Transcription:
Neck Pain, Causes and How to Manage

Prakash Chandran (Host): Neck pain is a common complaint adults have, especially as they age. It can be caused by a number of different things like muscle strain from poor posture or sleeping in an awkward position. When it comes to managing and treating neck pain however, orthopedic care is the gold standard because orthopedists are specifically trained to deal with problems involving the musculoskeletal system.

We're going to talk about it today with Dr. Esteban Cuartas, Orthopedic Surgeon at Montefiore St. Luke's Cornwall. Welcome to Doc Talk presented by Montefiore St. Luke's Cornwall. My name is Prakash Chandran. So Dr. Cuartas, really great to have you here today. I was hoping to start by you sharing a little bit more about the most common causes of neck pain.

Esteban Cuartas, MD: Thank you. Yeah. So, the most common causes of neck pain probably would be degenerative conditions, arthritis and along with sometimes work-related or occupational problems.

Host: Yeah. And like I mentioned at the top, I'm sure poor posture falls into that category, especially because a lot of people are working from home. Is that correct?

Dr. Cuartas: Yeah, I would say so. It's obviously, recently because of the pandemic, a lot of folks that have been working from home especially at the beginning, working on small laptops were coming in complaining of neck pain. And it had to do with in that case, occupational, yeah.

Host: So I wanted to ask a more high level question. If someone is experiencing neck pain, how do they separate out the pain that can be treated with, you know, medication or a hot pad or something like that versus something that's more acute and needs to be seen by a specialist like youself?

Dr. Cuartas: Yes. I would say that we have this general kind of term called nonspecific neck or back pain and that refers to pain that it hasn't been present for too many days, that is not associated, for example, with trauma or with any unusual symptoms, such as fever, chills, weird sensations, for example, feeling pins and needles or numbness going into your arms. Not associated with any significant prior history of say surgery or medical problems, including things like cancer, et cetera. So if the neck pain is not associated with any of these other unusual circumstances, which we call those red flags, then it's a nonspecific neck pain and that's okay to treat initially at least, with the usual conservative care, you know, maybe an anti-inflammatory or Tylenol, a heating pad, et cetera.

Host: Okay. So it really sounds like the time to see an orthopedic specialist is when something isn't going away, when the pain is more acute or caused by trauma, or one of the things that you just mentioned. Is that correct?

Dr. Cuartas: Yes. I think from a both an informational perspective for the, for the patient to understand and sometimes alleviate the stress and worry about it. But also to try to obtain the best, the best treatment plan moving forward.

Host: Okay. So talk a little bit about how that visit or that initial visit looks like. When a patient comes in, how do you go about assessing what is causing that neck pain and then how do you go about treating it?

Dr. Cuartas: So I try to break it down initially into, I do see some patients with non-specific neck pain without anything unusual. And they are usually you know, we kind of separate them sort of in, in terms of, the treatment plan initially is going to be quite straightforward, quite benign, maybe some physical therapy, some activity modification, some anti-inflammatories, and then we tend to group the other set of patients, if there's, for example, worrisome neck pain that presents with any additional numbness and tingling or any other one of these worrisome things such as trauma or cancer, things like that. So that's another group of patients. And in those patients, then we're worried more about how do we diagnose more specifically what's going on A and B, the medications and other recommendations for alleviating, alleviating the symptoms. Maybe more, more detailed. Also along the lines of what you were asking is obviously we do a thorough physical exam, including the musculoskeletal exam and also an exam of the nerves or a neurologic exam.

As well as we usually, at some point, if the pain persists we'll obtain a plain x-rays. Now if there is a red flag type of situation such as a pain shooting down an arm or weakness in an arm, for example, then we will proceed with advanced imaging, which is basically MRI imaging in most cases.

Host: Understood. And what exactly causes neck pain? Is it something that is localized to the neck itself? Is it rooted in the spine? Maybe talk a little bit about what's going on physiologically and what really causes neck pain to occur in the first place.

Dr. Cuartas: There's actually many different structures in the neck that can generate painful signals and including first glance, I guess, the skin and subcutaneous ligaments that can be injured by say, for example, a contusion or something like that, or the muscles underneath, by either straining them and doing sports or gym related activities or such. And then more at a deeper level would be the joints in the spine. Each level of the spine, so to speak because the spine is built of separate blocks that are joined together. Kind of like, you know, like a snake is a flexible creature, the neck is at least initially when, when the person is young, can flex and bend and twist so each block is joined to the others through several joints, including the facet joints, posteriorly which can generate pain. And we have one on each side. In the front, we have the disc and we also have uncovertebral joints. So we have another three joints in the front. Any of these structures can hurt. And they tend to hurt in slightly different ways. Usually through physical exam, we can start to suspect if one of these structures is the predominant generator.

Host: Okay. So let's say in the physical exam, you do identify that, is then physical therapy the thing that's recommended? I'm trying to get a sense of when things like physical therapy come into play versus things like surgery.

Dr. Cuartas: Yeah. So, in a case where there's no significant problem that we can find on the physical exam in terms of weakness or a radiating pains or pins and needles, no concerning signs we will usually begin either with activity modification usually of the daily routine or work routine as well as either a home exercise program or physical therapy and observation in general.

Host: So, let's say that you have tried every like physical therapy and nothing seems to be working. At what point does surgery become an option?

Dr. Cuartas: Right. So let's suppose a person has tried physical therapy. They try to make you know, some set of say neck pain and pain radiating down into the right shoulder elbow. And it hasn't responded. And we find that the MRI there's a correlating problem, for example, a narrowing or damaged disc that's pressing on the nerve.

At that point we assess, well, is there, is there is there, what's the risk benefit analysis in terms of considering something invasive is how much is this bothering the person? How much is it impacting their lifestyle, or are there things that are not doing because of the pain? Are they having to take an extraordinary amount of medication, et cetera?

Host: So one of the things I wanted to move on to was trying to be proactive about preventing neck pain. So if someone is listening to this and they just want to be proactive about their health or they're experiencing even just a slight level of pain, what would you recommend that they do to really take care of themselves so nothing more serious happens?

Dr. Cuartas: Yeah, I would say to quickly try to review the if there's any, any thing that they can trace it back to either heavy lifting. I always tell patients that the arms are partially attached to the neck, in a way through the trapezius muscles. And heavy lifting, repetitive lifting can bother the neck, especially heavyweight lifting, for example. Also positioning I mentioned earlier, the sort of, epidemic of laptop use. The issue with laptops is I find that often patients are leaning forward to work on the laptop. And in, in effect that makes them look up to at the screen. So they're looking up and looking up tends to be a more stressful position for the neck rather the the more proper ergonomic positioning would be with the face slightly down from the horizon and the eyes looking down.

Host: Oh, okay. So I think this is an important thing to clarify, because so many of us are on our laptops these days. So typically when you're on a laptop, you're looking down, right. And you're typing on your lap or on a desk. So, my assumption was that you are looking down, you're typing for long periods of time, and that is what causes the strain on your neck, specifically the back part of your neck. However, from what you're saying, being on a laptop, you're positioned upwards or your neck is positioned up, maybe it's like a terminology thing, but maybe you could clarify or explain that.

Dr. Cuartas: What I find is that a lot of laptops these, the screens are naturally a little smaller. So, even if they're below on your lap, for example people tend to lean into or towards the screen. And if you're leaning forward, you actually have to angle your head to neck, up to look forward. If you're leaning backwards at the, at the waist, for example, if you're leaning backwards at the, at the waist, then your gaze actually goes down. And that's a more relaxed positioning. The issue there becomes, if you're leaning forward to, you know, lean up to look at the screen because it's, you know, small and then you're actually looking up, but you could be looking up for hours if you're working with that type of position.

Host: Okay. So it seems like the takeaway there is if you are on a laptop or any sort of screen it's really important to look up proper ergonomics. So you can make sure that your eyes are angled slightly down, that your neck isn't strained and that for long periods of time, you're able to work without the fear of neck pain. Is that correct?

Dr. Cuartas: Right. That's correct.

Host: So, Dr. Cuartas, just before we close here today, is there anything else that you wanted to share with our audience regarding neck pain?

Dr. Cuartas: Anything else? So I would say that I think that generally, a program of wellness is essential for, for wellbeing. I think that we've heard this wellness being mentioned often. I think the elements of wellness come from one is doing, doing things or activities for yourself to feel good.

And I think that that's important. I think that oftentimes we get tied up in the daily routines and we're not really doing anything for our own wellness or our own health. For example, a little course of exercise, a little walk and I think so I think that that's essential, especially the cardiovascular part of it.

We all are constantly fighting an excessively sedentary lifestyle. And I think walking or even more than that running or elliptical, et cetera, that type of cardiovascular exercise provides a certain level of wellness. So kind of not working so much on say the pain and rehab side, but more on increasing your body's ability to tolerate the discomforts from arthritis and such. So, working on the pains, pain coping mechanisms.

Host: Yeah, that totally makes sense. Well, thank you so much for your time today, Dr. Cuartas. I really appreciate it.

Dr. Cuartas: You're welcome. Thank you.

Host: That was Dr. Esteban Cuartas, Orthopedic Surgeon at Montefiore St. Luke's Cornwall. Thanks for listening to Doc Talk presented by Montefiore St. Lukes Cornwall. For more information, you can visit Montefioreslc.org. That's M-O-N-T-E-F-I-O-R-E-S-L-C.org. Please remember to subscribe, rate and review this podcast and all other Montefiore St. Luke's Cornwall podcasts. I'm your host Prakash Chandran. Thanks again for listening.