Cervical segmental joint dysfunction
Your neck, or cervical spine, is made up of 7 vertebrae, with your skull sitting on top. Each vertebrae have facet joints that allow movement in your neck.
What can cause joint dysfunction in your neck?
Mechanical neck pain and joint dysfunction often arise sporadically without an obvious cause (15). Mechanical dysfunction often arises from an outside force acting on a segment for a brief period, such as a trauma, or an extended period of overuse or micro traumas. Dysfunction may also begin from an imbalance between the associated muscle groups in your neck such as upper crossed syndrome (see below)(3).
Symptoms of cervical joint dysfunction:
Presenting complaints of point tenderness and stiffness are common. Patients may notice a decrease in range of motion, making it difficult to look a particular direction. Pain may increase with neck movement, especially extension (looking up). Patients may also notice discomfort in the shoulders and upper back associated with joint dysfunction (16). Cervicogenic headaches, temporomandibular joint dysfunction and/or vertigo can arise from joint dysfunction in the upper cervical spine.
Can posture affect this issue?
Joint dysfunction in the cervical/neck area is often accompanied by upper crossed syndrome or other postural imbalances such as “text neck”.
Upper Crossed Syndrome:
Tension in the cervical extensors, levator scapulae, upper trapezius, suboccipitals, pectorals and rhomboid muscles. (56)
Weakness in the deep neck flexors, rhomboids, and scapular stabilizers.
Are x-rays necessary?
The task force on Neck Pain states “Diagnostic imaging and laboratory studies are not typically necessary for mechanical neck pain unless they are needed to rule out potentially pathologic conditions” (17).
- For neck pain patients, manual therapy has been shown to produce results in fewer visits than physical therapy (6.1 vs. 10.0 treatments at 52 weeks). (63)
- The most effective manual treatment for cervical joint dysfunction is spinal manipulation.
- Several randomized clinical trials and subsequent systematic reviews have proven that spinal manipulation (SMT) provides both short and long-term benefit for acute and chronic neck pain and is superior to other treatments (19-21,31-35,44,47-55,58,60,61).
- Cervical spine manipulation improves joint position sense, pressure pain thresholds, and NDI scores for chronic mechanical neck pain. (68)
- Related thoracic restrictions should also be corrected for optimal outcomes. (42,43,66)
- Manipulation has been shown to be more effective than mobilization for pain of cervical origin (22,40,41,45).
- Cervical manipulation is associated with range of motion (ROM) improvements and decreased pain scores. (67)
- The most common and realistic complication of cervical SMT is brief local soreness (26).
- There have been some concerns about the safety of cervical spinal manipulation. One of the most sobering is the suspected link between cervical manipulation and vertebral artery compromise, which may lead to stroke.
- Cassidy reviewed 100 million patient-years of data and concluded that chiropractic SMT produced no greater risk of major complication, including stroke, vs medical care (23).
- One large multi-center cohort study found that the benefits of cervical SMT outweigh the risks (24).
- Another study concluded that using NSAIDs for neck pain produced 400 times greater mortality risk when compared to SMT (25).
- The current consensus is that “Manual therapy does not result in an increased risk of cervical arterial dissection” (69).
- SMT is more effective than exercise alone, but combining the two therapies has a beneficial effect (27-29).
- Supervised stretching and strengthening programs, including yoga, are beneficial. (59)
- Postural correction may be necessary for “upper crossed syndrome” and breathing exercises are appropriate for those with dysfunctional respiration.
- Stretching, massage and myofascial release may be appropriate for the cervical, levator scapulae, upper trapezius, pectoral and rhomboid muscles. (37-39)
- Chin retraction exercises may encourage better head posture.
- Strengthening exercises will help address postural concerns and should focus on the deep neck flexors, shoulder external rotators, rhomboids and other scapular stabilizers.
- Acupuncture and manual therapy have demonstrated cost-effectiveness (57).
- Dry needling may provide benefit. (62)
Conflicting evidence for cervical joint dysfunction treatments (maybe beneficial) (58,61):
- Therapeutic ultrasound
- Electrical stimulation
Ineffective treatments for joint dysfunction in the cervical spine (46):
- TENS units
At Creekside Chiropractic & Performance Center, we are highly trained to treat cervical joint restrictions. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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