Neck

The cervical spine is made up of seven bones numbered C1-C7. Cervical Spine Fractures primarily are the result of traumatic injuries to the head and neck. An individual with an unstable fracture is at risk of a spinal cord injury unless the fracture is stabilised.

Occurrence/Frequency of Injury
Cervical Spine Fractures are commonly the result of motor vehicle collisions, falls and diving into shallow water as these incidents generate the forces required to fracture the cervical spine. Motor vehicle accidents account for 50% of Cervical Spine Fractures with falls accounting for another 20%. Sports-related activities cause another 15%.

Treatment and Recovery Timeframes
When a Cervical Spine Fracture is suspected, the first step should be complete immobilisation of the neck to prevent any damage or further damage to the spinal cord. This is the why neck collars are put on RTA victims with a suspected neck fracture as soon as possible, often while they are still in the car.

Specific treatment depends on which of the seven cervical vertebrae are damaged and the nature of the fracture. Management of acute cervical spine injuries without neurologic deficits includes procedures such as surgery to realign the bony fragments.

Cervical fractures that result in spinal cord injury can be fatal or cause permanent neurological deficit. The higher up the spine the cervical fracture occurs the greater the probability of permanent disability or even death.

Interesting Facts
Evel Knievel earned his place in the Guinness Book of World records for suffering the 'most broken bones in a lifetime' with a count of 35. Despite fracturing his middle and lower back numerous times, his cervical spine was one of the few body areas that escaped un-scathed.

The spine is separated into three main sections with the neck region being known as the cervical spine or 'C-Spine' for short. It is made up of a series of seven vertebrae that are separated by inter (between) vertebral discs and are medically know as C1 (top) to C7 (bottom).

A prolapsed disc describes an injury whereby the softer centre of an intervertebral disc pushes outwards (prolapsing) against its tyre like surrounding, which in turn leads to a bulge developing.

The bulges can be small or large in size and on occasion the pressure will be great enough within the discs that the soft centre of the discs tear through their surround and into the space beyond.

Occurrence/Frequency of Injury
The two most common levels in the cervical spine to herniate are the C5 - C6 level and the C6 - C7 level, with the next most common level to be affected being that between C4 and C5.

As a consequence of a prolapsed disc, spinal nerves can be irritated or, in extreme cases, damaged as they sit just behind the intervertebral discs within the spinal column.

The pain caused by a cervical herniated disc is caused by a combination of pinching of the nerve root and inflammation associated with the disc material itself.

Arm pain from a cervical herniated disc is one of the more common symptoms felt and most commonly develops in the 30 - 50 year old age group. Although a cervical prolapsed disc may originate from some sort of trauma or injury to the cervical spine, the symptoms commonly start spontaneously.

The arm pain from a cervical herniated disc results because the herniated disc material "pinches" or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc in severe cases.

Treatment and Recovery Timeframes
Taking anti-inflammatory medications to remove some of the inflammation can help to reduce pain when felt from a prolapsed disc while the pressure component (pinching of the nerve root) generally resolves on its own.

Most minor prolapses heal within several weeks however severe herniations may not heal of their own accord and may require surgical intervention.

For those people who suffer from a prolapsed disc, review by a medical professional should be sought and often gentle exercises and postural advice are imparted to try and assist in resolving any symptoms felt.

On the whole there is no need to alter your daily activities if you are diagnosed with a minor cervical disc prolapse and, as mentioned above, these will normally resolve themselves over a few weeks.

Interesting Facts
A prolapsed disc is widely referred to as a 'slipped disc', but this term is not medically accurate as the spinal discs are firmly attached between the vertebrae and therefore cannot slip.

Spondylosis occurs over many years due to everyday wear and tear that affects the facet joints and discs within the neck. Facet joints are where one vertebra meets another vertebra within the spine and wearing at these joints is very common as we age.

When Spondylosis causes pain and problems within the neck (Cervical Spondylosis), it is usually as a consequence of irritation of the worn linings between the joints or as a result of overstretched ligaments that support the joints.

Occurrence/Frequency of Injury
Due to the wear and tear that happens in the neck, the space between the bones (facet joints) diminishes and the discs between the vertebrae also become thinner.

As a consequence of the above, the body starts to develop spurs of bone (known as osteophytes) at the edges of the vertebrae and the facet joints themselves, which when x-rayed are very similar in appearance to the changes seen in other joints of the body due to osteoarthritis.

Because these changes occur within the neck area, they are known as Cervical Spondylosis (cervical referring to the section of the spine within the neck). These changes can also occur at the base of the spine too, where they are known as Lumbar Spondylosis (lumbar being the lower back section of the spine).

Treatment and Recovery Timeframes
The NHS recommends exercise and lifestyle changes to assist with Cervical Spondylosis pain and suggests the following:

- Low-impact aerobic exercises such as swimming or walking
- Regular range of movement exercises
- Using one firm pillow at night to reduce strain on your neck
- Correcting your posture when standing and sitting.

Occasionally, as a consequence of Cervical Spondylosis, the nerve roots may be pinched, either by bulging discs or osteophytes, causing pain or numbness in the hands or arms. Very rarely, in severe Spondylosis, the spinal cord is squeezed, which can cause weakness and numbness in the arms and legs.

As Cervical Spondylosis is part of the normal wear and tear process within the body, it isn't usually something that affects work and lifestyle significantly. If, for any reason, difficulties are encountered with either of these rather than avoiding movements of the neck due to pain, it is recommended to keep the neck as mobile as possible by adhering to the above advice and continuing with daily routines as much as possible.

Employers need to maintain an open dialogue and try to manage the symptoms in the best way possible within the work place as the issue itself will not resolve. This may mean undertaking worksite assessments and providing modified duties.

Eventually all options may be exhausted and the only route may be to find alternative employment in a less physically demanding role.

Interesting Facts
Almost everyone will have Spondylosis somewhere in the spine by the age of 65, but often it doesn't cause any pain at all.

Many people develop a painful or stiff neck for no obvious reason. Sometimes it can happen after sitting in a draughty area or after a minor twisting injury, i.e. when gardening. This is referred to as 'Non-Specific neck pain' as the cause behind the pain isn't always fully understood.

The top three joints in the neck allow for most movements we achieve with our neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Occurrence/Frequency of Injury
'Non-Specific Neck pain' is very common and may also be referred to as torticollis, cervical dystonia and acute wry neck. Pain from a stiff neck can be felt in various different places including:

- The middle of your neck or on one side
- Your shoulder and shoulder blade
- Upper chest
- The back or side of your head
- The centre of your head, behind your eye
- Your ear

Often people will also notice:

- The neck is painful to move
- Muscles feel tight
- Stiffness after a period of rest or sitting in one position for a long time
- The neck won't twist as far as it normally does

It is thought that the pain felt from non-specific neck pain is due to spasm in the muscles supporting the neck but there is no lasting damage and the pain usually disappears after a few days along with a return of full normal movement.

During this time a patient is advised to try to continue with working and social activities as normally as possible and avoid prolonged periods of static positions. Regular movement within the limits of the pain is much more effective at relieving the symptoms as quickly as possible than avoiding movements all together.

Treatment and Recovery Timeframes
The aim is to keep the neck moving as normally as possible and try to gradually increase the range of the neck movement.

For 5 minutes or so gently move the neck in each direction as far as comfortable and repeat several times a day while trying to continue with normal activities as much as possible.

Interesting Facts
It is thought that two thirds of the world's population will experience neck pain of some sort within their lifetime with some 330 million people thought to be affected at any one time.

Most muscles relax completely when they're not being used, but some (known as anti-gravity muscles) have to work all the time in order to keep your body upright. When we're worried or stressed we often tighten these muscles even more, which can cause neck pain and Tension Headaches. Tension Headaches are very common and are often wrongly called migraines.

Occurrence/Frequency of Injury
Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache. The headache pain may be described as:

- Dull, pressure-like (not throbbing)
- A tight band or vice on the head
- All over (not just in one point or one side)
- Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

People with Tension Headaches tend to try to relieve pain by massaging their scalp, temples, or the bottom of the neck.

Treatment and Recovery Timeframes
Tips to prevent Tension Headaches:

- Keep warm if the headache is associated with cold
- Use a different pillow or change sleeping positions
- Get plenty of sleep and rest and massaging sore muscles may also help.

To reduce the effects of Tension Headaches on your work and social activities, try to exercise the neck and shoulders frequently when typing, working on computers, or doing other close work and practice good posture when reading, working or doing other similar activities

Interesting Facts
Tension Headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

Whiplash occurs when your head is suddenly jerked or jolted, causing it to move violently backwards, forwards, or sideways. The force of the motion makes the neck move beyond its normal range of movement, overstretching the ligaments, tendons and muscles, along with muscle spasm as the body tries to splint the injury. There is often a delay before any pain or stiffness is felt but this normally improves within a few weeks or months.

Occurrence/Frequency of Injury
Car and motorcycle accidents are a common cause of Whiplash because they often involve a sudden stopping force or collision that makes your head move violently. As Whiplash can occur when the head is thrown forwards, backwards, or sideways, the condition can develop following collisions from the front, back or side.

Treatment and Recovery Timeframes
- If Whiplash is diagnosed, it is important to keep the neck mobile by doing some gentle neck exercises. The neck may be painful, but keeping it mobile from an early stage will improve its functionality and speed up the recovery. Any pain experienced when moving the neck is normal and will not cause further damage. Physiotherapy may also be recommended.
- Resting the neck and keeping it still is likely to prolong symptoms and delay recovery. Therefore, using a neck brace or collar is not recommended.
- As well as keeping the neck mobile the following self care measures below may also help to manage neck pain and stiffness and prevent them getting worse.
- Good posture - always maintain a good, upright posture by keeping a straight back while sitting, standing and walking. If a lot of time is spent using a computer, the chair and computer screen should be adjusted correctly.
- Supportive pillow - some people find a firm, supportive pillow helps when sleeping. Avoid using more than one pillow.
- Exercises and stretches - controlled exercises, such as those used in activities like yoga, will help improve strength and posture. However, there is no evidence they help reduce neck pain.

Stopping, or avoiding normal social and working activities following Whiplash has been proven to have adverse effects on recovery times. As much as possible, therefore, a person should try to continue with normal daily routines and follow the above advice to assist with reduction of any symptoms.

Interesting Facts
As well as road accidents, Whiplash can also be caused by:

- A sudden blow to the head - for example, during contact sports, such as boxing or rugby
- A slip or fall where the head is suddenly and violently jolted backwards
- Being struck on the head by a heavy or solid object.