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Cervical Pain


Cervical pain is the third leading cause of pain following headaches and then low back pain.  At some in their life, at least 80% of the population will experience some form of cervical or neck pain. 

45% of working men have been affected with at least one episode of stiff neck.  The frequency of cervical pain syndromes doubles from ages 25-45.

To understand cervical pain, it is essential that one have a concise knowledge of cervical anatomy.

In the adult spine the neck is held in a slightly lordotic position with a slight scoliosis that can be identified in 80% of the people to the left.

All range of motion is possible in the cervical spine with flexion having the chin touch the sternum, extension to have the eyes horizontal to the ceiling, rotation 90 degrees is to have the chin over the shoulders.

The cervical spine is comprised of seven vertebrae. Just below the occiput or the skull the first and second vertebrae are unique in their anatomical structure and function.

The more distal cervical vertebrae of the third through the seventh vertebrae are more identical and functionally perform as a unit in flexion, extension rotation and lateral flexion.

The first two vertebrae C1 and C2 are unique. C1 is called the atlas adjacent to the occiput. The primary function of the atlas is to allow flexion and extension having flexion of 10 degrees and extension of 25 degrees.

Some have functionally related the atlas as being a washer when using the analogy of a bolt and nut.

The second cervical vertebra is called the axis. Its function is to provide rotation, which gives 50% of functional rotation of the cervical spine. It allows for 45 degrees rotation to either side.

Cervical vertebrae three through seven inclusive allow for another 50% rotation to accommodate for the full 90 degrees to either side as well as optimize flexion and extension and promote lateral flexion.

Lateral flexion is obtained from the primary lateral flexors, the scalenes which have their origin in the upper cervical attachments.

The spine achieves its greatest flexion in the mid cervical region of C4-5 and C5-6. The greatest extension is noted in the C4-5 region. Therefore it is obvious that with repetitive motions and repetitive use, osteoarthritic changes can be first noted in the regions of C4-5 and C5-6.

The cervical area contains many pain sensitive structures, which includes the bone vertebrae, the many including the large ligaments being the anterior and posterior longitudinal ligaments, the nerve roots, the facet joints and capsules as well as the attaching muscles of the neck.

The source of pain can originate from any one of these structures, as well as create a pattern of referred pain for these structures that mimic peripheral nerve neuropathics.


Should you have any further questions regarding this article, please direct your questions or comments to "Ask the Doctor" section.


Copyright © 2004 - 2012Taras V. Kochno, M.D.  All Rights Reserved
Board Certified in Physical Medicine and Rehabilitation









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