle and chest. These exercises need to be done regularly enough to strengthen your muscles. Swimming backstroke can be helpful as part of your regimen. The difficulty comes in maintaining your exercise regimen long term. As you start to get more comfortable you can begin to slowly return to more enjoyable forms of exercise.
Much of the strength and stability of the spine comes from the muscles of the stomach, back and upper thigh. These muscle groups form your own ‘internal muscular corset’ or ‘core’ that serves to support and protect your spine. Many people think that looking after you core is only important for lower back, but having a good core is equally as important for anyone with neck problems, as having a strong core will help with your general spine control and posture. Your physical therapist will be able to teach you specific core strengthening exercises. As you become more comfortable with these exercises then you may benefit from joining a Pilates class.
It is also important that you do some general fitness exercise. High impact sports such as squash, long distance jogging, and rowing should be avoided if possible. Breaststroke swimming can also often aggravate neck problems. To begin with you will often feel sore the day following exercise. If you have a longstanding history of neck pain, then it is important that you increase your activity level gradually so that you hopefully avoid getting into a cycle of activity followed by pain and inactivity.
Anti-inflammatory medication
Inflammation of structures in the neck is a big factor in neck pain. Anti-inflammatory medication can be very effective in helping to reduce this inflammation and improve your symptoms.
Many people do not want or feel the need to take regular medication but prefer to use it only when their symptoms are bad. Even if not taking anything on a regular basis, it can often be helpful to take something half an hour before exercise (or other activity that you feel is likely to aggravate your neck) so as to keep to a minimum any discomfort that you may feel afterwards. If you suffer with your neck first thing in the morning it can be beneficial to take a painkiller before you go to bed at night.
When taking any medication always follow the instructions on the leaflet and do not exceed the recommended dose. Anti-inflammatories are not be suitable for everyone, especially if you have a history of asthma, high blood pressure, kidney or heart failure, heartburn or stomach ulcers. You should check with your GP or pharmacist if you have one of these conditions or if you are taking any other form of medication.
Lifestyle modification
Many people with neck pain will have particular things that they like or have to do in their daily lives that aggravate their neck. You should consider your daily activities both at home and at work. Rather than giving up some activities, aim to reduce or modify those activities that appear to aggravate your neck. You will also benefit by looking at your posture. Poor posture is one of the biggest factors in people who suffer with chronic neck pain. Attention to your posture coupled with some simple lifestyle modifications can significantly improve your symptoms.
There are a number of activities in our daily lives that can contribute to neck pain and which can be easily modified:
Workstation modifications: The back of your chair should be high enough to support your shoulders, and the back of the chair should be at right angles to the seat. The position of your head is determined by the position of your computer screen. Your screen needs to be raised off the desk, level with your head. You may be surprised as to how high it needs to be. Your keyboard needs to be raised as well.
Working at a laptop is a disaster for people with neck problems, as we assume a terrible, hunched posture when working at a laptop. If you have to work regularly on a laptop, then get a separate keyboard and a plinth so that your screen can be set at the right height.
Many work place assessments result in a new chair. However, the chair is rarely the problem. If your desk is high enough and your keyboard and screen in the correct position for you, then your posture will improve, whatever chair you have. It is also helpful to have a desk that tilts so that you do not have to look directly down when using paper. Regardless as to how well you have your workstation set-up, you should never sit at your desk for more than one hour at a time. Having a variable height ‘sit-stand’ desk can be very helpful in the management of neck problems.
If you spend a lot of time on the telephone, then use a headset so that you do not sit with your head and neck tilted over to one side.
If your neck is aggravated by long journeys in the car, allow a bit more time for your journey so that you can take regular breaks. Likewise, if you have to do heavy physical tasks at home such as hoovering the house or digging the garden, then try to avoid doing it all at once and have regular breaks.
At night you should use one firm pillow, rather than two soft pillows, as this will reduce the strain on your neck.
Collars: Collars should only be worn when absolutely necessary. In the short term, you may feel more comfortable with a collar on. However, if you wear a collar for a prolonged period of time then the muscles which support the neck will become weaker.

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SPINAL CONDITIONS
Whiplash
Whiplash is the term used to describe a neck injury that is caused by a sudden movement of the head forwards, backwards or sideways. Whiplash most commonly occurs following motor vehicle accidents in which the force of the collision has jolted the head violently forwards, backwards or sideways causing the ligaments in the neck to be overloaded and sprained. Whiplash can also occur following a violent blow to the head.
Following an accident, it may take six to 12 hours for the symptoms of whiplash to develop. Symptoms are not usually obvious at the time of the accident. Typically, pain and stiffness will develop gradually and is usually worse the day after the injury. The pain may then get worse over the next few days before starting to improve. Patients may also experience neck swelling, muscle tenderness, a reduced range of movement and headaches. Some patients develop pain, numbness or pins and needles in the arms and hands.
If you have recently been involved in a road traffic accident and are experiencing pain and stiffness in your neck, then you should make an appointment to see your GP. A diagnosis can normally be made from the history and physical examination. X-rays and scans are not usually required.
Treatment of whiplash
There are a number of things that you can do to ease the symptoms of whiplash:
Apply an ice pack to the neck. This will help to reduce any inflammation. Ideally this should be done as soon as possible after the injury. Be careful not to apply ice directly onto the skin. A bag of frozen peas wrapped in a tea towel is ideal. Apply the ice for 10 to 30 minutes at a time.
Try to move your neck normally. If you have had whiplash injury, then it is important that you try to move your neck normally. Even if the pain is severe it is important that you exercise your neck gently so that it does not become stiff. You should try to move the neck slowly in each direction, gradually increasing the range of movement. It is important that you continue with your normal daily activities.
Maintain good posture. Following a whiplash injury, it is important that you try to maintain a good posture. This can help prevent the pain and stiffness in your neck from getting worse. Using a firm, supportive pillow will help you to maintain a good neck posture whilst you are asleep.
Take regular painkillers. Painkillers such as paracetamol will help to ease the pain caused by whiplash. For the first few days following an accident it is better to take painkillers regularly, rather than only take them when the pain is severe. Non-steroidal anti-inflammatories, such as ibuprofen, will also help.
When taking any medication always follow the instructions on the leaflet, and do not exceed the recommended dose. Anti-inflammatories are not be suitable for everyone, especially if you have a history of asthma, high blood pressure, kidney or heart failure, or heartburn or stomach ulcers. You should check with your GP or pharmacist if you have one of these conditions or if you are taking any other form of medication.
If paracetamol and anti-inflammatories do not relieve your pain, then you may require a prescription for a stronger medication from your GP.
Physical therapy
If you have experienced a whiplash injury and are experiencing neck pain, then you are likely to benefit from seeing a physiotherapist, osteopath, or chiropractor. They will be able to help by using treatments such as manipulation and massage. Additionally, they will be able to give you advice on neck exercises and other things that you can do to help relieve the pain and stiffness in your neck. Some people find acupuncture helpful following this type of injury.
Recovery period
After a few days the symptoms of whiplash should begin to improve. In the majority of cases, the symptoms improve significantly or completely disappear within six weeks. However, as with any sprain, it can sometimes take a few months for the symptoms of whiplash to disappear completely. If you have an underlying problem with your neck, or established wear and tear then it can take a bit longer for your symptoms to settle down. You should not drive whilst you have neck pain and stiffness that prevents you from turning your head quickly.
In a small number of cases the pain caused by whiplash can become chronic. In severe whiplash cases, the pain can persist for six months before it disappears. Prolonged pain may make it difficult for you to carry out normal daily activities or to enjoy your normal recreational activities. It can also cause problems at work. Sometimes chronic pain can result in anxiety and depression. If your pain is not settling down and is interfering with your ability to undertake your normal everyday activities, then you should seek further advice from your doctor.
