Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Wednesday, 27 July 2022

How to release neck pain?

Neck pain is very common. About 2 in 3 people had neck pain at some point in their life. A survey in the UK has shown that 1 in 4 women and 1 in 5 men between ages 45 and 75 had current neck pain.

The cervical spine and the muscles and ligaments are at the back of the neck. The cervical spine is made up of seven vertebraes between which is a disc. Spinal cord is within the spine and protected by the spine. Nerves come out from the cervical spine and innervated the neck and arms.

Non specific neck is the most common type of neck pain. The exact cause is unknown. It may caused by minor strains to the muscles and ligaments in the neck. Poor posture is often related to the neck pain.

The nuchal ligament and neck pain

The nuchal ligament is a ligament at the midline of the neck which extends from the bottom of the skull to the spinous process of the seventh cervical vertibrae which is the lowest cervical vertebrae on the neck. It forms a septum between the muscles on the either side of the neck. There are four muscles including trapezius, splenius capitis, rhomboid minor and serratus posterior superior attached the nuchal ligament. The nuchal ligament limits flexion of the neck, stabilizes the neck and affects muscular activity in the neck. Trauma and overuse of nuchal ligament can result in ossification of the ligament which causes neck stiffness and pain, progressive cervical spine instability and malalignment and nerve route irritation. Acupuncture can help release neck stiffness and neck pain.

Acupuncture treatment for chronic neck pain

Chronic neck pain is a long-lasting pain on the neck or back. This pain commonly started from improperly healed acute injury. Scar tissues formed during the healing process. These scar tissues are called fibrosis. They can develop inside of the body, under the skin, muscles, tendons or inside of a joint capsule. Fibrosis always occurs at the end stage of inflammation and it causes adhesion which grabs the connective tissue and surrounding muscles together causing pain and tension, limiting the function. There are more pain receptors in the fibrosis tissue making the area more sensitive to protect the area by the body automatically.

Acupuncture can help to release the pain and tension to help the area functioning. Also acupuncture can help the body repair to get rid of the scar tissue and remodel the tissue.

Acupuncture for sudden severe pain in the neck

Acute neck pain is a sudden-onset pain in the neck. It is often due to neck muscles strain and muscle spasm. This can be caused by poor posture, sleep in an awkward position, carrying heavy loads, stay in one position for a prolonged period of time etc. One might not find exactly causes. The pain is sudden and can be very severe. This makes the person with the pain panicking. Movement of the neck is restricted because of the pain. The recovery can take a few days or a week. Acupuncture can help release the pain and speed up the recovery.

Acupuncture helps a stiff neck

Neck pain or a stiff neck is a common problem. The neck becomes sore and tender and movement is limited. it is difficult to move the neck and turn the head to the side. It could be associated with a headache, neck pain, shoulder pain or arm pain. The most common cause of a stiff neck is a muscle strain or soft tissue sprain. The levator scapula muscle located at the back and side of the neck connecting the neck with the shoulder is most affected. These muscles can be strained by everyday activities: for example, sleep in an awkward position, use a computer for a prolonged period of time, have a bad posture or have some sports injury such as swimming sudden fall, hold a phone between the neck and shoulder etc. Anxiety and stress can cause tension in the neck muscles leading to neck pain. Tight muscles are often chronic and need to be treated. Tight muscles block blood circulation of the body and muscles don’t get enough nutrition and become weak and easily get further damage. Because of blocked energy supply, you will feel tired all the time. Poor posture is a common cause of tight neck and shoulders. This causes overuse some groups of muscles and causes micro injury to the muscles which become tight to protect themselves from further injury. Furthermore the tight neck and shoulders will make poor posture worse. It becomes a viscous circle. This needs to be treated, otherwise tight neck and shoulders would not resolve itself. Stretching the muscles, applying heat or warm bath may help. Acupuncture is very effective to release the muscle tension, reduce the tightness, correct poor posture and improve blood circulation. Acupuncture can help stiff neck by relaxing muscles spasm.

Poor posture, acupuncture can help

Poor posture is a major cause of neck pain; while neck pain prevents the neck from getting back to normal posture. Poor posture results from certain muscles shortening and lengthening in an abnormal way. Poor posture can place strain on the related muscles and other soft tissues causing pain, such as neck and back pain. Inflammation is one of the causes of poor posture. If there is an inflammation in somewhere in the body, it causes pain. The body automatically protects itself to avoid the pain resulting in an abnormal posture. For example, people with neck pain would tilt the head involuntarily to one side to avoid the neck pain. Acupuncture can help to reduce the inflammation and pain to help to correct the poor posture.

Acupuncture treatment is recommended for acute and chronic neck pain

Current interventions for neck pain include themal, electrotherapy, ultrasound, mechanical traction, laser, and acupuncture.  But definitive knowledge about optimal modalities and dosage for neck pain is limited. Granham N et al from McMaster University, Hamilton Canada analysed existing data to provide the evidence for recommendations on physical modalities for acute to chronic neck pain. The data included was from January 2000 to July 2012. Their result showed that short term pain relief- moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofacial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical uscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. They concluded that the current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain.

Liang Z et al in China studied the effect of acupuncture on chronic neck pain. 178 patients with chronic neck pain were recruited. These patients were allocated into two groups 88 in acupuncture group and 90 in control group which received acupuncture and placebo treatment respectively. The Northwick park neck pain questionnaire (NPQ), visual analogue scale (VAS), short from 36 health survey (SF-36) and doctor’s judgement were applied for measuring effectiveness. The effect was assessed before treatment, immediately after the treatment, at the end of first month of follow-up and at the end of third month follow up. They found that the NPQ, VAS and SF 36 scores in acupuncture group were significantly improved after the treatment and the two follow-ups compared with before the treatment. Acupuncture group had better effect than that for control group. They concluded that acupuncture has immediate effect and lasting effect for chronic neck pain.

Another research of effectiveness of acupuncture on neck pain by Dong and Lin was published recently. They compared different effects of acupoints. 60 patients with neck pain were divided into two groups with 30 patients of each group. In first group, the acupoints selected at the start and end of trapezius muscle including Tianzhu (BL10), Fengchi (GB20), Quyuan (SI 13), Jugu (LI16) and Ashi points. In the second group, Jiaji (Ex-B2) on the neck were selected. The patients received acupuncture 5 times a week for 2 weeks. The Pain Rating Index (PRI, VAS and Present Pain Intensity (PPI) were measured before and after the treatments. They found that the scores were significantly reduced in both group. The better effect in first group was observed. They concluded that the points at the start and end of trapezius muscle had better effects than Ex-B2 points. 

A review summarised the most current scientific evidence on the effectiveness of acupuncture for neck pain. They found 27 studies investigated this subject. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). They found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Acupuncture appears to be a safe treatment with minor adverse effects. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective. 

Tech neck pain, acupuncture can help

Modern technology such as smart phone and tablet may cause stress to the neck. When using them, you hold your head flexed and forward while looking down at your handheld device causing severe angle to the neck. Over long periods of time, maintaining this head-forward posture can lead to muscle strain, disc injury, nerve impingement and arthritic changes of the neck—and the potential for developing ongoing neck and shoulder pain, headaches, and pain radiating down the arms. The symptoms of tech neck pain include pain in the neck, upper back, and/or shoulder; the pain may be mild or intense and feeling stabbing, achiness and soreness; the pain is associated with neck, upper back or shoulder tightness and reduced movement of the region; it may also accompanied with headache due to muscle spasm at the base of the neck; pain may be worse with neck movement. Acupuncture is very effective to release tech neck pain by releasing muscle spasm and tension.

Neck spasm and sudden neck pain, acupuncture can help

Neck spasm occurs when the muscles in the neck contract involuntarily and sudden tightening of the muscles can cause severe pain. The pain come up suddenly. Other symptoms accompanied with the pain include problems moving the neck and shoulder, increased pain when moving the neck and shoulder, headaches, dizziness or tingling at the neck. Neck spasm can be caused by a few reasons: repeated or prolonged movements of the neck, sitting at one position for a long time, poor posture, turning suddenly while sleeping, carrying too much weight at one shoulder or one arm, cradling a handset against neck, stress, and dehydration.

One of the first muscles to cause headache and neck pain is trapezius. This is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.

Acupuncture can effectively release muscle spasm.

Acupuncture is recommended for non specific neck pain by two guidelines from the Danish Health Authority.

There are twelve recommendations for neck pain treatment based on research evidence. . For neck pain treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy are recommended before medicine and acupuncture is also recommended. Oral NSAID (oral or topical) and Tramadol after careful consideration are also recommended. These guidelines are agreed with the guidelines from North America.

 

References

Ceccherelli F et al Clin J Pain 2010 26:807-12

Liang Z et al Complement Ther Med (2011) 19 supple 1:S26-32

Dong WK and Lin XH Zhongguo Zhen Jiu (2012) 32:211-4

Graham N et al Open Orthop J (2013) 7:440-60

Carlesso LC et al Chieopr Man Thera (2014) 22:11

Trinh K et al Cochrane Database Syst Rev (2016) May 4;5:CD004870. [Epub ahead of print]

Kjaer P et al Eur Spine (2017) May 18. doi: 10.1007/s00586-017-5121-8. [Epub ahead of print]

 

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