Have you ever woken up with a sore or stiff neck because you slept on it funny? Have you ever done a prolonged activity such as driving, being on the computer or playing sports where you felt stiff or soreness in your neck afterwards? These kinds of injuries are usually non-traumatic in nature. It is commonly known as wry-neck or also referred to as “torticollis”, and is a condition in which muscle spasms occur from soreness and stiffness in the neck causing it to be out of alignment.
Wry neck can occur due to the prolonged or sudden stretch of the neck for a few possible reasons. The shock absorbing cushion called the meniscoid structures within the zygoapophyseal joint of the neck vertebra can become blocked and jammed in its rest position, swelling and thickening of ligaments / capsules and the surround soft tissue around the joint(s), or a slow shift of the disc in the neck vertebra can all cause muscle spasms. Moreover, old injuries causing unstable joints, constant “self adjustments”, and hyperflexibility can all be contributing factors to developing wry neck.
As well, it can also occur following an upper respiratory tract infection (mainly affecting children), which causes the lymph gland under the neck muscle to swell; this is known as “Grisel’s Syndrome”. Non-activity related causes of torticollis include neurological disorders or tumors.
There is usually a limitation of movement toward one side and the posture is slightly flexed away from the painful side. You can wake up with pain on one side initially which can then occur on both sides. Initially the pain can be localized but may later radiate to other areas in the neck, shoulders, arms, hands or fingers. As well, you may experience a headache.
Using ice and resting your neck for the first 48 to 72 hours is the recommended first step. Swelling, pain and having the neck vertebra out of alignment can cause the joints to lose its normal range of motion. More over, the altered function of the neck causes imbalances such as muscle weakness and tightness to develop. Physiotherapy, through the use of manual therapy and specific exercises, has been shown to help in the restoration of the movement of the neck joints and the optimal functioning of the muscle imbalances that can occur.[2,3,4] The use of Intramuscular Stimulation (IMS) has also been shown to be beneficial in these types of neck injuries5. Overall, successful management of wry neck includes regaining joint mobility, muscle strength and flexibility, as well as retraining the coordinated movements.[2,3,4]
For more information about neck injuries please contact InSync Physio.Contact Us
Whiplash “Whiplash Associated Disorder (WAD)” occurs when a certain force is transmitted to the neck or “cervical spine”. Motor vehicle accidents, any sudden forceful movements of the neck, a fall causing impact on the head, or sports involving impact to the head can result in injury. Any acceleration and deceleration forces absorbed can cause damage to structures of the neck.
A small amount of force can sometimes cause more significant injury than large amounts of sudden force. Reasons for this is largely due to the fact that the degree of damage depends on the amount of force involved as well as the direction of the force.
Signs and Symptoms can occur immediately after impact or may take a day or two to develop.
Here is a scale to help you understand how whiplash signs and symptoms can be classified and how to grade its severity:
|Grade||Signs and Symptoms|
|0||No complaints about the neck|
|1||Stiffness, pain or tenderness only|
|2||Stiffness, pain, increased soreness, loss in mobility|
|3||Stiffness, pain soreness, loss in mobility, Neurological Signs of weakness in shoulder, arm or hand(s), pain or loss in sensation in shoulder, arm, hand(s)|
|4||Stiffness, pain soreness, loss in mobility, Neurological Signs of weakness in shoulder, arm or hand(s), pain or loss in sensation in shoulder, arm, hand(s), AND Fracture or dislocation|
|Note||Symptoms and disorders that can occur in all grades, but are not limited to: deafness, dizziness, ringing in ears, memory loss, difficulty with swallowing, and jaw pain (TMJ)|
*** If you are experiencing symptoms that are similar to either grade 3 or grade 4 whiplash it is highly recommended that you see a doctor immediately. Radiology must confirm grade 4 classifications WAD.
For grades 1-3 whiplash, immediately following your injury apply ice for 10 to 15 minutes every hour for the first 3 days. Early physiotherapy intervention using manual therapy to guide soft tissue and joint movements, therapeutic ultrasound, electrical stimulation, and specific home exercises are very effective.[2,4,5] Dry Needling intramuscular stimulation (IMS) is also effective in controlling pain and reducing muscle spasms and promoting therapeutic increase in mobility. After the first few days and beyond if your function in activities and perhaps even sport participation increases it is important to continue to achieve functional mobility and strength of injured segments.[2,3,4,5] Progressive techniques using manual therapy, massage and specific home exercises and postural education is very effective to achieve this.[2,4] Dry needling (IMS) can also help to progress with your recovery.
Full functional recovery from Whiplash can take anywhere from 6 weeks up to 12 weeks or longer depending on the severity and nature of the injury. As you begin to recover and resume certain activities, and even participation in sports within the first 2- 3 weeks, your joints, ligaments, and muscles are still healing.[1,4] By regaining joint mobility, strengthening muscles and retraining the coordinated movements of injured areas you will get back “InSync” to your active lifestyle.
For more information about neck injuries please contact InSync Physio.Contact Us
Whiplash of the cervical spine or neck is common among patients who have been involved in rear-end motor vehicle collisions, and also can also affect those who participate in contact sports such as rugby and football, or those who have experienced other physical trauma affecting the neck.
The most common cause of whiplash injury happens in response to a rear-end vechicle collision. As such, most studies that have been conducted have simulated a rear-end vehicle collision. During the collision, the spine of the person(s) being hit behave much like a cracking whip in the way that the spine moves in response to the sudden force. At impact, the torso continues to travel forward towards the steering wheel. The chin tucks downward and the skull travels backwards, causing an almost ripple-like motion through the spine, towards the head. That is a lot of different directions for your body to be trying to go all at one time. This movement causes the normal curvature of the cervical spine or neck, which is usually slightly convex to become more concave in shape. The sudden force pushes the spinal vertebrae into a sudden and unnatural alignment. This in turn causes surrounding muscles to tense up to try to stabilize the neck, which can cause muscle strain. The ligaments and discs in the neck can also be affected from the force.
Symptoms of whiplash may be delayed. Generally, you may experience the following as a result of a whiplash injury:
* Neck pain and stiffness
* Pain in and around the shoulder joint or between the shoulder blades
* Low back pain
* Pain or numbness in the arms/hands
* Difficulty concentrating or remembering or irritability or sleep disturbances (concussion symptoms)
Whiplash injuries are assessed and graded due to the severity of symptoms. Further information regarding severity and the grading scale can be found here on our website.
Since whiplash injuries can involve a variety of tissues and can differ greatly from one person to the next based on the exact mechanisms (e.g. amount of force, direction of force, pre-existing conditions, speed of the vehicle or vehicles in question, etc.), there is no single way to treat a whiplash injury. The best thing you can do is visit your doctor or physiotherapist to assess the injury and work with you to build a treatment plan that is specific to you. We treat many whiplash injuries at Insync Physiotherapy and do accept ICBC claims. We would love to meet you and work with you to get you back to feeling your best.
Posture and Neck Pain
Poor posture is the most common reason many people will complain about neck pain during their lifetime. Luckily, several lifestyle habits that cause neck pain can be reversed. Most typically experience pain in the back of the neck where the postural muscles are located. Trapezius, splenius capitis, erector spinae, and the suboccipital group are a few of the muscles continuously working to hold the head upright. These postural muscles become tight, tense, and overworked when the head is too far forward.
When muscles are continuously contracted and overstretched they become depleted of water and nutrients usually creating trigger points. Tension headaches are the result of trigger points in the upper trapezius muscle that refer pain to the temples. When the head is too far forward, the ear is in front of the shoulder, the muscles in the front of the neck such as the scalenes and sternocleidomastoid are shortened pulling the head forward. Those who treat themselves at home with a sports cream or a hot or cold pack usually don’t think about the front of the neck. Unfortunately some massage therapists may overlook these muscles as well. Assessing one’s lifestyle and habits, especially when a considerable amount of time is involved performing a given task, can help alleviate the potential causes of neck pain.
Sitting at a Desk
Writers and office workers can develop neck pain if their workstation is not properly set up. The computer screen should be level with the eyes to prevent straining the neck muscles. Those of us who work on a laptop are at a disadvantage. In order for the screen to be eye level the keyboard will most likely be too high for us to reach. If the table is too high, or the chair too low, many will have to elevate the shoulders to reach the keyboard. Lifting the shoulders to reach the desk or keyboard will result in a continuous contraction of neck and shoulder muscles.
When using a mouse make sure it is close so that your arm isn’t continuously reaching for it. Over time the shoulder will project forward and create tension between the shoulder blades as well as the upper trapezius. Those who use the telephone regularly should invest in a headset. Otherwise the neck muscles will be overworked by holding a phone to the ear with the shoulder.
Carrying a heavy bag repeatedly on the same side of the body will create shoulder and neck tension. Try to switch shoulders when carrying a heavy bag or purse or look for a bag that distributes the weight evenly. If you can forego the fashion trend of an over sized bag and carry a smaller version your neck will thank you for it. For those who cannot escape with a small bag look for an ergonomic bag that distributes the weight evenly. May ergonomic bags are worn across the body or carried on both shoulders simultaneously. Some backpacks are now equipped with wheels and a handle so that they can be pulled instead of carried.
There are two explanations for those who wake up with more neck pain than they had the night before. Tight neck muscles are depleted of circulation, but they receive a greater blood supply during the day than at night. As people go about their daily chores the neck muscles are constantly in use. When muscles contract and relax they release metabolic wastes and absorb fresh fluids. Yes, it may not be the ideal amount, but when we sleep the neck muscles are at rest for roughly 8 hours. Sleeping gives tight muscles a chance to stiffen because circulation is diminished from lack of use.
The more obvious explanation is poor alignment and support of the neck while sleeping. There are a variety of pillows available for back, stomach, and side sleepers, but many of us rotate through all 3 positions during the night. Unfortunately I’ve never seen one pillow that can accommodate all sleepers. Back sleepers need cervical support with a flatter surface for the head to rest on. Those who sleep on their side need a pillow roughly as thick as the distance between the ear and shoulder. The head should be in alignment with the spine and the pillow should help take pressure off of the bottom shoulder. Although sleeping on your stomach can be cozy it’s one of the worst positions for those suffering from lower back pain. Stomach sleepers need a flatter pillow to keep the neck in line with the spine.
Hobbies are meant to help a person unwind from the stresses of life, but they can contribute to neck pain as well. Of course, if you sustain a blow to the head playing soccer, football, or rugby your neck will probably hurt. Most people don’t think about the sedentary hobbies such as scrap-booking, knitting, and cross-stitch. When a person looks down for extended periods of time on a regular basis it will put a strain on the postural muscles of the neck. It is essentially the same as having a forward head posture.
Special neruons called proprioceptors continuously monitor our joints and muscles to to let out body know where we are in relation to the horizon. Many of us have misaligned skeletons due to muscle tension asymmetry. However, we don’t typically see people walking around bent to the side. When the body is crooked the brain will recruit muscles to realign the body with gravity and the horizon. For example, if the right hip is high we would expect to see the torso lean to the left. In this case the brain will shorten the muscles on the right side of the lower back in an attempt to bring the body back to center. Now the torso is slightly off so muscles on the left side of the upper to mid back will tighten. The neck unfortunately is the final balancing point for the brain to level the eyes with the horizon, hence the reason so many people complain of neck pain.
Standing in front of a mirror look at your shoulders. There are a few common patterns that create neck and shoulder pain. Is one shoulder higher than the other? A high shoulder can be the result of carrying a heavy bag, holding the phone with the shoulder, carrying a baby, and even sleep. Some people will experience pain on the high shoulder side. Others will feel pain on the lower side even though the muscles are not as tight. As the brain levels the eyes with the horizon a tug-of-war occurs with one side of the neck trying to overpower the other.
Is the distance between the shoulder and the center of the body the same on both sides? With the arms relaxed by your sides do your thumbs point forward or do you only see the back of the hand? Both of these questions look to see if the shoulders are rotated forwards. When the shoulders are rotated forward the head is usually pulled forward as well. Unfortunately most of us have this posture because we reach for things all day. Forward head and shoulders will create tension in the neck, shoulders, and upper back between the shoulder blades. To correct this posture the muscles in the chest and neck need to be lengthened by stretching, yoga, and/or massage. Conversely the muscles in the back need to be strengthened, usually with weight training.
What is Whiplash Exactly?
What can you do for it?
Do you have neck pain from:
|Neck ‘Cervical’ Vertebrae in Red|
|Musculature of the neck|