The Cervical Spine (neck)

The cervical spine is made up of the upper first seven vertebrae in the spine. It starts below the skull and ends above the thoracic spine – mid-back and shoulders. The cervical spine has a lordotic curve, backward

C-shaped like the lumbar spine, and is much more mobile than the thoracic and lumbar spine.

 

Unlike the rest of the spine, there are openings on each side of the 6th to 1st cervical vertebrae for the vertebral arteries which carry blood away from the heart to the lower and rear parts of the brain. The upper two vertebrae in the cervical spine, the atlas and the axis, differ from all other vertebrae. The ‘upper neck complex’ provides approximately 50% of the overall rotation of the cervical spine.

 

The atlas is the first cervical vertebra. It is located between the skull and the rest of the spine. It is like a ring, unlike all other vertebrae, it does not have a vertebral body, but a thick forward (anterior) arch and a thinner back (posterior) arch with two prominent sideways masses.

 

The atlas sits on top of the second cervical vertebra - the axis. The axis has a bony peg called the odontoid process at the front, which reaches through the centre hole in the atlas. It is this special arrangement that allows the head to turn from side to side as far as it can. Specific ligaments between the atlas and the axis and the head guarantee a stable position of the atlas on the axis during rotation.

 

The head weighs approximately 5.5 to 6.5 kg and is balanced on top of the atlas at the top of the spine. Since there is relatively limited muscle support in the cervical area, it is like most very flexible joints at risk of injuries from strong, sudden movements, such as ‘whiplash-type’ injuries. Sudden, strong head movements can cause damage to the muscles, ligaments, nerves, bones or even the arteries that carry blood to the brain.

Neck pain or a stiff neck are extremely common and can affect life in many ways.  Whether it is sharp neck pain on movement, constant dull muscular ache, headaches, or an inability to fully move the head, neck problems can be very frustrating. It is essential to make an accurate diagnosis of the cause of neck dysfunction and pain so that appropriate treatment can be explicitly directed towards the condition.

 

Neck pain and joint stiffness 

Neck joints, so as all other joints, can gradually become stiff as a result of progressive degeneration (osteoarthrosis). This will lead to some muscle tightness and weakness over a period of time but will not necessarily be painful.

Sometimes, often as a result of a trauma, joints can also suddenly feel ‘locked’. The exact cause of this clinical phenomenon is unclear. Protective muscle spasm of certain neck and shoulder girdle muscles and ‘weakness’ of other regional muscles is the almost immediate response of the nervous system. The longer this condition exists, the more areas will be affected and the harder it is to reverse the pattern. Postural change and altered movement patterns will establish themselves, and ultimately a chronically sore neck may develop. Chronic conditions often require a combination of different treatment techniques to achieve lasting improvement or alleviation of the symptoms.

 

Neck-related headaches

A neck-related headache, or cervicogenic headache, is a secondary headache disorder. In other words, the headache is caused by a neck problem. The good news is that by fixing the neck problem, the headache can often be alleviated. Researchers assert that cervicogenic headaches account for approximately 20% of all headaches seen clinically. A thorough clinical examination usually allows determining whether the cervical spine is the likely cause of the headache. 

 

Causes of neck-related headaches

Cervicogenic headaches can originate from a variety of neuromusculoskeletal structures. Clinically, however, dysfunctions are most commonly found within the upper three cervical segments. Dysfunction within the 'upper neck complex' can trigger pain signals that travel to the trigeminocervical nucleus (TCN) in the lower brainstem. This information is then transmitted to the brain, where it is interpreted as a headache.

 

Typical symptoms of neck-related headaches

Cervicogenic headaches can often be confused with other types of headaches. Tension-type headaches and migraines (without aura), for example, can affect the same areas as cervicogenic headaches. Cervicogenic headache sufferers will often report that their pain started in the neck. The top of the cervical spine and base of the skull will be tender, and neck stiffness and loss of movement is felt. Typically neck-related headaches affect one side only and the pain may be moderate to severe but not throbbing. Specific neck movements or postures can often trigger the typical pain. Ultimately a combination of Manual Therapy treatments, Dry Needling, behavioural changes and exercise should relieve cervicogenic headaches. 

 

Some of the above treatments can be considered as part of a treatment concept when treating tension-type headaches and some forms of migraine.

 

 

Pillows, neck pain and stiffness

Advice on pillows and mattresses is very involved. What is right for one person may not suit somebody else, which is why we see such a broad range of different products on offer. A proper mattress and pillow should at least be comfortable and offer support for the body to get a good night sleep. 

 

Facts are mattresses and pillows ‘work’ together. The same pillow will ‘work’ differently on another mattress. Someone that has no significant neck problems during the day but always wakes up with an achy and stiff neck likely has a bad pillow and/or mattress. Most quality pillows will gradually lose their support over time and should be replaced after approximately five years. Some lesser quality pillows may not be supportive or only remain supportive for a few months. Whether the pillow’s internal material is down, feather, foam, memory foam, rubber, latex or any other natural or synthetic product, they will all eventually disintegrate with time and use.