Physical Therapy | Scott D. Schafer, MSPT

Mr. Schafer is a Licensed Physical Therapist and has practiced in the area of outpatient orthopedic and sports physical therapy since 1997. Mr. Schafer may be reached at (412) 257-0314. Schafer Physical Therapy, PC is located at 3249 Washington Pike, Suite 1102, in the Portman Commons Plaza. Please see his website, www.schaferpt.com.

You’re Such a Pain in the Neck…

How many times have you heard this statement? In most cases, someone at wit’s end uses it quite figuratively. In the case of true neck (or cervical) pain, it can be one of the most disruptive and uncomfortable conditions that we face, literally putting us at “wit’s end.” In terms of musculoskeletal origins, the primary causes of cervical pain are usually due to posture-related muscle imbalances, possible limitations in cervical (or upper thoracic) spinal mobility, disc-related issues, and impingement of the nerve roots. These causes usually are present as a combination of one or the other. While there are other more medically serious causes of neck pain (i.e., fractures, tumors, heart-related issues), for the sake of this article we will assume that proper evaluation and diagnostic testing have ruled out these causes.

Posture-related muscle imbalances are among the most common reasons for referral to physical therapy. The main function in terms of posture for our neck muscles is to keep our head oriented in space, usually to the horizon. If a person is unable to stand erect with a neutral head posture, it is inevitable that the muscles of their neck and back are going to have to “work overtime,” resulting in fatigue and pain especially noted by evening. Over time and left untreated, this imbalance can further manifest itself into shoulder problems, back pain and, in extreme cases, irreversible spinal involvement. Limitations in spinal mobility can occur alone or in combination with the other causes of cervical pain. Spinal mobility can become restricted due to inflammation of the joints and soft tissue between vertebrae, avoidance to movement due to a disc or muscle-related pain, or as a “guarding” response after trauma such as whiplash. As a response to limited spinal mobility at one level of the cervical or thoracic spine, you may develop an abnormal excessive movement at another level to compensate for the limitation, which in turn can manifest itself as pain. This type of pain is also frequently seen in patients who have a history of indiscriminate “popping” or “self-mobilization” of their own neck or back.

Disc-related pain usually is related to abnormal loading of the discs between the vertebrae. In addition to trauma, prolonged poor posture and/or changes in spinal mobility can cause considerable stress to the discs, resulting in inflammation, bulging or, at worst, herniation.

Nerve root impingement can occur within or immediately as the nerve exits the spine. Nerve root pain can occasionally be localized right along the spine or can express itself over specific distributions of that nerve root farther down the arm occasionally as far as the fingertips. Arthritic changes in the openings where the nerve root exits the spine, soft tissue restrictions or muscle tightness due to posture or trauma, or disc injuries are the usual causes of nerve impingement.

Neck and upper extremity pain should be taken seriously and evaluated by your physician, physical therapist, or other qualified health professional. Prompt personalized physical therapy intervention can assist in minimizing your symptoms and provide you with exercises to improve your neck flexibility and posture, as well as techniques to modify your activities to minimize the potential causes of your symptoms.

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