By Robin L. Dennis, MD
Cervical myofascial pain stems from the muscles and connective tissue, including tendons, ligaments, and joint capsule that support the neck’s underlying structures—vertebrae, intervertebral discs, and facet joints. Commonly referred to as a sprain or strain, muscular neck pain involves tearing or excessive stretching of the muscle’s connective tissue that produces microscopic contusion, hemorrhage, or both. A strain also can be a pulling of the muscle, tendon, ligament or joint capsule, but without tearing.
Pain relief and decreasing inflammation of the tissues involved is first-line treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics are prescribed, occasionally along with muscle relaxants. These medications facilitate early mobilization and stretching as well as decrease sleep disturbance due to pain. Physical modalities such as therapeutic massage, ultrasound, and electrical stimulation can increase blood circulation, decrease pain, and facilitate exercise. Cervicothoracic stabilization therapy trains and coordinates muscles of the neck area, shoulder girdle and shoulder blade to limit pain, maximize function and prevent further injury.
Should I wear a soft collar to help with the pain?
Initially, soft collars (orthotics) help to immobilize the neck minimally and reduce the workload of the postural muscles of the neck. However, these should be discontinued after 48 to 72 hours to prevent tightening of soft tissue (muscle, tendon, ligament) and weakening of the neck muscles.
Many patients are unaware of just how poor their posture is (e.g., sloped shoulders, neck leaning forward, etc.). Because this posture is often the initial cause of their neck pain, it is optimal for a trained, objective practitioner to evaluate each patient’s biomechanics to customize the most effective and appropriate stabilization program. Restoring normal range of motion and good posture is necessary to prevent repeated microtrauma to the neck structures from poor movement patterns. Once the patient has mastered the proper techniques and skills required for their stabilization program, transition to an independent home-based program should continue to help—especially if done daily.
Muscular neck pain is a common problem most of us will experience sometime in our lives, whether from acute accidents or chronic posture problems. But despite its cause, adequate and appropriate treatment with conservative measures can provide long-lasting results.
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