Neck+Pain

Also See Crick in the Neck (Lao Zhen) -10% of people will have neck pain in any given month. -Almost any injury or disease process within the neck or adjacent structures will result in reflexive protective muscle spasm and loss of motion. -Some shrinking of the intervertebral discs and degeneration of the facet joints is inevitable as we age; if severe, this can lead to nerve or spinal cord impingement. -Potential pain generators include bones, muscles, ligaments, facet joints, and intervertebral discs.

Causes & Classifications
Neck pain has an extensive differential diagnosis: The most common causes are biomechanical: -Axial neck pain: Most common type, axial pain is musculoskeletal, and is pure neck or soft tissue pain. -Whiplash-associated disorder (WAD) -Radiculopathy: Refers to neck and arm pain due to nerve root compression. Symptoms include arm pain, numbness or weakness. -Rheumatic causes -Ankylosing spondylitis -Spondyloarthropathies -Rheumatoid arthritis -Diffuse idiopathic skeletal hyperostosis -Myelopathy: Myelopathy refers to pressure on the spinal cord. May result from trauma, viral processes, inflammatory or autoimmune disorders, tumors, or degenerative processes including spondylosis and intervertebral disc herniation. Symptoms include: neck pain with arm and/or leg weakness, numbness, or walking problems. -Torticollis -Cervical dystonia -Major trauma, including fractures, dislocations, and cord injuries -Referred pain from other sources (shoulder disorders, thoracic outlet syndrome, esophagitis, angina, and vascular dissection) Neck pain may also present as part of complex generalized pain syndromes such as fibromyalgia.

Normal Neck ROM
Forward flexion: 45 degrees Extension: 45 degrees Left Lateral Flexion: 45 degrees Right Lateral Flexion: 45 degrees Left Lateral Rotation: 80 degrees Right Lateral Rotation: 80 degrees

Whiplash
Grade I: comprises general, nonspecific complaints regarding the neck, such as pain, stiffness, or soreness without objective physical findings Grade II: comprises neck complaints plus decreased range of motion and point tenderness in the neck. Grade III: comprises neck complaints plus neurologic signs such as decreased deep tendon reflexes, weakness and sensory deficits. Grade IV: comprises neck pain plus fracture or dislocation, or injury to the spinal cord.

GRADE DEFINITION 0 No tenderness I Tenderness to palpation WITHOUT grimace or flinch II Tenderness WITH grimace &/or flinch to palpation III Tenderness with WITHDRAWAL (+"Jump Sign") IV Withdrawal (+ "Jump Sign") to non–noxious stimuli (ie. superficial palpation, pin prick, gentle percussion)

TCM Disease Categorization
The following information refers to symptoms of uncomplicated stiffness and pain of the neck with restricted range of motion. Luò Zhěn : “crick in the neck;” “stiff neck;” literally means “fallen from the pillow;and” includes the following biomedical disorders: torticollis, cervical muscle strain, cervical fibrositis, and cervical rheumatism

Etiology and Pathogenesis
-Improper posture while sleeping: this restricts the flow of Qi and Blood locally in the channels and collaterals of the neck causing pain and stiffness. -Trauma: hyperextension, flexion or rotation damages the channels and collaterals in the neck, restricting Qi and Blood flow and resulting in pain. -Emotional stress: intense or prolonged stressful emotional states can stagnate Qi and Blood, causing stiffness and pain and the neck. -Exogenous Pathogens: invasion of exogenous Wind-Cold into the channels and collaterals of the neck restrict the flow of Qi and Blood, causing stiffness and pain.

Qi Stagnation and Blood Stasis
+ Yunnan Bai Yao
 * Symptoms:** recent onset of stiffness and fixed pain of the neck; pain mild to severe in intensity and possibly sharp or stabbing and worse at night; heat provides temporary relief; possible twisting or tilting of head toward affected side; local tender spots that may have palpable cord-like masses
 * Tongue:** normal color with thin, white coat
 * Pulse:** wiry
 * Treatment Principle:** Move Qi, quicken the Blood, soothe soft tissues, harmonize and open the channels and collaterals, stop pain
 * Herbal Treatment:** Shu Jin Huo Xue Tang

Wind-Cold Invasion

 * Symptoms:** stiffness and fixed pain of the neck; pain mild to severe in intensity; pain exacerbated by cold and relieved by heat; possible twisting or tilting of head toward affected side; local tender spots; may have aversion to wind and cold, slight fever and headache
 * Tongue:** normal color with thin, white coat
 * Pulse:** wiry or floating and tight
 * Treatment Principle**: Expel Wind, scatter Cold, soothe soft tissues, harmonize and open the channels and collaterals, stop pain
 * Herbal Treatment:** Ge Gen Tang

Stagnation of Liver Qi
Herbal Treatment: Xiao Yao San Jia Wei
 * Main Symptoms:** stiffness, muscle spasm, or tension and aching pain on one or both sides of the neck as well as the occipital and/or temporal regions of the head; pain mild to moderate in intensity; pain is related to emotional situation (e.g., anger, frustration, irritability, depression) and stress
 * Additional Symptoms**: feeling of tightness or stuffiness in the chest, tendency to sigh, headache, bitter taste in the mouth, insomnia
 * Tongue:** normal or slightly purplish in color with thin, white coat
 * Pulse:** wiry
 * Treatment Principles:** Course the Liver, rectify the Qi, soothe and nourish soft tissues, open the channels and collaterals, stop pain

Acupuncture Channels That Traverse the Neck

 * Anterior aspect:** Ren Mai, Yin Wei Mai, Yin Qiao Mai, Lung (main channel branch, divergent channel), Stomach, Large Intestine, Du Mai branch
 * Lateral aspect:** Triple Burner (main, divergent, sinew channels only), Small Intestine main channel, Gallbladder (main, divergent, sinew channels only), Yang Qiao Mai, Yang Wei Mai
 * Posterior aspect**: Small Intestine sinew channel, Bladder (main, divergent, sinew channels only), Du Mai, Chong Mai (internal branch), Yang Qiao Mai, Yang Wei Mai
 * Other:** Spleen (internal branch of main channel, divergent channel), Heart (internal branch of main channel, Luo-connecting channel, divergent channel), Kidney (internal branch of main channel, divergent channel, sinew channel), Pericardium (divergent channel only), Liver channel (internal branch of main channel), Chong Mai (internal branch)
 * Note: all Yang channels of the body meet at GV14 (below C-7)

Acupuncture for Stiff Neck
Qi stag., Blood stasis: + BL17, BL18, SP10, 4 Gates Wind-Cold Invasion: + GV14, BL12, GB20, LI4, TB5 + moxa LV Qi stagnation: + LV3, GB20, PC6, BL18, GB41
 * Local points:** Ashi, GV14, GV15, GV16, Jia Ji, BL10, GB20, GB21, SI16
 * Distal points:** SI3, BL60, BL62, GB39, Luo Zhen, LU7, TB5
 * Modification based on the pattern:**

Acute pain & stiffness: TW-3, SI-3, BL-62 Pain in the occiput region: BL-67, GB-20, LU-7
 * Sanzhen protocol:**

Auxillary Treatment Methods:
**Ear Acupuncture**: Neck, Cervical Spine, Shen Men
 * Plum Blossom Needling:** tap over painful, stiff areas of the neck, upper back and shoulders until skin is slightly red
 * Zhu Scalp**: Cervical zone

Treatment Notes:
One method for treatment of stiff neck is to needle Luo Zhen, GB39, or SI3 and have the patient rotate the neck while stimulating the needle. A few minutes of this can dramatically reduce pain and stiffness. This can be followed up with more extensive treatment including local and distal points, moxibustion, cupping and/or massage.