A Pain In The Neck
Lately I have had a spate of people presenting to the clinic with a ‘crick in the neck’. You may have seen a victim of this syndrome before, or experienced one yourself! The sufferer tends to walk a bit like a Thunderbird, turning their whole body to look at things, rather than turning their head. Usually people have woken in this state, but may have had some warning signs in the days prior. Known in the physio world as ‘acute wryneck’, this article will explain more about this painful problem, which certainly is not ‘cute’ at all!
There are two main neck structures that can cause a wryneck. One is a facet joint, the other is a disc. Although issues with either of these structures can present in deceptively similar ways, I will explain them separately, as the expected outcomes are quite different.
Facet joints are located in pairs along the back of your spine, joining adjacent vertebrae together. With every movement you make of your spine (in this case your neck), the joints move, with opposing bony surfaces sliding over each other.
Acute wryneck can be caused by a facet joint becoming irritated, and ‘jammed’. Sometimes a fancy dance move or driving head check can suddenly cause a joint to become painful, but most of the time, there have been one or more factors that have accumulated to make you more vulnerable to the aforementioned dance move.
Prolonged postures, like sitting at a computer, can, over time, cause muscle tightness and joint stiffness to accumulate. The facet joints fail to get enough full range of movement required to maintain flexibility, and, bit by bit, the joint stiffens. Muscles overlying the joints tighten also, feeding the joint stiffness and creating a downward spiral. As this process is gradual, many do not even notice it, or feel any pain from it. Poor posture, poor fitness, muscle over-development from gym, and increased muscle tension from stress are also common contributors to this process.
Suddenly it’s Saturday night, and there is an awesome band playing at your local. You feel the band is worthy of your presence on the dance floor, and you pull out some of your best moves. Just as you flick your head around to get your sweaty hair out of your eyes, you feel it – ‘twang’. Unfortunately, the joints in your neck have stiffened to a point where this maneuver is no longer easy. Some ligaments around a joint have overstretched. It may only be a little painful now (plus, the liquid muscle relaxant sold over the bar is probably helping you out), so you continue the fun, and eventually tumble in to bed.
The next day starts badly - as soon as you wake up and move there is a stabbing pain in your neck. Inflammation has built up over night, and in response, the muscles in the area lock on as a protective measure.
Now for the good news! A wryneck which has been caused by a facet joint, usually settles within a week. Physiotherapy can help it to settle more quickly, and, importantly, can address any issues which may predispose you to having it happen again.
The other structure which can lead to wryneck is the disc. These are fibrous cushions sandwiched between the vertebral bodies. The risk factors that lead to disc damage are much the same as for facet joints. Pain and movement restriction can develop suddenly, but can also build up over days or weeks. The back wall of the disc develops inflammation, and muscle spasm again responds.
Often it is very difficult to diagnose whether a wryneck is facet or disc related in the early stages. Severe pain, restricted movement, and muscle spasm are common to both. The diagnosis, therefore, is made via a highly technical method. If it gets better within the week, it’s a facet joint problem; if it doesn’t, it’s a disc! You see, discs are slow to heal, and are often the culprit for stubborn, grumbling pain that can last weeks or even months. Of course a Physiotherapist can speed the recovery process up for you, and again, prevent a recurrence (which can be very common if contributing factors are not addressed).
So, to prevent this nasty problem from happening to you, sit up straight, move around a lot, get fit, and practice your dance moves more regularly!