LET’S TALK ABOUT OUR NECK

BONES

There are seven cervical vertebrae, named C1 – C7, stacked one above the other. C1, also called Atlas, is the first of the cervical vertebrae and articulates with the base of the skull, which sits above it. C7 is the last of the cervical vertebrae and articulates with the first thoracic vertebra below. The cervical region of the spine has an “inwards” C-shaped curve called lordosis, which plays an important part in correctly supporting the weight of the head.

INTERVERTEBRAL DISCS

The intervertebral discs are located between the vertebrae. They provide cushioning, act as shock absorbers and along with the ligaments and muscles, they help to hold the vertebrae in place whilst still allowing movement. The discs have two main parts: the annulus fibrous is the outer portion of the disc made up of concentric layers of tough fibrous tissue. The nucleus pulposus is the gel-like inner structure of the disc.

MUSCLES

The muscles in the neck are responsible for creating movement and for promoting stability and can be referred to as deep or superficial. Generally speaking, the deep muscles are responsible for stabilising the neck whilst the superficial muscles are responsible for generating torque and providing range of motion. In the presence of pain, the function of the muscles is affected; the deep muscles are inhibited resulting in the loss of segmental control and poor posture, whereas the superficial muscles show increased levels of activation, producing pain and a limited range of motion.

MUSCLES

The muscles in the neck are responsible for creating movement and for promoting stability and can be referred to as deep or superficial. Generally speaking, the deep muscles are responsible for stabilising the neck whilst the superficial muscles are responsible for generating torque and providing range of motion. In the presence of pain, the function of the muscles is affected; the deep muscles are inhibited resulting in the loss of segmental control and poor posture, whereas the superficial muscles show increased levels of activation, producing pain and a limited range of motion.

JOINTS I

The cervical spine has a number of different joints, some are common to the whole spine whereas others are specific to the cervical section. The disc joints comprise the intervertebral discs which join the vertebral bodies of adjacent vertebrae. In the cervical spine, the disc joints total approximately 40% of the height allowing for an increased range of motion compared to other sections of the spine. The facet joints are formed between the superior and inferior articular processes of adjacent vertebrae and their main function is to limit and guide movement of the vertebral segment.

JOINTS II

The cervical spine has some unique joints that aren’t found in other sections of the spine. The atlanto-occipital joint is the articulation between the atlas and the base of the skull, it joins the occipital condyles with the articular processes of the atlas. The atlanto-axial joints join the atlas (C1) and the axis (C2) vertebra and are of two types; the medial atlanto-axial joint and the lateral atlanto-axial joints. The uncovertebral joints are located on each side of the four intervertebral discs between C3 and C7 and help in the formation of the anterior wall of the vertebral foramen.

LET’S TALK ABOUT OUR NECK

There are seven cervical vertebrae, named C1 – C7, stacked one above the other. C1, also called Atlas, is the first of the cervical vertebrae and articulates with the base of the skull, which sits above it. C7 is the last of the cervical vertebrae and articulates with the first thoracic vertebra below. The cervical region of the spine has an “inwards” C-shaped curve called lordosis, which plays an important part in correctly supporting the weight of the head.

The muscles in the neck are responsible for creating movement and for promoting stability and can be referred to as deep or superficial. Generally speaking, the deep muscles are responsible for stabilising the neck whilst the superficial muscles are responsible for generating torque and providing range of motion. In the presence of pain, the function of the muscles is affected; the deep muscles are inhibited resulting in the loss of segmental control and poor posture, whereas the superficial muscles show increased levels of activation, producing pain and a limited range of motion.

The spinal cord descends through the spinal canal of the vertebrae. Spinal nerves exit the spine through the vertebral foramen, between adjacent vertebrae. A pair of Spinal nerves emerge at each level of the vertebral column, one on each side. The nerve root refers to the initial segment of said nerves and consists of a dorsal (sensory) root and an anterior (motor) root, which then join forming the spinal nerve. Outside the vertebral column, the spinal nerves then branch out into different nerves that innervate different areas of the body.

The intervertebral discs are located between the vertebrae. They provide cushioning, act as shock absorbers and along with the ligaments and muscles, they help to hold the vertebrae in place whilst still allowing movement. The discs have two main parts: the annulus fibrous is the outer portion of the disc made up of concentric layers of tough fibrous tissue. The nucleus pulposus is the gel-like inner structure of the disc.

The cervical spine has a number of different joints, some are common to the whole spine whereas others are specific to the cervical section. The disc joints comprise the intervertebral discs which join the vertebral bodies of adjacent vertebrae. In the cervical spine, the disc joints total approximately 40% of the height allowing for an increased range of motion compared to other sections of the spine. The facet joints are formed between the superior and inferior articular processes of adjacent vertebrae and their main function is to limit and guide movement of the vertebral segment.

The cervical spine has some unique joints that aren’t found in other sections of the spine. The atlanto-occipital joint is the articulation between the atlas and the base of the skull, it joins the occipital condyles with the articular processes of the atlas. The atlanto-axial joints join the atlas (C1) and the axis (C2) vertebra and are of two types; the medial atlanto-axial joint and the lateral atlanto-axial joints. The uncovertebral joints are located on each side of the four intervertebral discs between C3 and C7 and help in the formation of the anterior wall of the vertebral foramen.

DOES YOUR NECK HURT?

Muscle strains are the most common cause of neck pain and occur when fibres in the muscles or tendons tear due to excessive mechanical stress. This can happen when a muscle is stretched too far, or due to a strong muscular contraction in a stretched position. Some causes of neck strain include: 1) poor posture or holding an awkward position such as when one sleeps on their stomach forcing the cervical spine into rotation, 2) traumatic injury due to a fall or collision such as a traffic accident, 3) overexertion or repetitive motions for example when lifting weights or practising sports.

Symptoms of neck strain include pain, stiffness and limited range of movement amongst others and can last anywhere from a few days to several weeks, although in most cases symptoms tend to go away in less than a week.

Cervical osteoarthritis can also be referred to as cervical spondylosis and is a degenerative disorder that affects the cervical spine. It is a complex multicausal disease that affects many structures such as the vertebral bodies, the intervertebral discs and ligaments, the articular cartilage and the underlying bone. It can affect the whole cervical spine but most commonly affects the C5-C6 or C6-C7 joints. It is common in people above the age of 50 and rare in younger individuals. Incidence increases with age and women have a higher risk of developing this condition. Ageing, previous injury, repetitive mechanical stress, metabolic disorders… are all factors that can cause the different components of the spine to suffer degenerative changes. The intervertebral discs lose fluid and become stiffer, the articular cartilage wears away, osteophytes (bony spurs) form, ligaments become stiffer and the spinal cord and nerves may be compressed.

Symptoms include pain that can worsen with movement and which is usually located around the affected joints, stiffness, crepitus (grinding sensation), limited range of movement, and neurological symptoms if the spinal cord or nerves are affected.

A whiplash injury is caused by an abrupt acceleration/deceleration movement of the cervical spine, muscles and supporting tissues, and usually happens as the result of a traffic accident. Symptoms include neck pain, shoulder pain or pain between the shoulder blades, headaches, dizziness, neck stiffness, irritability and fatigue, and neurological symptoms, especially in the arm or hand. The symptoms might not appear immediately but may develop over the next few days following the accident. The evolution of the condition is unpredictable; some cases make a full recovery whereas others become chronic with long-term pain and disability.

Cervical fractures usually result from high-energy trauma with traffic accidents being the most common cause, followed by diving into shallow water and sports injuries. Any of the vertebral segments making up the cervical spine can be affected with outcome and symptoms being highly dependent on the location of the injury and on the presence of other associated injuries, like that of the spinal cord.

A herniated disc occurs when the inner nucleus pulposus of the intervertebral disc pushes out against a weakened annulus fibrous and causes a bulge or altogether breaks through. The herniated disc can then compress nerve roots causing radiculopathy or can invade and narrow the spinal canal causing spinal stenosis. Symptoms will depend on where the disk has herniated but can include an intermittent or continuous pain in the neck, shoulder and/or arm, muscle spasms, numbness and tingling sensation in the arm or hand amongst other symptoms.

Neck pain with no known cause is referred to as non-specific. It usually disappears within a few days or weeks but in some cases can become chronic. Since a specific cause for the pain cannot be identified treatment options are quite general.