The skull and spine are part of the axial skeleton, which includes the ribcage and pelvis, above of which there are 7 cervicals, 12 thoracic, 5 lumbar. Below there are 5 fused sacral vertebrae and four fused coccegeal vertebrae. The ribeage involves 12 pairs of mobile ribs - the sternum - manibrium - and the xyphoid process.
The weight transfer from the skull to the spine is the key to postural alignment , for the head weighs between 6.5 - 10 kilos in the average adult. This weight is passed to the rest of the spine through the first vertebrae - the atlas, and spreads around the bones of the pelvis through the sacrum and is transferred to the ground via the legs and feet.
Disorders of cervical origin are very common in both sexes at most ages. Pain of cervical origin may be experienced as neck pain or referred to the head, shoulders and chest. There are 35 cervical joints and pain may arise from any of the intervertebral discs and the muscles. This cervical spine is a complexity of joints, which permits exceptional mobility.
This mobility is enhanced by the anatomical arrangement of the atlas and axis, by the relative smallness of the antero posterior diameter of the vertebral body relative to the height and by the sagittal apophyseal angle of 45 degrees which permits movement in every direction.
These weight bearing joints lie in a firm column called the articular pillar . The main muscles are the extensors, stemodomastoid, trapecius, splenius and the smaller rotators. The muscles which have an exceptionally high innervation ratio, are capable of very rapid and delicate movements.
The cervical spine is a prolific source of referred pain patterns. This can arise from one of two mechanisms:
- Nerve root pain
- Segmental dysfunction (spondyloginic)
Nerve root pain can arise from nerve root compression caused by a prolapsed disc or by a narrowing of an intervertebral foramen. Segmental dysfunction, which is by far the more common cause results in irritation of the posterior primary rami, causing referred pain in the dermatomal pattern. (The area of the skin that provides a sensory input to one pair of spinal nerves or to the cranial nerve is called a dermatome.)
Vertebral dysfunction of the apophyseal joints, and spondylosis, known also as degenerative osteoarthritis or
Osteoarthritis are the main causes of neck pain.
In children and adolescents neck pain is often the manifestation of an infection or inflammation or cervical lymph nodes - an infected throat, tonsillitis or pharyngitis.
In adults, the outstanding causes of dysfunction of the joints and spondylosis with the acute febrile causes encountered in children, are rare. The painful acute wry neck can affect all ages and may be considered to be caused mainly by acute disorders of the apophyseal joint rather than a disc prolapse.
A cervical headache is usually suboccipital and unilateral, but can be bilateral, commonly misdiagnosed as migraine. Acute torticolllis (wry neck) is a lateral deformity of the neck - usually transient - a painful joint disorder with associated muscle spasm of variable intensity. A feature is that any segment of C2 - C7 can cause this affliction, muscle energy work, shiatsu and mobilisation are key therapies to be employed.