Physio Referrer Online-
Should you send your patient with Neck Pain to physio?
Neck pain is one of the top five reasons that patients come to our practice. It includes a range of clinical presentations including:
– Joint dysfunction
– Acute wry neck with deformity
– Cervicogenic headaches
– Postural neck pain, and
– Cervical radiculopathy
These problems affect your patient’s ability to sleep, work, care for themselves and others, and participate in their fitness routines. In this issue of Physio Referrer, we, describe three common cervical spine disorders that physiotherapy can help with.
1. Postural Neck Pain
One group of patients we see have neck and shoulder pain from sitting too much. This could be at work but can also be related to recreational activities at home, for example patients who spend a lot of time doing craft or electronics as a hobby. These patients only get their symptoms with prolonged sitting and don’t have trouble moving or turning their head. On examination they have full range of movement of their cervical spine with no pain. They will sometimes have tenderness in the muscles and soft tissue of their neck and get temporary relief from remedial massage.
These patients have postural neck pain and need to understand the relationship between their posture and symptoms, as well as how to correct this. This is not just a matter of them learning to sit up straight but involves examining their workstation or set up and looking at what can be improved.
2. Joint Dysfunction in the Cervical Spine
Joint dysfunction in the cervical spine typically presents as unilateral neck pain with difficulty moving in one or more directions. Your patient’s pain may be in their neck but often involves the scapula area as well. This is a common referral pattern from the lower cervical spine and is important to let your patients know about. On physical examination these patients demonstrate loss of movement in one or more directions, usually rotation and/or extension. These patients have a mechanical obstruction to movement and do well with structured physiotherapy over 3 to 4 sessions. This includes exercises that address their loss of movement, clinician procedures if required, and education about activities and positions that affect the cervical spine.
3. Cervical Radiculopathy
Cervical radiculopathy is a common presentation involving compression of one or more cervical nerve roots as they exit the cervical spine. Disc and/or facet joint pathology may be involved. These patients present with arm pain and neurological symptoms that can be reproduced, increased or decreased with movements or loading of the cervical spine. Physiotherapy is effective for many of these patients (but not all) and they should be referred for a trial of physiotherapy over 3-4 visits. If, over this period of time, we arrive at a diagnosis of mechanically unresponsive radiculopathy (MUR)your patient has three options:
1. Time: some of these patients get better slowly over time (weeks and months) with close monitoring by their physiotherapist of their symptoms, movement and function.
2. Guided injection to the affected level of the cervical spine: this intervention can provide some relief to these patients, but we have know clinical criteria to tell us which patients will benefit from injection.
3. Referral to a neurosurgeon: this is reserved for patients with specific pathology that relates to their symptoms, such as a disc extrusion or facet joint cyst displacing or compressing the relevant cervical nerve root.
Conclusion:
Joint dysfunction, postural neck pain and cervical radiculopathy are three common neck related presentations that physio can help with. If you have any questions about your patients with neck pain, please call us on 6056 6616.
