Injury Breakdown: Pain In The Neck
by Abby Sims
Tiger Woods is in the news again, this time for withdrawing from The Players Championship in the middle of the final round at Sawgrass with complaints of neck pain. Tiger was quoted as saying that he first experienced neck pain before the Masters, which was played in early April. He claimed to have been playing through the pain since that time. By Sunday the pain had evidently become untenable. However, while at the Masters, Tiger was reported to have responded to questioning about injuries he suffered in his November accident by saying that in addition to a “busted-up lip” he’d also had a “pretty sore neck”.
There has been much speculation about the nature of Tiger’s injury and the degree to which it has been a factor. Some have advanced the idea that he is simply suffering the consequences of a history of aggressive training. That seems very unlikely. Others said his condition was probably brought on by stress – and we all know he has had plenty of that! There were skeptics who pointed to Tiger’s ability to put on a good show at the Masters in spite of the pain he now claims to have had. Did this same pain cause him to miss the cut last week and result in another sub-Tiger performance at Sawgrass? That is definitely plausible because pushing himself might have exacerbated the symptoms and made his condition worse over time. Whatever the situation, it does seem clear that all is not well with Tiger Woods. Obviously, only Woods truly knows how he has felt since his accident, the extent to which his neck had been an ongoing issue and whether the pain has escalated to the point that it was clearly counterproductive to attempt to play through it, especially in a losing effort.
Tiger reportedly said that he was experiencing tingling in his hand along with neck pain and he was planning to undergo an MRI. Despite the valuable diagnostic information that MRIs can provide, they are not foolproof. Sometimes they don’t show all that is going on (false negative results) and in other instances they seem to show a more involved condition than is actually present (false positive findings). Along these lines it is also helpful to note that repeated studies assessing the MRIs of healthy subjects (without complaints of pain) found that a significant percentage had positive findings in spite of their lack of symptoms. With this in mind, a physical exam will also provide insight as to what might be causing Tiger’s symptoms and how to proceed once a diagnosis is made.
Causes of radiating pain
There are a number of potential causes for radiating (also called radicular) pain in the upper extremity; some don’t even involve the spine at all. This type of pain is generally due to compression or stretch of a nerve. Compression can be from a bulging or herniated disc in the cervical (neck) region, from a narrowing of the spaces in the spine (due to arthritic changes) where nerves exit, from pressure at the first rib, or from a muscle spasm that causes a constriction. Compression of a nerve can also occur in the arm itself (due to scar tissue or swelling, etc), causing tingling, numbness or weakness below the constricted area. For instance, in Carpal Tunnel Syndrome the compression is at the wrist and causes symptoms in the hand.
Tightness of a nerve results in excessive tension on that nerve, and is another possible cause of radiating symptoms. In addition, a traumatic nerve stretch is likely to provoke acute neurologic pain. The latter is typical of the “stingers” and “burners” that football players often experience.
[pullquote]There are a number of potential causes for radiating pain in the upper extremity; some don’t even involve the spine at all.[/pullquote]
The specific nature of an injury and the findings on physical exam determine the nature of treatment. If a disc is involved, manual or mechanical traction may be beneficial. Massage and other manual techniques to release the tension in the soft tissues of the cervical region, shoulder girdle and upper back are also helpful, particularly just prior to working on the spine itself. If range of motion of the neck (or shoulders) is restricted, therapy should include work to restore full mobility. When nerves are tight, tensioning techniques to release them are enormously beneficial. In addition, working toward normal upper body strength should be a part of any therapy program for the cervical spine. An imbalance of strength can result in compensatory reliance on muscles that go into overdrive as a result, causing pain from muscle tension or spasm. This is most common at the upper trapezius muscle, which runs from the neck to the shoulder (and acts to hike the shoulder toward the ear).
A focus on posture, alignment, muscle recruitment patterns and the mechanics used in sports performance are also vital aspects of care. Attention to activities of daily living and how they are performed should also be addressed as part of a comprehensive treatment program. For instance, someone who sits hunched over a computer, has a less than ideal ergonomic set-up of the workspace or cradles the phone between the ear and shoulder rather than using a headset is a candidate to develop neck pain. Improper sleeping positions (especially lying prone – on one’s stomach – with the neck rotated all the way to the side) or using the wrong pillow can also predispose to neck problems, and sufferers might even need advice as to how to modify the way they sleep.
Understanding how elevated levels of stress can impact neck pain is also part of good care. In my experience, neck and back pain as well as jaw (TMJ) pain seem to be the orthopedic conditions most influenced by a patient’s level of stress. For those who recognize that stress is an issue, relaxation training or other coping mechanisms (music, improving sleep patterns, counseling…) may be advocated.
Anti-inflammatories and/or muscle relaxants may be prescribed in the more acute phases of treatment and only when signs and symptoms are severe and alarming (such as a loss of sensation, isolated muscle weakness and a significant alteration of reflexes) is surgery considered.
As for Tiger Woods, with the ever-present glare of the media upon him, we will soon learn more about his condition by way of whatever is leaked or released to the press. It may or may not be the full story. Tiger will be the only one who will know…
Abby Sims is an orthopedic and sports physical therapist who has been in private practice in NYC for the past 30 years (you may be familiar with her husband, sportscaster & WFAN alum Dave Sims). Abby has a Masters of Science in Physical Therapy from Duke University and has extensive experience working with professional, collegiate and recreational athletes with musculoskeletal injuries – both non-operative and operative. She has also enjoyed lecturing at many medical conferences. Abby looks forward to responding to your questions or writing about topics that you suggest. For more information about Abby, or her practice, please check out www.RecoveryPT.com as well as www.AthletiSense.com.