Chronic Neck Pain (Part 1)

Do you find yourself having recurring pain in the neck and shoulders despite receiving Chiropractic care? Do you get periods of relief only to find out that as time goes on the pain, discomfort, and stiffness recurs? I want to discuss some of the issues that are in play here.

My experience is that most chiropractors are competent, if not excellent, adjusters. However, the fact that symptoms recur despite appropriate manipulation indicates that there may be some other unresolved issues that are predisposing the person to recurring neck symptoms.

These issues are usually associated with four different underlying problems. The first is the vestibular system, the second is the visual system, the third is motor planning muscle recruitment systems, and the fourth is disuse atrophy. These problems can occur singly, but they frequently present with two or more systems involved. Here in part 1, I want to discuss dysfunction in the vestibular and visual systems as a source of recurrent neck pain.

The vestibular system is a complex group of sensors that we have in our inner ear that tell us when we are moving, which direction we are moving and also which way is up and which way is down. The brain uses vestibular information to make adjustments to our postural muscles, so that as we turn, bend, lift and reach we don’t fall down, dislocate joints or otherwise hurt ourselves. When one side of the vestibular system is not working as well as the other, we develop a discrepancy between what our vestibular system is telling the brain and what is really happening. When that occurs, the brain is making adjustments in the postural muscles that are not appropriate for the position the person is in, and this can cause tightness and pain throughout the spine, particularly in the neck. Until the underlying vestibular dysfunction is resolved, adjusting may temporarily help the symptoms but it will not resolve them. Research has recently come out implicating vestibular dysfunction as the underlying cause of scoliosis, which shows how powerful this underlying effect can be. For more detailed information, you can search the internet using the following terms:

1) Vestibulospinal reflexes
2) Vestibulocollic reflexes
3) Vestibular system Scoliosis

The visual system is also intimately tied to the neck. When we move our eyes we fire neck muscles that help point our eyes in the direction we want to look. Eye movement and positioning is extremely complex, and failure of these systems causes significant strain on the neck. We frequently see people who develop neck pain from reading or being on computers for even short periods of time. My experience is that there are usually two causes of this kind of neck pain. One is a deficient near-response, which means it is difficult for them to maintain focus on a near object. When that happens, we reflexively fire our neck muscles in a way that is associated with pulling the head back. This can occur at a low level, so that even though there is no movement the muscles at the back of the neck develop considerable tension from the low-level firing. The other problem is that they may not be able to fully stabilize their gaze, so the image is being slightly smeared on the retina. This can cause quite a bit of tension as the brain fires the neck muscles to try to hold the image still. For more information I recommend an internet search using the terms “cervicoocular reflexes neck pain.”

When vestibular or visual systems are involved in neck pain, resolving the symptoms requires addressing the underlying causes. These issues are usually very treatable and respond quickly to treatment with subsequent significant changes in neck-related symptoms.

If you have chronic neck pain that does not resolve despite competent chiropractic care, call us for assessment to see if there are underlying issues that are preventing you from full recovery.

In part 2 we will discuss muscle recruitment and disuse atrophy.


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