FAQ Category: Cervical Spine

Blood testing is done for some musculoskeletal conditions, but it’s usually to rule out an infectious or inflammatory condition. There are no definitive blood tests of the type you are looking for.

A few studies have been done looking at blood results during the acute phase of whiplash. They found slightly raised levels of blood markers three days after a whiplash injury. These changes were back to normal within two weeks’ time.

Blood markers are substances found in the blood that can indicate a particular disease process. For example, tumor markers are used in oncology to help determine the presence of cancer. An elevated level of a tumor marker can indicate cancer; however there can often also be other causes of the change. For some types of cancer, it’s possible that a tumor marker could be identified for someone with cancer that had metastasized to the bones of the neck.

Other tests of blood markers found no differences in people with neck pain exposed to work-related repetitive motion. More studies are needed to find out if a blood test can predict or identify various conditions associated with neck pain.

You have expressed an opinion that many patients, health care providers, and insurance companies have shared for quite some time. In fact, there’s a trend now in health care toward what’s called evidence-based medicine (EBM).

EBM directs that if there’s no proof (or not enough proof) that a test, procedure, or treatment is beneficial, then it shouldn’t be used without just cause. Many researchers are studying injuries, illnesses, and other health conditions with this in mind.

When it comes to diagnosing neck pain, there are many diagnostic tests available. There are surveys patients can take to measure function and disability. There are range of motion, strength, and nerve tests that physical therapists perform. Electromyography (EMG) and nerve conduction velocity can be done to further examine muscle or nerve function.

The physician may order imaging studies such as X-rays, MRIs, and CT scans. In select cases myelography (dye injected into the spinal column) and discography (dye injected into the disc) are ordered. For some patients, blood tests may be needed.

It’s likely that some tests work better for certain groups or subgroups of patients. Researchers are working to find a decision algorithm (formula) that will help doctors (and others) know when to do which tests and on what patients. This will help us avoid the overuse of expensive tests that have no validity.

At the same time, it should be said that psychologic, social, and economic factors may have more to do with chronic pain then the mechanism or type of injury. These variables must be tested for as well. Again, finding factors that predict who will get better and who won’t is needed. Likewise, finding patient factors that point to one type of testing over another would be helpful and cost-effective.

There are some medications that can be taken for pain relief that are not linked with GI upset. Your doctor or pharmacist can help direct you to the most appropriate drug choice.

Second to that, physical therapy (PT) is a choice used by many patients. The therapist can help correct posture and alignment issues that may be contributing to your symptoms. PTs can also mobilize and/or manipulate the cervical spine (neck) if needed. This form of treatment is referred to as manual therapy. Exercises are often part of the program.

Chiropractors can also provide joint manipulation referred to as adjustments. Studies show that manual therapy is effective with neck and back pain. There’s no evidence that one approach is better than the other in terms of life expectancy or quality of life.

Other measures may be used to help quantify the benefit of specific treatment approaches for each patient. For some patients that may be simply pain relief. For others, return to full activities at home and at work is their definition of successful treatment.

Talk to your doctor about the best approach for you. Given your goals, your past medical history, and what’s currently available in your area, the right kind of program can be designed.

That report came as a result of some work done by a group of doctors, physical therapists, and chiropractors from the United States, Canada, and the Netherlands. They reviewed the harms and benefits of the five most commonly prescribed treatments for nonspecific neck pain.

The treatment approaches included standard nonsteroidal antiinflammatory drugs (NSAIDs), selective COX-2 inhibiting NSAIDs (Coxibs), exercise, manipulation, and mobilization.

Some of these methods do have some potentially life-threatening adverse effects. For example, NSAIDs can cause internal bleeding of the stomach or GI tract. And cervical spine manipulations have been linked with strokes. Either of these problems can be very serious (even deadly).

But for the most part, treatment for neck pain is helpful and not life-threatening. When used with the right patients, the results can be reduced neck pain, improved motion, and restored function.

There have been many studies done on the results of surgery to treat cervical radiculopathy. Cervical refers to the neck and radiculopathy describes the painful symptoms that travel down the arm.

Surgery for this condition varies depending on the extent of the problem, the condition of the patient, and the preferences of the surgeon. Most often, patients are directed to try a series of noninvasive treatment measures first before considering surgery.

Conservative care usually includes medications (pain relievers, antiinflammatories); physical therapy; or rest, heat, and massage. If a six-month trial of care does not reduce the painful symptoms, then steroid injections may be suggested next. When all else fails and the patient’s quality of life is significantly affected, then surgery may be advised.

It may be that your mother has gone through all the steps of conservative care possible. But it’s worth asking what has been done so far. If these steps haven’t been taken, then there are some options before accepting surgery.

Age is an important factor. Most operations performed for disc herniation are done on patients under the age of 65. Osteoporosis (brittle bones) and general health are always factors when considering surgery in older adults.

When surgery is done for cervical radiculopathy, about 70 to 80 per cent of the patients experience pain relief and improved function. These results occur in the first six to 12 weeks after surgery. However, this also means that 20 to 30 per cent have no improvement or only minimal change in their pain.

It may be best to express your concerns and questions directly to the surgeon. Accompanying your mother to her next appointment can be very helpful. If this is not possible, then a phone call or written communication may help you understand the risks and benefits of the proposed surgery.

Most people with neck pain have a nonspecific cause. In other words, all the imaging and testing in the world wouldn’t show anything wrong. That doesn’t mean X-rays and other tests aren’t needed at times. It’s just that in today’s high-cost health care environment, doctors are careful to order expensive tests when there is just cause to do so.

How can they tell? They use the information gleaned from both the history and physical exam. They take into consideration your age, general health, and risk factors for significant disease.

The major causes of serious conditions leading to neck pain include infection, tumor, and fracture. Anyone suspected of these three things would automatically have further imaging testing done.

Other risk factors for neck pain that doesn’t go away include the use of tobacco products (or exposure to second-hand smoke), poor health, and psychologic distress. A history of car accident or other trauma leading to whiplash and whiplash-associated disorder (WAD) is another risk factor for chronic neck pain.

Hopefully, the history would have brought out the possibility of car accident, domestic violence, or other trauma suggesting the need for further imaging or testing.

Hospital emergency staff are trained to warn patients what red flags to look for. These warning signs suggest the need for a return visit to the emergency department or a follow-up visit with their regular doctor.

If you develop visual changes, dizziness, numbness of the face or down the arm, or slurred speech, don’t wait. Get to a doctor or medical facility right away. These are symptoms of an impending stroke. Immediate attention is needed.

Headache pain generated from neck structures is often referred to as cervicogenic headache. Treatment may not be different but the area of concentration may change.

For example, the pain relievers or other medications used for headache pain probably won’t be any different. But manual therapy approaches used by the physical therapist or chiropractor may be applied to the cervical spine (or other parts of the spine).

A home program of exercise and self-management that goes beyond rest and relaxation may be possible. Postural and muscle imbalances that might be part of the problem can be identified and corrected.

Your doctor or therapist will be able to apply what are referred to as best practice methods in treating cervicogenic headache pain. This means they can search the medical literature for guidelines on this topic.

Ask your doctor what his or her best recommendations are for you with this new diagnostic information. Don’t give up if recovery doesn’t occur right away. Chronic pain is a complex issue. Sometimes, even with a correct (or more accurate) diagnosis, the problem is not resolved immediately. Give yourself some time to try each step in this new approach.

Neck pain can be very disabling when it interferes with daily work or activities of living. Sometimes caring for the family and household chores takes a back seat to just getting through each day at work.

In both situations (work and home), think about dividing tasks and activities into essential (must be done) and nonessential (can wait) tasks. Until your pain is under control, stop taking on any extra work in either place that is not absolutely required.

Modify your work tasks as much as possible. This may depend on the nature of your job and the degree of control you have over your job tasks. Can you break tasks down into smaller segments? It may take you longer to complete the job, but you will get it done and without exhausting yourself or setting yourself back in terms of recovery.

Can you share or alternate work tasks with others? There may be more room for negotiation than you realize in both the work and home setting.

If you live alone, this can be both easier and more difficult. On the one hand, you may be able to get the support you need to cope and complete household jobs from other family members. Or if living alone, you may be able to set aside a fair number of chores until you are further along in the recovery process.

If you have access to medical care, it may be time for a follow-up visit or check-up. Your doctor may be able to suggest appropriate medications to help with your particular situation. A physical therapist may be able to use modalities such as biofeedback or electrical stimulation to break the pain-spasm cycle and get you on the road to recovery.

Most people with neck pain never see a doctor, physical therapist, or other health care specialist. The decision to seek medical care is often based on availability of these services and reimbursement allowances.

In many places around the world (and even in rural America), treatment options are very limited. There may only be a remote clinic staffed by a nurse or physician’s assistant. Urgent health care may not be available.

No care and self-care are the main options when professional health care isn’t available for whatever reason. Self-care may include self-massage, over-the-counter pain relievers, hot or cold compresses.

Some patients begin with a program of simple range of motion exercises. Rhythmical and repetitive activities such as walking with reciprocal leg and arm action can be very helpful for some people. Basic yoga classes are often offered on public television or available from the public library on tape or DVD for home viewing.

If you feel you need the services of a medical doctor, chiropractor, or physical therapist, you may be able to arrange for a long-term plan of billing for services. Many local health care professionals are willing to spread payments out as far as needed by the patients/clients. It’s always worth asking. You have nothing to lose and everything to gain.

Chronic pain leading to loss of function and disability can occur following whiplash. In fact, this happens enough to have a name for the condition: Whiplash associated disorder (WAD).

Many insurance companies and third party payers are geared for acute health care problems. Coverage may be limited for chronic conditions that require continued treatment. Each work place negotiates the terms of their agreement with insurance companies.

It may be possible to work on an individual basis with your provider. Sometimes with the proper documentation from your physician, physical therapist, or other health care providers involved, coverage can be extended. What really needs to happen is a policy change.

The World Health Organization (WHO) has set up a Neck Pain Task Force to report on various aspects of chronic neck pain. Prevention, education, treatment and its prognosis are just a few of the topics studied by this group. Understanding neck and back pain is the first starting place.

They agree that policy changes are needed that will help improve the health and well-being of many patients. They hope that the result of their work will lead to such changes.

Your course of recovery with symptoms that haven’t gone away suggest that you may have a chronic pain condition. The early period of recovery is called the acute phase (first six to eight weeks). Most of the injury to the soft tissue has gone through the inflammation-healing process during the acute phase.

Whiplash that results in chronic painful symptoms may be referred to as whiplash-associated disorder (WAD). Patients in both the acute and chronic stages of whiplash often wonder what will be their course of recovery? In other words, will the symptoms go away? And how long will it take?

Studies on whiplash and WAD have found that there are some predictive factors. When present, these factors are linked with delayed recovery. For example, women seem to have a longer recovery period and are more likely to have less complete recovery compared with men.

Overall, children recover the fastest. Recovery is slower for people who have severe symptoms or who seek health care early on. Psychologic factors such as postinjury distress and passive types of coping are also linked with poor recovery.

The speed of recovery after whiplash injuries is not well understood. Differences in attitudes and beliefs may help explain the variation observed. Feelings of helplessness, anxiety, or fear of movement are common in chronic conditions.

Chronic neck pain may have many factors leading to this problem. It often requires a multidisciplinary approach. You may be able to make better progress with psychologic counseling or behavioral therapy than with medical care. If you have not seen a doctor, it might be a good idea to do so. An accurate diagnosis can help guide your treatment and successful recovery.

Many people experience neck pain after a traffic accident. Whiplash is the term most often used to describe or classify this type of neck pain. It represents the mechanism of injury: the head is whipped forward and back. There is an acceleration and a deceleration force on the soft tissues and joints of the neck.

The term whiplash-associated disorder (WAD) was first used in 1995. A Canadian Task Force on Whiplash used this term to describe the cluster of symptoms that often occur after such an injury. Patients with WAD report neck pain along with dizziness and pain in other parts of the body.

Damage to the soft tissues of the neck such as the ligaments and muscles result in a cervical sprain or strain with WAD. The joints may be involved, too but there’s no fracture.

The acute whiplash injury usually results in soreness of the neck muscles two or three days after the event. The symptoms can be mild to severe but go away within a few days to a week. Chronic pain and symptoms that persist resulting in loss of motion and function fall into the WAD category.

There is a difference between these two terms. The mechanism of injury is the same but the severity and duration are different.

There have always been whispered reports and hearsay about damage done by chiropractic adjustments. Evidence is lacking to support these statements. The big concern is for the risk of vertebrobasilar stroke (VS) with chiropractic care.

The theory is that the force of the chiropractic manipulation can tear blood vessels leading to the brain. Vertebrobasilar stroke affects the posterior portion of the brain. Loss of blood supply to this area leading to strokes affects about 25 per cent of adults who have a stroke.

The first thing to look at is who is at increased risk for VS? Age over 70 and the presence of atherosclerosis top the list. But men and African American ethnicity raise the risk even more. These patients and anyone with diabetes, high blood pressure, or who smoke may want to check with their medical doctor first before having a manipulation of the cervical spine.

According to the World Health Organization’s (WHO) Task Force on Pain, there is a link between younger age and vertebrobasilar artery stroke after chiropractic treatment. But the same association was observed in this age group receiving services from a general practitioner.

It’s likely that patients with neck pain from vertebrobasilar artery problems were seeking care for their symptoms before having a stroke. The treatment may not have brought on the stroke.

Whiplash, an injury to the neck caused by the sudden pitching forward of the skull and then snapping back, can be a very painful injury and can result in chronic pain and disability.

The most common cause of whiplash is a motor vehicle accident, but it can also be caused by falls and other types of injuries. People have even gotten whiplash while riding on carnival rides.

The best way to prevent whiplash is by using the proper precautions like the head rests in cars. Many people don’t adjust the head rest properly, making it so it doesn’t protect them in case of an accident.

When getting into the car, be sure that the head rest is 2 inches or less from the rear of your head. If there are more than 4 inches, there is too much room for your head to snap back.

Adjust the height of the head rest so it is directly behind the head, not at the neck level. The head rest should be at the same level as the ears. Since everyone is different in size, don’t assume that the head rest is in the right position for you.

When researchers and doctors say that there may be some psychological factors associated with some types of pain, they usually mean that the intensity of the pain may be affected by psychological factors, such as stress or depression.

When stress, anxiety, depression, or any similar feeling strikes, people can feel physical sensations more acutely, causing an increase in pain. Often, the approach to treatment is helping relieve the psychological distress. This could be through counseling, biofeedback, relaxation exercises, or perhaps medications.

Seeing someone for the psychological aspect of pain will not likely make the pain go away, but it may help someone learn how to manage it more effectively.

Many people with upper back or neck pain do end up having to have surgery to relieve the pain or to regain good function.

Just like people who have disc problems in the lower back, if the problem is in the neck, the disc can be removed and the remaining discs can be fused together with bone either from the patient’s hip or a cadaver donor, or a replacement can be put into place.

Anyone with pain that lasts or is severe should be assessed by a doctor. It’s important to have an assessment done to rule out anything serious or to prevent further injury.

If someone has pain in their neck and is waiting, not sure if he or she should go to a doctor, there are a few signs to watch for. If you experience any of the following, you should see a doctor or speak to one, as soon as possible:

• numbness in the hand or arm
• tingling in your hands, arms or legs
• losing balance
• difficulty walking
• pain won’t go away
• pain radiates down or up

Whiplash, injury to the neck from a severe jerking motion, can be a very painful and debilitating injury. Up to 75 percent of people who have whiplash see it resolve on its own, however, many people require treatment and some people end up with chronic pain as a result.

Many treatments have been tried for whiplash, ranging from medications to injections to surgery, but none has proven to be effective all the time. Now, there are data that suggest that Botox may help relieve the pain from whiplash. The Botox is injected directly into the trigger point, the area that is causing the pain.

The results are promising, but more study needs to be done.

The best rule of thumb when it comes down to seeing a doctor is if you are worried or concerned, you should get it checked.

Whiplash, however, doesn’t always require medical care, particularly if it is a mild case. Although being checked whenever the possibility of whiplash is not a bad idea, you really should see a doctor if you experience any of these signs or symptoms:

1 – The pain goes away and then returns.

2 – The pain gets worse instead of better.

3 – The pain spreads to your shoulders and/or upper arms.

4 – You get dizzy or you get pain in your head when you move your head.

5 – Your arms become weak or numb.

You may not be doing anything wrong. Trigger points (TrPs) are hypersensitive spots in the muscle caused by overuse. They can be very persistent. If you treat the TrP but don’t change your daily habits, then the aggravating factors are still present.

Most of the time, TrPs signal an active process of biochemical changes in the muscle tissue. Recent research from the National Institutes of Health (NIH) has reported on this phenomenon. Scientists were able to take tiny samples of muscle tissue without damaging the muscle or irritating the TrPs.

An analysis of the chemicals in and around the TrP showed elevated levels of many inflammatory markers. Similar testing was done on muscles in other parts of the body that didn’t have active TrPs. It turns out that these same chemicals are present with just everyday regular use of the muscles but at much lower levels.

With this new information, research can move ahead in finding more effective ways to treat TrPs. For now, you may want to consider some other methods of treatment that have helped other patients. In addition to the stretching and postural changes you are already doing, acupuncture or steroid injections may be beneficial.

Talk to your doctor about what might be the next step for you. Find ways to break up your day at work. Even 10 second breaks every 10 minutes or a one-minute break every hour would be helpful. Changing positions, stretching, and practicing deep breathing are all very useful tools in a work setting such as yours.