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Back to Basics 2.

Osteopathy approach to the diagnosis and management of neck pain and headache

There are many causes of neck pain and headache, some of them coexist. In this post I will identify the different types and explain how an Osteopath might approach those that are within the realm of their skills. I put it this way because there are some causes of neck pain and headache that are outside the remit of manual therapy and it is the job of the Osteopath, first and foremost to identify if the patient is safe to treat and, if so, ask if Osteopathy is the right treatment.

Hence when you first visit the Osteopath you will go through a thorough consultation. You may be asked questions that at first glance may not appear to be relevant to your condition but this is part of the process. In order to safely and effectively treat neck pain, it is important to understand the underlying any medical condition that might be causing it. The Osteopath needs to be sure that the patient does not have a serious condition that will need referral to the GP and/or specialist.

Some of the issues that might make the Osteopath think twice about treatment include the type of pain, its duration and frequency. Any initiating causes like a car accident, a fall or head trauma might be cause for concern. As might dizziness, loss of balance or coordination, fainting, feeling sick and even vomiting. You might think that this would be obvious to the patient but sometimes it is not and the Osteopath has to be certain.

Electrical nerve-like pain, loss of sensation to the the skin of the arms and loss of power might indicate a nerve pathology that needs to be properly identified first.

After the consult there will be an examination and based on the signs and symptoms this might include some special testing for example of the nervous system or the cardiovascular systems.

Causes of acute neck pain:

The most common causes of neck pain, muscle, tendon and ligament issues, resolve fairly quickly though the after-effects can linger. Many cases of strain (muscle) and sprain (ligaments) result from some sort of overuse or over-extension from, for example:

  1. sustained inefficient posture

  2. sleeping in an awkward position

  3. repetitive movements and

  4. trauma like whiplash.

Causes of chronic neck pain:

When neck pain lasts or keeps coming back over a period of months and even years, it is typically due to a reaction to some sort of spinal degeneration from wear and tear over time (also called cervical spondylosis)

  1. degenerative disc disease

  2. osteoarthritis of the little joints of the vertebra

  3. herniated disc

These conditions do not have to be causes of pain but the restriction in movement can itself become pains as muscles, tendons and ligaments have to work differently, sometimes harder.

As the degeneration progresses there is an increased risk for a narrowing of the canals through which spinal nerves travel or of the central canal down which the spinal cord travels. If the nerve is impinged one can get symptoms of pain, tingling, numbness and weak ness in the arms. If the canal becomes narrowed and the cord in compressed symptoms can become much more serious including changes to bladder and bowel control.

There are other causes of neck pain which include:

  1. emotional stress

  2. infection

  3. myofascial pain syndrome

  4. fibromyalgia

  5. spinal tumour

  6. spondylolysthesis ( a slippage forward of a spinal vertebra

Besides the above. most of which are technical, physical causes, the following are also considered causative though more research is needed in some of these.

  1. weak neck muscles

  2. previous history of neck problems

  3. head and shoulder posture

  4. smoking

  5. occupations that is physically hard work

  6. being female

  7. feelings of poor social support

As can be seen from the above there are physical, psychological and social aspects to neck pain and all of them have to be considered in the treatment. The approach is called the biopsychosocial model of treatment. The implication being that the hands-on work is not enough. The management of the patients opinions and emotions about the pain as well as their social circumstances all need to be addressed in order to get the best possible outcome. Although the Osteopath cannot ‘treat’ two of the three, the practitioner is in a position to make the patient aware of these factors, can ask questions and even suggest options for help in these areas.

The manual treatment of neck pain can include massage of the soft tissues, mobilisation of joints, including manipulations if indicated. Some Osteopaths may use acupuncture for pain relief. Stretching and strengthening can be recommended as well as the use of hot and cold therapy. Lifestyle changes and work place set-up are two other areas that can be considered in the management of neck pain and can help with prevention as well as lessening the symptoms if they do recur.

The treatment of neck pain is a cooperation between patient and Osteopath. The former understanding what is to be done and what is required of them when not at the clinic, the latter ensuring that the patient understands and agrees to the treatment approach and that consent for the approach is acknowledged.

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