Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
What are some potential Causes?
Often the exact etiology is unclear and can be resulting from
a combination of many different factors. Some potential
causes can include:
1. Muscle Strain
2. Facet arthritis:
The joints that help to stabilize spine at the neck level
develop arthritis. Over time, bony arthritis can form on
the vertebra which is called spondylosis and this can
narrow the spinal canal where the spinal cord or nerve
roots are located. Bony narrowing of the spine is also
known as spinal stenosis.
3. Disc bulging:
The fibrous tissue that make up the disc become less
elastic and the disc begins to dry out. Consequently,
the disc can bulge out and pinch on the spinal cord or
a nearby nerve root.
4. Disc herniation:
The disc contain a jelly material called the nucleus
pulposis that helps to cushion the spine. With aging,
the outer fibrous tissue can develop a hole and the
inner jelly can protrude out resulting in a herniation.
This jelly material can compress on the spinal cord or
nearby nerve root. Also, there are inflammatory
irritants in this jelly material that can affect the spinal
cord or nearby nerve root resulting in pain.
5. Other causes of neck and low back pain:
Ometimes tumors, infection or inflammatory diseases
can mimic musculoskeletal pain. Patients with risk
factors must be worked up closely to rule these
diseases out. Important risk factors include
history of cancer, recent unintentional weight loss,
severe pain that wakes patients from sleep, new
numbness or weakness, fevers or chills, and recent
Important factors to consider in your medical
1. Pain intensity
2. Is the pain intermittent or constant
3. Does the pain radiate or move to other areas of your
body? Pain that radiates down the extremities can
sometimes be due to an irritated nerve root which
may require special attention
4. Are there certain positions that make the pain worse?
Pain that is aggrevated by neck flexion can sometime
be due to disc bulging or herniation while pain that is
aggrevated with extension can be caused by
compression from behind as in spinal stenosis
5. Are there certain activities that make it better?
6. Do you have a history of trauma such as a fall, motor
vehicle accident, etc?
7. Do you have a history of cancer or inflammatory
disease such as rheumatoid arthritis or lupus?
8. What medications have you tried?
9. Have you had imaging tests in the past such as X-rays
or MRIs? If so, please be sure to bring your films or
reports to your doctor. They can be used to look for
new changes and minimize doing unnecessary repeat
10. Have you had physical therapy and if so, what
exercises were performed, were they helpful?
11 Have you had injections before such as trigger point
injections, epidural steroid injections, or pain
procedures performed in a surgery center?
12 Have you had surgeries performed on the spine in the
13 Do you have a history of anxiety or depression or
sleeping difficulties?
What are common factors to consider on physical
1. Neck and back range of motion:
A limitation can be caused by inflammatory diseases,
muscle imbalances, or caused by pain.
2. Tenderness on the spine:
The spine can be due to fractures or focal abnormalities
of the spine itself.
3. Muscle atrophy:
Also known as muscle wasting. Atrophy can be caused
by compression of a nerve root or elsewhere.
4. Sensation:
If a deficit is present, It’s location can hint on
the cause. If a nerve root is compressed, the level can
sometimes be determined by the sensory exam.
5. Reflexes:
If reflexes are decreased, it could mean nerve root
compression. If they are increased, it hints at
compression of the spinal cord itself or an abnormality
of the central nervous system.
6. Muscle spasm or trigger points:
Tender bands of muscle that limit range of motion.
For more information, please refer to the myofascial
pain section.
7. Special Tests:
Certain tests or provocative maneuvers can be used to
further characterize the pain.
What are common Studies used to evaluate for
neck pain?
1. X-rays are used to rule out fracture. Sometimes
flexion and extension films are need to rule out
spondylolisthesis which is movement of one vertebrae
on the other resulting in narrowing on the spinal canal
which can compress on nerve roots or the spinal cord.
X-rays are important if pain has not gone away and the
physical therapist is planning to perform traction or
spinal mobilization.
2. CT and MRI studies:
MRIs are used to evaluate for soft tissue abnormalities
such as disc herniations, tumors, or infections that
could be causing compression. CT scan are more
helpful in assessing for bony arthritis of the spine.
3. Blood tests:
Sometimes lab work is necessary to check for
inflammatory problems such as rheumatoid arthritis
or spondyloarthropathies.
4. Electromyography and Nerve Conduction
This study is used to check the integrity of nerves. This
test is typically ordered if numbness or weakness is
present. It can locate whether a nerve is pinched,
where, when, and how bad is the damage. The test is
also helpful to rule out other nerve disorders that can
mimic nerve compression.
What are common treatments for neck and low back
Treatment effectiveness depends on appropriate diagnosis,
patient compliance, psychosocial factors, medical
comorbidities, and it’s duration. Some treatment options
to treat mild, nonspecific neck and low back pain using a
conservative approach include:
What are common pain medications for neck and low
back pain?
1. Tylenol:
Be sure not to take more than 4 grams a day because
of the drug effect on the liver at excessive doses.
Patients who consume alcohol or have liver disease
need to be especially careful.
2. Nonsteroid anti-inflammatory medications
Include naprosyn, ibuprofen, and celebrex. These
medications can result in GI irritation or ulcers if used
excessively. Patients with kidney problems need to be
monitored closely and patients who have a history of
heart problems should get clearance from their
3. Antidepressants:
Amitriptylene, nortriptylene, and cymbalta have been
shown to not only improve mood but also improve pain
4. Muscle relaxants:
Are most effective when used in combination with an
anti-inflammatory medicine.
5. Tramadol also known as Ultram that prevents reuptake
of Serotonin and Norepinephrine. It has some opiate like
properties so it can be habit forming and should be used
What are some Nonpharmacologic Treatment options
for neck pain?
1. Heat:
Apply a moist hot pack to the painful area for fifteen to
twenty minutes followed by some range of motion and
stretching exercises.
2. Ice:
Is most effective at controlling acute pain and following
exercises. Apply a cold pack to the painful area for
fifteen to twently minutes every four to six hours until
your symptoms improve.
3. Massage:
Apply gentle pressure to the affected area followed by
a stretch. Some commercial devices are available for
purchase at your local pharmacy to assist you.
4. Range of motion exercises:
Should be done twice a day as tolerated. For specific
exercises, please refer to the neck and low back
exercise sections. If you are experiencing severe pain,
pain shooting down your arm, numbness, or weakness,
you should be promptly evaluated by your doctor for a
possible pinched nerve.
5. Posture training:
Typically reviewed by physical therapists. Also, an
ergonomic assessment can be helpful which used
to determine what your daily work activities are and
whether job modification strategies can help.
6. Stress reduction:
Meditation, biofeedback, and relaxation techniques can
be taught by certain health clubs and pain centers.
7. Transcutaneous electric nerve stimulation (TENS):
A device that provides a low level stimulation to block
pain going to the brain. The etiology is unclear but is
believed to be due to stimulation of certain receptors
that then interfere with transmission of pain receptors.
Another theory is that serotonin and dopamine levels
are increased which help to decrease pain.
8. Trigger point Injections:
Can be used to break the pain cycle and help to reset
the hypersensitive muscles. Injections typically include
anesthetic agents such as lidocaine with or without a low
dose of steroid. Some studies even demonstrated that
dry needling (no medication) and Botox can be helpful.
Because trigger point injections are often used to treat
chronic pain, it is sometimes necessary to perform a
series of injections to get optimal effect. The injections
are typically performed in two to three week intervals.
However, if the pain has not responded after three
rounds, it should be considered that there may be
some other factor that needs to be assessed further.
9. Acupuncture has been shown to be beneficial under
certain conditions.
10. Epidural Steroid Injections:
These injections are usually used to target a specific
nerve that is suspected to be irritated. The nerve root
is localized using X-ray guidance then steroid and an
anesthetic are injected at the site. These medications
are used to target the inflammatory components that
are believed to be causing the pain. Symptoms that
typically warrant an epidural steroid injection include
severe pain radiating down an extremity that has not
responded to conservative treatments. Imaging studies
such as an MRI should first be obtained to evaluate for
the pain source such as a herniated disc as well as rule
out other problems such as infections, tumors, etc.
11. Facet joint injections:
These joints initially stabilize the spine but actually
become weight bearing with aging which leads to
arthritis. Facet arthritis can be targeted with certain
procedures if conservative treatments fail. A facet joint
injection is typically used to determine if the facet joint
is truly the source of the problem. Typically, an
anesthetic is injected into the facet joint using X-ray
guidance. If the pain subsides following the injection,
the facet joint is the likely culprit. This procedure can
also help limit pain but it’s effectiveness can be limited
which may warrant other procedures such as medial
branch blocks or rhizotomies.
"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only.
Please consult a physician for medical advice regarding any medical condition."
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