The cervical spine is one of the key links in the kinetic chain of physical motion. It controls head movement and, therefore, a person’s ability to direct his or her organs

of sensation. When bone, muscles, or nerves of the neck region are damaged, activities ranging from sedentary to record-setting are disrupted.

What causes Cervical spine pain?

The posterior aspect of the cervical vertebral articulation contains the facet joints, which are true synovial joints, while a bony lip off the lateral margin of the upper vertebral body forms the uncovertebral joint with the vertebra below. Both joints are subject to degenerative changes that may produce pain with cervical extension combined with lateral bending and rotation. Hypertrophy of these joints may affect the surrounding anatomic structures, including the spinal cord, nerve roots, and exiting spinal nerves, as well as the vertebral artery and the sympathetic rami.

Muscles of the neck are divided into four major compartments: anterior (flexion), posterior (extension), and the lateral groups (lateral bending). The posterior muscles are the strongest group and most likely to be the source of pain in conditions resulting from poor posture, in which these muscles are chronically contracting to hold the head upright. The weaker anterior and lateral muscles are involved more in whiplash type injuries in which they stretch suddenly.

Management

Management of neck pain is divided into three phases: acute (immediate), recovery (rehabilitation), and maintenance.

In the acute phase, the goal is to minimise pain and inflammation. Initial treatment of acute injuries consists of a 4- to 6-Day course of nonsteroidal anti-inflammatory drugs (NSAIDs) and frequent self-administered ice packs to the painful area for 20 to 30 minutes. The patient should discontinue activities that aggravate symptoms.

Manual therapy can be a valuable empiric adjunct to other measures during both the acute and recovery phases of treatment. Whether high-velocity manipulation, passive mobilization, the athlete may find that pain decreases and range of motion improves faster with manual therapy.

Recovery

As pain and inflammation are being controlled, the athlete is advanced to the recovery phase of rehabilitation, where the goal is to recover lost function. Physio is appropriate for any athlete who has acute neck pain and is slow to recover, or for a patient who has chronic neck symptoms but has never had a thorough physio evaluation and treatment.

The patient should also work on aerobic conditioning during the acute and recovery phases because maintaining overall fitness will facilitate return to activities. Aerobic exercise can include stationary biking, brisk walking, using a stair-climbing machine, or some other nonimpact activity.

Returning to Activity

Few things are more frustrating for an athlete than to be out of sports because of an injury, but one of them is reinjury as a result of a premature return. To minimize the chance of reinjury, the athlete is promoted to the maintenance phase of rehabilitation only after certain criteria have been met. The goal in this phase is to ensure a graduated return to sports while maintaining the gains made during the recovery phase.

The athlete should resume his or her sport at a level or intensity that allows pain-free participation, then increase the time, distance, weight, number of throws, etc, by approximately 10% each week. If the patient’s symptoms return at any point, he or she must drop back to the previous pain-free level and continue working on strength, flexibility, and good mechanics before attempting to advance. A qualified coach can be invaluable in helping many athletes develop proper technique, which will facilitate injury-free participation.