Background & Etiology
The spine is composed of three main sections: the cervical (neck) thoracic (middle back) and lumbar (low back). The cervical spine is the section of the spine responsible for turning the head and neck, in addition to providing stability and support for the structures connecting the brain with the rest of the central nervous system in the spine.
The muscular system of the spine is large and complex, each area of the spine has a group of muscles that serve to support, move and stabilize it. The spinal muscles work together with the ligaments to provide movement, stability, and postural support to spine. They can be categorized according to their function. The four basic categories are the flexors, extensors, lateral flexors and rotators. Irritation or injury of the structures of the spine may produce spasm and pain in the muscles of the cervical spine.
Cervical Muscle Spasm
A muscle spasm is a sudden and involuntary contraction, tightening, or shaking of a muscle. A spasm often occurs as a result of trauma, strain, overuse, weakness, or pain. In the cervical spine, a muscle spasm may or may not cause the head to turn or move without warning. A cervical muscle spasm that occurs close enough to the spinal cord or nerve roots can put pressure on important nerves. The nerves of the cervical spine provide sensation and motor control to the neck, shoulder, arm, and down to the hand
Cervical muscle spasms often occur in response to another condition, or as a result of pain, fatigue or overuse. Common causes of cervical muscle spasm include:
- Muscle strain or fatigue
- Increased physical exertion
- Stress, and having tense muscles
- In response to certain medications
- As the result of a fracture in the cervical spine
- Conditions that degenerate or put pressure on the intervertebral discs
- Trauma such as a motor vehicle accident.
- Pain in the neck or back
- Muscle weakness or strain
- Stiffness in the neck
- Pain or difficulty moving the shoulders or arms
- Involuntary muscle movements
- Numbness or tingling in the shoulders or arms
If an individual suspects they have had a cervical muscle spasm, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that includes rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to repair an underlying condition.
In mild cases rest, ice and medication may be enough to reduce the pain. Many patients will do well with this regiment. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent reoccurrence of the injury. Return to activity should be gradual to prevent a return of symptoms.
Moderate to Severe
If the problem persists, consulting with your health care provider should be the next step. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.
Procedures that your physician may recommend and perform in addition to physical therapy may include:
- REST and ICE
- Splinting or bracing the affected area
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
Your physical therapist will perform a thorough evaluation to assess and determine the following:
- Spinal Examination: where the patient is put through a series of movements and tests to determine the most probable cause of the condition.
- Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances.
- Flexibility: tight muscles can contribute to poor mechanics and weakness creating imbalances and making one more susceptible to disc and back injuries.
- Posture Analysis, ADL’s and technique: discuss and observe the activity that may have started the problem. An examination of the dynamic and static postures that may have caused or contributed to the back problem. A review of your current activities at home and work that may or may not be causing or prolonging your present condition.
Physical therapy for a cervical muscle spasm must remain conservative at the onset to avoid aggravating the condition. Your program design will be based on the structure and cause of your symptoms. A program not tailored to your problem could aggravate your symptoms.
Common Physical Therapy interventions in the treatment of cervical muscle spasm include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the neck and cervical spine. Use of mobilization techniques also helps to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to restore joint mobility, range of motion, and strengthen muscles of the back and neck support, stabilize and decrease the stresses place on the spinal joints, and discs.
- Neuromuscular Re-education (NMR) to improve posture, restore stability, retrain the patient in proper sleeping, sitting and body mechanics to protect the injured spine.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser, traction and others to decrease pain and inflammation of spinal structures.
- Home programs including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of cervical muscle spasm.