Neck pain is a very common condition affecting 22-70% of all people at some point within their lifetime. It is also the second most common affliction treated in outpatient physical therapy clinics, making up approximately 25% of cases seen.
Not all neck pain is the same, however, and the treatment is entirely dependent on the structures that are involved. Additionally, while there are multiple musculoskeletal problems that lead to neck pain, care must be taken to rule out serious pathology.
The physical therapists at Life’s Work Physical Therapy are very skilled in the hands on assessment and clinically diagnosing disorders in the cervical spine. Detailed below is what you can expect from an examination of the cervical spine by the Physical Therapists at Life’s Work Physical Therapy:
The first part of any assessment involves a very structured subjective evaluation, with the therapist asking detailed questions about the pain complaint, such as how it started, where exactly the pain location is, what makes the pain worse and/or better, which functional activities are affected, etc. We also benefit from learning any past medical history to this (or other) area, what medications are currently being taken, what other services have been sought for this condition, and how it has changed since the initial onset of pain. It is important to learn as much information about the pain complaint and other medical history, as it will help determine the appropriateness for physical therapy and help guide us towards various treatment options depending on the patient’s health status or other history.
Objectively, we begin by observing posture, as many afflictions affecting the cervical spine stem from the way we posture our neck and back throughout the day. This involves looking at the posturing of the head, neck, upper back, shoulders and overall muscle tone. Second we look at active and passive range of motion, of the neck to assess the overall mobility of the cervical spine, followed by assessment of neck strength.
There are numerous vital structures that are located in the neck, including the carotid and vertebral arteries, and numerous ligaments, which work to provide stability to the spine, both of which can be jeopardized with trauma or various medical conditions. Every evaluation of the neck looks to screen for serious pathology, which includes ligament tears, or ligament insufficiency, and vascular issues stemming from arterial damage.
The nerves exiting the cervical spine innervate the muscles and skin of the neck, shoulders, arms, and hands and are often affected by injury and cervical dysfunction. In fact, many conditions, which include muscle weakness, numbness, or pain in the upper extremities, can be caused by problems located in the cervical spine. Thusly, every examination of the cervical spine includes a thorough inspection of nerve involvement, including sensory changes (numbness, tingling, etc.), muscle strength, and spinal reflexes. Determining patterns of nerve involvement assists the physical therapist in diagnosing specific levels of dysfunction in the cervical spine.
Once the therapist is able to determine the patient’s problem is musculoskeletal in nature, LWPT clinicians use manual therapy to assess specific segmental mobility restrictions and changes in muscle tone of the cervical spine. Additionally, a more detailed assessment of a patient’s movement pattern is examined, looking for compensatory patterns which may contribute to cervical spine dysfunction.
After the evaluation, the physical therapist devotes time to educate the patient what is felt the clinical diagnosis is and why, and what the plan of care and expectations regarding therapy is. We then work collectively to develop a plan of care which involves a combination of evidence-based manual therapy (mobilizations and/or manipulations), postural education and ergonomic changes as appropriate, and functional retraining through specific exercises in order to get back to full activity.
Here are some of many conditions affecting the cervical spine that we treat at Life’s Work Physical Therapy:
- Neck pain from muscle strain and ligament sprain
- Limited cervical mobility
- Shoulder and upper back pain
- Arm/hand numbness, paresthesia, weakness
- Cervical Radiculopathy
- Cervical Disc Herniation
- Thoracic Outlet Syndrome
If you are experiencing neck pain which is affecting your functional activities, or are experiencing any of these symptoms described above, contact Life’s Work Physical Therapy today and get scheduled for an evaluation by one of our skilled therapists today!