Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physiotherapist about where the underlying pathology might be found and what treatment approach might be.
The first investigation of the physiotherapist will be into the location and kind of pain. It is vital to understand if the pain is specific to one spot or whether it also affects other parts of the body. For example, if the pain is intense and specific the physiotherapist would conclude that the cause may be poor posture or a kind of degenerative problem on the other hand, a referred pain may suggest a pinched nerve or a problem elsewhere.
Because neck pain could be an indicator of various pathologies the physiotherapist will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.
Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physiotherapist understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.
Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physiotherapist presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.
Mobilization techniques are a core manual skill for physiotherapists and abnormal joint mechanics, known as dysfunctions, can be identified by palpation of the main spinal and facet joints by the physiotherapist. Treatment can use repetitive small movements to relieve pain and encourage normal motion, to more forceful manipulations which take the joints beyond their typical ranges and restore movement. Any increase in movement gained by treatment is maintained by home exercises.
Typical physiotherapist treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough to allow recovery to start, either by physiotherapist treatment or auto-traction from a home traction kit.