Many manual therapists, chiropractors, physical therapists, and trainers agree that neck pain is a common complaint in our society. Our poor posture causes the neck to hinge forward as we squint at the computer screen and adds 10lbs of pressure onto our cervical spine for every inch. Then, since our eyes have to be level for screen viewing, the brain begins to rotate the head upward so we have a level horizon, thus causing a lack of functional movement. It’s no wonder we are screaming in pain with upper and lower neck/cervical vertebrae problems.
In today’s world, sometimes we find that it’s not enough to just release the connective tissue and spasmodic muscles, or a quick adjustment, or even simple stretching. In fact, it comes down to pretty much “all the above” combined with motor control training. Motor control training means learning how to use the muscles correctly to achieve the desired movement without pain or compensation.
The first question to ask: “Is the pain truly cervical?” This means, is the pain really coming from the neck or somewhere else? A perfect example of this is the “Bruger Test.” This test can help determine if the neck pain is truly cervical, or if it’s coming from the hips and the ground up. This is considered the “ascending and descending syndromes.” Quite often, ground reactive forces can travel up the kinetic chain and cause neck issues and could be something as simple as a weight bearing hip issue.
C1- is considered the Atlas
C2- is considered the Axis
If it is a neck issue, from there we start to assess the Occipital Atlantal (O-A) joint along with cervical flexion. The O-A joint is responsible for 20 degrees of cervical flexion. The O-A test is a great way to determine if the issue is coming from the upper or lower, or maybe both. If rotation is restricted, then we want to test C1-C2. The total motion we like to see in cervical rotation is 80 degrees. C1-C2 is responsible for 40 degrees of that motion.
From there, we can determine if it is an upper or lower dysfunction (or maybe both) causing restriction in rotation. There are some special tests to perform such as the Vertebral Artery Test (Wallenburg’s Test) and Nerve Root Compression (Spurling Test).
Sometimes the neck can cause nerve sensations traveling down the arm as it traps the nerves between the tissue and joints. As nerves stay dysfunctional, they lose their nutrients (axonplasm) and it is important to treat with nerve flossing, which helps rehydrate those nerves.
Assessments are key to help the client with real long term pain relief. Thus the adage, “If you are not assessing, you are guessing.” Sometimes it is just the connective tissue like Trapezius, Levator Scapula, Scalenes and Sub-Occipitals which can all lead to headaches and painful restricted movement in the neck. From there, the pain can continue to spiral and travel further through the body to create compensations, which may help achieve the desired movement.