Pain in the neck is a common complaint. It is the product of a fast, mechanical life full of tension, lack of exercise and bad posture, use of cushy pillows and a soft bed. It may also be due to an injury. No specific cause can be pin-pointed. Some patients develop a stiff neck due to the incorrect positioning of the head in bed, especially while lying on the tummy with the head turned to one side. Sometimes the pain in the neck lasts for a few days and wears off on its own. But when it persists for a long time, it presents greater problems.
The cervical vertebrae have many peculiarities. They protect the spinal chord which carries practically all the nerves to the whole body. A disease of the cervical spine can have much wider effect than a similar disturbance in the dorsal or lumbar spine. The neck has to be mobile and yet it has no support like the ribs in the dorsal spine or the pelvis in the lumbar spine. It has to support the head and a considerable strain is borne by the neck when the arm muscles are put to vigorous use. It carries its own blood supply through the vertebral arteries and veins. These vessels are well protected in transverse processes, but they still experience mechanical problems.
Limitation of movement is one of three main problems. It may occur due to osteoarthritis of the cervical spine, which is called spondylosis. As a person grows old, there is always some generalised wear and tear of bones, including the cervical spine. The most common complaints mentioned are those of pain and stiffness in the neck. These generally occur in the three lowest cervical vertebrae. Patients are not able to turn their necks and look behind. This pain may radiate to the posterior part of the head or upper back between the two shoulder blades and to both shoulders. It is likely that only referred pain is prominent – that is, the patient may not complain of pain in the neck but pain between his shoulder blades only. These patients, especially women, often have swelling in the lower part of the neck. As the swelling subsides there is improvement of mobility and the pain is also reduced or relieved.
In this condition, there is degeneration of the disc between the vertebral bodies. A few osteophytes can be seen at the joint margins in an X-ray. These osteophytes may encroach upon the intervertebral foramen (the passages between the vertebrae) and reduce their size. This causes pressure on the cervical nerves. There may be numbness, tingling and a feeling of pins and needles in the hands. There is a tenderness over the muscles of the neck. Occasionally creaking sounds can be heard while moving the neck.
The therapeutic result of manipulation cannot be judged by changes seen in the X-ray. In advanced osteoarthritis excellent results are achieved with the spine recovering its normal range of movement and the pain completely subsiding. On other occasions, minor changes may take much longer to respond. When osteoarthritis involves facet joints, the results of manipulation are less satisfactory. In such cases manipulation which is too brisk should not be used; the technique must be gentle with a steady progress.
The patient should not be manipulated in an acute phase. A clear cut distinction must be made as to whether the problem is mechanical or inflammatory. In an inflammatory condition movement in al directions is painful. Cases of rheumatoid arthritis should not be manipulated. A preliminary test and examination of the patient will provide enough indication about the therapeutic success of manipulative treatment. In a majority of cases treatment is possible and induces immediate beneficial results upon the mobility of the spine. The pain and other complaints start getting better. Manipulative treatment of cervical spondylosis is therefore helpful. A few select exercises after the cure diminish any chance of recurrence.