Neck pain
The unique neck.
The neck is among the most complex regions of the musculoskeletal system. This complexity is a key reason why neck injuries can be especially difficult to treat effectively and achieve lasting improvement.
Founder’s Clinical Pointers
The Unique Neck
The neck’s distinct clinical presentation reflects its specialized biomechanical and neurophysiological development, which can result in:
A wide range of symptoms not typically reported after injuries to other parts of the body
Clinical features that patients and clinicians alike may find difficult to recognize or describe
Psychosocial profile which may initially develop because of a post-traumatic event or over time because obscure physical and/or psychological symptoms remain unresolved
“Clinicians have hunted effective treatment methods for neck injured people – for decades.”
Upper versus Lower Neck
Understanding the biomechanical and neurophysiological differences between the upper and the lower cervical spine requires an evolutionary perspective. These regions developed distinct functional roles as terrestrial vertebrates adapted to life on land approximately 350 million years ago.
Climbing to land from the ocean forced the unique development of the upper neck. (Drawing by Brian Pilkinkton)
Axis – Key Vertebra
In the assessment of osteokinematic and arthrokinematics function and dysfunction in the neck—particularly in the upper neck—Axis is the key vertebra. For this reason, it is recommended that every ‘hands-on’ assessment starts with a manual examination of the movements of Axis upon C3.
Treatment directed at Axis—the most robust vertebra in the upper neck—may also improve restricted movement of Atlas, which is the most fragile vertebra in this region. Because of the vertebral artery and the relatively weak ligamentous structures that stabilize the upper neck, Atlas also carries the greatest potential risk for adverse effects or adverse events.
Reference: Kristjansson E. Osteokinematics and Arthrokinematics of the Upper Cervical Spine in all 3 Cardinal Planes. The Journal of the Icelandic Physiotherapy Association 1988; 1: 5–11.
The Small Window to Prevent Chronicity
Early Intervention Matters
After a neck injury, clinicians have a limited window to assess and treat patients before symptoms become persistent or begin to recur. The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurses for more than three months. Clinical experience, however, suggests that effective intervention may still be possible for up to six months or longer.
Timely assessment and treatment are therefore important for all stakeholders:
Patients who may benefit from earlier symptom resolution and reduced risk of chronicity
Clinicians, who need to identify and address occult and evolving functional deficits
Employers and health - social security systems, which may be affected by prolonged sick leaves and disability payments
Third-party payers, including insurers and compensation bodies, which carry the costs of compensation claims and delayed recovery.
Clinical message
In chronic cases, signs and symptoms of injury may abate, but the functional deficits persist and adaptive patterns develop secondary to the remaining functional deficits. This may be one important reason for recurrent neck pain episodes; a major feature characterizing people after neck injuries.
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