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Cervicogenic Pain

  

 
Figure 1. Pain from irritation to the cervical spine structures is referred to as ‘Cervico-genic’ pain.
 
 
What Is Cervicogenic Pain?
Cervicogenic pain is pain that is generated from the cervical spine. It can include headaches, dizziness, shoulder pain, and upper back pain. Pain originating from the cervical spine can be felt from the base of the skull, into the neck, upper shoulders, and the upper back or shoulder blade region. The different structures and different cervical/neck joint levels can cause pain in different regions. The neck is comprised of 7 cervical vertebra or bones; these are referred to as joint levels C1-C7. Each of these neck bones is connected to the ones above and below by ligaments, spinal discs, and muscles. Injury to the different components causes pain in different locations. For example, in Figure 2, the different colors show the area that injury to the different cervical joints will be felt in.
 

 

 

Figure 2. Pain originating from the cervical spine can be felt from the base of the skull, into the neck, upper shoulders, and the upper back or shoulder blade region. The neck is comprised of 7 cervical vertebra; these are referred to as C1-C7. Injury to the different components (ligaments, disc muscle) causes pain in different locations. Here, the different colors show the area that injury to the different cervical joints will be felt in.

 
 
Who Does Cerviogenic Pain Affect?
Cervicogenic pain affects a large part of the population. Those with abnormal postures and disc degeneration are more prevalent. Cervical pain can affect anyone. From studies on large populations, it is known that approximately 13.8% of people between the ages of 18-67 years of age will suffer cervico-genic type pain.1
·         Studies have found women (9.4%-13.5%) are more likely to suffer from neck pain than men (7%-9.5%),2,3
·         Recent studies have found that up to 15% of initially asymptomatic people will experience the presence of cervical spine/neck pain over a 10 year period.4
Contrary to popular belief, on average, cervico-genic pain does not improve on its’ own; once a person has experienced this type of pain the odds favor the recurrence of this pain.3,5-9 Thus, the cause of the cervico-genic pain should be sought and possible treatment intervention may prevent prolonged pain and improve future episodes if a direct cause is found.
 
What Causes Cervicogenic Pain?
The majority of cervicogenic pain comes from the facet joints, disc and muscles. The nerves attached through the neck become irritated and cause ‘referred’ pain into other parts of the body.
Cervico-genic pain has a number of possible causes. The majority of cervical pain comes from:
·         Injury and damage to neck joints and ligaments,
·         Injury to the neck intervertebral disc,
·         Injury to and overuse of the neck muscles,
·         Acute or recent neck pain may come from injuries such as whiplash (car crashes),
·         Chronic or long-standing pain typically comes from reoccurring pressures of the soft tissues because of the abnormal posture and abnormal neck curvatures. See Figure 3 and 4.
·         Abnormal Posture of the head and neck causes increased pressures on the muscles, ligaments, and discs of the neck leading to pain. See Figure 4,
·         Rarely, cervico-genic pain may be caused by infections or tumors.
 
 

Figure 3. Shown in A, is the human spinal column from the side showing you perspective for where the neck or cervical spine is located. Then 2 neck curvatures are shown; a normal one (green line) and an abnormal reversed curve (red line).
Abnormal neck curves can stretch and irritate the neck joints which may cause neck pain. Only spinal x-rays can show a Chiropractor what the state of your neck curve is.
 

 
 
 
 
 
 
Examination Procedures for the Diagnosis of Cervical Pain
The cause of cervicogenic pain is evaluated with a complete history, posture analysis, x-rays, neurological, orthopedic tests and possibly an MRI to rule out other underlying and/or contributing conditions.
The cause of cervico-genic pain is evaluated using multiple procedures to help determine a possible cause of the pain. These procedures include:
·         A history of the condition,
 
 
·         Neck or cervical spine x-rays. See Figure 3,
·         Detailed posture analysis. See Figure 4,
·         Range of motion of the head and neck,
·         Muscle strength and possibly Emg evaluation for muscle function,
·         Neurological and orthopedic tests,
·         Possibly an MRI to rule out other underlying and/or contributing conditions.
 

Figure 4.  Abnormal posture of the head and neck can contribute to cervical spine/neck pain. In A, the ear is very far in front of the shoulder; this is termed forward or anterior head posture. In B, the head is tilted off center relative to the vertical black line.
            Abnormal head posture causes the neck muscles to contract and this contraction increases pressure on the tissue of the neck causing pain.
 
 

 
 
Common Chiropractic & Other Conservative Treatments
Treatment for cervicogenic pain is geared towards correcting the cause of pain (ex. abnormal posture/fibrosis), increasing ROM and reducing pain and inflammation.
Conservative treatment can consist of:
·         Joint Manipulations;
·         Posture rehabilitation head, neck, shoulder girdle;
·         Stretching;
·         ROM Exercices;
·         Massage Techniques (Myofascial release);
·         Cryo-therapy –icing.
·         Nutritional supplements to aid in inhibition of inflammation and promote healing.
 
Common Medical Interventions
Medical treatment usually consists of anti-inflammatory medications and cortisone injections. Due to the common adverse risks associated with anti-inflammatory drugs (stomach bleeding, kidney damage, accidental death, etc…),10 it is our opinion that Chiropractic treatments should be attempted initially for those patients with spinal and joint involvement.
Chiropractic Care May Positively Influence Cervical Spine or Neck Pain
            Chiropractic adjustments and rehabilitation procedures offers a safe and effective means of an initial course of treatment for patients suffering from Cervical or Cervico-genic pain. Several randomized trials and many other types of studies (like case reports) have shown the potential benefits of chiropractic care for improving pain originating from the Cervical Spine structures.11-44
Significantly, Chiropractic BioPhysics® (CBP®) Technique care has been found to improve cervical spine pain or neck pain compared to the natural history of the condition in patients suffering from chronic neck pain and disabilities.4-6
References
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  2. Praemer A, Furner S, Rice D. Musculoskeletal conditions in the US. Park Ridge, IL. American Academy of Orthopaedic Surgeons, 1992:23.
  3. Makela M, Heliovaara M, Sievers K, et al. Prevalence determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991;134:1356-1367.
  4. Gore DR. Roentegenographic Findings in the cervical spine in asymptomatic persons. A ten-year follow-up. Spine 2001;26:2463-2466.
  5. Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998;23:1689-1698.
  6. Takala J, Sievers K, Klaukka T. Rheumatic symptoms in the middle-aged population in southwestern Finland. Scand J Rheumatol Suppl 1982;47:15-29.
  7. Harrison, Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-Point Bending Traction Method of Restoring Cervical Lordosis Combined with Cervical Manipulation: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(4): 447-453.
  8. Harrison, Harrison DE, Harrison DD, Betz J, Janik TJ, Holland B, Colloca C. Increasing the Cervical Lordosis with CBP Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Non-randomized Clinical Control Trial. J Manipulative Physiol Ther 2003; 26(3): 139-151.
  9. Harrison DE, Harrison DD, Haas JW, Betz JW, Janik TJ, Holland B. Conservative Methods to Correct Lateral Translations of the Head: A Non-randomized Clinical Control Trial. J Rehab Res Devel 2004;41(4):631-640.
  10. Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drug administration; 1998-2005. Archives Internal Med 2007;167(16):1752-1759.
  11. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21(15):1746-1759.
  12. Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18:148-154.
13.    Bronfort G, Evans R, Nelson B, Aker P, Goldsmith C, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001; 26:788-99.
  1. Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. J Manipulative Physiol Ther. 1992;15:570-5.
  2. Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007 Apr;87(4):431-40. Epub 2007 Mar 6
  3. Coppieters MW, Stappaerts KH, Wouters LL, et al. Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicogenic pain. J Manipulative Physiol Ther 2003; 26:99-106.
  4. Evans R, Bronfort G, Nelson B, Goldsmith CH. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 2002;27(21):2383-9
18.    Giles LGF, Muller R. Chronic spinal pain syndromes : a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther 1999; 22:376-81.
19.    Giles LGF, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003;28(14):1490-502; discussion 1502-3.
20.    Haas M, Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, Cummins C, Baffes L. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther 2004;27:547-55
21.    Hemmila HM. Bone setting for prolonged neck pain: a randomized clinical trial. J Manipulative Physiol Ther 2005;28(7):508-15.
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Assendelft WJ, Pool JJ, Scholten RJ, Korthals-de Bos IB, Bouter LM. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. Clin J Pain 2006;22(4):370-7.
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  1. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study. J Manipulative Physiol Ther 2004;27:16-25.
  2. Jordan A, Bendix T, Nielsen H, Hansen FR, Høst D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial. Spine 1998;23:311-8; discussion319.
  3. Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, et al. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. Arandomized clinical trial. Spine 1992;17:28-35.
  4. Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GJ, Hofhuizen DM, et al. A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures. J Manipulative Physiol Ther. 1993;16:211-9.
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  6. McReynolds TM, Sheridan BJ. Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc 2005 February;105(2):57-68.
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  8. Palmgren PJ, Sandström PJ, Lundqvist FJ, Heikkilä H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther. 2006 Feb;29(2):100-6
  9. Parkin-Smith GF, Penter CS. A clinical trial investigating the possible effect of two manipulative approaches in the treatment of mechanical neck pain: a pilot study. J Neuromusculoskel System 1998;6:6-10.
  10. Savolainen A, Ahlberg J, Nummila H, Nissinen M. Active or passive treatment for neck-shoulder pain in occupational health care? A randomized controlled trial. Occup Med (Lond) 2004;54(6):422-4.
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Disclaimer

The primary purpose of this list of and general discussion of health conditions is to inform the public of the possibility that use of Chiropractic care may be associated with positive improvements in a variety of health conditions for patients actively undergoing Chiropractic care. Many of these symptoms require co-management and/or referrals to other health care specialists.  This information is not intended, nor should it be used, to diagnose or treat any individual’s unique health condition.

 

  

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