Neck pain is very common. About 2 in 3 people had neck pain at some point in their life. A survey in the UK has shown that 1 in 4 women and 1 in 5 men between ages 45 and 75 had current neck pain.
The cervical spine and the muscles and ligaments are at the back of the neck. The cervical spine is made up of seven vertebraes between which is a disc. Spinal cord is within the spine and protected by the spine. Nerves come out from the cervical spine and innervated the neck and arms.
Non specific neck is the most common type of neck pain. The exact cause is unknown. It may caused by minor strains to the muscles and ligaments in the neck. Poor posture is often related to the neck pain.
The nuchal ligament and neck pain
The nuchal ligament is a ligament at the midline of the neck which extends from the bottom of the skull to the spinous process of the seventh cervical vertibrae which is the lowest cervical vertebrae on the neck. It forms a septum between the muscles on the either side of the neck. There are four muscles including trapezius, splenius capitis, rhomboid minor and serratus posterior superior attached the nuchal ligament. The nuchal ligament limits flexion of the neck, stabilizes the neck and affects muscular activity in the neck. Trauma and overuse of nuchal ligament can result in ossification of the ligament which causes neck stiffness and pain, progressive cervical spine instability and malalignment and nerve route irritation. Acupuncture can help release neck stiffness and neck pain.
Acupuncture treatment for chronic neck pain
Chronic neck pain is a long-lasting pain on the neck or back. This pain commonly started from improperly healed acute injury. Scar tissues formed during the healing process. These scar tissues are called fibrosis. They can develop inside of the body, under the skin, muscles, tendons or inside of a joint capsule. Fibrosis always occurs at the end stage of inflammation and it causes adhesion which grabs the connective tissue and surrounding muscles together causing pain and tension, limiting the function. There are more pain receptors in the fibrosis tissue making the area more sensitive to protect the area by the body automatically.
Acupuncture can help to release the pain and tension to help the area functioning. Also acupuncture can help the body repair to get rid of the scar tissue and remodel the tissue.
Acupuncture for sudden severe pain in the neck
Acute neck pain is a sudden-onset pain in the neck. It is often due to neck muscles strain and muscle spasm. This can be caused by poor posture, sleep in an awkward position, carrying heavy loads, stay in one position for a prolonged period of time etc. One might not find exactly causes. The pain is sudden and can be very severe. This makes the person with the pain panicking. Movement of the neck is restricted because of the pain. The recovery can take a few days or a week. Acupuncture can help release the pain and speed up the recovery.
Acupuncture helps a stiff neck
Neck pain or a stiff neck is a common problem. The neck becomes sore and tender and movement is limited. it is difficult to move the neck and turn the head to the side. It could be associated with a headache, neck pain, shoulder pain or arm pain. The most common cause of a stiff neck is a muscle strain or soft tissue sprain. The levator scapula muscle located at the back and side of the neck connecting the neck with the shoulder is most affected. These muscles can be strained by everyday activities: for example, sleep in an awkward position, use a computer for a prolonged period of time, have a bad posture or have some sports injury such as swimming sudden fall, hold a phone between the neck and shoulder etc. Anxiety and stress can cause tension in the neck muscles leading to neck pain. Tight muscles are often chronic and need to be treated. Tight muscles block blood circulation of the body and muscles don’t get enough nutrition and become weak and easily get further damage. Because of blocked energy supply, you will feel tired all the time. Poor posture is a common cause of tight neck and shoulders. This causes overuse some groups of muscles and causes micro injury to the muscles which become tight to protect themselves from further injury. Furthermore the tight neck and shoulders will make poor posture worse. It becomes a viscous circle. This needs to be treated, otherwise tight neck and shoulders would not resolve itself. Stretching the muscles, applying heat or warm bath may help. Acupuncture is very effective to release the muscle tension, reduce the tightness, correct poor posture and improve blood circulation. Acupuncture can help stiff neck by relaxing muscles spasm.
Poor posture, acupuncture can help
Poor posture is a major cause of neck pain; while neck pain prevents the neck from getting back to normal posture. Poor posture results from certain muscles shortening and lengthening in an abnormal way. Poor posture can place strain on the related muscles and other soft tissues causing pain, such as neck and back pain. Inflammation is one of the causes of poor posture. If there is an inflammation in somewhere in the body, it causes pain. The body automatically protects itself to avoid the pain resulting in an abnormal posture. For example, people with neck pain would tilt the head involuntarily to one side to avoid the neck pain. Acupuncture can help to reduce the inflammation and pain to help to correct the poor posture.
Acupuncture treatment is recommended for acute and chronic neck pain
Current interventions for neck pain include themal, electrotherapy, ultrasound, mechanical traction, laser, and acupuncture. But definitive knowledge about optimal modalities and dosage for neck pain is limited. Granham N et al from McMaster University, Hamilton Canada analysed existing data to provide the evidence for recommendations on physical modalities for acute to chronic neck pain. The data included was from January 2000 to July 2012. Their result showed that short term pain relief- moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofacial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical uscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. They concluded that the current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain.
Liang Z et al in China studied the effect of acupuncture on chronic neck pain. 178 patients with chronic neck pain were recruited. These patients were allocated into two groups 88 in acupuncture group and 90 in control group which received acupuncture and placebo treatment respectively. The Northwick park neck pain questionnaire (NPQ), visual analogue scale (VAS), short from 36 health survey (SF-36) and doctor’s judgement were applied for measuring effectiveness. The effect was assessed before treatment, immediately after the treatment, at the end of first month of follow-up and at the end of third month follow up. They found that the NPQ, VAS and SF 36 scores in acupuncture group were significantly improved after the treatment and the two follow-ups compared with before the treatment. Acupuncture group had better effect than that for control group. They concluded that acupuncture has immediate effect and lasting effect for chronic neck pain.
Another research of effectiveness of acupuncture on neck pain by Dong and Lin was published recently. They compared different effects of acupoints. 60 patients with neck pain were divided into two groups with 30 patients of each group. In first group, the acupoints selected at the start and end of trapezius muscle including Tianzhu (BL10), Fengchi (GB20), Quyuan (SI 13), Jugu (LI16) and Ashi points. In the second group, Jiaji (Ex-B2) on the neck were selected. The patients received acupuncture 5 times a week for 2 weeks. The Pain Rating Index (PRI, VAS and Present Pain Intensity (PPI) were measured before and after the treatments. They found that the scores were significantly reduced in both group. The better effect in first group was observed. They concluded that the points at the start and end of trapezius muscle had better effects than Ex-B2 points.
How many needles are suitable for neck pain treatment with acupuncture?
How many needle numbers are used to obtain best effect? Ceccherelli F et al from University of Padova Italy studied this subject. They compared the clinical efficacy of different number of needles used in patients with mayofascial pain. There were 36 patients between 29-60 years of age with cervical myofacial syndrome participated the study. These patients were divided into two groups: 18 patients were in the first group and treated with 5 needles; another 18 patients were in the second group and treated with 11 needles. The same of needle stimulating time and the same cycle of treatment were applied to both groups. Pain intensity was evaluated before, immediately after and 1 and 3 months after the treatment. The needles in the two most painful trigger points were inserted deeply and other needles were applied superficially. They found that a good treatment effect was obtained in both groups and this is not associated with the number of needles used. Their conclusion was that the number of needles either 5 or 11 used is not essential to obtain good therapeutic effect when the simulation time remains the same.
Physiotherapy and chiropractic treatments are popular options for treating neck pain. Do you know that physiotherapist and chiropractors also use acupuncture to treat neck pain? What treatment options are available for neck pain? There was an international survey with Canada having the largest response to investigate physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. Both physiotherapist and chiropractors used exercise and manual therapies which is 98-99%. Physiotherapists used exercise, orthoses and 'other' interventions more, while chiropractors used phototherapeutics more. 46% acupuncture is used by these professions to treat neck pain. If you go to see a physiotherapist or a chiropractor, you may get an acupuncture treatment from them.
A review by Trinh K et al from Canada summarised the most current scientific evidence on the effectiveness of acupuncture for neck pain. They found 27 studies investigated this subject. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). They found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Acupuncture appears to be a safe treatment with minor adverse effects. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.
Ceccherelli F et al Clin J Pain 2010 26:807-12
Liang Z et al Complement Ther Med (2011) 19 supple 1:S26-32
Dong WK and Lin XH Zhongguo Zhen Jiu (2012) 32:211-4
Graham N et al Open Orthop J (2013) 7:440-60
Carlesso LC et al Chieopr Man Thera (2014) 22:11
Trinh K et al Cochrane Database Syst Rev (2016) May 4;5:CD004870. [Epub ahead of print]