What is Neck Pain?

Neck pain can be defined as pain in the neck that comes with or without referred pain that can be felt in one or both shoulder and/or arms that can last for at least one day. Neck pain is common throughout the world which puts a burden in the health care system. Pain and disability that is often associated with neck pain can have large impact on someone's life, family, community and business.

Prevalence

10 to 20% of the world’s population report neck pain and 54% of those individuals have experienced neck pain within the last 6 months. Neck pain is usually higher in women rather in men and it usually peaks at 45 years of age.


Reoccurrence rate of neck pain are high and most people who experience neck pain usually do not have a complete resolution of their symptoms. About 50 to 85% of individuals with neck pain report a relapse of symptoms 1 to 5 years later after their first episode.


Some studies have shown that 30% of individuals with neck pain can develop chronic symptoms and report persistent problems for 12 months or more. Individuals with chronic conditions usually report their symptoms as being stable or fluctuating. A "stable" individual has no change in symptoms, whereas the "fluctuating" individuals report their pain as being recurrent where there are periods of improvement and period of worsening. Both stable and fluctuating individuals report that treatment may alleviate their symptoms in the short term.


Risk Factors

Like many other musculoskeletal conditions, neck pain shares similar risk factors such as genetics, depression, anxiety, poor coping skills, sleep disorders, smoking and sedentary lifestyle. However, there may be unique risk factor for neck pain such as history of trauma (MVA, traumatic brain injuries) or playing certain contact sports. There are also certain occupations that have a higher prevalence of neck pain that include office workers, manual labourers and health care workers.


Neck Pain Classifications

Understanding someone's neck pain should be the primary goal of a practitioner when seeking to determine which specific treatment plan will be effective.


Classification Types: Neurological or Mechanical Neck Pain

It is important for the physiotherapist or health care practitioner to clear out serious spinal pathologies before treating the neck. This is usually done in the first session through a series of questions or tests the physiotherapist will perform on you. Once those are cleared the physiotherapist will determine if your neck pain has a neurological or mechanical component. Usually, 50% of people that come in with neck pain usually have a mix of the two because the neurological component is usually caused by a degenerative condition. It is also important to note that identifying the exact tissue causing symptoms is not as important as we once thought to treat and management individual with neurological or mechanical neck pain.


Neck Pain and Physiotherapy

Although most acute episodes of neck pain can get better with time, about one third of individuals have low grade symptoms that can persist one year later after initial symptoms. The best evidence suggest that exercise is the best for managing neck pain and a physiotherapist has a detailed knowledge of the neck which can help you manage the mechanisms that may be contributing to your symptoms. They can also help prescribed appropriate exercises to help an individual experiencing neck pain to return to normal function.


References:

Childs MJ, Fritz JM, Piva SR, Whitman JM. Proposal of a classification system for patients with neck pain. Journal of Orthopaedic & Sports Physical Therapy. 2004 Nov;34(11):686-700.


Steven P Cohen and W Michael Hooten. Advances in the diagnosis and management of neck pain. BMJ 2017;358:j3221


Fritz, J. M., & Brennan, G. P. (2007). Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Physical Therapy, 87(5), 513-524.


Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998;77:1-13


Hush JM, Maher CG, Refshauge KM. Risk factors for neck pain in office workers: A prospective study. BMC Musculoskelet Disord. 2006;7:81


Wang, W. T. J., Olson, S. L., Campbell, A. H. M., Hanten, W. P., & Gleeson, P. B. (2003). Effectiveness of Physical Therapy for Patients with Neck Pain: An Individualized Approach Using a Clinical Decision-Making Algorithm. American Journal of Physical Medicine & Rehabilitation, 82(3), 203-218.


Wang, H., Naghavi, M., Allen, C., Barber, R.M., Bhutta, Z.A., Carter, A., Casey, D.C., Charlson, F.J., Chen, A.Z., Coates, M.M. and Coggeshall, M., 2016. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053), pp.1459-1544.


Damian Hoy, Lyn March, Anthony Woolf, Fiona Blyth, Peter Brooks, Emma Smith, Theo Vos, Jan Barendregt, Jed Blore, Chris Murray, Roy Burstein, Rachelle Buchbinder. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:1309–1315


Childs, J.D., Cleland, J.A., Elliott, J.M., Teyhen, D.S., Wainner, R.S., Whitman, J.M., Sopky, B.J., Godges, J.J., Flynn, T.W., Delitto, A. and Dyriw, G.M., 2008. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 38(9), pp.A1-A34.


Kenneth Olson. The Cervical Spine. Chapter 6 In: Olson, K. Manual Physical Therapy of the Spine. Elsevier, 2015.


Haines T, Gross A, Burnie SJ, Goldsmith CH, Perry L. Patient education for neck pain with or without radiculopathy. The Cochrane database of systematic reviews. 2009;CD005106.


Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. InMayo Clinic Proceedings 2015 Feb 28 (Vol. 90, No. 2, pp. 284-299). Elsevier.


Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017 Aug 14;358:j3221.

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