Description
Acute, subacute or chronic neck pain associated with occupational activities.
Synonyms
- Repetitive strain injury (RSI)
- Cumulative trauma disorder (CTD)
- Occupational cervico-brachial disorder (OCD)
- Work-related musculoskeletal disorder (WMSD)
Etiology/Types
- Neck pain probably arises from individual or workplace (Occupational) factors or a combination of both.
Epidemiology
- The highest prevalence of occupational neck pain is found in office and hospital workers.
- The lowest prevalence of occupational neck pain is found in forest and industrial workers.
Pathogenesis
- Excess shoulder girdle muscles loading-
- FROM AXIAL SKELETON TO SHOULDER GIRDLE (SCAPULA AND CLAVICLE)
- Serratus anterior
- Upper trapezius
- Middle trapezius
- Lower trapezius
- Rhomboideus major and minor
- Pectoralis minor
- Levator scapulae
- FROM SCAPULA AND CLAVICLE TO HUMERUS
- Deltoid
- “Rotator cuff”
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
- Teres major
- Coracobrachialis
- Biceps brachii (long head)
- Triceps brachii (long head)
- FROM AXIAL SKELETON TO HUMERUS
- Pectoralis major
- Latissimus dorsi
- Muscle strains are uncommon with computer use as there is less than 5% of maximal voluntary contraction.
- Increased cervical pain is associated with decreased cervical rotation and increased activity in the superficial cervical flexors (Platysma) with an associated compensatory decreased activity in the deep cervical flexors (longus coli and longus capitus muscles).
- Increased inflammatory mediators have been found in local muscles that correlate with pain.
Risk Factors
- Females
- Forced exertions
- High job demands
- High level static contractions
- Increasing age, particularly in the 4th and 5th decades of life
- Low physical ability
- History of musculoskeletal pain
- Poor social support at work
- Poor work posture
- Poor workstation ergonomics (the science of designing the workplace environment to fit the user)
- Prolonged static loads and extreme postures
- Repetitive job tasks
- Sedentary job activities
Clinical Features
- Neck pain without symptoms in the lower extremities
Differential diagnosis
- Infection
- Osteoarthritis
- Radiculopathy
- Referred pain from cardiothoracic structures
- Tumor
History
- Increased pain, tiredness, and stiffness
- Pain worse during workday and improved during weekend
- Sleep difficulty
- Associated headaches
Exam
- Poor posture/head forward posture
- Decreased cervical range of motion, particularly with rotation
- Increased muscle tension in the upper trapezius muscles, levator scapulae, and scalenes
- Tenderness to palpation of the superior nuchal line
Testing
- Plain radiographs for loss of the normal lordotic curve suggesting spasm.
- MRI to rule out soft tissue pathology.
- Electrodiagnostic studies to assess for radiculopathy.
Pitfalls
- Overlooking workplace and psychological factors
Red Flags
- Weakness, numbness, or tingling
- DD with a fracture.
Treatment
Medical
- Cognitive behavioral therapy
- Ergonomic interventions
Exercises
- Exercise program focusing on motor relearning training
- Manipulation
- Mobilization
Modalities
- Heat, cold, ultrasound, and transcutaneous electrical nerve stimulation
Surgical
- Surgical decompression for radicular symptoms
- Percutaneous or open surgical treatment
Homoeopathic Trteatment Short Repertory of Neck Pain
BACK – ASLEEP; sensation as if – Cervical region – Nape of neck- rhus-t. spig. BACK – BALL; as if a – Cervical region – Nape of neck- bell.
BACK – BLUISH – Cervical region – Nape of neck- ars. Lach. Rhus-t.
BACK – CERVICAL REGION; complaints of – Nape of neck- acon. agar. agn. alum. Am-c. am-m. ambr. anac. ang. ant-c. ant-t. arg-met. arn. ars. asaf. asar. aur. BAR-C. BELL. borx. bov. bry. CALC. camph. cann-s. canth. caps. carb-an. Carb-v. Caust. cham. chin. Cimic. cina clem. cocc. colch. coloc. con. croc. cupr. cycl. dig. dros. dulc. euph. ferr. graph. guaj. hell. hep. hyos. ign. iod. ip. Kali-c. kali-n. Lach. laur. led. Lyc. m-ambo. m-aust. mag-c. mag-m. mang. meny. merc. mez. mosch. Nat-c. NAT-M. Nit-ac. nux-m. NUX-V. olnd. op. par. Petr. ph-ac. Phos. Phyt. plat. plb. Puls. ran-b. rheum rhod. RHUS-T. ruta sabad. sabin. samb. sars. sec. sel. SEP. SIL. spig. spong. squil. stann. staph. stront-c. SULPH. tarax. thuj. valer. verat. viol-o. viol-t. zinc.
BACK – COLDNESS – Cervical region – Nape of neck- Calc. sulph.
BACK – COLDNESS – Cervical region – Neck- calc. dulc. kali-c. phos. sulph. valer. BACK – COLDNESS – ice, as from – Cervical region – Nape of neck- chel.
BACK – CONSTRICTION or band – Cervical region – Nape of neck- asar. BACK – CONVULSIONS – tetanic – Cervical region – Nape of neck- op.
BACK – CRACKING – Cervical region – Nape of neck- anac. nat-c. nicc. ol-an. petr. puls. spong. sulph. thuj. BACK – DORSAL REGION; complaints of – Scapulae – extending to – Cervical region – Nape of neck- nat-c. BACK – FORMICATION – Cervical region – Nape of neck- dulc. sabin.
BACK – HEAT – Cervical region – Nape of neck- cycl. ign. lach. par. phos. BACK – HEAT – Spine – extending to – Upward – Neck and ear; to- plut-n.
BACK – HEAVINESS, weight – Cervical region – Nape of neck- apis chel. kali-c. meny. Nux-v. Par. petr. phos. Rhus-t. sabin. samb. tab. verat.
BACK – ITCHING – Cervical region – Nape of neck- agn. alum. am-m. bufo carb-v. caust. mez. nit-ac. rhod. rhus-t. sep. sil. staph. sulph. ther.
BACK – LAMENESS – Cervical – Nape of neck- zinc.
BACK – LUMBAR REGION; complaints of – extending to – Cervical region – Nape of neck- kali-bi. BACK – LUMPS – Cervical region – Nape of neck- ant-c. caust. hep. nat-c. zinc.
BACK – MENSES – before – agg. – Nape of neck- carb-v. iod. nat-c. nit-ac. nux-v. sulph. BACK – MENSES – during – agg. – Nape of neck- berb. Calc. mag-c. nat-m. nit-ac.
BACK – NUMBNESS – Cervical region – Nape of neck- dig. merc-i-f. petr. plat. rhus-t. spig. tell.
BACK – PAIN – Cervical region – compressed; as if – fingers; as if skin of neck were compressed between two- spong.
BACK – PAIN – Cervical region – Nape of neck- Acon. aesc. agar. alum. Am-c. anac. ant-t. apis bapt. bell. bry. cann-s. chin. chinin-ar. Cimic. coloc. dulc. fel ferr-pic. ferr. gard-j. Gels. glon. Graph. ham. hyos. hyper. ign. ip. jug-c. kali-bi. kali-c. Kali-n. kali-p. lach. lyc. meny. merc. mez. Mosch. musca-d. myric. nat-ch. nat-m. nat-s. nux-v. par. petr. phos. PHYT. pneu. rad-br. rhod. rhus-t. ruta sabad. Sabin. sars. sep. spig. spong. stann. stram. symph. tab. tritic-vg. vanil. verat. vib-od. x-ray zinc-val.
BACK – PAIN – Dorsal region – Scapulae – Between – extending to – Back of neck- dioxi. stict. vanil. BACK – PAIN – Dorsal region – Scapulae – right – extending to – Neck- hydrog.
BACK – PAIN – extending to – Neck- dulc. sang. tritic-vg.
BACK – PARALYSIS – sensation of – Cervical region – Nape of neck- cina BACK – PERSPIRATION – Cervical region – cold – Nape of neck- con. Sulph.
BACK – PERSPIRATION – Cervical region – Nape of neck- Anac. ars. bell. brass-n-o. CALC. Chin. ferr. hell. hyos. m-ambo. mag-c. mang. mosch. nit-ac. nux-v. PH-AC. phos. puls. rheum Samb. Sanic. Sep. Sil. spig. stann. stry. SULPH. tub. verat.
BACK – PULSATING – Cervical region – Nape of neck- BELL. camph. cann-xyz. con. ferr-p. GLON. kali-n. laur. manc. nat-m. op. plb. sulph.
BACK – SENSITIVE – Cervical region – Nape of neck- nux-v.
BACK – SHIVERING – Cervical region – Nape of neck- am-c. bell. caust. cham. con. croc. Graph. staph. valer. BACK – SPASMS – Cervical region – Nape of neck- ant-c. asar. nat-m. nux-v. spong.
BACK – STIFFNESS – Cervical region – Nape of neck- Acon. agar. alum. am-m. anac. ang. ant-t. apis arg-met. arg-n. ars. Aur. BAR-C. BELL. bov. brass-n-o. bry. bufo calc-caust. calc-p. CALC. camph. cann-xyz. canth. caps. carb-an. CARB-V. CAUST. cham. chel. chin. Cimic. cocc. colch. coloc. Con. dig. dros. dulc. ferr-p. fl-ac. form. gels. glon. graph. guaj. hell. hyos. hyper. ign. jug-c. kali-bi. KALI-C. kali-n. lac-c. LACH. Lachn. lat-m. laur. LYC. MAG-C. mang. med. mentho. meny. merc-i-r. merc. mez. NAT-C. Nat-m. nicot. NIT-AC. nux-v. petr. ph- ac. PHOS. phyt. pimp. Plat. podo. psor. puls. rad-br. rhod. rhodi. Rhus-t. rhus-v. ruta sars. sec. Sel. SEP. SIL. spig. spong. squil. stann. staph. stel. STICT. sulph. tab. thuj. trif-p. verat. vinc. x-ray zinc.
BACK – SWELLING – Cervical region – Nape of neck- agath-a. ail. apis ars. Bar-c. BELL. berb. calc. carb-v. der. iod. lach. lyc. phos. puls. sep. sil. spong. sumb. tub.
BACK – TENSION – Cervical region – Nape of neck- agar. aloe alum. am-m. anac. ant-c. apis arn. aur. bar-c. bov. bry. calc. camph. canth. carb-an. Caust. chin. cimic. Coloc. Con. dig. euph. graph. hyos. ign. iod. ip. kali-c. lach. laur. mang. meny. mosch. Nat-c. nat-m. nit-ac. par. plat. plb. Puls. Rhod. Rhus-t. sanic. sars. sep. sil. Spong. staph. stront-c. sulph. Thuj. tub. viol-o. viol-t. zinc.
BACK – TENSION – Dorsal region – Scapulae – extending to – Neck- fic-m. mang. BACK – TENSION – extending to – Neck- lac-leo. laur.
BACK – TREMBLING – Cervical region – Nape of neck- carb-v.
BACK – TUMORS – steatoma – Cervical region – Nape of – neck- apis bar-c. Bell. Merc-c. merc. mez. Puls. BACK – TWITCHING – Cervical region – Nape of neck- ang. arg-met. asaf. caps. caust. chin. mag-c. nat-m. ph-ac. sep. sulph. tarax.
BACK – WEAKNESS – Cervical region – Nape of neck- abrot. acon. aesc. aeth. all-c. ant-t. arn. ars. bry. Calc-p. caps. carb-v. caust. cocc. colch. crot-h. Dig. eup-pur. fago. gels. glon. Kali-c. lil-t. lyc. nat-m. nit-ac. op. par. petr. phos. plat. Sil. spig. stann. staph. verat. viol-o. zinc.
BACK – WIND was blowing; as if – Neck; on- olnd.
CHEST – COMPLAINTS of chest – extending to – Neck- calc. dios. mur-ac. sulph. ther. zinc. CHEST – CONSTRICTION – alternating with – drawing in occiput and nape of neck- kali-n. COUGH – SWELLING – neck; from swelling of- ars. Coff. kali-bi.
COUGH – TOUCHED; from being – neck agg.- bell. brom. Lach.
EAR – PAIN – Behind the ears – extending to – Neck- agath-a. lith-c. plut-n. EXTERNAL THROAT – SENSITIVE – rope around neck; sensation of a- aids. EXTERNAL THROAT – SPASMS – Sides of neck- Carb-ac. Med. pall.
EXTERNAL THROAT – SWELLING – Cervical Glands – string around the neck; glands are like a- aeth. cist. EXTERNAL THROAT – TIGHT around neck and waist; cannot bear anything- aids. LACH. Sep. spong.
EXTERNAL THROAT – TWITCHING – Sides – left – Neck to the left side of the throat; from left side of the- agar.
EXTREMITIES – COLDNESS – Fingers – extending to – Nape of neck- coff. EXTREMITIES – LAMENESS – Upper arms – extending to – Neck; back of- iris
EXTREMITIES – PAIN – Shoulders – extending to – Neck- agath-a. anag. apis lac-ac. sal-fr. sang. EXTREMITIES – PAIN – Shoulders – left – extending to – Neck- sal-fr.
EXTREMITIES – PAIN – Shoulders – rheumatic – extending to – Neck- lac-ac. luf-op. nat-sil. EXTREMITIES – PAIN – Thumbs – Balls – extending to – Back of head and neck- plb.
EXTREMITIES – SHOULDERS; complaints of – left – extending to – Neck- spig. EXTREMITIES – TENSION – Shoulders – extending to – Neck- choc.
FACE – PAIN – accompanied by – Neck; stiffness of- mez.
FACE – PAIN – extending to – Neck- Bell. Coloc. Guaj. lyc. Puls. sang. Spig.
HEAD – COLDNESS, chilliness, etc. – Occiput – rising from neck like cold air- CHEL. sep.
HEAD – COMPLAINTS of head – accompanied by – Nape of neck – Glands in nape of neck; swollen- bar-c. mur- ac.
HEAD – CONSTRICTION – Occiput – extending to – Nape of neck; into- graph. nat-c. HEAD – HYDROCEPHALUS – accompanied by – Neck; emaciated- calc-p.
HEAD – MOTIONS in head – moved from back of neck up to head; as if something- glon.
HEAD – PAIN – accompanied by – Neck – pain in – Nape of neck- aeth. alum. am-c. ambr. anac. asar. bar-c. Bell. berb. borx. bry. Calc-p. calc-sil. Calc. cann-s. carb-an. carb-v. caust. chel. cimic. cinnb. clem. COCC. con. corn. crot-t. GELS. Glon. graph. Hell. hydr-ac. hyos. iod. ip. kali-c. kali-n. Kalm. lac-c. lil-t. lyc. mag-c. manc. merc. mez. mosch. mur-ac. nat-c. Nat-m. nat-s. nept-m. op. paeon. par. PH-AC. Phyt. PIC-AC. plb. plect. Puls. ran-b. rhus-t. sabin. sang. sars. sil. spong. Stry. sulph. tarax. tarent. tritic-vg. verat.
HEAD – PAIN – accompanied by – Neck – stiffness in – Nape of neck- CIMIC. nept-m. Rhus-t. HEAD – PAIN – alternating with – Neck; pain in nape of- hyos.
HEAD – PAIN – clothing about the neck agg.- arg-n. Bell. crot-c. Glon. Lach. sep.
HEAD – PAIN – extending to – Nape of neck- Bar-c. calc. ferr. graph. lyc. Mosch. puls. Sabin. sep.
HEAD – PAIN – Forehead – extending to – Neck- Bry. chel. cystein-l. euon. gels. kali-n. kalm. kola lac-d. lil-t. lyc. menis. mosch. nux-v. onos. Oreo. prun. sep. tub. viol-t.
HEAD – PAIN – Forehead – Eyes – Above – left – extending to – Neck; nape of- kola HEAD – PAIN – Forehead – Middle of – extending to – Neck; nape of- kola
HEAD – PAIN – Forehead – Nose; above – extending to – Neck; nape of- gink-b. HEAD – PAIN – Forehead – right – extending to – Neck- aids.
HEAD – PAIN – Occiput – accompanied by – Neck; stiffness in- bit-ar.
HEAD – PAIN – Occiput – boring pain – bolt had been driven from neck to vertex; as if a- cimic.
HEAD – PAIN – Occiput – extending to – Neck – Down back of neck- androc. arg-n. bell. berb. bit-ar. Bry. chord- umb. cimic. Cocc. com. dulc. gels. Graph. hell. Hep. hydr-ac. kali-c. kali-cy. kali-n. lac-leo. laur. lil-t. limen-b-c. lob. mang. med. merc. mur-ac. nat-c. nat-s. NUX-M. NUX-V. pic-ac. podo. ran-b. sabin. sal-fr. sep. spong. sulph. tarent. vanil.
HEAD – PAIN – Occiput – extending to – Neck- ambr. androc. aq-mar. Bell. Bry. Carb-v. chord-umb. COCC. dulc. glon. hell. hep. ip. kali-c. ketogl-ac. lac-leo. laur. Lil-t. limen-b-c. phyt. podo. sal-fr. sulph. suprar. tung-met. HEAD – PAIN – Occiput – Protuberance; occipital – extending to – Neck; down- podo.
HEAD – PAIN – pressing pain – accompanied by – Neck; pain in nape of- bamb-a. HEAD – PAIN – pressure – neck agg.; on back of- sec.
HEAD – PAIN – Sides – extending to – Nape of neck- elaps sars. tritic-vg. vanil. HEAD – PAIN – Sides – extending to – Neck- chel. cupr. Lach. lyc. Merc.
HEAD – PAIN – Sides – left – extending to – Neck- sanguis-s.
HEAD – PAIN – Sides – left – Head and face – extending to – Neck- guaj.
HEAD – PAIN – Sides – one side – extending to – Neck – Shoulders with stiff neck; and- chir-fl. lach. HEAD – PAIN – Sides – one side – extending to – Neck- chir-fl. guaj. Lach. lyc. merc.
HEAD – PAIN – Sides – right – dull pain – accompanied by – Neck; stiffness in- lavand-a. HEAD – PAIN – Temples – dull pain – accompanied by – Neck; stiffness of- bit-ar.
HEAD – PAIN – Temples – extending to – Neck- acon-ac. bry. fum. kali-i. kola pic-ac. pitu-gl. pot-e. puls. x-ray HEAD – PAIN – Temples – stretching neck amel.- bit-ar.
HEAD – PAIN – Vertex – extending to – Neck- calc-p. Chel. dios. gels. glon. kalm. HEAD – PULSATING – extending to – Neck- nat-m.
HEAD – SHOCKS – Occiput – dull, heavy, throbbing pain through head – blow on back of head and neck; with a sensation like a heavy- cann-i.
HEAD – SHOCKS – Vertex – bolt from neck to vertex, agg. at every throb of the heart; as from a- cimic. HEAD – TEMPLES; complaints of – extending to – Neck and face- tarent.
LARYNX AND TRACHEA – CONSTRICTION – Throat-pit – bending neck agg.- ph-ac. LARYNX AND TRACHEA – CROUP – accompanied by – Neck stretched out- ant-t.
MIND – RESTLESSNESS – headache, during – occiput and neck; pain in- crat. MOUTH – PAIN – extending to – Head and down into neck; through- lyss.
NECK – SWELLING – External neck- alum. am-m. arn. Ars. Bar-c. Brom. canth. Caust. croc. Hep. hyos. Iod. lach. Lyc. Mag-c. Merc-c. mez. nat-c. Puls. rhod. Rhus-t.
RESPIRATION – IMPEDED, obstructed – accompanied by – Neck; pain at nape of- lyc. RESPIRATION – IMPEDED, obstructed – drawing and stitching; from – Nape of neck; in- sep. SKIN – FORMICATION – insects; as if from – Shoulders, neck and hands; on- lac-c.
STOMACH – NAUSEA – pressure – neck agg.; on- cimic.
THROAT – COMPLAINTS of throat – extending to – Neck and Shoulders- kali-bi. THROAT – PAIN – Esophagus – pressure – agg. – neck; on- kali-sula.
THROAT – PAIN – extending to – Neck; glands of- chir-fl. sep.
THROAT – PAIN – sore – accompanied by – Neck and occiput; aching in- bit-ar. THROAT – PAIN – swallowing – neck to get food or drinks down; has to turn- kali-m. VERTIGO – BEGINNING in nape of neck, or occiput- fl-ac. gels. iber. petr. senec. sil.
Top Homoeopathic Remedies for Neck Pain
Sulph > Sep > Lyc > Bell > Caust > Lach > Sil > Nat m >Cal c > Rhus t > Puls > Apis > Petr > Bry > Carbo v > Kal c > Graph > Nat c > Spig > bar c > Cim > Nux v > Gel > Nit ac > Kali n > Glon > Phos > Thuja > Ars a > Zinc > Hyos > Mez > Staph > Chel > Mag c > Alum > Merc > Spong > Con > Hep > Mosch > Sabina > Anac > Arn > Iod > Mang > Par > Laur > Mur ac > Verat a > Cocc > Acid ph > Phyt > Colo > Ant t > Chin > Hell > Rhod > Ant c > Sars > Stan > Pic ac > Dig > Guaic > Lil t > Plat > Agar > Am m > Dulc > Ign > Ip > etc….
References
Andersen JH, Kaergaard A, Frost P, et al. Physical, psychosocial, and individual risk factors for eck/shoulder pain with pressure tenderness in the muscles among workers performing monotonous, repetitive work. Spine. 2002; 27(6):660–667.
About Author
Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Dr. (Km) Ruchi Rajput BHMS