What Are the Most Common Causes of Neck Pain and Fatigue?

The basic pathological change of cervical spondylosis is degenerative change of the disc. The cervical spine is located between the skull and the thorax. The cervical intervertebral discs need frequent activities under load, and they are susceptible to excessive microtrauma and strain.

Occipital and posterior neck pain

Frequent occipital pain is mostly related to insufficient blood supply to the vertebrobasilar artery, which is mainly caused by cervical spondylosis.

Affected area: neck
Related diseases: Cervical Spondylosis Neuropathy Osteoporosis Nerve Root Cervical Spondylosis Cervical Spondylosis Cervical Spondylopathy Esophageal Compression Cervical Spondylosis Cervical Spondylosis Cervical Spondylosis Accumulation Edema Lumbar Disc Herniation
Related symptoms: Inflatable sweating abnormalities sudden nausea earplugs tinnitus tinnitus vertigo fatigue spinal cord compression shoulders back heavy anxiety tension headache neck back pain neck pain cervical dizziness acute pain falling pillow peripheral neuritis migraine weakness neuralgia insomnia hand numbness Grips, weakness, paralysis, severe head and neck pain, dizziness, dizziness, chronic pain, dysphagia, carpal tunnel syndrome, tennis elbow, bedridden, lower limb weakness, tachycardia, palpitations, psychological injury, eye swelling, dryness, dazzling eyes, hardening, depressed pillow Joint and posterior neck pain

Affiliated Department: Department of Integrated Traditional Chinese and Western Medicine
Related inspections: EMG

The main pathological changes are: early cervical disc degeneration, reduced water content in the nucleus pulposus, and swelling and thickening of the fibers of the fibrous ring, followed by hyaline degeneration and even rupture. After cervical disc degeneration, the pressure resistance and traction resistance decreased. When subjected to the gravity of the skull and the traction between the head and chest muscles, degenerative discs can be localized or extended to the surrounding process, narrowing the disc space, overlapping and dislocation of articular processes, and the longitudinal diameter of the foraminal Get smaller. Due to the weakening of the intervertebral disc's resistance to traction, when the cervical spine moves, the stability between adjacent vertebrae decreases and intervertebral instability occurs. The mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then occurs. Bone hyperplasia in the posterior facet joints, hook joints, and laminae, degeneration of the ligamentum flavum and the ligamentum flavum, changes in cartilage and ossification.

Due to the swelling of the cervical intervertebral disc around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the periosteum of the vertebra can be lifted, and a gap is formed between the vertebral body and the protruding intervertebral disc and the lifted ligament tissue. Among them, the accumulation of interstitial fluid, coupled with bleeding caused by micro-injuries, made this bloody fluid organic and then calcified and ossified, thus forming osteophytes.

The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases osteophytes. Osteophytes, together with bulging fibrous rings, posterior longitudinal ligaments, and edema or fibrous scar tissue caused by trauma reactions, form a mixture that protrudes into the spinal canal at the site of the intervertebral disc. The osteophytes of the hook joint can protrude from the anterior to the posterior foramina to compress the nerve root and vertebral artery. Osteophytes at the front edge of the vertebral body generally do not cause symptoms, but there are also reports in the literature that such an osteophyte affects swallowing or causes hoarseness. After compression of the spinal cord and nerve root, it is only a functional change at the beginning. If the pressure is not reduced in time, irreversible changes will gradually occur. Therefore, if non-surgical treatment is not effective, surgical treatment should be performed in time.

[Pathogenesis]

Pathogenesis of cervical spondylosis:

1, cervical spine degenerative changes.

2. Traumatic factors.

3. Chronic strain.

4. Cold and humid.

Supplementary note:

Cervical spondylosis is mainly caused by degenerative changes of the cervical intervertebral disc and cervical spine and its ancillary structures.

The pathogenesis of cervical spondylosis is the same as that of lumbar disc herniation. It cannot be explained solely by mechanical compression factors. There are also vascular and chemical factors at play, which cause edema and inflammation to cause or aggravate neurological symptoms.

Symptoms of cervical spondylosis are very rich, diverse and complex. Most patients have milder symptoms at first, which gradually worsen in the future, and some patients have more severe symptoms. This is related to the type of cervical spondylopathy, but often there are few simple types. One type is the main type and there are one or several types mixed together. It is called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.

These symptoms are related to the degree of onset, the length of the onset, and the individual's physical fitness. Most of them are mild and not taken seriously by people. Most of them can recover on their own, and sometimes light and severe. Only when symptoms continue to worsen and cannot be reversed, do they pay attention to work and life. If the disease is not cured for a long time, it will cause psychological damage and produce symptoms such as insomnia, irritability, anger, anxiety, and depression.

The clinical symptoms of cervical spondylosis are more complicated. It mainly includes neck and back pain, weakness of upper limbs, numbness of fingers, weakness of lower limbs, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia, and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the lesion location, tissue involvement and individual differences.

[Clinical typing]

1. Neck type:

Complain about head, neck and shoulder pain and other abnormal sensations, accompanied by corresponding tenderness points.

The cervical spine on X-ray showed changes in curvature or intervertebral joint instability.

Other diseases of the neck (falling pillow, periarthritis, rheumatic myofibertitis, neurasthenia, and other non-vertebral disc degenerative shoulder and neck pain) should be excluded.

2. Nerve root type:

It has more typical root symptoms (numbness, pain), and the range is consistent with the area dominated by the cervical spine nerves.

The indenter test or brachial plexus pull test was positive.

The findings from imaging studies are consistent with clinical manifestations. Pain point closure is not effective (those with a clear diagnosis may not do this test). (5) Excluded are diseases mainly caused by pain in the upper limbs caused by extra-cervical spine lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, periarthritis, biceps tenosynovitis).

3. Spinal cord type:

Clinical manifestations of strong cervical spine damage.

X-ray showed osteogenesis and spinal stenosis at the posterior edge of the vertebral body. Imaging confirmed spinal cord compression.

Excluding amyotrophic spinal cord sclerosis, spinal cord tumors, spinal cord injury, secondary adhesion arachnoiditis, and multiple peripheral neuritis.

4. Vertebral artery type: The diagnosis of cervical spondylosis of the vertebral artery type is a question to be studied.

There was a sudden onset. And accompanied by cervical vertigo.

Rotating neck test was positive.

X-ray films showed segmental instability or osteoarticular hyperplasia of the vertebral joints.

often accompanied by sympathetic symptoms.

Except for eye and ear vertigo.

Except for vertebral artery insufficiency caused by compression of vertebral artery segment I (vertebral artery segment before entering cervical transverse transverse foramen) and vertebral artery segment III (vertebral artery segment before exiting cervical vertebra into intracranial).

Vertebral angiography or digital subtraction vertebral angiography (DSA) is required before surgery.

5, sympathetic nerve type: clinical manifestations of dizziness, vertigo, tinnitus, numbness, tachycardia, pain in the precardiac area and a series of sympathetic nerve symptoms, x-ray films have instability or degeneration. Vertebral angiography negative.

6, other types: cervical vertebral anterior salivary hyperplasia oppression of the esophagus caused swallowing difficulties (confirmed by esophageal barium examination) and so on.

Differential diagnosis of occipital and posterior neck pain:

1, chronic occipital pain: Occipital neuralgia refers to pain in the posterior head occipital nerve and small occipital nerve. The sensation of the posterior occipital region and the neck is dominated by the first, second, and third pairs of cervical nerves. The posterior branch of the second cervical nerve constitutes the greater occipital nerve. Deep tissue is located in the middle of the line connecting the mastoid and the midpoint behind the first cervical spine Simple, distributed in the back of the occipital region is equivalent to the external ear canal on both sides after the head and neck line. The anterior branch of the third cervical nerve constitutes the occipital nerve and the auricular nerve. The small occipital nerve is mainly distributed on the skin above the auricle and the outside of the occipital, and the large auricular nerve is mainly distributed on the front and back of the lower auricle, on the surface of the parotid gland and the angle of the mandible. When the three nerves are involved, it can cause pain in the posterior occipital and neck and often appears as neuralgia. Because the posterior root of the first cervical nerve is generally small, the posterior pillow and neck pain caused by spinal nerve disease of the upper cervical segment are collectively referred to as occipital neuralgia. Frequent occipital pain is mostly related to insufficient blood supply to the vertebrobasilar artery, which is mainly caused by cervical spondylosis.

2, severe head and neck pain: severe head and neck pain is one of the characteristics of tension headache. Tension headache, also known as muscle contraction headache, is the most common type of headache. It is generally considered to have a higher prevalence than migraine, accounting for about half of outpatient headaches. Mainly due to the neck and head and facial muscles caused by continuous contraction of the head pressure, heavy feeling, some patients complained that the head has a tight feeling.

Its main symptoms are sore head, neck, shoulders, back, arms, stiff neck and restricted movement. Neck and shoulder pain can be radiated to the headrest and upper limbs. Some are accompanied by dizziness, house rotation, severe cases with nausea and vomiting, bedridden, and a few may have dizziness and sudden collapse. On one side, the face becomes hot and sometimes sweats abnormally. Heaviness of shoulders and back, weakness of upper limbs, numbness of fingers, sensation of skin on limbs, weakness of hand grips, and sometimes unconscious holding of the ground. Other patients have weakness in the lower limbs, unstable walking, numb feet, and feel like walking on cotton when walking. When cervical spondylosis affects sympathetic nerves, dizziness, headache, blurred vision, swelling, dryness, occlusion of the eyes, tinnitus, ear blockage, imbalance, tachycardia, palpitation, tight chest, sensation, yes Even symptoms such as flatulence. A small number of people suffer from uncontrollable urination, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms are related to the degree of onset, the length of the onset, and the individual's physical fitness. Most of them are mild and not taken seriously by people. Most of them can recover on their own, and sometimes light and severe. Only when symptoms continue to worsen and cannot be reversed, do they pay attention to work and life. If the disease is not cured for a long time, it will cause psychological damage and produce symptoms such as insomnia, irritability, anger, anxiety, and depression.

[Clinical typing]

1. Neck type:

Complain about head, neck and shoulder pain and other abnormal sensations, accompanied by corresponding tenderness points.

The cervical spine on X-ray showed changes in curvature or intervertebral joint instability.

Other diseases of the neck (falling pillow, periarthritis, rheumatic myofibertitis, neurasthenia, and other non-vertebral disc degenerative shoulder and neck pain) should be excluded.

2. Nerve root type:

It has more typical root symptoms (numbness, pain), and the range is consistent with the area dominated by the cervical spine nerves.

The indenter test or brachial plexus pull test was positive.

The findings from imaging studies are consistent with clinical manifestations.

Pain point closure is not effective (those with a clear diagnosis may not do this test).

(5) Excluded are diseases mainly caused by pain in the upper limbs caused by extra-cervical spine lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, elbow tunnel syndrome, periarthritis, biceps tenosynovitis).

3. Spinal cord type:

Clinical manifestations of strong cervical spine damage.

X-ray showed osteogenesis and spinal stenosis at the posterior edge of the vertebral body. Imaging confirmed spinal cord compression.

Excluding amyotrophic spinal cord sclerosis, spinal cord tumors, spinal cord injury, secondary adhesion arachnoiditis, and multiple peripheral neuritis.

4. Vertebral artery type: The diagnosis of cervical spondylosis of the vertebral artery type is a question to be studied.

There was a sudden onset. And accompanied by cervical vertigo.

Rotating neck test was positive.

X-ray films showed segmental instability or osteoarticular hyperplasia of the vertebral joints.

often accompanied by sympathetic symptoms.

Except for eye and ear vertigo.

Vertebral angiography or digital subtraction vertebral angiography (DSA) is required before surgery.

6, other types: cervical vertebral anterior salivary hyperplasia oppression of the esophagus caused swallowing difficulties (confirmed by esophageal barium examination) and so on.

First, the prevention of cervical spondylosis

1. Read books about cervical spondylosis, and master scientific methods to prevent and treat the disease.

2. Maintain the spirit of optimism, establish the idea of contending hard with the disease, cooperate with the doctor to reduce the recurrence.

3. Strengthen the exercise of neck and shoulder muscles. Doing forward, backward and rotation of head and upper limbs during work or after work can not only relieve fatigue, but also develop muscles and strengthen the toughness, which is beneficial to the neck. The stability of the spine increases the ability of the neck and shoulders to adapt to sudden changes in the neck.

4. Avoid the bad habit of high pillow sleep, high pillow makes the head bend forward, increase the stress of the lower cervical spine, and may accelerate cervical degeneration.

5. Pay attention to the neck and shoulders to keep warm, avoid head and neck weights, avoid excessive fatigue, do not doze off when riding.

6. As early as possible, thoroughly treat the neck and shoulder and back soft tissue strain to prevent it from developing into cervical spondylosis.

7. Avoid flashes and bruises when working or walking.

8. For long-term desk workers, the head position should be changed regularly to exercise the neck and shoulder muscles on time.

9. Pay attention to the postures of head, neck, shoulders and back. Don't shrug your head, talk, or look at your head while reading. Keep your spine straight.

10 Chinese medicine believes that walnut, mandarin meat, raw land, black sesame, etc. have the function of nourishing the kidney marrow. Taking a small amount reasonably can strengthen the bones and bones and delay the degeneration of the kidneys and joints.

Second, the bed of patients with cervical spondylosis

Each kind of bed has its own advantages and disadvantages, and it is related to personal residence, climate, living habits and economic conditions. However, from the perspective of prevention of cervical spondylosis, it should be better to choose a bed that is conducive to stable disease and maintains spinal balance. Therefore, it is better to choose a flexible Simmons mattress on the bed. It can regulate with the change of the physiological curve of the spine.

Pillows for patients with cervical spondylosis

Pillows are the main tool for maintaining a normal head and neck position. This normal position refers to maintaining the physiological curve of the head and neck segment itself. This weight curve not only ensures the external muscle balance of the cervical spine, but also maintains the physiological anatomy in the spinal canal. Therefore, an ideal pillow should meet the requirements of cervical physiological curvature, soft texture, good air permeability, with a low in the middle, high ingot shape at both ends is better. Because this shape can use the middle depression to maintain the physiological curvature of the cervical spine, it can also play a relative braking and fixing role on the head and neck, and can reduce abnormal movements of the head and neck during sleep.

Secondly, it is also important to select the contents of the occipitalis. Commonly used are:

Buckwheat hull: cheap, breathable, you can adjust the height of the pillow at any time.

Purong: Soft texture, good air permeability, can be adjusted at any time.

Mung Bean Shell: Not only has good air permeability, but also cools and relieves the heat. It is better if you add an appropriate amount of tea or mint, but it is mainly used in summer. Others such as duck feathers are also good, but the price is higher.

Pillows should not be too high or too low. Don't worry about pillows. It is better to be physiological. Generally speaking, pillows should be 8-15cm high, or calculated according to the formula: (shoulder width-head width) 2.

Cervical vertebra pillow can also play a preventive or therapeutic role.

Fourth, the sleeping position of patients with cervical spondylosis

A good sleeping position should not only maintain the physiological curvature of the entire spine, but also make the patient feel comfortable, so as to relax the muscles of the whole body and easily restore fatigue to adjust the physiological state of the joints. According to the requirements of this good posture, the natural curvature of the chest and waist should be maintained, and both hips and knees should be flexed. At this time, the muscles of the whole body can be relaxed. In this way, it is best to take a side or supine position, not prone.

Five, cervical spondylosis dumbbell medical gymnastics

1. Elbow flexion and chest expansion: The legs are shoulder width apart, the dumbbells in both hands hang down naturally, the arms are flexed with flat shoulders, and the chest is expanded at the same time. Repeat 12 to 16 times.

2. Orthogonal attack: two legs separated and shoulder width, two dumbbells held elbows on both sides of the chest, the upper body moved slightly to the left, the right hand to the left front oblique attack, alternating left and right, each repeated 6 to 8 times.

3. Side attack: separate legs and shoulder width, hold the dumbbells on both sides of the chest, hold the dumbbells to the right, strike left and right, and repeat 6 to 8 times each.

4. Strike from above, with legs apart and shoulder width. Hold the dumbbells on both sides of the chest when flexed. Hold the dumbbells to the right to strike upwards, alternating left and right, repeating 6 to 8 times each.

5. Outrigger abduction: Two legs separated with shoulder width, both hands holding dumbbells drooping, right upper limb straightened from front to upward, repeated left to right 6 to 8 times.

6. Shrug back and spin: The legs are separated and the shoulders are wide, the dumbbells are held down with both hands, the arms are straight down, the shoulders are raised upwards, the shoulders are rotated backward and lowered, and repeated 12 to 16 times.

7. Both shoulders are widened and the chest is stretched back: The legs are separated and the width of the shoulders, the two hands are holding the dumbbells to sag, the shoulders are stretched straight out, the shoulders are stretched back, and the chest is expanded at the same time, repeating 12 to 16 times.

8. Straight arm swing back and forth: two legs separated front and back, two hands holding dumbbells sag, left and right upper limbs straighten and swing back and forth alternately, repeating 6 to 8 times, both legs exchange standing positions, and swing 6 to 8 times at the same time.

9. Head-to-side flexion: Separate legs and shoulder width, hold dumbbells down, hold head and neck flexed to the left, reaching the maximum range, then rotate to the right to the maximum range, alternating left and right, repeating 6 to 8 times.

10. Head forward and backward: Two legs separated with shoulder width, two dumbbells held down, head and neck flexed forward as much as possible; head and neck tilted back to the maximum range, repeat 6 to 8 times.

11. Head rotation: legs separated and shoulder width, both hands holding dumbbells drooping. Rotate the head and neck once in a clockwise direction, and then turn it counterclockwise once, repeating 6 to 8 times.

The above movements should be gentle, and the rotation movement can be done 1 to 2 times a day depending on the person.

What Are the Most Common Causes of Neck Pain and Fatigue?

Occipital and posterior neck pain

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