Movement Of The Neck-Part Three

Published: 08th September 2009
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Loss of the ability to move the neck normally means that the capsules of the facet joints, sensitive ligamentous bags around the joints, are exposed to the risks of over-stretching. A sudden turn or twist of the head without thinking can lead to the ends of the joint movements being reached, when an overstrain injury and fibre damage happens. Joint pain and increasing joint tightness then follows as the capsules tighten further with the scarring of healing and the neck is held in a guarded position. Increasingly less able to cope with stretching, the stiffness can spread throughout the neck and this only becomes obvious when suddenly we can't do something we want to.

Facet arthropathy causes pain from several sources: the local pain from the abnormal facet joint itself; referred pain from this source and the resulting muscle spasm. The joint pain itself is fairly closely localised and may sometimes be felt by one's own fingers as a tight lump. Referred pain is often felt as an ache which is difficult to clearly define, its just an annoyingly vague but troubling pain in the arm, shoulder or thoracic area. These symptoms can eventually become important and disturb sleep, which has knock-on effects such as tiredness, irritability, increased muscle tenderness, anxiety and depression.

Turning the neck suddenly, being jarred unexpectedly or towelling the hair vigorously can result in a sudden onset of severe neck pain and loss of movement, a condition referred to as acute wry neck. People can also awake with the same kind of problem, perhaps because they have slept awkwardly and strained the neck. The facet joint locks instantly as the speed and unexpectedness of the activity bypasses our control and stability mechanisms. The sensitive capsular joint surround might be strained in these events or the joint could pinch a synovial membrane fold, resulting in instant, severe pain in the neck and limiting muscle spasm.

An acute wry neck is an unpleasant experience with acute pain on one side of the neck and a loss of neck movement. There may be very strong muscle spasm holding the neck in an odd posture to one side. Careful guarding of movements and avoidance of jarring or sudden motions is evident to avoid any sudden movement which might increase the muscular spasm and the forces of neck compression. It can be a challenge merely to get into and out of, with holding of the head typically needed as the movement down or up is performed to minimise muscle activity in the neck.

A locked neck joint can be unlocked, sometimes very quickly and with complete relief, by cervical manipulation from a manipulative physiotherapist, chiropractor or osteopath, with the mechanism thought to be un-trapping of the nipped tissues by gapping which could also allow the joint to realign itself. This is less common that the normal recovery which takes place over a few days with painkilling and anti-inflammatory drugs until the neck begins to move more normally again. Therapists can also employ a repeated therapy called joint mobilisations which helps to restore normal movements to the joint and prevent recurrence.

A fast onset of neck pain is not always due to facet lock but can, with a gradual onset taking several days, be indicative of a disc related or inflammation related nerve root insult. An initial facet joint injury may in some cases not settle down well, allowing fluid to collect around the nerve root exit from the spinal canal which slowly thickens and forms into scar tissue and can stick down the nerve to the surrounding structures. Tethering the nerve exposes it to risk of injury due to the fact that nerves are very sensitive to stretch in particular, which can result in an agonising pain syndrome developing in the shoulder, arm and neck.

Although neck pain may not be the major presenting part of the problem, patients often indicate there were some warning signs from their neck previously, with the neck or arm being less predictable and reliable on various activities. The precipitating reason for the full syndrome may be something small, just in the right direction to stress the nerve.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Glasgow, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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