(Keywords: neck pain anatomy, atlanto axial joint anatomy, chiropractic HELP, atlanto occipital joint, why do we hiccup, slipped disk)
This page will help you understand the complexity of the neck. It is no simple organ. Cervical spine conditions are so common because of the extreme complexity and sensitivity of the many structures in the neck. This brief survey highlights the exquisite construction of the neck, explaining why a painful neck is so common.
The heavy skull and brain are precariously balanced on seven highly complexly engineered and exquisitely made neck bones or vertebrae, each a possible source of neck pain. The cervical spine starts just below the skull and ends just above the shoulder. It normally has a lordotic curve (a backward C-shape) which, if altered by injury, almost always is associated with chronic neck pain. The cervical spine is much more mobile than both of the other spinal regions - think about all the directions and angles you can turn your neck, normally without any painful neck.
The structure is tightly bound together by discs, ligaments and muscles, all potential sources of neck pain.
Not so tight though that it cannot move. 33 joints make the neck highly mobile, though each may be a source of the common painful neck.
Though the cervical spine is very flexible, it is also very much at risk for injury from powerful, sudden movements, such as whiplash type injuries and falls.
This high risk of harm is due to: the limited muscle support that exists in the neck, and because this part of the spine has to support the weight of the head.
This is a lot of weight for a small, thin set of bones and soft tissues to bear. Therefore, sudden, strong head movement can cause damage.
Horse riders and gymnasts, boxers and rugby players almost always have injuries in this region causing a painful neck.
Through the neck travel the most exquisitely sensitive pain structures in the body: the spinal cord and nerves emerging to supply various parts of the body, particularly the arms and scalp.
They are very prone to injury by stretching, as in whiplash, by pinching by facet joints, uncovertebral joints, disc joints and other conditions such as tumours, aneurisms etc.
The BONES, known as vertebrae
Two vertebrae in the cervical spine, the atlas and the axis, differ in their neck pain anatomy from the other vertebrae because they are designed specifically for rotation. These two vertebrae are what allow your neck to rotate in so many directions, including looking to the side. Because of their proximity to the brainstem and the spinal cord, any injury, fracture, displacement, or fixation (jamming) has the potential to cause severe neck pain, headache and a host of neurological conditions. Car accidents, falls, blows to the head commonly injure this part of the spine. The Hangman’s knot is specifically designed to fracture the axis, and rupture the spinal cord. Hence the so-called ‘Hangman’s fracture’, found in serious accidents.
The atlas is the first cervical vertebra -- the bone that sits between the skull and the rest of spine. The atlas does not have a vertebral body, being made up of a complex ring. The atlas sits on top of the second cervical vertebra -- the axis. The axis has a bony knob called the odontoid process, also known as the the dens that sticks up through the hole in the atlas. It is this special arrangement that allows the head to rotate so far from side to side. Special ligaments between these two vertebrae allow a great deal of rotation to occur between the two bones.
Seven delicate and highly complexly engineered vertebrae make up the bony structure of the neck pain anatomy, cushioned by the "inter-vertebral disc".
The black arrow shows where the so-called "hangman's fracture" occurs - through the pedical on both sides. This is also caused by the head hitting the dashboard in a headon collision. One more reason to use a safety belt. Research shows that in most suidicidal hangings there isn't sufficient drop to fracture the pedicles, and the victim dies a horrible prolonged death by asphyxiation.
Notice in this X-ray below how a short leg, giving a tilted pelvis and a scoliosis, goes all the way up into the neck. New research suggests that a heel lift to correct a leg length inequality may also help neck pain.
Joints in the neck.
There are 33 tiny joints between the bones of the neck and between the neck and the skull. The bones are separated by discs, made up of concentric circles of fibrous material with a bubble of gel in the centre, acting as shock absorbers for the all bouncing, jogging, jumping movements of the neck.
There are several different types of joints in neck pain anatomy. Disc joints, facet joints, unco vertebral joints, and some other highly specialised joints in the upper neck, but they all have one thing in common: important nerves, the most sensitive tissue in the body, travel close by.
Any injury, swelling, strain and sprain has the immediate potential to affect the nerves traveling to the neck, shoulder, arm, head and the whole body, causing pain, headache, tingling and dysfunction of the organs they supply.
What's more, the sensory nucleus of the nerve to the jaw joint is
located in the upper neck. Thus jaw and neck pain are often intimately
related, and to be jointly and separately addressed in teh management of
facial, neck, and jaw joint pain.
TMJ ANATOMY ...
Why do we hiccup ? Hiccuping is a reflex contraction of the Diaphragm muscle, causing a sudden intake of breath that snaps the epiglottis closed. A hic. Irritation of the Phrenic nerve roots (C3-C4-C5), the nerve itself or one of the tissues supplied by the Phrenic nerve are the usual causes. Read more …WHY DO WE HICCUP ?
The so-called brachial plexus is a large group of nerves that emerge from tiny foramena in the neck. They travel to and from the arms, as explained in neck pain anatomy, where they initiate muscle action (eg picking up a sandwich) and sense changes at the skin. Cold, hot, touch, vibration etc. They also tell the brain where the hand is in space for example, without your eyes having to look.
Between each pair of spinal bones is a large disc. It consists
of two parts, an outer washer made of very tough fibres and an inner
bubble of gel which is like a large shock absorber. whilst reading about
neck pain anatomy I feel sure you have heard of the so-called
in which the gel has bulged out through the surrounding washer. it may cause for example very specific pain, numbness and tingling in fingers one and two ...
Frank pinching of these nerves may cause severe pain and disability in the arm, but even irritation of the nerve roots will cause shoulder pain, and make one prone to other conditions in the lower arm:
The neck is stabilised in the upright position by MANY very strong ligaments, that stretch from bone to bone maintaining the correct structure and preventing a painful neck. Some are tiny, for example the ligaments holding the ring of the atlas in position, whilst others are very large and strong. They are a very important part of neck pain anatomy.
Ligaments are highly innervated, so that the brain will know where the neck is in space whilst the eyes are closed. Any excessive stretching of ligaments, as in whiplash will cause these nerves to fire off, giving pain. If the ligaments are stretched beyond their elastic limits then important changes in the posture of the neck, and the position of the bones will occur, causing further neck pain.
In the normal neck, the curve is known as a lordosis. After a whiplash, the curve is reversed, producing a kyphosis. My take on neck pain anatomy is that Kyphosis = Pain.
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Painful neck can originate in the muscles of the neck. The head and neck are able to move because of muscles that control and initiate the movements. Looking up at the ceiling, checking under your bed for your shoes, looking for traffic as you cross the street - all these movements are controlled by muscles. There are also stabilising muscles whose primary function to maintain the neck in the upright position.
Muscles were designed to move. Even maintaining a healthy muscle in the same position for a long period of time (eg sitting in front of a computer, driving a car, or lying on the stomach all night with the head turned) will cause fatigue and neck pain.
There are many large and tiny muscles in the neck, each a source of neck pain anatomy.
I found a page that will give you a simple test that you can do find out how strong your neck muscles are, and some really quite profound neck exercises: JULLS TEST ...
Manipulation of the neck has recently received strong condemnation from Chiropratic's critics as being highly dangerous and can cause a stroke. While this is acknowledged, it is so rare that it can largely be ignored (approximately equivalent to being struck by lightning on the golf course).
What our critics conveniently ignore is just how much more dangerous anti inflammatory drugs and analgesics are. All forms of treatment of any and every condition have potential dangers it should be candidly admitted, and in this regard chiropractic is no different.
I hope NECK PAIN ANATOMY has given you some idea of the complexity of your neck.
We haven't forgotten you, Maureen. One of those very special people. She was one of the 14,000 Americans who die every year from a bleeding ulcer, directly caused by anti inflammatory drugs. That's medicine's own research figure.
Any very sudden, traumatic jolt to the head and neck has the potential to injury all of these structures. That could be when the body suddenly stops, but your head keeps going (as when a car hits a tree), or when something smashes into your head.
This week it was young woman whose head was very forcibly struck by a water ski, last week a child kicked on the head and neck by a horse, every week car accidents, old and new. Falls from a horse, sport, bicycles... all need to be carefully managed, otherwise Immobilisation Arthritis and irritation of nerves almost invariably occurs.
DANGERS OF ANTI INFLAMMATORIES
Go to Kidney.org and see what drugs can do to your organs: http://www.kidney.org/atoz/atozItem.cfm?id=145
Tip: Especially don't take medication before your consultation with your chiropractor. Deaden the pain and you may confuse him/her. It's far more difficult to diagnose and assess the problem of the drugged patient.
An apparently insoluble neck problem?
It's not often that I rave about a commercially available product. However there is no doubt whatsoever that She-who-must-be-obeyed needs less than half the amount of chiropractic help since I bought her a Posturite, quite expensive, worth every cent.
Notice too the small 3 watt LED lamp. We are rapidly changing over to LEDs. Requiring extremely little energy, a fifteen year warranty on the globes, they will quite soon be the only globes available. Solar power generator ...
IMPORTANT CONSIDERATIONS @ Neck Pain Anatomy
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.