We often refer to life’’s challenges as “a pain in the neck,” and for good reason. Neck pain can be a nagging annoyance that interferes with your ability to focus mentally and perform physically. Neck pain can stem from a number of causes, and treating the symptoms alone is not enough. You need to find and treat the source of your neck pain if you want to get rid of it for good.
Resolving neck pain requires a holistic approach that takes into consideration the entire functional chain of structures and tissues that govern neck alignment. Modern medicine’s reductionist approach aims to treat the locus of pain, when in fact the neck is dependent on multiple tissues and structures for biotensegrity – the interplay of tension and alignment that provides mechanical integrity.
At NYDNrehab we take an integrative approach to diagnosis and treatment of neck pain. Our highly specific clinical examination of multiple anatomical areas and their functional interrelationship is backed up by high resolution diagnostic ultrasonography. Ultrasound imaging lets us look at the interplay of multiple structures in much greater detail than MRI, all in a single session.
Before we begin physical therapy to restore function, we take measures to address pain and restore structural integrity.
Our physical therapy plans are customized, based on the patient’s unique profile. Thanks to our extensive diagnostic toolbox, we are able to gather an enormous amount of information on your first visit, so we can get started on eliminating your neck pain right away.
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Neck pain often involves muscles and fascia, with multiple interconnected pain generators. For example, multiple myofascial trigger points in the trapezius muscle can lead to abnormal tension in its deep fascia, irritating the spinal roots that pierce the fascia at that level. Because each pain generator can influence others, it is difficult to pinpoint whether the pain originates from muscle, fascia or nerves.
Some doctors attempt to diagnose cervical neck pain with MRI, but that is almost always a waste of time, except in rare cases of radicular symptoms, such as numbness and tingling in the fingers. Even then, radiating radicular pain often involves the peripheral nerves, which cannot be examined with MRI. Patients often end up going from scan to scan, and from doctor to doctor, without resolving their neck pain.
For diagnosing neck pain, ultrasound is a superior imaging modality because most cervical pain is neuro myofascial in nature, and we need to image peripheral nerves, brachial plexus nerves, shoulder nerves, as well as trigger points in the neck and thoracic spine. We also need to examine fascia. Ultrasound is the only modality that allows us to examine all of those areas in a single exam while viewing the structures in motion — something that cannot be done with Xray or MRI. At NYDNRehab, we use the highest resolution ultrasound imaging to view the structures of your neck, shoulders and upper spine in real time. Your ultrasound exam takes place right in our clinic, so there’s no wait time for lab results. Treatment often commences on the same day as your ultrasound session.
When diagnosing your condition, we look at the whole person, not just the part that hurts. Only after we learn more about your activities, lifestyle, health history and other factors do we begin our diagnostic process. You may undergo ultrasound imaging, postural evaluation, gait analysis and other assessments until we pinpoint exactly what is going on. Once we get to the source of your problem, we design a custom treatment plan especially for you, based on your unique patient profile.
Conventional medical treatment for herniated discs often involves the use of anti-inflammatory medications and epidural steroid injections (ESIs) to reduce disc inflammation. However, those measures only provide short-term relief, with the effects wearing off after several weeks. Repeated steroid injections can gradually erode the joint cartilage, causing permanent damage and worsening the patient’s condition.
By contrast, addressing disc herniation with a holistic approach can net superior results by fixing the underlying factors that caused the disc to bulge in the first place. There is a large body of research that supports conservative care over medical intervention, citing similar or superior outcomes over time.
In one study of 90 patients with lumbar disc herniation, participants were treated with acupuncture, with MRI screenings of the lumbar spine after every 12 sessions to measure disc herniation sizes. The disc reabsorption rate was 100% in the study participants, without the use of steroids or anti-inflammatories.
Because neck pain can originate from a number of different causes, accurate diagnosis of your condition is critical. Once the source of pain is identified, a treatment plan can be put in place to resolve it.
To diagnose your neck pain, your therapist will conduct a thorough exam that may include some or all
of the following:
Diagnostic ultrasonography
Diagnostic ultrasound lets us visualize your neck in real time, to get a picture of the structures of your neck in motion
Patient history
Physical exam
Your physical exam may include:
It is common knowledge among medical practitioners – backed by extensive scientific evidence – that most back and neck pain is NOT caused by disc herniations/protrusions. Yet conventional medical treatment zeros in on the locus of pain, often treating a bulging disc with epidural steroid injections (ESIs), with the end goal of eliminating pain, enhancing functional mobility, and shrinking the protruding disc.
However, research indicates that while ESIs may provide some short-term relief, the effect is not maintained in the long run. In fact, the disc itself is rarely the primary pain generator, and even when it is (in less than 15% of cases) treatment needs to be applied to the entire lumbo-pelvic hip complex, since back pain is multifactorial and requires a holistic approach.
Spinal surgeries are even less effective, with potential horrific side effects that lead to adjacent segment disease (ASD) – a condition that arises after spinal fusion surgery where degenerative changes occur in the discs and vertebrae above and below the surgery site – leading to even more surgeries.
While conventional treatment may temporarily suppress back and neck pain, the pain is likely to return when normal daily activities are resumed, or when the effects of steroids wear off. Moreover, protruding discs typically self-resolve, reabsorbing the disc in a matter of several days. When pain returns, the cycle of futile treatment resumes, until surgery becomes a last resort. Meanwhile, narcotic pain medications prescribed to treat back pain can quickly cause dependency that leads to substance abuse.
When visualized with MRI, mechanical issues rarely present themselves. You may see an image of a bulging disc, but that does not tell the full story of your back pain.
By contrast, diagnostic ultrasonography resolution is up to 100X higher than MRI for visualizing superficial connective tissues. It lets us examine the body in real time, with the patient in motion, giving us a full picture of how pain-generating nerves interact with other structures, to help us identify mechanical issues that contribute to disc herniation.
High resolution diagnostic ultrasound surpasses MRI as a diagnostic tool in multiple ways:
Fascia is a network of connective tissue that provides tensegrity — tensile integrity that mediates intrinsic and extrinsic forces and holds the body’s structures and organs in place as you move. Healthy fascia tissue is smooth, slippery and elastic, enabling muscles, nerves and blood vessels to glide without friction. Fascia’s gliding properties are due to high concentrations of hyaluronan, an important polysaccharide that acts as a lubricant.
When damaged due to injury or lifestyle factors, fascia can become densified, making it thick and sticky, and reducing its elastic properties. Sticky fascia can adhere to other structures, entrapping nerves and blood vessels, and disrupting coordinated muscle actions. It can also develop tears that cause pain, because fascia is densely embedded with proprioceptive nerve endings.
Stecco fascia manipulation is an evidence-based methodology for treating densified fascia. Stecco’s deep friction technique heats up fascia tissue and stimulates mechanical action by producing mechanical contact stress, fragmenting densified hyaluronic chains and triggering the production of new hyaluronic acid molecules. Densified or torn fascia in the neck area can be a key driver of chronic neck pain. When combined with other treatment modalities like shockwave therapy and ultrasound guided dry needling, Stecco fascial manipulation can play a major role in eliminating chronic neck pain.
The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.
EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.
HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.
Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.
Surgery for neck pain should only be considered as a last resort. Most neck pain can be resolved with non-invasive conservative treatment. Your neck pain specialist will likely incorporate a combination of approaches in your customized treatment plan.
Some of the unique neck pain treatment approaches at NYDNRehab include:
Exercises for motor control of the upper quarter of the body
Range of motion exercises
Postural correction
Ergonomic workspace correction
Individualized home exercise program
Chiropractic care
ESWT and EMTT
Staying in shape with regular exercise is the best way to prevent neck pain. You should also be aware of your posture, especially when using a computer or mobile device. Be sure to use protective gear when playing sports or engaging in high risk activities. Good sleep hygiene, including and appropriately firm mattress and pillow can help protect your neck while you sleep.
At NYDNRehab, we never take a cookie-cutter approach to patient care. The symptoms of neck pain vary from one patient to the next, each with their own causative mechanisms. We thoroughly examine each patient and base our treatment solutions on your unique diagnosis. We provide one-on-one Physical Therapy, custom-designed for the individual patient.
At NYDNRehab, we make it our mission to get to the source of your pain and dysfunction and correct it, so you can move freely again and enjoy life to its fullest. Contact us today and make an appointment to get rid of your pain in the neck or good.