Neck
Degenerative Disc Disease - General Neck Stiffness
Description: As we age, the discs between our vertebrae gradually decrease in size and become less hydrated (degeneration). This affects their ability to absorb shock in the spine. This decrease in size also causes the passageways for nerve roots to narrow. Muscles can also shorten over time as a result of decreased movement in the spine.
Symptoms: The first symptom of degenerative disc disease is often a progressive lack of rotation in the cervical spine. Looking overhead may also become more difficult. Initially, pain is usually described as stiffness. This may progress to sharp or stabbing pain as the degree of degeneration increases. With severe degeneration, burning pain, numbness, and/or tingling may start in the neck and radiate down the arm. Weakness in the muscles supplied by the affected nerves may also become weak.
Treatment: Modalities such as heat or ice, electrical stimulation, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode) can help alleviate localized pain and muscle tightness. Manual (hands-on) therapy interventions are commonly used by therapists, and include stretching, joint mobilizations, and other techniques aimed at improving movement and decreasing pain. Finding positions and movements which alleviate symptoms is also an important component of treatment. Stretching and strengthening exercises to improve muscle balance in the spine and upper body can help improve overall mobility and may significantly alleviate symptoms.
Cervical Nerve Root Impingement - Pinched Nerve, Bulging Disc, Radiculopathy
Description: In the cervical spine, nerve roots branch off the spinal cord and travel through openings between vertebrae to innervate the tissues of the arms and hands. Sometimes, these nerves can become irritated or pinched. The cause of the irritation may be narrowing of the vertebral openings, swelling or inflammation around the nerve root, disc degeneration, or bulging of the cervical intervertebral disc. Symptoms can be caused by a traumatic event, such as a fall, or can be the result of progressive damage over time.
Symptoms: There is often, but not always, pain in the neck when a nerve root is irritated or pinched. An irritated nerve root can cause pain, numbness/tingling ,and possibly muscle weakness into the shoulder and down the arm. Muscle spasms in the neck and upper shoulder are also a common complaint. The symptoms are sometimes made worse by coughing, sneezing, or straining. Symptoms usually start at the neck and may travel into the shoulder or arm, depending on the degree of nerve irritation.
Treatment: Determining the cause of the impingement is the first step in the treatment process. An X-ray or MRI to rule out serious pathology is sometimes recommended. Findings positions which minimize symptoms will help relieve irritation and compression at the nerve root. Traction, a method of gently pulling the spinal segments apart, can provide relief from disc compression and muscle tension. Modalities such as heat or ice, electrical stimulation, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode) can help alleviate localized pain and muscle tightness. Manual therapy is often a component of treatment. These hands-on techniques consist of positioning to achieve nerve decompression, joint mobilizations, and soft-tissue massage/stretching. As treatment progresses, exercises and stretches to stabilize the spine and stretch tight muscles are initiated.
Description: Muscle tightness and pain in the upper shoulders and neck is a commonly treated condition in physical therapy. These symptoms usually develop over time. People who work in stationary positions, such as factory or office workers, often complain of tension between the shoulders and neck. Tension in the neck and shoulders is common in people with certain postural deviations, such as increased curvature in the neck, rounded shoulders, and increased curvature in the upper back (Dowager's hump). The cause of the tightness can include problems with the intervertebral discs, weakness of the muscles which support the shoulders, or poor posture.
Symptoms: Tension which develops in the upper shoulder area is commonly felt in the upper trapezius muscle, as well as in the muscles near the spinal vertebrae. Symptoms are commonly described as dull, aching pain, and often progress as the day goes on. Sitting, standing, or typing for prolonged periods of time are activities which commonly aggravate symptoms. Headaches or tightness which begins just below the back of the skull is often reported by people who also have upper shoulder and neck tension.
Treatment: Modalities such as heat or ice, electrical stimulation, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode) can help alleviate localized pain and muscle tightness. A key component of treatment is postural awareness and body mechanic training. This entails movement and postural awareness exercises designed to improve the alignment of the spinal column and upper body during daily activities. Since muscle imbalances are commonly observed in this condition, strengthening weak muscles and stretching tight muscles is very important. When prolonged sitting or computer work increases symptoms, an analysis of a person’s work station or job duties is often helpful in determining whether or not work activities are contributing to symptoms.
Description: The temporomanibular joint (TMJ) is the junction of the jaw bone and the skull. As with any other joint, the TMJ may become inflamed, swollen, or irritated. Unbalanced joint mechanics, muscle spasms, or overuse of the jaw muscles are common sources of TMJ problems. Symptoms tend to be chronic in nature, and are usually affected by one’s diet and activities, such as chewing hard foods or smoking.
Symptoms: About 80% of patients with a TMJ disorder complain of headache. Fifty percent of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Foods which are more difficult to chew, such as taffy, or foods which require large bites, such as a whole apple, often aggravate symptoms. Noises such as grinding, crunching, or popping are common for patients with a TMJ disorder. These sounds may or may not be accompanied by pain. People with TMJ problems may also report fullness or ringing in the ears.
Treatment: The first step in treatment is to modify one’s diet so that foods which are difficult to chew are kept to a minimum. Restricting the diet to liquids and soft foods can help decrease the irritation at the TMJ. Bite splints are usually fit by a dentist and can help the jaw maintain proper alignment and decrease clenching and grinding of the teeth. Physical therapy treatment usually begins with modalities such as moist heat, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode). Stretching of fascia and muscles around the jaw helps restore normal joint alignment and movement. Since problems at the TMJ often co-exist with upper neck problems, stretching and strengthening of the cervical spine and surrounding musculature is often indicated. TMJ disorders can often take many weeks to resolve. The goal of therapy is to alleviate symptoms and establish an independent home management program, which is often continued for several months after formal treatment has ended.