Neck pain and headaches
The Cervical Spine is intrically associated with the vestibular and occulomotor system and dysfunction of the neck can be associated with symptoms such as headache, dizziness, cervical vertigo, occulomotor problems and tinnitus type (ringing in ears). Below some common neck problems are described as well as some of the assessment and treatment protocols.
Our Physiotherapists at Back in Action Physio Whistler all have post graduate training and advanced manipulative therapy skills which gives them expertise in these problems. They are all Fellows of the Canadian Acadamy of Advanced Manipulative Physical Therapy. (FCAMT)
FACET JOINT PROBLEMS
These usually involve pain to one side of the neck which may or may not refer. Restriction to one side in rotation and/or side bending is present.
As the Physiotherapist assesses your neck they will have in mind that these joint restrictions can have an ‘opening’ or ‘closing’ pattern. Generally these conditions respond extremely well to joint mobilisations or occasionally manipulation. Neck muscles are assessed and specific local muscle control and strengthening may be needed. The physio may also prescribe occulomotor reflex patterning exercises, soft tissue massage, IMS (intramuscular stimuation) or dry needling, and exercises for scapula and pelvic symmetry. Additionally, thoracic joint and rib movements usually require assessment for inferior lateral respiratory excursion as well as scapulothoracic mobility. The serratus anterior and trapezius muscles generally require specific attention regarding scapula stability. It should be remembered that movement disturbances will create spasms in some muscles whilst weakness in others. In turn these altered muscle patterns place dysfunctional and asymmetrical loading on the joints.
CERVICAL VERTIGO & DIZZINESS
Vertigo can be from several causes, sometimes the neck is involved. The Physiotherapist can assess for neck involvement. Often this may occur as a result of a Whiplash injury.
‘Signs & Symptoms of Cervical Vertigo
‘spinning of the head’ rather than spinning of the person ,light headedness, tipsy feeling, (this is a consequence of ‘noise ‘ in the peripheral nervous system)
Usually worse in the morning and tappers during the day
Correlating symptoms of imbalance with neck dysfunction
Cervical vertigo is characterised by a feeling of unsteadiness when standing and walking rather than rotatory vertigo (Brandt 1991)
Accompanied by pain – occipital, temporal, temporomandibular to orbital or forehead region
Tenderness on neck palpation, sometimes dizziness/nausea on palpation of atlas (C1 vertebrae) (Scherer 1985)
Blurred vision, photophobia, direction-fixed, directional changing positional nystagmus, tinnitus, low frequency hearing loss
Correlating subjective findings (mechanism of onset, history of duration, frequency, area, and intensity) with physical and functional impairment is important in making a diagnosis and monitoring progression
The therapist may also use questionaires, neurological examination,balance testing, vertebral artery screening, occulomotor and visual testing and use of tests such as Dix – Hallpike manoeuvre for BPPV, to confirm the type of vertigo and the most appropriate treatment.
TREATMENT FOR CERVICAL VERTIGO/DIZZINESS
Essentially treatment involves normalization of joint movement, via mobilizing and /or manipulating techniques, normalizing muscle tone and recruitment with soft tissue techniques, muscle energy, dry needling and IMS (intramuscular stimulation). Then introduction of active recruitment exercises for control of posture and movement. Balance exercises, visual tracking exercises for occculomotor control and such exercises are also introduced as needed as well as graded return to actitivies, particularly those which bring on the symptoms.
Some studies that have shown Physiotherapy to be effective in the treatment of dizziness/vertigo are listed below.
Positive affects have been reported for manipulative treatments (Cronin 1997, Galm et al 1998; Hulse et al 2000)
Both acupuncture and manipulation reduced dizziness/vertigo, neck pain and improved head repositioning error (Heikkila et al 2000)
Postural training with a significant eye-neck coordination component (Revel et al 1994) and vestibular component (Yardley et al 1998) have been shown to improve posture and dizziness
Multimodal approach advocated (Bracher et al 2000)
Recruitment of deep cervical flexors in neutral head and shoulder position (Jull 2000)
Loss of cervical lordosis in chronic whiplash patients (Kristjansson & Jonsson 2003) due to weak deep cervical flexors of the upper cervical spine (Jull 2000) and deep cervical extensors of the lower cervical spine (Kristjansson 2005)
Revel et al (1994) conducted an 8 week eye-neck co-ordination exercise and awareness of movement with significant improvements in neck pain
NECK HEADACHES ( CERVICOGENIC HEADACHE)
Chronic neck and shoulder pain affects up to 18% of the population (Guez et al 2003). It has been estimated that up to one in five headaches are of musculoskeletal (neck or thoracic) origin (Jull et al 2007a). According to these researchers only 1/4 are due to trauma. These conditions are usually accompanied by pain and stiffness as well as impaired neck mobility. . Impairments have included a mismatch between efference copy and the afference weighting of information (Djupsjoebacka 2008) suggesting both peripheral and cortical processing affecting the chronicity of the dysfunction.