How Neck pain can be caused by a lower back issue
Updated: Apr 1, 2020
The body is a Unit
This is the first and most important principle of Osteopathy. Separating the body into segments is great for learning anatomy, however that is where it should stop. The total amount of nerve reflexes, and compensation patterns in all humans is infinite. Not one body is the same as another. Even identical twins will show different patterns in their movements due to their history in the environment, history of lesions and movement patterns. When presented with a patient that has neck pain, obviously the neck must be examined, but many times fixing the alignment of the neck lasts for a short time before it returns into its unaligned state. A practitioner can continuously fix the neck over multiple treatments, and constantly see it return back to its unaligned state. This will offer neck relief for the patient between treatments, however the root problem is still not being solved. This is when treatment gets very difficult, and the body is a unit principle must come into effect during treatment. Pain is a symptom. It is great to know the patient’s painful areas, but pain of the patient must never drive a treatment. Osteopathy involves a great amount of assessing of the entire body while in both motion and not in motion. Practitioners quickly begin to realize that areas in which pain is felt is often caused by areas away from the painful site. This may seem strange at first, but the more you begin to understand the purpose of the entire body as a unit the clearer it becomes. It is obvious the body will compensate in anyway possible, in order for the head to be looking forward, and not on a tilt, for example. How the lower back is involved Lets introduce a low back lesion to the body. The muscles in the low back, hip, and lower limb thigh region are by far the most powerful, and have the most mass in the body. If the alignment of the hip and low back are in lesion, these large muscle groups will often begin to work harder on one or both sides, to stable the spine and make sure our head and eyes are levelled with the horizon. During day to day activity, the patient does not feel any pain in this region, as the muscles are doing their job to compensate and get the patient through the day. They will never mention to any practitioner that they are having low back pain, because none is felt, however there is usually a lesion in the region if motion is tested and palpated. When it comes to athletes Not all patients are athletes or do vigorous activity. An athlete may notice that one side feels different than another during stretching or explosive movements. However, the miracle that our body can compensate for lesions and allow us to carry on through our day without any issues, can also be a curse. The muscles of the lumbar regions including the lumbar erector mass, the large psoas muscles, and the powerful QL muscles will do a great job to keep that pelvis aligned, however one side may be working harder than the other to keep this possible. As we go up the chain of the body, the muscles are not as powerful, but they will need to be used to continue to compensate for the hip region. The constant tugging of larger lumbar spine region may handle it but not up the chain when smaller and less powerful thoracic spine and neck spine muscles have to do it.
How the mid-back is involved In the thoracic region we have muscles smaller than the lower back and pelvis, but still quite large. These muscles such as the trapezius and the pectorals muscles may be used to compensate the thorax on the other side. These muscles however cannot handle this strain as easy as the muscles below can. They begin to work harder and harder, leading the muscles to be in a more shortened state, and also pulling the superficial fascia on that side of the body where the muscles are attached to. The body begins to swing to the other side by the pull on the ribs, sternum, clavicle, and thoracic vertebrae, which the pectorals, and trapezius muscle are attached to. Now that the lumbar region is side bending left, and the thorax is side bending to the right even more, for the head to be straight while walking, the muscles in the cervical region will have to work to keep the head level. Compensations Compensation patterns similar to the one above is very common throughout the population. The side bends of the spine occur over multiple vertebrae, and are very minimal from one vertebra to another. The cervical region is the least stable region of the spine. For what it lacks in stability, in makes up for in mobility. The cervical vertebrae are the lightest of the spine, and can move through all planes and axes well. Although it is a small region, there is a vast amount of nerves (brachial / cervical plexus / sympathetic ganglion / cranial nerves (mainly vagus) ) traveling in the periphery of the spine. There is a vast amount of arteries (supply to the brain and upper limb). There is a vast amount of veins (drainage of the brain and the upper limb). There is a vast amount of lymphatics leading to the thoracic ducts. If any of these structures are impeded by a muscle which is short or on tension, pain will most likely occur in the region. Blood flow and nerve conduction All of the nerves, arteries, veins, and lymphatics in the cervical region travel very closely to the muscles involved in side bending the cervical spine (the scalene muscles, and the sternocleidomastoid). These muscles can shorten to side bend the cervical region allowing the head to be levelled once again. Now you have muscles which are short on one side of the cervical region. These shortened muscles become thicker and may impede the nerves, arteries, veins, and lymphatics function in the area. The other side of the cervical region will have muscles lengthened and tensioned. Just like pulling a loose string from both sides, the muscle will change position. This muscle on tension may also impede the nerves, arteries, veins, and lymphatics in the region. In my experience, the cervical region with the muscles on tension is where the pain is more often, but not always. A practitioner can go to the cervical region and relax the shorten muscles, or thrust the cervical vertebrae back in to place which were pulled out of position by the short compensating muscles. This will offer relief for the patient. However, the issue in the lower back which caused a domino effect leading to the neck problem is not taken care of. As discussed before, no pain is felt in the lower back at the moment. Over the next few days the inevitable compensation in the neck will return for the patient to have a level head. Pain returns to the neck, and another adjustment is done to offer relief. This can be a continuous occurrence leaving the patient and the practitioner frustrated with the results. Luckily the body is very good at healing itself, that in some instances the lower back issue will resolve itself, and the practitioner and patient will have a successful relationship. However, many times the situation is not so fortunate. How Can Osteopathic Manual Practitioners help This is where an Osteopathic manual practitioner may seem like a magician or a nut, but it is just following common sense, and basic science that the body is a unit. A patient comes in with neck pain that has not gone away for months. Many practitioners have worked on it, including other osteopaths, and the results are the same. An osteopath following the first principle of Osteopathy listens to the pain complaint, but does not let it drive their treatment. They examine the whole body and find that the area of least movement, and what can most likely be the primary lesion of the body is in the lower back / hip region. They work over the next few sessions on the lower back much to the dismay of the patient who feels like they are not listening to them. After a few sessions, the neck pain starts to recover. Over the next few weeks the neck pain does not return. The patient starts to feel amazed at what the osteopath was able to do, even though it is not rocket science. Conclusion This is one of many examples which can occur throughout the body while assessing the body as a unit. The area of pain is important, and can give the practitioner many clues of what is going on in the body. Over years of palpating people, the practitioner begins to learn common body patterns which can give them clues where to look next. For example the L5/S1 joint and the OA joint often mirror each other. A shoulder issue is often associated with the hip on the other side. These are all clues, but must never be used to fall in to repetitive treatment. Everybody is different, and everybody must be fully assessed before engaging in treatment.
Dr. Still, the founder of Osteopathy is quoted as saying “Find it, fix it, leave it alone.” This quote sounds very straight forward, but now you have a sense of how difficult finding “it” can be.