Chronic Neck Pain

After 3-4 weeks of pain with an injury or ongoing neck pain beyond 1 month, the condition is considered chronic. Chronic neck pain may result from improper treatment in the early stages of a neck injury or a condition that persists for months or years.

To examine how a neck condition becomes chronic, we must start with the initial stage. An acute condition results from injury and lasts from a few days to a week depending upon the severity. If we take a whiplash neck injury as an example, the initial trauma causes damage to the muscles, tendons and ligaments. Ligaments connect bone to bone and are important to maintain joint stability. Tendons are found at the end of muscles and connect muscle to bone. Muscles contract and pull on tendons to create movement.

Sprains and strains refer to damage of the muscles, ligaments and tendons. A mild strain (muscle) may heal quickly, whereas a sprain (ligaments) may take longer to heal.

In a whiplash neck injury, there is damage to the muscles and ligaments; inflammation occurs as blood flows into the injured area and it becomes warm to the touch as it swells with blood and tissue fluids. The blood brings in white blood cells to clean up dead tissue and fight infection which is often responsible for feeling like one has the flu after an injury of this type.

Inflammation is an important part of the healing process, however, as muscles, ligaments and tendons tear, the blood and fluids block normal circulation and prevents motion. Additionally, as the tissues stretch, the bones can become slightly out of place and not set back evenly which may continue when the inflammation is gone and cause a more chronic pain and weakness.

It is important to reduce inflammation as quickly as possible to restore motion. Muscle atrophy (wasting) begins after only a few days and when prolonged, leads to weakness which may progress to a chronic state of inflammation, atrophy, pain, weakness and repeated injury. This is often seen with long term damage as in poor posture or repetitive type injuries.

By moving the muscles, tendons and ligaments, we may significantly reduce joint stiffness and weakness, increase circulation to the area to assist the body in cleansing and healing the area and help to correct muscle imbalance.

Initially, rest is recommended to decrease activity which may cause further damage. A soft neck brace or neck collar helps with this. Ice is recommended to help reduce inflammation by restricting blood flow to the injured area along with anti-inflammatory medications when not contraindicated.

Anti-inflammatory medications pose a risk of complications, so that leaves ice to reduce the inflammation. Unfortunately, many people do not like ice on their neck. Personally, I fall into this category and I have found many patients do not follow instructions for icing the neck to reduce inflammation and help to prevent a chronic condition. Icing the neck may feel good on a hot summer day, but injury has no season and the cold may cause muscle spasm. This muscle spasm or contracting can decrease local blood flow causing blood stasis and obstruction which can slow the healing process and prolongs the return of normal motion.

Fortunately, there are some alternatives to ice which can help to reduce inflammation and restore normal circulation, helping to heal the neck quickly and reduce the risk of chronic pain. There are healing herbs which can help to reduce pain and restore normal circulation. These herbs can be taken internally and applied topically and are very effective and safe when used as directed. These healing herbs can help to reduce swelling and inflammation, alleviate pain and restore normal circulation quickly, without any of the negative effects produced by icing.

In a more severe injury or in chronic, the disruption of normal circulation is greater causing more stagnation of Qi(Energy) and blood. The stagnant blood becomes trapped in spaces between layers of tissue and, over time, glues the tissues together creating adhesions. The adhesions stick and catch restricting motion and causing neck pain. If the damaged area is not cleared, the area never feels quite right and become sensitive to cold and damp weather and eventually begin to degenerate as the body attempts to stabilize the area.

In Chinese medical terms, the area developes a chronic obstruction of energy in a joint or muscle. If normal circulation is not restored, the body cannot repair itself. Adhesions form which limit motion and causing a low level inflammation. In repeated injury and/or chronic inflammation, scar tissue forms. Ongoing inflammation may cause calcium deposits in muscles, tendons and joints which create more inflammation and a chronic neck pain cycle as seen with bursitis and tendonitis.

Additionally, neuroimaging has shown chronic pain is related to regions in the brain for cognition and emotions, therefore, it is important to address any emotional problems that may be related to chronic pain as a multifactoral approach. Furthermore, certain nutritional supplements may benefit chronic pain individuals with multiple symptoms as discussed in the fibromyalgia article

Considering the progression from acute to chronic neck pain, it is vitally imprtant to treat any injury as soon as possible to prevent this type of obstruction and chronic neck pain. Once chronic pain has developed, ongoing inflammation is perpetuated by poor neck posture at work and when sleeping contributing to a repetitive type injury. Stopping the cycle of inflammation is necessary by correcting this poor posture using neck supports, ergonomics and neck pillows, removing specific irritation with neck traction, using healing herbs to reduce pain and inflammation, along with specific neck exercises. This type of approach can help to break the pain - inflammation cycle, promote healing and help resolve long-standing chronic neck pain.