Pain in the neck? When should you avoid massage or chiropractic treatment?

SPEAKER_1 (0:01)

Best of Live Well ft. Lance Alexander.

Lance Alexander (0:05)

Now, we're all guilty of the spending hours hunched over our phones and laptops, like a praying mantis staring at the screen. Sometimes your fingers stiffen up in your neck, it gets really painful. Physical strain, stress, poor sleep, diet and age related changes. I can tell you a whole string of problems I'm having, even when I get out of bed, or even when I stand up after sitting on the sofa for a while. It can lead to body aches and inflammation. But when do you say to yourself, hey, wait a minute, this is more sinister. The pain is traveling into the arm, there's a bit of numbness, your grip isn't as strong. You've got clumsy hands because you can't grip as well as well.

Even having problems with your balance.

These may point to pressure on a nerve or even the spinal cord. Now in those cases, the neck needs to be properly assessed before any treatment should be attempted. So ask yourself, when is a stiff neck simply a muscle strain or tension? And when should you get it checked? Dr. Teo Ke Jia is a Senior Consultant, Precision Neurosurgery Singapore at Mount Elizabeth Medical Center. He joins me now, Dr. Teo. Good morning and thank you for coming in.

Teo Ke Jia (1:24)

Hi, good morning everyone. Thanks for the invite, Lance.

Lance Alexander (1:27)

My pleasure, sir.

Most of us assume a stiff neck is caused by those tight muscles I was speaking about. When could it become more serious and when do we say, oh, this is a cervical spine nerve or a spinal cord issue?

Teo Ke Jia (1:43)

I think before we go into that, maybe I should give a very quick anatomy lesson on how our neck is.

Lance Alexander (1:49)

Yes, please.

Teo Ke Jia (1:51)

So that people understand better how the pain comes about. So our neck, just imagine it's like a Lego set, that one bone is pulled over on top of one another. And between these bones, you've got a disc. So the disc acts like a cushion. So this disc do have pain receptors and they do have caused pain. On top of that, just behind the disc, you get joints. So in order for this Lego to not fall over one another, you get these joints, like a knee joint, a shoulder joint. There are joints in our neck. So on top of the disc, you got joints. Those are called facet joints. So anything from the disc to the facet joints can cause pain. When you get an injury to the disc, a slip disc, for example, you get pain and you get a degenerative facet joint, you get pain as well. Now inside this spine, you get the spinal cord.

That's the more serious part. And any impingement there can cause pain. And in addition, you get other problems like, like you mentioned earlier, weakness and numbness. And there are little holes at the side where the spinal cord gives out nerves to our hands. Talking about the neck here. So for the leg, for the lower spine, they go to the legs. So anything, all the structures I mentioned earlier can cause pain.

Now surrounding the bone, you get muscles and ligaments and soft tissues. Those can cause pain as well.

So most of the time, the neck pain is caused by things outside the spine, like the muscle, you get a strain muscle, a whiplash. Those are soft tissue injuries outside the spine itself.

However, when they start involving the bony structures, the discs, the facet joints, which I mentioned, they tend to last a little longer. And if they involve the nerve and the spinal cord, now you get more symptoms on top of just pain alone.

Lance Alexander (3:36)

Okay, okay. When you say the pain lasts a little longer, how long are we talking about?

Teo Ke Jia (3:44)

That's not really a ballpark figure, but in general, if you get like a neck strain from a bad posture, most of the time, all this pain should resolve in 6 to 8 weeks, in general. But of course, this 6 to 8 weeks, proper rest, proper posture and not just doing things to aggravate the pain even more.

And they shouldn't worsen, and they shouldn't have more symptoms during this period of time.

Lance Alexander (4:05)

Okay.

So are you finding that you're seeing more patients, sadly, young patients, because some of them are doing extreme sport perhaps, or not looking after themselves as well as they ought to? And even, you know, I can imagine you've got older patients, but are you also seeing younger patients coming to you because they may do something or they may attempt a stunt or may be getting on the skateboard or doing some rock climbing or doing something quite extreme and next thing you know, they've got an injury and they may not know it's quite severe because they've got a higher threshold for pain. When do they come and see you then?