How to treat Neck Pain: 9 of the Best Clinical Tips

This eZine focus on assisting clients presenting with complex neck complaints, by using a system of integrated solutions recommended by our guest presenter Dr.Shaun O'Leary. Here are Shaun's 9 Handy Hints when Managing Chronic Mechanical Neck Pain.

1. When your patient complains of a 'heavy head', it is important to remember that without muscles, the cervical spine can buckle, under a mass of less than 1/5 the weight of their head.
   Bearing this in mind it is important to understand the anatomy of the cervical spine. During our training we are introduced to a wide variety of muscles and yet with the cervical spine, it seems there is always another muscle someone can mention which you haven’t heard of. A challenge here is to revisit your cervical anatomy, so you can assess and train muscle function with purpose.
   Music to my ears ..... and that is why we offer Anatomy Workshops Doug
2. Remember when observing general neck motion, the craniocervical and other typical cervical regions, often are moving in different directions to each other.
   Although motion of the craniocervical and other cervical regions, are complimentary during normal movement, they can function independently of one another. The craniocervical region alone accounts for 1/3 of the total cervical spine motion in the sagittal plane (flexion and extension) and ½ of motion in the transverse plane (rotation). Pretty impressive for just 2 joints! Of additional importance for rehabilitation is the orientation of the craniocervical region. This has a big impact on the pattern of muscle usage, when performing neck exercises.
3. Impairments in neck muscle function are multifactorial. The emphasis of rehabilitation will depend on the individual patient's needs.
   We are all taught this at university, it’s obvious when you think of it. However the measure of what to address in which patient is a skill. As science adds more and more to our understanding, it may seem that clinical practice is becoming more difficult. However, never under estimate the power of simple reasoning and take in the big picture. Where is the patient now and where do they need to be? This powerful question may give you a large hook on how to start your treatment.
4. The combination of exercise and manual therapy has the strongest evidence of all conservative interventions, for the treatment of neck pain.
   A Cochrane report (Gross 2005), and a separate article in the journal of Rheumatology, concluded that this combination of modalities had the strongest effect with respect to pain, function and global perceived effect. The foundation for correct technical application of these modalities, is good handling skills and a sound knowledge of regional functional anatomy. However, the foundation for correct practical application of these modalities, is good clinical reasoning and judicious reassessment. It is important, when treating a patient to keep asking yourself if both these modalities are appropriate for this patient, and what is the best way to combine these modalities for this patient? Always be questioning and reevaluating.
5. A patient's emotional health may not only affect their neck pain experience, but may also affect their postural habits and subsequently, strain to their neck. Whilst we are not psychologists, coaching a patient to establish links with the various situations they find themselves in through the course of a day, may provide valuable information for self management. Our psychological and physical well-being is influenced by our cognitive processes. Having a healthy appreciation of the link, between their cognitive processes and physical behaviors (such as postural control and movement), may allow a patient better understanding, and use to their advantage.
6. Changes in physical structure and behavior of the cervical muscles are evident in mechanical neck pain disorders and this impacts their function.
    With the ever growing evidence base of impairments found in neck muscles and the equally expanding range of technologies used to measure them, it can all sometimes seem perplexing. Put simply, some studies have shown changes in the physical structure of muscles (morphology and composition), some studies have shown changes in the behavior of muscles (coordination), which helps explain the findings of other studies, that have shown changes in the physical performance of muscles (capacity to generate and sustain force) appropriate for normal function. Tests that assess the change in function of these muscles, may also serve as a powerful clinical treatment and rehabilitation tool, which are accessible to all clinicians.
7. Be specific when addressing postural issues of the neck, forward head postures and flexed neck postures result in very different physical challenges to the neck and different emphases on correction.
   Postural neck pain presentations don’t all come in the one package and neither should the strategies to correct them. When someone says sitting, how do they sit, at what height, what position is their neck in? Get them to show you! Just 30 additional clarifying seconds in the patient interview and 30 in the physical examination could save you a lot of time in misdirected effort. By showing attention to this you will connect with the patient and you will make sure that you are not missing important information about their problem.
8. Give due consideration to the shoulder girdle. An important question when evaluating the role of the shoulder girdle in a patients neck pain is ‘What aggravates your pain the most, activities that involve positions or movements of your neck, or positions and movements of your arm?’ There are many ways poor shoulder girdle function can upset the neck. Some patients just don’t seem to get better if problems with the shoulder girdle are not addressed.
9. Not all neck muscles are made equal. Because neck muscles come in all shapes and sizes, what may be challenging for one may not be challenging for another. For example the extensor muscles of the neck are nearly twice as strong as the flexors which is why its much easier to lift your head off the bed when on your stomach then when on your back. Consequently some muscles will require more challenging tasks to test/train their performance than others.

I hope you enjoyed these Great Tips provided by Shaun and can see that it represents the tip of the iceberg, when integrating a client's story with the physical and psychosocial aspects, contributing to their 'pain'. Using his expertise and training, Shaun will demystifies this complex situation when he comes to Perth to present his course Integrated Solutions for Head & Neck Pain.

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