Characteristics

Terminology confusing
Pain generators
Non specific Neck Pain?
MRI Findings, X ray findings
Disc dynamics
Posture and neck pain
Assessment- Weinners cluster
Loss of lordosis
X ray bent and straight
Wieners cluster
Treatment
Sleeping, Pillow
Directional preference-
Sagittal -- retraction , extension,
Loaded, unloaded,
Frontal- Side flexion, loaded, unloaded
Improvement- Symptomatic, Mechanical, functional.
Other treatments
Maintenance.
“Every Patient contains a truth… The clinician must adopt a conscious
humility, not towards the patient, but towards the truth concealed within
the patient” (Cyriax 1982)
 Discogenic Arm and Neck
Pain

Rajkannan. P
Chief Physiotherapist- RMV Hospital,
Bangalore
Founder President- Dry Needling Association
Director- Apter Institute
 Neck Pain
Prevalence
Defined as Pain in the neck with or without pain referred into one or both
upper limbs that lasts for at least one day. (Wang, 2016)
 4th Leading cause of disability. (Hoy, 2014)
 10-20% of population experience neck pain at any given time. (Childs, 2008)
 50% of neck pain continue to experience pain in varying frequencies and
intensities.
 Lifetime prevalence 22-70%.
 73% of dentists complained of back and neck pain (Pargali, 2010)
 50-85% reoccurrence within 5 years.
 One of the top five reasons for chronic pain. Ranked 4 th highest in terms of
disability(Wang 2006)
 Considerable socio-economic burden
 Neck pain shall NOT be only in
the NECK and PAIN is NOT the
only symptom.
 Spasm , Catch, Stiffness, Pulling, Discomfort, feeling to get cracked.
 Burning, Tingling, Numbness, Paraesthesia, Swelling
 Neck, shoulder, upper back, arm, forearm, hand, mid back
 Ear pain, Tinnitus, Jaw pain, Nausea, Dizziness, Vomiting, Head ache,Chest pain,
Pain during breathing . (C1,C2 & C3)- UNCOMMON SYMPTOMS
 Pain in the neck radiating to the shoulder, elbow, forearm, wrist, hand- COMMON
 Pain can be constant/intermittent/ More at night/ More at early morning
 Activity dependent/varying severity/relapses and remission.

THE ONLY CONSISTENT SYMPTOM IS “VARIABLE SYMPTOMS”

 Diagnostic dilemma- No
Consensus
 Neck Sprain/ Neck Strain,
Muscle catch/spasm/tightness/weakness- Often the Patient’s
perception
 Cervical spondylitis/Spondylosis- Often the Orthopedicians
diagnosis
 Non specific neck pain/Mechanical Neck Pain- PHYSIO Diagnosis
 Diagnosis depend
Cervical disc bulge/prolapse/herniation/degeneration- MRIupon to
Diagnosis which doctor the patient goe
 Myofascial trigger points
 Fascial Densification/Tightness
 Pain Generators in the
NECK

All innervated structures and innervating nerves

can cause PAIN.
 Ligaments
 Facet Joints
 Capsule
 Muscle
 Fascia
 Disc
 Nerves
 Duramater
 Vertebra
No “GOLD STANDARD” Test exist
to isolate A Structure and
provocate it.

HENCE NAMED AS NON SPECIFIC

NECK PAIN, AS THERE IS NO ONE
CONCRETE IDENTIFYABLE
STRUCTURE BEING THE REASON
FOR PAIN.
 Can Disc Cause Neck Pain ?

 Disc is Aneural(inner nuclueus) and

Avascular.
 Outer annulus is innervated and more
innervated when diseased. (Neo
Innervation)
 Gets tremendous compression and
tensile stress every day.
 Close proximity to the duramater,
nerves.
 Diseased disc can grow new nerves
making it more sensitive.
 Disc independently cannot cause pain
unless it conflicts with a major nervous
 Dynamics of the Disc

 Nucleus Pulposis migrates : Posteriorly in flexion, Anteriorly in extension

 Majority of the disc bulges are posterior migration
 Majority of our functions are in flexion
 History of injury would be correlated with flexion stress
Importance Lordosis

Change of LOG

Loss of
Lordosis
Maintaining the Cervical and
Lumbar Lordosis is vital for Disc
Health
Why Secondary Curve is important?
 Maintains the normal load transmission.
 Minimal Disc and joint compression
 Less muscular effort.
 No nerve irritation

Cervical Kyphosis- A New

Term???
 Nervous Tissues are as
pervasive
As fascia

Mechanical Compression of the nerves can lead to

- Pain
- Stiffness, tightness, spasm due to excitatory
impulses.
- Sensory alterations
- Weakness
- Central Sensitization
- Nerve inflammation (Scarring – Adherent Nerve root)

All provocative test will be falsely positive

with sensitized nerves.
Posture and Disc Pathology