Treatment for Neck Pain in Gaithersburg, MD

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Most people will experience neck pain at some point in their life. Neck pain can range from being minor and easily ignored to excruciating and interfering with daily activities, such as the ability to dress, concentrate, or sleep.  We frequently hear people talk about having a “stiff neck”, and they may say that their stiff neck feels “achy” or “sore”.  Sometimes this can be severe to the point of loss of ability to turn the head in any direction without pain (this is called “torticollis”).

Neck pain may be sharp and located in one spot, or it might feel less intense but spread across the shoulders and upper back. Sometimes the pain gets referred up to the head and may produce headache or migraine-like pain.

Neck pain can be accompanied by muscle spasms in the neck, upper back, or around the shoulder blade. In some cases tingling or “pins and needles” sensations may travel  from the neck down into the shoulder, arm, and/or hand.

The most common cause of non-traumatic (i.e. not from an accident) neck pain occurs when the muscles and ligaments in the neck and upper back become strained from overuse. This type of injury may become chronic (meaning it doesn’t go away by itself) if the overuse continues. We may refer to this as a “repetitive strain injury” or RSI.  Repetitive strain injuries of the neck and upper back have become common among IT workers. These injuries occur slowly over time, are cumulative, and may cause changes in the muscle tissues that have been injured.

Poor posture and inappropriate work ergonomics are major contributors to neck and upper back pain.  Forward head posture, with rounded upper back and shoulders rolled forward makes the muscles that support the head, neck, and upper back work harder because the muscles are doing the supporting work that should be carried by the bones and joints. 

Another cause of neck pain or limited range of motion is degenerative joint disease, also known as DJD. This refers to changes in the shape of the bones and joints in the neck.  DJD changes occur over time in response to wear and tear. These changes can also be brought on by trauma, for example whiplash injuries that occur in a motor vehicle accident or a fall.

Whiplash injuries of the neck occur when the head and neck are thrust quickly forward and backwards or side to side.  The effect upon the soft tissues may not be felt immediately. The pain of the injury may build gradually, and only become severe a few days or even a week following the injury. Left untreated the damage to the muscles and ligaments can become a source of chronic pain and stiffness. Sometimes the tender points that form from the injury can refer pain to other areas – down the arms, into the upper back, or up to the face and head.  A common result of whiplash is migraine –like headaches, which are actually pain referred from damaged muscle tissues at the base of the skull or on either side of the neck.

A more serious source of neck and head pain is damage or deterioration of the soft pads that separate the bones of the neck. These are called intervertebral discs. When a disc is damaged or worn it may flatten and bulge out on either side – hence the term “bulging disc”. This bulging may impinge or press upon other tissues in the spine (muscle, ligament, or nerve) and cause an ongoing irritation and an inflammatory response.  Pain from a bulging disc can be constant, deep, and sometimes debilitating. An extreme case of disc injury occurs when the soft material inside a disc begins to leak out (usually due to a tear in a disc). This is called a herniated disc, and the pain from a herniated disc can be unbearable.  In part this is due to the fact that the soft material from inside the disc is highly irritating to other tissues. It may also be due to pressure on and inflammation of a nerve root. 

Diagnosis of the cause of neck pain is best done by doctors who are trained in examining and treating these issues.  The doctor will first listen to the patient’s history, asking how long the problem has been going on, how did it happen (gradual onset vs sudden or traumatic), what makes it feel better or worse, and if there have been any previous episodes. Next the doctor will examine the patient, moving the patient through various ranges of motion and noting what positions make the pain better or worse. The doctor will test the patient’s muscle strength, reflexes, and sensitivity to touch. Finally the doctor will palpate the soft tissues of the patient’s head, neck, and upper back, looking for tense (“hypertonic”) and tender muscles, and seeing if there are tender areas that reproduce or worsen the patient’s symptoms. 

How We Treat Neck Pain

Treatments may include gentle myofascial release (a way of relaxing and releasing tight muscles), mobilization, dry needle therapy (a form of treatment that uses acupuncture type needles to release very tightly contracted bands of muscle), cold laser, therapeutic ultrasound, and electrical stimulation.  The goals are first to reduce pain and increase pain-free range of motion.  Once this has been achieved, in-office and home exercises usually follow, so that the underlying issues of muscle tightness or weakness and postural compensations can be addressed.  This usually takes place over the course of several visits – the time frame depends on the severity of the problem and patient compliance with the doctors instructions on home care.

Some neck problems may be too severe to be addressed by manual and physical therapies. In this case the doctor will refer the patient to an appropriate provider. This may be a pain management physician for injection therapies to reduce pain sufficiently for manual therapies to be effective. In the most severe cases referral to a neurosurgeon may be necessary to address nerve or spinal cord compromise due to a herniated disc. 

It is our experience that the majority of neck and upper back issues can be resolved by the kinds of manual and physical therapies we offer.  The road to recovery begins with an initial consultation.