The significance of neck pain lies in its ability to affect one’s quality of life and the potential to lead into chronic disability. With the different populations affected by neck pain, it is something that will have increased prevalence with the aging population. Addressing the long-term effects of neck pain can be quite challenging and it is a condition that Muir Orthopaedic Specialist physicians are well versed in caring for.
Neck pain is very common; in fact it is more common than low back pain. Most people can recall a specific time in their life when they experienced neck pain. Fortunately, this is usually self-limiting and non-debilitating. In many cases, episodes of neck pain are a result of a muscle strain or soft tissue sprain and recovery occurs with time. However, there are times when neck pain can be relentless, affecting one’s quality of life or even cause radiation of pain or other neck pain symptoms and treatment. This type of pain will often result in time lost from work and can lead to a decrease in the quality of life. At its worst, neck pain can be disabling. An example would be the stiff neck of acute torticollis, which can be quite painful and disabling. This will often prevent normal function of the neck and surrounding structures.
There are many causes of neck pain. It can be the result of injury, like whiplash or a strain from overuse; degenerative disorders such as osteoporosis, rheumatoid arthritis, or disc disease; viral infection; or pinching of the nerves in the neck delicate nerve endings. Other more serious conditions can also cause neck pain. These conditions include meningitis, cancer, or other systemic diseases. The common thread to these conditions is the involvement of the nervous system and the need for an accurate diagnosis and precise treatment of the problem.
Understanding Neck Pain
Diagnosing the cause of neck pain in Singapore can become complex, with the profusion of symptoms arising from the various structures in the neck and the referred pain from other areas. To compound the confusion, sometimes symptoms do not clearly match with the condition that is present. It is rare for serious pathology to be the cause of neck pain. The most common problems are the ‘mechanical’ issues that come from the neck’s intervertebral discs and the small joints between the bones. While it is not common for serious problems to cause neck pain, you should always seek the advice of a doctor if the pain does not improve with the usual methods or is not due to a recent trauma. Medical research will help to rule out the more serious causes, and if required, you will be referred to an appropriate specialist.
Common Causes of Neck Pain
Understanding the cause of neck pain is essential. However, as a general understanding of the human body, the spine is the key to flexibility, facilitating movement in all directions. The many muscles that maintain movement move the head and support the neck. The upper spine and neck are often described as the cervical spine. This part of the spine is very flexible and supports the weight of the head and also allows the head to move. Any impact, strains, or sprains that occur on the neck will result in pain. There are many different causes of neck pain, which can include injury, activities, as well as some diseases and conditions. Injuries to the soft tissues, including the muscles, tendons, and ligaments, are a common cause of neck pain. A sudden force such as a whiplash injury can cause the neck to move beyond its normal range. This can result in tears and can also overstretch the muscles and ligaments. This type of injury often occurs from a car accident in which the victim has been rear-ended. Another example of an injury to the neck is when the head is directly impacted, resulting in a blow that forces the head to the side. This can cause tearing or overstretching of the muscles and ligaments, as well as possibly a fracture or dislocation of the cervical vertebrae. A neck fracture can also cause long-term pain and discomfort and upper extremity weakness. Although injuries to the soft tissues in the neck can cause acute pain, it usually will not result in any long-term damage to the neck. Wearing a stiff neck collar can help treat this kind of neck pain.
Symptoms of Neck Pain
Neck pain is a common problem among people, particularly from office and computer workers to drivers. The onset of neck pain is often accompanied by a feeling of stiffness in the neck. The pain may be confined to the neck or may radiate down the arms. In some cases, there is also a feeling of numbness or tingling in the arms. This type of pain is often caused by an irritation or injury to the structures of the neck including the muscles, ligaments, joints, and discs, any of which may radiate pain to the arms. In some cases there is a ‘crackling’ sound with neck movement. This is not usually a cause for concern, if it is not associated with pain or any other symptoms. Osteoarthritis in the neck characteristically causes pain in the back of the neck which may radiate to the shoulders and arms, headaches and dizziness. Facet joint pain often causes neck and head pain which occurs with specific movements of the neck. In some cases, the pain is relieved by arm resting. A ‘whiplash’ injury to the neck, caused by an abrupt jerking motion of the head, backward then forward, can cause severe neck pain often with delayed onset, which worsens with neck movement. In rare cases, neck pain can be a symptom of a more serious problem. Seek medical care if the pain is caused by an injury, if it causes neurological symptoms such as weakness, persistent numbness, or tingling, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.
Neck Stiffness
Neck stiffness is caused by an interference to the normal range of motion in the neck. This is usually due to muscle strain, sprain of ligaments or muscle spasms. When the muscles in the neck and upper back are overused, which is common with today’s postural imbalances such as round shouldered posture, the muscles and the spindles within the muscles become hypersensitive. This causes them to spasm or tighten up, making it difficult to move the neck. Any of these scenarios, when the muscle or ligament is overstretched due to a forceful movement or a repetition of a particular movement can cause a significant level of pain and discomfort in the neck, resulting in muscle guarding of the affected area and restriction of neck motion.
Neck stiffness is a common symptom of neck pain. It is described as a discomfort in moving the neck, especially when trying to turn the head from side to side. The discomfort is also usually accompanied by muscle spasm or tightness in the neck. Often, the degree of stiffness is what dictates a person to seek medical attention to cure their neck pain. Usually the pain is temporary, lasting only a few days. In more severe cases of neck pain, the pain is prolonged and can be chronic in nature.
Muscle Tension in the Neck
Muscle tension in the neck is a common complaint seen in people who seek treatment for neck pain. The cause of neck muscle tightness is often multi-factorial. One reason is that the tightness is a reflex reaction to pain in the neck. The individual muscles may spasm in response to a perceived injury, inflammation, as a protective mechanism. This would be the body’s attempt to limit movement to the affected area in order to encourage tissue repair. Unfortunately, this can be counterproductive as the prolonged immobilization of the muscles can cause further problems and lead to a chronic condition. Other causes of muscle tension include emotional stress and depression, poor posture and carrying heavy loads, for instance in backpacks the shoulders and neck are forced to take on the extra burden. The more the head drops forward or backward, the more the muscles need to contract to maintain head and eye position. Over time, this can fatigue muscles, generate trigger points, and chronic tightness. In older adults, the most common cause is osteoarthritis and degenerative changes in the neck. Muscle tension can even lead to connected problems in the upper body and arms known as Myofascial pain syndrome. This is a chronic pain disorder that affects the connective tissue that covers the muscles. Trigger points, which are felt as nodules in the muscle, develop as a result of muscle trauma. This ongoing muscle pain and inflammation will cause the band of muscle to shorten as it takes a guarded position. Immobilization, posture, and isometric exercise all stress the muscle and trigger point, and in time, this muscle can become fibrotic and weaker as muscle fibers are replaced by inelastic fibrous tissue.
Headaches and Dizziness
Lastly, headaches can also occur as a result of whiplash injury to the neck. This can be of a post traumatic nature occurring over a long period of time and may be difficult to treat. In one particular case study, a lady experienced chronic pain and headache for one year post whiplash injury. She had tried multiple different treatments with no success until she underwent a course of 12 massage therapy treatment sessions over a 6 week period. This resulted in complete relief of headache and neck pain at a 6 month follow up. These types of results demonstrate the importance of finding the right treatment for post traumatic headaches.
Tension and cervicogenic headaches have been found to be the most frequent type of episodic headache in the general population, and the single type of headache most commonly associated with analgesic use. They are very common among people with chronic head or neck pain, but can be difficult to treat. In a study comparing the effectiveness of acupuncture and physiotherapy on chronic neck pain, with particular focus on myofascial trigger points and head pain, it was found that both treatment techniques were effective but acupuncture resulted in a quicker improvement compared to a different study that found that spinal manipulation resulted in cervicogenic headache relief. With the varying efficacy of different treatments it is important to consult a health care professional to assess the best option for you.
Headaches associated with neck pain can be of several different types. Two of the most common are tension headaches and cervicogenic headaches. These are headaches which are caused by an irritated structures in the neck and are felt in the head. They are usually a band-like pain around the head, are often of moderate intensity (but can be severe) and are not usually associated with an upset stomach. Tension headaches usually start from some sort of emotional stress and are not eased with physical activity. Cervicogenic headaches on the other hand may start from an incident such as a whiplash injury, or following awkward neck movements and positions, the pain may be eased with posture change or specific movements of the head or neck.
Treatment Options for Neck Pain
In handling neck pain, it is important to remember that the neck and upper back support the weight of the head; the average human head weighs 4-5kg. While the small neck muscles work to support this weight, the larger shoulder and upper back muscles are also involved. In patients who have neck pain, the control of the shoulder girdle muscles can be altered and they may have weakness in the muscles around the scapular (shoulder blade) region. This can set up abnormal patterns of movement in the shoulder girdle and neck, which can lead to problems with the function of the arm and pain in the neck and/or arm. In posture-related neck pain, faulty patterns of movement can be identified as a significant contributing factor. A specific rehabilitation program addressing strength and control in the scapular and shoulder muscles can be beneficial in these cases. Finally, a general fitness exercise program may be beneficial for patients with chronic neck pain, and a physiotherapist can guide you as to the appropriate forms of exercise.
Physical therapy is the cornerstone of treatment for neck pain. A physiotherapist will first assess your range of movement and the degree of neck pain and stiffness. Then a specialized treatment program will be devised. In order to relieve pain, manual therapy, such as mobilization, may be applied to move the muscles and joints in your neck. In addition to manual therapy, other treatment modalities, such as ultrasound and electrical stimulation, might be used. There is also evidence that acupuncture may be beneficial when combined with other treatment options such as manipulative therapy.
Physical Therapy and Exercises
Aerobic and strengthening fitness programs have a short-term effect on the intensity of neck pain and a long-term effect on the disability of patients with chronic neck pain. Although the benefit is not large, and large programs have not been developed to assess the full potential of fitness programs, it is a simple and cost-effective step patients can take to decrease their pain. Sessions with a personal trainer can provide motivation for patients and ensure safe, effective, and correct exercise in specific fitness programs.
General physical fitness has been determined to be important in preventing neck pain. Fitness provides the endurance, strength, and flexibility that can decrease the likelihood of developing neck pain. Endurance programs for neck and other strengthening exercises have been revealed to be beneficial for reducing pain, with long-term positive effects. Low-load isotonic endurance exercises conducted during neck pain have a long-term benefit for reducing pain and disability in the chronic neck pain patient. Neuromuscular exercise can enhance coordination of deep cervical flexor muscles to improve the efficacy of the exercises. Pilates, yoga, and other specific fitness programs reported to have positive effects are growing in popularity.
Physical therapy is often helpful in relieving neck pain, and it may focus on improving posture, muscle strength, flexibility, and range of motion. This therapy often involves an experienced physical therapist who will give instruction on specific exercises. It is important to keep doing the exercises, as research indicates that often people will do a few exercises wrong, or do too many, with the wrong posture which increases pain and disability. A very important aspect of exercise is to learn the exercises from a professional because exercising with poor form is a common cause of increased pain. Overall, the distinction between the exercises is small, and it is not clear which are the best for pain relief. However, increasing overall fitness through these exercises, and specific emphasis on posture has a clear effect on decreased pain.
Medications for Pain Relief
Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs that are prescribed to reduce inflammation. These drugs work together to inhibit the enzyme cyclooxygenase, an enzyme that is involved in the inflammation process. By inhibiting this enzyme, less of the chemicals that are involved in inflammation are produced, therefore reducing pain and stiffness. “Traditional” NSAIDs work by inhibiting cyclooxygenase 1 and 2, which means that they can cause stomach irritation and sometimes even stomach ulcers in some people. Newer NSAIDs (coxibs) only inhibit cyclooxygenase 2, which in theory should cause less stomach side effects. These drugs are now widely prescribed and available over the counter, although if the neck pain is severe and chronic, stronger preparations are available by prescription. Another group of drugs that are commonly used for neck pain are muscle relaxants. Neck pain can often be caused by past injuries which have resulted in muscle spasm. When the muscles “spasm,” they seize up and are unable to relax. If muscle spasm is the cause of neck pain, using muscle relaxants can have a good effect in reducing pain given that they allow the muscles to relax. This will help alleviate pain and it also means that the muscles can then respond to physiotherapy and rehabilitation.
Heat and Cold Therapy
It is advised that superficial heat should not be used, especially if the damaged area has not fully healed. This is because the reaction to heat can be delayed, and it is increasingly easy to misjudge the amount of heat being applied. Cold therapy works by reducing blood flow to the affected area. This helps to reduce the swelling and edema (build up of fluid) which can put pressure on the nerves causing pain. An ice pack or bag of frozen peas can be applied at regular intervals throughout the day for 15 to 20 minutes; this is especially useful following activities, such as housework or exercise, which can cause re-aggravation. Compression and elevation of the neck while using cold therapy can also help to maximize the reduction of swelling. A reusable gel pack held in place by an elasticated wrap is an alternative. This may help by giving light compression and it can be used to apply heat or cold therapy. Note: I have just written how heat and cold therapy should be used to maximize their effectiveness, it would be better to include this above and make it a separate point.
Heat and cold treatments are often used to alleviate neck pain for many people. There are several ways to apply heat to the affected area. Heat packs, heat wraps, hot water bottles or hot baths are common methods. Cold packs are also widely used. It is just a case of finding which one works best for you. It has been difficult for scientists to find out exactly how heat and cold therapy works to help heal damage. But the deep pain relief (about 1.5 cm below the skin) provided by heat to treat strained neck muscles is very useful. Heat also dilates the blood vessels of the muscles surrounding the neck. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged area. Heat can be a self-perpetuating treatment as it can help to relax the muscles which in turn increases the pain relief. Heat therapy in the form of a hot shower directed to the neck is an alternative. Treatment sessions should be about 15 to 20 minutes long, and the last session of the day should be followed by a cold pack to prevent re-aggravation during the night.
Massage and Chiropractic Care
Chiropractic care is one of the most effective and safest forms of therapy for pain in the neck and lower back. It is also proven to be cost-effective in that it can result in less money spent on pharmaceuticals and is much more extensive and less costly than invasive medical procedures. Chiropractic is so successful in treating neck pain because it takes into consideration the initial cause of the pain which is often times the result of some form of joint dysfunction. This helps to reduce the pain around the area and help joints to begin healing. Through a physical examination and taking a complete history of your health, a chiropractor will determine where the nerve irritation is and the cause of your pain and construct a plan to help solve the problem and relieve the pain in a natural and conservatively invasive way.
People seek massage and chiropractic care for a variety of reasons. One of the most widely recognized benefits of massage is pain relief. When the body is in pain, it tenses up and often guards itself, which can perpetuate the cycle of pain by creating more soreness and stiffness. This happens naturally as the body tries to stabilize an injured area. For example, if you injure your lower back, you will likely move and hold your upper body in an effort to lessen the strain on the lower back. This will likely lead to soreness in the upper back and neck as those areas take on more of the load, and the stiffness and pain in the lower back will likely only get worse from the lack of movement. Massage can break the cycle by helping the body to relax, thereby enhancing the body’s natural restorative processes.
Neck Pain Treatment in Singapore
If the illness becomes more chronic and serious, an MRI scan and even more serious surgery may be recommended. This is where costs can significantly rise. An MRI scan may range from $800 – $2000 depending on the institution. Any surgical recommendation will cost in the thousands. This is where patients need to decide whether the cost-effectiveness of surgery outweighs its efficacy in treating neck pain.
It is usually recommended that physiotherapy is the first line of therapy to be pursued for neck pain treatment medicine. Physiotherapy costs average around $90 – $110 per session in a private clinic. This can amount to a total of $900 – $1100 for a 10-session therapy. Due to the effectiveness and rapid relief a patient can obtain from a good physiotherapy session, it could thereby still be good value for money. Massage therapy may be a temporary relief to neck pain and can cost around $50 – $70 per session, depending on the type of massage. Chiropractic therapy is a popular choice but can be quite expensive considering the range of $50 – $90 per session and may require multiple sessions if the condition does not improve. Often times, medication can be relatively inexpensive in Singapore, especially if generic brand NSAIDs are prescribed. A doctor’s consultation at a polyclinic and subsequent NSAID treatment may amount to $50 – $60 for a one-month stint. This would greatly depend on whether the pain subsides during this period.
The medical facilities and specialists in Singapore are abundant and readily available. There has been a steady increase in the number of orthopaedic surgeons, neurosurgeons, pain specialists, and general practitioners in Singapore, all of whom are well-versed in managing neck pain. The availability of alternative therapies for neck pain, such as chiropractic and physiotherapy, is also increasing. However, such treatments for the most part are provided by the private sector, and costs may pose a significant importance to alternative therapy recommendation. The cost of neck pain treatment in Singapore has a tremendous range. It does not aid that price transparency of the medical institutions and treatment available in Singapore are poorly regulated. This can result in patients being loaded with unexpected bills at the end of their treatment.
Medical Facilities and Specialists
The city state of Singapore is well known for the standard and accessibility of its medical facilities. There are 13 public hospitals and numerous private hospitals in Singapore, all of a high standard. This provides Singaporeans with a wide range of choice for their healthcare needs. In addition, medical treatment in Malaysia is an alternative for some Singaporeans. It is common for a Singaporean to visit a private hospital in Malaysia if the medical procedures are not too different and the costs are lower. The strong Singapore Dollar makes medical treatment in Malaysia even more attractive. Due to these factors, the medical sector in Singapore is very competitive. This is an advantage for the patient as they are able to seek out the best, most cost-effective treatment for their condition. Competition is particularly evident in private hospitals and this has driven the standard of care and medical practice to a high level. High levels of competition also mean that medical services are widely available and waiting times are short. This is a great advantage to the working individual who has a neck pain condition that requires expert medical attention but cannot afford time off work. These individuals may have health insurance coverage and therefore will most likely seek medical treatment at private hospitals. The treatment of neck pain often begins with seeking care from a family doctor. If the pain does not subside after a week or two, the doctor may refer the patient to a specialist or a physiotherapist. General practitioners are widely available in Singapore and are typically the first level of contact with the medical system. This is no different for private general practitioners and those in polyclinics. Pricing for consultation is competitive, between $10 to $20 in polyclinics and between $20 to $50 for private general practitioners. However, it is common for private general practitioners to provide more thorough consultation and closer follow-up of the patient’s condition. As patient to doctor interaction and consultation time is important in the diagnosis and treatment of a neck pain condition, patients often find that the extra cost of seeing a private general practitioner is worthwhile.
Availability of Alternative Therapies
Acupuncture is the most established of the alternative therapies available for neck pain. The Chinese Physician and Acupuncturist registered with the Singapore Medical Council has undergone 3-4 years of full-time training locally or in China. In recent years, more physiotherapists have undergone acupuncture training and also practice dry needling techniques. Randomized controlled trials support the use of acupuncture for chronic neck pain. Recommendations are for 1-2 treatments weekly for 4-8 weeks. Symptoms that often respond include pain at the neck and between the shoulder blades, headache, and restricted movement of the neck.
The availability of alternative therapies is limited in Singapore. Despite promising potential for therapies like acupuncture, chiropractic, and osteopathy, there is a low quantity of such therapists in Singapore. This is largely due to the fact that local training institutions only started offering training courses in these fields in the last 10-15 years. Most of the therapists currently practicing in Singapore were trained overseas.
Cost of Neck Pain Treatment in Singapore
Treatment for neck pain can be expensive, although it depends on the cause and the type of treatment. Medication, physiotherapy, and chiropractic treatment can cost about the same. If the neck pain is caused by a traumatic event, the medical and surgical costs could be overwhelming. Treatment, including medication, costs less than SD$100 to intensive physiotherapy or chiropractic sessions costing about SD$1000 – SD$1500. Surgery can cost at least SD$5000, depending on the type of surgery and duration of hospitalization. Do note that surgery is usually recommended in severe cases and should be considered only if other treatments have not been effective. Premier specialists or therapists providing care for neck pain may cost more than the other run-of-the-mill health providers. If the cost is a concern, it is worthwhile asking the specialist if there are any non-premier specialists available.
