Key points
The term cervicalgia defines a generic pain in the neck that lasts for a variable period of time (months / years). It is an extremely widespread musculoskeletal disorder among the population.
Causes
Cervicalgia can be triggered by a set of particularly numerous and heterogeneous causes.
Symptoms
Cervicalgia is perceived as a constant pain, of variable magnitude, at the level of the cervical spine.
Pain can be accompanied by secondary symptoms, such as: muscle tension and fatigue, localized numbness and tingling, brachialgia, weakness of the arm and hand.
Diagnosis
In the event of neck pain, the diagnosis is necessary to trace the cause of the neck pain. The most used diagnostic techniques are: medical history, radiography, CT, MRI and electromyography.
Therapy
The therapy, which depends on the cause responsible for the neck, may include: specific exercises program for cervical pain, physiotherapy, painkillers and, in the most serious cases, surgery (recommended for example in cases of neck pain due to a cervical hernia ).
Definition of cervicalgia
Improperly known as cervical, cervicalgia is the most appropriate term to indicate a generic neck pain that lasts for a variable period of time (months / years). In the western world, cervicalgia is one of the most widespread musculoskeletal disorders, comprising many and heterogeneous symptoms of different origins.
Cervicalgia affects the cervical spine, which is one of the most vulnerable points in the human body: the disorder is perceived at the level of nerves, muscles and vertebrae of the cervical spine.
A little anatomy to understand ...
The cervical spine is composed of 7 vertebrae identified with the letter C, and progressively numbered from C1 to C7. The upper cervical spine consists of the atlas vertebrae (C1) and epistropheus (C2), while the lower portion is composed of the remaining 5 vertebrae (C3-C7).
A trauma to the spinal cord enclosed in the C1 and C2 vertebrae leads to the death of the victim. Injuries to the lower cervical spine are instead responsible for permanent paralysis of arms and legs (tetraplegia).
Causes
Cervicalgia recognizes various causes of origin. Among these, a sedentary lifestyle, strokes of cold and incorrect posture are the main sources of "chronic" cervical pain (albeit light and bearable). The causal factors described above are responsible for muscle tension and fatigue, which lead to sporadic or more frequent episodes of neck pain.
During youth, cervicalgia is not a rare condition as could be assumed. However, in this age group, cervical pain seems to be due not so much to bone and cartilaginous disorders, but rather to the simple contracture of the cervical muscles and shoulders.
The most intense cervical pain (acute form) is instead due to more serious etiopathological elements, such as:
- Flick
- Degeneration of one or more intervertebral discs
- Cervical hernia
- Dorsal hypercyphosis: marked accentuation of the physiological dorsal curve of the spine
- Lumbar hyperlordosis (excessive arching of the lower spine)
- Past traumatic injuries
- Osteophytes (bone spurs: bone growths located on the same surface as the bone)
- Spondylosis (osteoarthritis of the cervical vertebrae)
- Power sports with overloads (eg Bodybuilding)
Cervicalgia can be accentuated on several occasions: although it may seem obvious, even a too soft mattress or an inadequate pillow can considerably aggravate cervical pain. Similarly, even the incorrect position during driving can accentuate the neck pain, especially when one is forced to stay many hours behind the wheel. Not surprisingly, taxi drivers, representatives and bus drivers are very exposed to the risk of neck pain.
Another accused element is stress, which not only accentuates pre-existing cervical pain, but can even be the cause. Many subjects, stressed by work or life today, discharge their tensions by assuming incorrect postures that lead to muscle and joint contractures and rigidity. Such an attitude also ends up tightening the muscles of the neck and shoulder, creating neck pain.
Symptoms
The so-called "torticollis" is the symptom that most forms of neck pain have in common. It is an annoying and painful condition that hinders the natural movements of the cervical tract.
We have seen that cervicalgia also involves the nerves: in this case, the subject experiences an unpleasant sensation of tingling and numbness, flanked by weakness in the arm and hand.
Besides being clearly subjective, the intensity with which cervicalgia is perceived depends on the cause that originated it. For example, whiplash-induced cervical pain will be much more intense and penetrating than that caused by incorrect posture during sleep.
Depending on the site involved in the pain, and the symptoms related to it, it is possible to distinguish three variants of cervicalgia:
- Cervicalgia proper: cervical pain is concentrated in the cervical area
- Cervico-brachial syndrome (or brachialgia): pain extends from the cervical area to the arm
- Cervico-cephalic syndrome: cervicalgia is accompanied by secondary symptoms such as visual changes, swallowing disorders and vertigo
It is recommended to seek immediate medical attention in the event of neck pain associated with continuous tingling of the arms, inability to touch the chest with the chin, loss of strength of the lower limbs and hands, and persistent and relentless pain.
Diagnosis
Persistent cervical pain requires adequate investigative investigation. In fact, cervicalgia can hide different causes of origin, which must therefore be diagnosed by means of various tests:
- Medical history, observation and palpation
- Radiography (X-ray) of the cervical spine
- CT (computed tomography), possibly associated with myelography (to identify a possible compromise of the spinal cord)
- MRI ( Magnetic Resonance Imaging )
- Electromyography (identifies possible nerve root anomalies)
Care
To treat cervicalgia it is necessary to intervene on the cause that triggered the pain. The approaches to be followed are essentially:
- Relieve muscle stiffness
- Reduce inflammation
- Correct posture
Neck pain dependent on an unsuitable posture is relatively simple to remove. In such situations, it is necessary to follow a targeted exercise program, which must be performed with diligence and constancy. The exercises for cervical pain must be based on the aim of dissolving tension and stress, and of mobilizing the stiff and contracted cervical vertebrae. A good physiotherapist - or another competent and qualified figure - will instruct the patient on the correct execution of the exercise.
To get the maximum result in a short time, it is necessary to perform daily exercises for cervicalgia, with gentleness and slowness. In contrast, when performed hastily, with distraction and abrupt movements, the cervical exercises can even sharpen the neck pain.
Cervical exercises are no longer sufficient when neck pain depends on trauma to the neck (eg whiplash, cervical disc hernia etc.) or underlying pathologies. In similar situations, recovery (if possible) can be reacquired with alternative therapies and treatments, summarized below:
- Drugs to relieve cervical pain: anti-inflammatory drugs such as Ibuprofen, Acetaminophen or Naproxen temporarily relieve neck pain, although they do not act directly on the cause that caused it. Instead, costicosteroid drugs exert a powerful anti-inflammatory effect: for this purpose, topical application of methylprednisolone is particularly indicated. The same drugs can also be taken by mouth (eg Prednisolone) or, in cases of particularly intense neck pain, by topical injection (practiced near the nerve roots or neck muscles). Sometimes, the doctor recommends injections of lidocaine or other local anesthetics, or the administration of muscle relaxants and opioid derivatives to alleviate particularly intense acute pain.
- Use of the orthopedic collar: some forms of cervicalgia (especially dependent on whiplash) can be relieved by wearing the special collar that, by exerting a slight pressure on the structures of the neck, helps to relieve pain. Do not use the collar for more than 2 weeks, unless otherwise medically indicated.
- Oxygen-ozone therapy: involves the introduction of an oxygen / ozone mixture in the interdiscal area to remove the cervicalgia depending on an herniation. Ozone, exercising a discreet anti-inflammatory power, reduces disc pressure.
- Alternative therapies: electroanalgesia, massage therapy, thermotherapy, acupuncture
- Surgery: for the treatment of severe neck pain, surgery is the only viable option for resolving cervical pain that appears to be penetrating, intense and unstoppable. The most appropriate surgical strategies turn out to be:
- Anterior discectomy: useful to resolve cervicalgia dependent on a cervical hernia
- Posterior discectomy (less frequent intervention): indicated to relieve neck pain due to lateral cervical hernia
- Artificial Discal Prosthesis Graft that replaces the diseased disc preserving as much as possible the movement and function of the spine. This is an alternative intervention to anterior discectomy followed by intervertebral fusion.
