Most people have experienced a stiff neck in there life or have woken up with a crick in their neck. In chiropractic this is sometimes called a “subluxation”. They are defined as complex functional and structural problems that create neuro-musculoskeletal irritation capable of influencing general health (1). I will be using the word “spinal segmental joint dysfunction” instead of the work subluxation in this article. This is when there is altered joint alignment, motion, or physiologic function in a spinal motion segment.” (2) This mechanical segmental joint dysfunction most commonly results in local dull and diffuse pain or discomfort.

Anatomy of neck joint restriction

There are two causes of joint restriction in the neck. These are mechanical and reflexive. Mechanical dysfunction happens when there is a brief trauma or extend period of overuse. Periods of overuse cause joint restriction because of imbalances between the surrounding muscle groups. Tightness and irritation are common in the following muscles: levator scapula, upper trapezius, suboccipital, pectoral and rhomboid muscles. Weakness is common in the deep neck flexors, rhomboids, and scapular stabilizers (3). Psychological and emotional factors can cause reflexive joint restriction associated with irritation of the organs triggering muscular guarding, resulting in altered joint mechanics.

Both causes of joint restriction affect the synovial facet joints. Decreased movement of these joints is what causes pain and alters the information that is going to the brain this is called mechanoreceptive input (4,5,6,7). Once neck joint restriction begins it can become a self-perpetuating cycle of discomfort in which the negative effects of decreased motion of the joint are perpetuated by inflammation, tense muscles (via Hilton’s Law) and imbalance. Joint restriction rarely affects only one joint and can affects the spine as a whole (3). Over time this can lead to degenerative changes of the joint (30,65).

Causes of neck joint restriction

Neck joint restriction is a common cause of headaches, vertigo, and temporomandibular joint dysfunction. If accompanied by midline cervical spine tenderness may require imaging.

Common symptoms of neck joint restriction

Neck pain is common and most neck pain is the result of joint restriction. Medical providers see over 10 million neck pain visits per year (8). Many people will have neck pain in their lifetime (9,10). This pain will lead to lost workdays (11). Neck pain usually lasts longer than back pain and is more common in women. (12,13). It is rare that imaging will find a specific medical pathology in 50-80% of neck pain patients, supporting the idea that joint dysfunction and its associated muscle tightness is the most common cause of this problem (14). Even though the causes are not well understood in the mainstream medical community neck pain often comes out of nowhere without a good explanation (15). The most common presentation is tenderness when you press certain points on the neck and stiffness. This pain can increase with movement especially with looking up.

How to evaluate neck joint restriction

Neck joint restriction is first noticed with a loss of range of motion and it can be evaluated which specific segments of the neck are restricted. The most common tool used to analyze the neck is motion palpation. (36) Neck joint restriction is associated with postural imbalances. Tightness and irritation are common in the following muscles: levator scapula, upper trapezius, suboccipital, pectoral and rhomboid muscles. (56) Weakness is common in the deep neck flexors, rhomboids, and scapular stabilizers. Orthopedic tests such as foraminal compression will cause pain and traction of the neck will provide relief. Extreme dizziness, loss of feeling in the face, fainting, or difficulty speaking are all indications that you must go to the Emergency room.

Radiographs may be appropriate for patients with a history of cancer, bone disease, systemic disease, inflammatory arthropathy, steroid use, immunosuppression, prior cervical surgery, or a failed trial of care.

Upper cervical chiropractic for neck joint restriction

Manual therapy and upper cervical chiropractic has been shown to produce results in fewer visits than physical therapy. (63) These treatments provide both short and long-term benefit for acute and chronic neck pain and is superior to other treatments (19-21,31-35,44,47-50,58,60,61). In conjunction with improving thoracic restrictions for optimal outcomes. (42,43,66)

Upper cervical adjustments are gentle and so there are very little concerns about the safety of cervical spinal manipulation. Even though this type of chiropractic treatment is gentle it is important to understand vertebral artery compromise, which may lead to stroke. Cassidy reviewed 100 million patient-years of data and concluded that chiropractic produced no greater risk of major complication, including stroke, vs medical care (23). Another study found that the benefits of cervical manipulation outweigh the risks (24). Another study concluded that using NSAIDs for neck pain produced 400 times greater risk when compared to spinal manipulation (25). The most common complication is transient local soreness (26).

The best treatment is combining upper cervical adjustments with exercise (27-29). Stretching, massage and myofascial release of the levator, upper trapezius, pectoral and rhomboid muscles is helpful. (37-39) Chin retraction exercises may encourage better head posture. Strengthening exercises will help address postural concerns and should focus on the deep neck flexors, shoulder external rotators, rhomboids and other scapular stabilizers.

In addition to this it is important to discuss workstation ergonomics and to reduce exacerbating activities such as backpack/purse weight and carriage, childcare, and sedentary hobbies. Sleep postures should be discussed and consideration of a small, single cervical pillow for nocturnal use is appropriate.


Exercises to help heal neck joint restriction

To see more videos visit the Dr. Noah Volz YouTube channel.


Neck joint restriction can be healed and this article gives you some suggestions on what to look for to determine you have a joint restriction and what to do about it. I hope that this information helps you. If you have any additional questions please leave a comment. In addition to this article you can also read the Guide to Chronic Neck Pain eBook.

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