Neck Pain

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for cervical and neck pain in San Francisco, Oakland, Fairfield and Fresno.There are many causes of cervical pain of which the most common is cervical spondylosis. Spondylosis basically means that there is general wear and tear of the joint in the neck. With time these changes contribute to osteoarthritis of the neck and affect posture.

Cervical spondylosis and osteoarthritis are most common in people older than age 55, and both conditions progress with age. However, many sports related injuries, car-accident whiplash injuries and repetitive stress movements that occur on the job may also accelerate these degeneration processes.

Many people with cervical spondylosis and osteoarthritis have signs on X-rays but do not always have symptoms. The typical signs of these two cervical spine disorders include pain, stiffness and muscle spasms. When symptoms do occur, non-surgical treatments often are effective.

Most disorders of the cervical spine usually present with neck pain and stiffness. However, if a nerve is pinched or compressed, other symptoms may include:

- Constant aching neck
- Pain which radiates to the arms, back of the head or shoulders
- Numbness, tingling or pain sensations down the arms and legs
- Difficulty walking and lack of coordination
- Bladder and or bowel incontinence
- Headaches
- Neck tension
- Upper back aches
- Migraines

Causes of Cervical Pain & Complications

As one ages, the structures in the cervical spine like the bones, cartilage, tendons and ligaments get stiff and develop small tears. Over time, bone spurs may grow and the cartilage in between the joints will wear out.

Cervical spine problems are generally from the daily wear and tear of the joint, ligaments and tendons. By the age of 40, most people have some signs of joint degeneration on x-ray but symptoms do not start for another decade. With age, most people will have  loss of elasticity in the joint, bulging or herniations of the discs, stiffening of the ligaments, muscle spasm and formation of bone spurs. Aging and daily wear and tear are the chief risk factors for development of cervical spine spondylosis.
When arthritic changes of cervical spine progress, it can lead to compression of the nerves. Sometimes bone spurs may occur which compress the nerves. Once nerve impingement occurs, the condition is usually progressive if no treatment is undertaken


Diagnosis & Treatment

The diagnosis of cervical spine disorders requires a history and physical exam. In most cases, a neurological exam is performed to ensure that your reflexes and sensation are intact. X-rays are almost always done to look for bone spurs. Other individuals may require a CT scan or an MRI for more detailed views of the cervical spine. If nerve compression is suspected, you will undergo a nerve conduction study that may reveal if the nerve is working normally and where the lesion is located.

Without treatment, the signs and symptoms of cervical disease usually decrease, stabilize but on many occasions also worsen. The aim of treatment is to decrease pain, improve range of motion of the neck and prevent further injury to the nerves.

Treatment of mild cervical spondylosis

This may involve wearing a neck brace or cervical collar for a few days to reduce neck irritation and limit the neck range of motion. One may require over the counter non steroidal anti inflammatory drugs. Performing exercises as recommended by the physical therapist to strengthen the neck muscles and increase flexibility of the neck. Some of the best exercises for the neck include walking, water aerobics or swimming. For acute pain and swelling, one can apply heat and ice packs. There are also a variety of menthol ointments that can relieve the pain. Gentle massage or acupressure can also help relieve muscle spasms and reduce pain.

Severe Cervical Pain Treatment

When neck pain persists and  is intense, there are other modalities of treatment. Traction on the neck for several weeks can help reduce pressure on the nerves that exit the spine. Traction is best done under the supervision of an SFMMG physical therapist. There are many traction devices and it is best to discuss with your SFMMG physician which one to buy for home use.

Exercises. Controlled exercises are now recommended for people with certain types of neck pain. There is evidence that severe muscle spasm of the body is a common cause of joint pain and thus doctors now recommend a variety of exercises that can help keep the cervical spine relaxed and stable.

Prescription medications like muscle relaxants, anti depressants or sedatives are also widely used to treat cervical neck pain. Your SFMMG doctor may decide which is the most appropriate pill for you. Medications like neurontin, pregabalin or cymbalata can decrease pain, help with sleep and improve the mood. Sometimes a short course of prescription strength painkillers may be required. Our SFMMG doctors will determine which course of medication will work best in your situation.

Corticosteroid injections are also an option for some people with osteoarthritis. The corticosteroid is combined with a local anesthetic. These medications do help relieve inflammation and pain. Corticosteroid injections do take time to work but can often help prevent surgery.  In rare cases, a patient with cervical neck pain may even need admission to the hospital for pain control. Our doctors at SFMMG  are highly experienced and very gentle in doing injections. There are times when intravenous pain killers are required that can only be administered in a hospital or clinic setting.

Surgery

SFMMG surgeons will rarely recommend surgery immediately for many injuries. Surgery is not the first choice for treatment of cervical pain disorders. Attempts are made to treat cervical pain with conservative methods.  However, If these fail then surgery is an option. The type of surgery depends on the cause, presence of nerve impingement, bony spurs or prolapsed discs.

The general surgical approaches to the cervical spine are anterior or posterior approach. In the front or anterior approach, an incision is made along the side of the neck. The herniated discs or bone spurs are removed. Sometimes the bony defect is closed with a bone graft or an implant. With the anterior approach, the surgeon can relieve pressure on the spinal cord from multiple discs. To support the neck and head, the area is then reconstructed with bone or an implant.

In the posterior or back approach, the incision is made at the back of the neck and the diseased/abnormal bone fragments are removed. This type of surgery is called a laminectomy. An alternative is a laminoplasty which involves cutting and moving piece of vertebrae to make room for the spinal cord. Laminoplasty is a much bigger procedure but overall results may be much better for certain conditions.

Lifestyle and home remedies

One can help reduce cervical neck pain by making changes in life style. If the neck pain is mild, apply a warm compress just before bedtime or take a long hot shower. If the pain is moderate, take a non-steroidal anti-inflammatory drug. Most experts do not recommend regular use of a neck collar. The neck collar is fine for acute neck injury and should be limited to 1-3 days. Prolonged use of the neck collar can lead to neck stiffness.

Neck Pain Prevention

There is no way to prevent all disorder of the cervical spine. However, one can steps to reduce the risk by adopting the following principles:
- Always exercise on a regular basis, even walking is adequate
- If you have had prior cervical spine injury, avoid high intensity or high impact exercises like jumping or skate boarding
- When resting, do neck exercise to increase flexibility
- Learn to take break from work which requires constant straining of the neck. This means walking away from the computer or TV every hour for a few minutes
- Practice good posture and avoid straining your neck forward all the time
- When you drive, wear a seat belt and if you play sports wear a neck protective device
 
  
San Francisco Neck Pain Multi-Diciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your Neck Pain or Headaches. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine 
• Physiatry
• Chiropractic
• Podiatry
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely diagnosis and treatment in one place speeds recovery and reduces costs. Please call to schedule an appointment with our physicians at one of our locations.