Every second person struggles with neck problems. Anyone who does not eliminate the causes of these in the long term faces the risk of permanent damage. What warning signs you should pay attention to – and how to relieve acute neck pain, explains orthopedist Frank Jörder in the FOCUS online interview.
Only when the neck hurts badly, every turn of the head hurts or the neck cannot be moved properly at all, does it become clear that we actually need our neck all the time. In addition, a number of other signs come into question when talking about neck problems.
The pain can radiate to one or both shoulders, affect the arm, and extend to the fingers. At the same time, headaches may appear. The localization can also be very different. Because not everyone who complains of neck pain means the same part of the body.
Experience shows “that this can mean the entire area between the transition from the top of the skull to the cervical spine, down to the shoulder region,” reports Frank Jörder. He is a specialist in orthopedics and trauma surgery and director of the German Society for Musculoskeletal Medicine (DGMSM).
Symptoms can be triggered by a variety of factors, such as
Emotional stress can lead to neck problems because we involuntarily tense the muscles in this area and instinctively duck our heads when we are stressed. Constant stress leads to a shortening of the ligaments and muscles such as the trapezius muscle. This extended muscle extends in a trapezoid shape (hence the name) from the base of the cervical spine over the shoulders to the end of the thoracic spine. If it is tense and shortens, the intervertebral discs are pressed together and wear out prematurely – with the well-known consequences.
“When it comes to the causes, we differentiate between the nocigenerator, i.e. the structure that triggers the pain – muscle, joint, nerve – and dysfunction, i.e. the triggering mechanism behind it, such as a bad posture or a herniated disc,” explains the expert.
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Blame for problems in the neck area are by far the most common “bad posture and strain that has existed for years, as can be caused by sitting at a desk for a long time and working on the computer,” says Frank Jörder in an interview with FOCUS Online. The rigid, forward-facing posture causes tendons and muscles to change over time.
The trapezius muscle, which has to hold our shoulder blades in place, freezes, so to speak, when we sit for hours. Because the load is extremely heavy. For comparison: If we squat for five minutes, our thighs will burn afterwards. Everyone knows that. “However, if we tense the trapezius muscle for eight hours at a time in order to be able to hold our shoulder blades because we work at a desk, this also means massive strain and it is not surprising if the neck and shoulders are tense in the evening,” warns the orthopedist.
In the long run, the muscles and ligaments adapt to the bad posture, which in turn reinforces the bad posture, forming a vicious circle. These changes also affect vertebrae and intervertebral discs. The structures change, a herniated disc is possible.
A simple example given by the orthopaedist shows just how severe these limitations can be: You sit in front of the computer, push your head forward and look straight ahead at the screen. In this pose, try rotating the HSW. Your range of motion will be significantly reduced compared to when you keep your head and neck straight and sit up straight.
Tension and the resulting structural changes in the neck and shoulder area are by far the most common triggers for restricted mobility and pain in this area. But sometimes, albeit very rarely, serious and sometimes even life-threatening causes can be behind it. “The doctor is required here,” warns Jörder. Pain that occurs high up in the cervical spine, where it connects to the skull, may indicate processes in the posterior fossa, such as bleeding, the doctor said.
In addition to this high-seated head and neck pain, other complaints can also indicate a serious background.
1. Radiating complaints: In addition to the neck problems, the arms and hands are affected. Pain and sensory disturbances, tingling in arms and hands. This indicates that a nerve is being compressed, for example by a herniated disc. If the pressure on the nerve is not relieved, it can eventually die off over time. The index finger and thumb become numb particularly frequently, which indicates a disc problem in the C6 cervical vertebrae area. If, on the other hand, the little finger falls asleep, it can often be a problem in the shoulder girdle that is not so serious.
2. Limited mobility: The cervical spine can only be moved to a limited extent in any direction. The neck can therefore neither be moved properly to the right, nor to the left, up and down. “This is something completely different from the classic blockage, in which one direction of movement remains free, and can indicate structural lesions that can range from massive joint inflammation to a vertebral fracture,” explains the expert.
The two groups of symptoms listed should be clarified as soon as possible by a specialist. If the symptoms are not quite as pronounced, if the restriction of movement only affects one side, a doctor is usually not necessary. The symptoms often go away on their own after a few days. If they persist after three to five days, you should see a doctor.
The self-healing process can be supported with warmth and gentle movement. This means, for example, putting a hot water bottle on the neck or using a heat patch. However, if the nerve is irritated, heat can have a counterproductive effect.
Movement makes sense in order not to increase the tension. Important here: Do not move into the pain, but light, relaxing movement patterns make sense, such as going for a brisk walk, perhaps swinging your arms a bit, moving your head gently and slowly back and forth – only up to the point of pain, not beyond.
A detailed anamnesis gives the doctor important information: When did the impairment first appear, have you had it before, was there a trigger, a trauma? This is followed by the manual examination with a test of mobility, sensitivity, palpation of the spine, shoulders, arms and hands.
Imaging procedures such as X-rays are usually only announced if one of the alarm signs has occurred.
The treatment of neck pain depends on the diagnosis, i.e. the trigger. Surgery is rarely required. “They are important when the nerve is under such pressure that there is a risk of permanent paralysis,” explains the orthopaedist. The operation then ensures that the nerve is relieved and permanent damage is prevented.
“In 95 percent of cases, conservative treatment is the right way,” says Frank Jörder. His main concern is not to focus on the pain, but rather to help the patient to get back to everyday life as well as possible. Ultimately, regaining function is crucial.
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There are plenty of suggestions, from isometric exercises to gymnastics and stretching. Two aspects are particularly important:
1. The foundation, i.e. the upper thoracic spine and the transition to the cervical spine, must be kept mobile. As part of the bad posture caused by sitting for a long time and frozen in front of the computer, she is often bent forward and tense, the subject of a hunchback. Particularly important: Repeatedly intersperse small “upright” exercises, use an office chair with a backrest and the ergonomic design of the workplace in order to achieve the best possible sitting posture.
2. Train the front, deep neck muscles because they are weakened by the bad posture. The orthopaedist suggests the luge exercise, for example. Because luge athletes have to tense the front neck muscles extremely when lying on the sledge – the head must not sink backwards, otherwise it will slam onto the ice, but the head must not be held too high either, otherwise there will be too much air resistance.
And this is how the exercise works: Lie on your back, your legs are bent, if necessary a small pillow will support your neck. The back of the head, back and arms are in firm contact with the ground. Now take your chin towards your chest, but the back of your head should still be in contact with the ground. Raise your head just a few millimeters, open your mouth slightly and hold this tension for five to ten seconds.
The crux of the matter is regular practice. Often, after initial self-discipline, the “it’s better, I can let things slide” creeps in. But how can you make it clear that daily practice should become a habit? Frank Jörder reports how a colleague does it: The doctor asks his patient: “Are you breathing?” “Yes.” “You see, and that’s exactly how you have to do the exercises”.
Therapy, but also prevention, is ultimately any form of exercise – or at least almost any. Because some training overloads the cervical spine and is therefore not suitable. That’s breaststroke and all sports where you have to look up, like handball, volleyball, badminton and the like. Cycling is also rather unfavorable if the handlebars are adjusted far forward and low in a sporty way.
However, if the front neck muscles are well trained and there are no clear signs of wear and tear on the spine, these sports are also possible – if the thoracic spine is also flexible. If their mobility is restricted, such as with a hunched back, the movement required for sport is obtained from the lumbar spine or from the cervical spine.
Both mean overload for these areas. As is well known, problems in the so-called musculoskeletal system are not just limited to the spot where it hurts or where the restriction occurs. Because our joints, bones, muscles, tendons and fascia form a network together, one affects the other.
