A Pain in the Neck

By John Hanks, DC

My neck feels OK right now. I can turn my head left and right and down and back. (Well, that bending back thing actually doesn't feel very good right now.) So, maybe my neck does get a little annoying sometimes. But I have no idea when this periodic discomfort started.

Sound familiar? You're not alone. A report published earlier this year in the medical journal Spine revealed many people are often a little hazy on when their neck pain started. This monumental study, sponsored by the World Health Organization (WHO), started about seven years ago. WHO launched the Bone and Joint Decade and assigned a special task force the job of reviewing all the research about neck and associated disorders, and then evaluating the best treatment options. They reviewed 31,878 citations, 1,203 reviewed papers and four research projects - it makes me tired just thinking about it.

Sure enough, most people often don't remember when their neck discomfort or pain really got started. Researchers concluded, "There is usually no single cause of neck pain." Unless you have had an injury to your neck like "whiplash" from an auto accident, neck pain usually sneaks up on you. The study notes neck pain is quite common, and most people simply carry on with their activities of daily living. However, about 5 percent to 10 percent of people develop debilitating symptoms. Unfortunately, even among those folks who do not have disabling pain, the majority find their neck pain is stubborn and recurrent to some degree.

The task force also came up with a new classification of neck pain, which seems to be one of those things researchers like to do. They suggested four grades of neck problems, no matter whether it comes from injury, arthritis or any other cause. To paraphrase:

Grade I: Neck pain that doesn't interfere with living.
Grade II: Neck pain that does significantly interfere with living.
Grade III: Neck pain associated with a "pinched nerve," causing radiating pain, weakness or numbness in the arm.
Grade IV: Neck pain associated with tumors, infections, fractures and other serious conditions.

As you might guess, most neck discomfort is Grade I and II. However, what was quite gratifying from the task force report was the acknowledgement of what doctors of chiropractic already know: "Cervical manipulation is a reasonable option for people with Grade I or II neck pain."

On a near-daily basis, a patient with a significant neck disorder tells me their pain has decreased and they are more functional as a result of chiropractic care. Recently, a patient with chronic neck pain told me he had been sleeping in a recliner chair since he could not get comfortable enough in bed to sleep through the night. "Hands-on" manual treatment in my office finally improved his condition to the point he could once again join his wife (and their Rottweiler) in bed.

Chiropractors "adjust" the joints, muscles and connective tissues of the body in order to improve motion by reducing restrictions and nerve irritation. Concerning patients with Grade III neck problems including "pinching" or crowding of larger nerves, the Spine article suggests more research is needed to identify the best candidates for manual or manipulative treatment. Of course, chiropractors are the recognized experts in this type of care and are best trained to make that determination.

The renewed interest in neck disorders among clinical researchers has spurred some interesting studies. In the March/April issue of the Journal of Manipulative and Physiological Therapeutics (JMPT), Canadian scientists have shown that arthritis in the neck might affect balance. This could mean that in cases of poor balance or repeated falls among the elderly, treatment of the cervical spine might have value. This could represent a "top down" strategy, which is a bit different from the "bottom up" approach to balance training more commonly utilized in rehabilitation.

In the February issue of JMPT, a complementary study by New Zealand and Canadian researchers suggested spinal manipulation of the neck can relax muscles in the arms and could be useful in relaxation of the whole body. This implies anything causing tightness in the neck joints also might cause muscle pain in the arms or elsewhere. Since manipulation and manual therapy are primary treatments for neck problems, a doctor of chiropractic should be among the first providers consulted for this type of pain.

So, how fast can a patient with neck pain expect to feel better with chiropractic care? By chance, in the same March issue of JMPT, British authors studied which neck symptoms might respond the quickest to hands-on treatment. Overall, considering all possible neck area complaints, about 70 percent of patients reported immediate favorable responses to manipulation. However, if patients complained about more specific things like headaches, shoulder or arm pain, reduced arm or neck movement, neck pain, or upper or middle back pain, the percentage of those who reported immediate improvement in pain rose to an incredible 95 percent!

The popular humorist Nora Ephron wrote a book titled I Feel Bad About My Neck, in which she describes her thoughts about being a woman getting older. This also has been called the "I Hate My Neck" book. Well, hating your neck won't make it better, but chances are a trip to the chiropractor will.

John Hanks, DC, is a board-certified chiropractic orthopedist and is certified as a chiropractic sports physician. He currently serves as the senior chiropractic consultant in the Department of Complementary Medicine, Kaiser Permanente, Rocky Mountain Region.


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