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Neck Injuries
Written By : Bruce Kaler, MD 
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The neck is the connecting bridge between the spine and the brain, made up of seven boney vertebrae with cartilaginous disc pads that act as cushions in between each vertebra. As the neck supports the head it is relatively unprotected and vulnerable compared to the rest of the spine. Neck pain is very common but most of the time is a benign temporary condition.

Injuries most often affect the soft tissue muscles and ligaments. Larger traumatic forces can damage the discs between vertebrae or even the boney parts of the vertebra causing a more serious problem. Neck injuries are most commonly associated with motor vehicle accidents, contact sports, or a fall. Head, neck and shoulder injuries frequently occur together. Consulting a health care provider is prudent since determining the source of pain and symptoms can be difficult. Great care in initial treatment and diagnosis is necessary with the neck design of exceptional range of motion and important functions. Underlying problems of aging, overuse, degenerative changes and inflammation often make the neck even more vulnerable to injury and cloud the diagnostic process. Pain that does not subside with simple rest icing and over the counter anti-inflammatory needs further evaluation. Prompt consultation with a medical professional is important if you experience decreased range of motion of the neck, pain, numbness or weakness that radiates to the arms or legs.

The mechanism of injury should help focus the treating professional to the location of the problem. A thorough exam documenting the full extent of the symptom pattern will help dictate the treatment plan. With nerve root irritation in the acute phase, symptoms that radiate into the upper extremities, the source of the problem can be confusing requiring additional diagnostic testing. This may include, plain x-rays, magnetic resonating imaging (MRI) or a nerve conduction study (EMG). The EMG is helpful in verifying a pinched nerve and where along the nerve the pressure point is located. With an acute whiplash injury from a car accident or other trauma associated with pain numbness radiating down an arm, disk injury would be suspicious. These cartilaginous shock absorbers situated between each vertebra are vulnerable to twisting or severe flexion motions of the neck that are violent. This can cause a bulging, herniated disk as well as tear a disk. In either case, a portion of the disk it out of its normal position putting pressure on an adjacent nerve as it exits the spine. The pain and numbness will follow the path of the nerve branch. This is also known as the proverbial "pinched nerve".

Early diagnosis and intervention is always helpful. Understanding the full extent of the condition mild or severe provides great peace of mind as well as early initiation of treatment. Beyond the basics of treatment, other modalities may include physical therapy, chiropractic or acupuncture. Rest, gentle stretching, early mobilization within reason can help avoid stiffness and muscle atrophy compounding the original injury. Medications typically include an anti-inflammatory, muscle relaxant, and pain medicine. Physical therapy, which includes early gentle mobilization, home exercise program, and plan for transitional activities, is at the foundation of treatment. Chiropractic adjustment can also be helpful in many cases. Fortunately, only a small percentage of neck injuries require surgery. All modalities of conservative therapy are encouraged including guided imagery steroid injections and other medications for management of nerve related pain.

Accidents can be unpredictable and out of our control. Basic safety measures at home or in the workplace are paramount to injury prevention. The impact of overuse injuries can be reduced with thoughtful use of body mechanics. Maintaining general good health with special attention to good posture is foremost. Chronic weakness, poor posture without thought to ergonomics leads to repetitive motion injury. Take frequent breaks to change position, do simple stretches and restore good posture. Posture considerations include sleeping with the neck in a neutral or anatomic position, car or plane travel, working at a desk or rough job site. Sports injuries are also a contributor to neck and back problems. Since car accidents are a frequent source of neck problems, seat belt and head restraint use with a properly positioned seat and steering wheel can pay big dividends. With a small amount of effort the original "pain in the neck" can be avoided.

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