HEAD NECK PAIN

A CLASSIFICATION SYSTEM - how bad is my pain?

It still astonishes me how often I have a new patient with head neck pain of twenty years duration. Fifty years I can understand - there weren't too many chiropractors around in those days. But to have been suffering with head neck pain, gulping down prodigious quantities of pills that are known to poison the kidneys, or just suffering in misery, makes absolutely no sense.

A quote from the Kidney Foundation website: "Generally, when used according to directions, over-the-counter analgesics are safe. However, heavy or long-term use of these medicines, especially those that contain a mixture of painkilling ingredients--such as aspirin, acetaminophen and caffeine--in one pill, have been linked to chronic kidney disease."

Almost everyone will have head neck pain periodically.

Why? For many reasons, but not least that there are few of us who have not had a car accident, fallen down the stairs or taken a tumble from a horse. Getting out of bed in the morning is dangerous but there's only one thing more dangerous. Not getting out of bed! Most people die in their beds! But seriously, just when is the right time to go to your doctor or chiropractor, (sorry, got that wrong: your chiropractor, or your doctor) with neck pain and headaches?

"How bad is my head neck pain?" is a question you may have been asking yourself. "Am I being a baby with a low pain threshhold, or do I actually have a problem?"

A few thoughts. Just because you have a pain in the neck, or elsewhere, does not mean you must rush off to the chiropractor or your doctor. But when should you go then?

These are my golden tips. If you have

Really severe pain,
Neck pain which radiates down the arm
Neck pain and a fever
Pain which you KNOW is not getting better,
then it's better to get help.

After ...how many days? Difficult to say, best to use your own intuition. But recognise that if you arrive at the chiropractor with a pain you have had for three months or more (the definition of 'chronic') then you will certainly need more than a few treatments.

For an acute problem that has only begun in the last few days or weeks, as a rule, after a course of chiropractic treatment, one may expects it to go away completely, and if you go through a course of rehab, there's a good likelihood that it won't return for a long period.

But if you've had head neck pain for months, it is more difficult for your chiropractor to give you an assurance that your pain will recede completely. Don't wait too long. But don't go too soon either! Unless your head neck pain is really severe or radiates down your arm, or you have a fever. Meningitis is a killer.

In the interim, a good massage from your spouse may relieve your head neck pain, use some alternating ice and heat, do a few simple exercises, and don't go playing silly buggers! This is not the time for a game of rugby, or lifting pianos. Avoid carrying groceries on the affected side.

A simple classification system:

Grade I head neck pain: No signs or symptoms suggestive of major structural pathology (ie no severe pain, no radiation, no recent trauma) and no interference with activities of daily living. This will likely respond to those simple things suggested above; it does not usually require intensive investigations or ongoing treatment.
Grade II neck pain: No severe pain or radiation, but now begins to interference with activities of daily living. You wake in the night with pain. You can't turn your head, and driving the car is thus dangerous. After a week or ten days, you have to acknowledge that it's not really improving. Then we suggest it's time to make an appointment with your chiropractor (or even your doctor first, if that is your first choice). A good examination is in order, and perhaps some early intervention aimed at preventing long-term disability.
Grade III neck pain with the onset of neurological symptoms. Headache, radiation pain or tingling down the arm, or into the midback. Now it's definitely time to get help, particularly if it has lasted for more than a few days.
Grade IV neck pain: Still no signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness, and/or sensory deficits. In my opinion it is now definitely time for x-rays, perhaps even a scan. The pain of a pinched nerve in the neck is often severe, the ache in your arm something you cannot escape, no matter how you change your position. It's often worst at night. This head neck pain should no longer be ignored.
Grade V neck pain: Signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; requires prompt investigation and treatment, and probably a consultation with a specialist. Certainly if the condition is not responding within a few weeks to conservative treatment.

Arm pain?

Another cause of pain running down the arm is a subluxated first rib deep in the neck. It may cause what is known as a Thoracic Outlet Syndrome.

If it's the rib on the left side, then it may mimic a heart condition, with pain in the neck which radiates down the left arm.

What I always remind my patients is that before you get pneumonia, it all starts with a cold. Neglected and you will get bronchitis, then pleurisy and finally a good dose of pneumonia. Life threatening. An ounce of prevention when you are at the cold and flu stage makes good sense.

It's frightening how quickly a grade I head neck pain can progress to grade II and III when neglected. A sure sign that it is getting worse is increasing tingling, numbness or pain in the arm, and particularly if placing your hand on your head relieves the pain in your arm.

FROM THE COALFACE

A Mr S. consulted me about six weeks ago with head neck pain that turned out to be a Thoracic Outlet Syndrome. It started a year earlier whilst on holiday in Italy, perhaps after playing tennis which he hadn't done for some years. In the left arm, possibly from throwing the ball up to serve. This action requires use of the neck muscles, raising the arm, collar bone and first rib.

Severe pain in the chest, neck and left arm began in the middle of the night and, assuming the worst, they rushed off to the nearest hospital. A nightmare - they were on holiday in Florence.

Extensive heart tests, both that night, and after he returned to Holland revealed nothing amiss with his heart. Unfortunately, nobody considered a musculo-skeletal cause of the pain, or did Adson's Test, the classic orthopaedic test for TOS. The pain continued to plague him on and off, particularly with tingling in the arm at night, which would waken him. Twice more his wife rushed him off to the hospital in the middle of the night. A stent was mooted even though nothing specifically wrong with his heart could be found.

Why chest pain? The ribs attach posteriorally to the spine, but in the front they articulate with the breast bone. A dysfunctional rib may also cause pain in the front of the chest. Nevertheless obviously it is important to rule out at heart attack first. Do you know the classic signs of a heart attack? For more interesting cases from the Chiropractic Coalface, click here.

Yesterday, after only five treatments he was bemoaning the fact that he had suffered from this condition for over a year, yet chiropractic had fixed it so quickly. In fact, after the first treatment it was already 80% better. Miracles we do at once, the impossible takes a little longer!

Some understanding of the anatomy of the cervical spine may be useful.

HEADACHE

Some 80% of headaches are reckoned to be 'tension headache'. This is not from stress / tension, but tension of the meninges surrounding the neck and brain.

The most usual cause is a subluxation in the upper neck, or tension in the neck muscles, for example of long periods of studying with the neck flexed.

Another rare cause is meningitis. High temperature, stiff neck and a headache. Straight to hospital. If you are taking more than half a dozen analgesics per week then it is definitely time to consider chiropractic treatment. Remember that 'Rebound headaches' are caused by over-dosing with painkillers. The pills you are taking may actually be causing your headaches! Read more about Rebound Headaches.

Probably 10-20% of my day is taken up with patients suffering from headaches. Chiropractic manages headaches particularly well.

WHIPLASH

Whiplash is pooh-poohed in many medical and insurance circles, but after nearly thirty years in practice, I have come to the conclusion that not many people escape completely unscathed from a car accident. I am personally one of the lucky ones. I was hit from the side (the worst) some twenty years ago, and I have absolutely no problems. Perhaps because I was treated promptly by a colleague, and so didn't develop Immobilisation Arthritis.

I treat many, many people with neck pain and headaches. On questioning, we realise that most can trace the condition back to a whiplash that apparently caused no injury.

It remained pure mystery how a whiplash that caused no obvious injury could years later prove to be the source of the pain. That was until research proved that Immobilisation Arthritis was the nigger in the woodpile, excuse the expression. I'm no racist!

It's now been proved: FIXATIONS CAUSE ARTHRITIS.

STROKE

Chiropractic periodically gets bad press when a patient has a stroke after treatment. The recent case occured 17 days after the treatment! Another that gained wide publicity, on investigation, proved that the chiropractic treated only the patient's foot!

The chiropractic adjustment is probably the safest medical procedure in the treatment of head neck pain. There are one in two million manipulations serious mishaps after neck adjustments. Statistically you are more likely to be struck by lightning on the golfcourse than have a stroke after a chiropractic adjustment. Read what the latest research on stroke proves.

Popular story teller, chiropractor Bernard Preston, tells of his brush with STROKE.

TEMPERO-MANDIBULAR-JOINT (TMJ) pain.

The TMJ is a major cause of head and face pain. It's a very complex joint, so this next very interesting, but perhaps difficult page will certainly give you some insights, if you think you may have this problem. Clicking sounds in the jaw and pain just in front of the ear and the muscles around the jaw are the cardinal signs. For more info about the TMJ, click here.

Meantime you might be interested in these little exercises if you suspect your head neck pain is coming from your jaw, or if you are experiencing jaw joint pain. The TMJ is a common cause of head neck pain.

SHOULDER PAIN

The neck and shoulder are intimately connected, not only because they share muscles and bones, but because the nerves that innervate the shoulder come from the neck. For more about shoulder pain, click here.

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