Neck Pain in Paris: Assessment and Management of Neck Pain
Neck pain is common and can have a variety of causes, including muscle tension, joint disorders, disc disease, osteoarthritis, nerve root irritation, trauma, or changes in certain postural factors.
At the CCCV at Paris 7, the primary goal is to understand the likely cause of the symptoms, identify any neurological signs, and determine whether conservative management is appropriate.
Depending on the situation, the evaluation may include clinical, orthopedic, neurological, and postural examinations, as well as, when indicated, an analysis of available imaging studies.
What is neck pain?
The term "cervicalgia" refers to pain in the neck. It may be confined to the cervical region or may be accompanied by pain in the shoulders, shoulder blades, head, or upper limbs.
Neck pain can be acute or chronic. Its intensity alone is not enough to determine its cause or severity.
In some patients, the pain is primarily mechanical and varies with movement or certain positions. In others, it may be accompanied by neurological symptoms that require further evaluation.
What are the main causes of neck pain?
There is no single cause of neck pain.
It can be associated with various elements:
muscle or joint problems;
limited cervical mobility;
a disc disorder or a pinched disc;
cervical osteoarthritis or uncarthrosis;
osteophytes;
a disc protrusion or herniated disc;
foraminal narrowing;
irritation or compression of a nerve root;
cervical trauma, particularly following a “whiplash”-type acceleration-deceleration injury;
or certain changes in cervical alignment and posture.
Several of these findings may be present at the same time. However, their presence on an X-ray or MRI does not automatically identify the source of the pain.
Does an abnormality on an MRI or X-ray necessarily explain the pain?
No.
Degenerative changes in the cervical spine become more common with age and can be observed in people who do not experience any pain.
Disc disease, disc protrusion, osteophytes, and other changes may therefore sometimes be discovered incidentally.
Conversely, a patient may experience severe neck pain even though their imaging shows relatively few abnormalities.
Imaging findings should therefore be interpreted in conjunction with the symptoms, medical history, and physical and neurological examination.
What your report says — and what it doesn't say
Terms such as “C5-C6 discopathy, ” “uncarthrosis, ” “cervical straightening,” or “foraminal stenosis” describe an anatomical or radiological finding.
It does not automatically mean:
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that this abnormality explains your pain;
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that a nerve is compressed;
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that the situation is serious;
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or that invasive treatment is necessary.
It is the correlation between the imaging findings and your clinical condition that gives them their true significance.
When can neck pain be caused by a nerve?
When a cervical nerve root is irritated or compressed, pain can radiate from the neck or shoulder blade to the shoulder, arm, forearm, or hand.
It may be accompanied by tingling, numbness, changes in sensation, or, in some cases, decreased muscle strength.
In such cases, the condition is referred to as radicular pain or, when there is objective evidence of functional impairment of the nerve root, cervical radiculopathy.
In France, the term " cervicobrachial neuralgia " is also commonly used to describe certain types of neck pain that radiate into the upper limb.
A neurological examination is used, in particular, to assess sensation, strength, and reflexes in order to detect nerve damage.
What role can posture and cervical lordosis play?
When viewed from the side, the cervical spine typically has a curve called cervical lordosis.
Some reports mention a loss of lordosis, cervical straightening, or, in some cases, a reversal of the curvature.
These changes alone do not explain neck pain. There is significant variability in cervical alignment among individuals, including among some asymptomatic people.
In selected patients, when a postural change is objectively measured under standardized conditions and deemed clinically relevant, it may nevertheless be incorporated into the evaluation and, potentially, into certain treatment goals.
It is therefore important to distinguish between an improvement in symptoms and a change in a radiographic or postural parameter.
How do we evaluate neck pain at the CCCV?
The evaluation begins with the patient’s clinical history: onset of symptoms, location of pain, any trauma, factors that worsen or alleviate the symptoms, and changes over time.
The examination may then include:
assessment of cervical mobility;
orthopedic examination;
neurological examination;
assessment of trunk posture and balance;
analysis of potential radiation exposure in the upper limb;
and screening for signs that require further medical evaluation.
This evaluation helps determine whether conservative management is appropriate or whether further testing or a specialist’s opinion is needed.
When is cervical imaging useful?
An X-ray or MRI is not necessary for every case of neck pain.
In a patient with neck pain who has not sustained any trauma, has no neurological deficits, and shows no specific warning signs, imaging is not always necessary.
It becomes more relevant depending on the context: trauma, persistent symptoms, suspected neurological involvement, radiculopathy, a significant change in clinical status, or other factors requiring further investigation.
When tests have already been performed, we can also analyze them in conjunction with the clinical examination.
Imaging is therefore a complementary tool, not a diagnosis in and of itself.
How is neck pain treated?
Treatment depends on the clinical situation, not on a single protocol applied to all patients.
When conservative treatment is indicated, it may include, among other things:
maintaining or gradually resuming operations;
tailored chiropractic care;
mobility work;
strength-building and motor control exercises;
advice regarding certain activities or positions;
and, for certain selected patients, specific postural correction exercises.
The initial goal may be to mobilize, relieve pain, and improve function.
When a relevant postural factor is also identified, an additional correction goal may be considered and then reevaluated.
What role does CBP® postural correction play?
At the CCCV, we use the principles of Chiropractic BioPhysics® (CBP®) in particular when postural correction is deemed appropriate.
Depending on the situation, this approach may combine chiropractic care, corrective exercises, and specific postural traction.
The goal is not to seek a “perfect” posture in all patients.
When corrective action is proposed, it must be based on a measurable parameter, pursue an individualized objective, and allow for an objective reassessment of progress.
However, a change in cervical lordosis does not mean that disc disease, osteoarthritis, or osteophytes have disappeared. Structural and clinical objectives must remain clearly distinct.
When should you seek immediate medical attention for neck pain?
Some situations require prompt medical evaluation.
This is particularly true when the following occur:
new or progressive muscle weakness in an arm or hand;
significant or progressive sensory disturbances;
unusual clumsiness of the hands;
problems with walking or balance;
progressive neurological symptoms;
or symptoms that have appeared in a clinical context requiring specific medical evaluation.
These symptoms may, in particular, lead to the suspicion of nerve root damage or, more rarely, spinal cord damage.
Neck pain following an accident or whiplash
Rapid acceleration and deceleration of the head during a car accident, a fall, or a sports-related injury can cause neck pain and limited range of motion.
The absence of a fracture does not necessarily mean there are no symptoms.
The examination should take into account the mechanism of the injury, the progression of the pain, and any neurological signs.
Read our article on cervical changes after an accident
https://www.chiropractic.fr/articles/articles/votre-cou-ne-ment-pas-la-preuve-en-image-des-degats-d-un-accident-de-voiture
Neck Pain and Forward Head Posture
Prolonged screen time, maintaining the same position for long periods, and various daily habits may be associated with certain neck symptoms.
However, it is too simplistic to attribute all neck pain to “poor posture.”
Neck pain has multiple causes and must be evaluated holistically.
Understanding "Text Neck" or "Tech Neck"
https://www.chiropractic.fr/articles/articles/textneck-ou-techneck
The findings from your cervical examination
Your report may contain some expressions that are sometimes difficult to understand:
uncarthrosis or unco-discarthrosis
disc protrusion or herniated disc
Text Neck / Forward Head Posture
These terms should not be interpreted in isolation.
On the CCCV website, we are developing a series of articles specifically dedicated to explaining the terminology used in radiology and MRI reports for the cervical spine.
Key takeaways
Neck pain does not necessarily indicate a serious injury.
An imaging abnormality does not necessarily mean that it is causing your pain.
Pain that radiates into the arm does not automatically mean that a nerve is damaged.
A change in cervical lordosis should not be interpreted in isolation.
The goal is to correlate your symptoms, your functional status, the clinical and neurological examination, and—when appropriate—imaging results to determine the appropriate treatment strategy for your situation.
Frequently Asked Questions About Neck Pain
Should you get an MRI for neck pain?
Not always. The decision depends, in particular, on the duration and progression of symptoms, the neurological examination, any history of trauma, and the presence of signs warranting further investigation.
Is cervical disc disease serious?
Not necessarily. Disc changes become more common with age and can be observed in asymptomatic individuals. Their significance depends on whether they are consistent with the symptoms and the physical examination.
Does a straight neck necessarily cause pain?
No. The degree of cervical lordosis varies from person to person, and a straight cervical spine alone does not explain neck pain.
Is it possible to have a cervical herniated disc without pain?
Yes. Certain disc abnormalities may be seen on an MRI in people who do not have symptoms. Imaging findings must therefore always be interpreted in light of the patient’s clinical presentation.
Does arm pain always come from the neck?
No. Irritation of a cervical nerve root can cause pain in the arm, but other structures can also produce similar symptoms. The examination helps guide the diagnosis.
Can a loss of cervical lordosis be corrected?
Certain specific cervical traction methods have shown that it is possible to alter lordosis in select patients. However, this does not mean that every case of a straight neck must be corrected, nor does a radiographic change guarantee that symptoms will disappear.
Do you suffer from neck pain?
An evaluation will help determine whether your symptoms can be managed with conservative treatment and whether any abnormalities noted on your X-rays or MRI are actually relevant to your situation.
