Whiplash, back and neck pain

Pain in the lower back, shoulder, neck are very common problems that we treat on a regular basis. Whiplash injuries are very common after road traffic incidents, largely affecting the neck and in some cases the back also.

Lower Back Pain

Lower back pain is extremely common. Two out of three people can expect to have back pain bad enough to prompt them to seek help. Symptoms vary enormously ranging from localised back pain to referred pain into the hip, thigh, lower leg and foot. Thankfully most back pain is self limiting. There are however various activities that can either promote or delay recovery.

Shoulder Pain

Shoulder pain is very common but is most often felt in the upper arm rather than in the joint itself. Pain from whatever source in the shoulder begins to alter the natural movement patterns and complex balance of muscles that exists there. This is often difficult to identify oneself and requires professional help in overcoming the complaint and treatment may follow more than one direction. The following are some of the commonest employed:

  • Some form of anti-inflammatory tablet. This may be prescribed by your doctor, or you can buy several different types over the counter at the chemist. Nurofen is probably the most common, this is a proprietary name for Ibuprofen.
  • Injection of some cortisone into or around the shoulder joint.
  • Physiotherapy to concentrate of mobility, stability and correct of pattern of muscle recruitment.

The tissues most commonly involved are:

  • Tendons
  • Ligaments
  • Capsule

It is not uncommon for the neck to be involved in shoulder pain. It can be the major cause or a sequele to shoulder problems. Head posture will definitely affect the shoulder as many muscles and nerves travel between these two areas. A physiotherapist will show you good ergonomic postures and exercises to help maintain them.

Neck and Shoulder Pain

The neck can also be the source of shoulder and arm pain. Be especially aware of symptoms that extend below the elbow and if you get tingling or a deadness in the hand try to analyse if they are confined to any specific fingers or are generally throughout the hand. This sort of information can be very useful in coming to a more accurate diagnosis and therefore effective treatment.

For both neck and shoulder problems a combined approach using both physical therapy and drugs seems most beneficial.

Neck Pain

Although symptoms may have come on extremely suddenly, the cause is generally more long standing. The commonest contributory causes which are increasing in frequency are:

  • A sedentary occupation involving prolonged sitting, driving, computer/desk work with poor posture.
  • Adopting a common position known as a forward head posture. It is very common in office workers, teachers, designers etc. this occurs when the head is held in a position in which the chin is poked forward and the lower part of the neck and upper mid-back are held in a forward bent position.

This results in:

  • Tightness and shortening of the muscles at the base of the skull and back of the neck, which usually leads to headaches.
  • Stretching of the ligaments of the middle part of the neck resulting in excessive movement in the joints, leading to pain and eventually to pressure on the nerves as they emerge from the neck.
  • It is also a major reason for developing what has come to be called a dowager’s hump. The lower neck joints are held continually in a forward position and get stuck there. To compensate the very mobile joints directly above arch backwards so putting more emphasis on the disfiguring “hump”. This can become very painful.
  • A stiff thoracic spine, i.e the middle of your spine between your shoulder blades. This puts too much strain on your neck which has to move more to compensate for the lack of movement in the mid back.
  • People who are excessively mobile. They sometimes will catch part of the joint lining which can double over on itself in those with sufficient movement.

Common Neck Complaints

  • Sudden onset acute pain restricted to the neck or shoulder. Often occurs in younger very mobile people and characterized by sudden loss of movement, forcing the head to be held slightly to one side.
  • Gradually development of neck and or arm ache which becomes more severe. this can be extremely painful. There may also be a sensation of pins and needles or numbness in the hand or arm. Muscle weakness is also a possibility. This is due to involvement of the nerves in the neck that supply the tissues of the arm. This can occur, for differing reasons, in any age group.
  • Increasing stiffness in neck movements together with a constant ache in the neck and possibly also the shoulders. This is more common in the over forties but probably due to altering work habits we are beginning to see this in the younger age group as well.
  • Headache, normally associated with some neck dysfunction.

All the above would benefit from physiotherapy. This will probably involve some form of manipulation, plus exercises to improve either movement and or muscle strength and most importantly to improve the overall head/neck alignment and general spinal posture. I find this is one of, if not the most important aspect to deal with, if the problem is not to return in a few months time.