● Cognitive variables. Pain cognitions, such as catastrophizing, self-perceived poor health, fear- avoidance beliefs, and passive coping are related to increased pain such as neck pain. Low self-efficacy and low resilience have been shown to correlate with increased disability related to neck pain (Kazeminasab et al., 2022). ● Sleep problems . The relationship between sleep quality and neck pain is bidirectional, as each can lead to the other. Literature suggests that insufficient quality and quantity of sleep are significantly associated with increased chances of having neck pain (Kazeminasab et al., 2022). ● Social support . Neck pain is associated with poor general social support (Kazeminasab et al., 2022).
Healthcare consideration: Since depression is both a consequence of and causative factor for neck pain, the presence of the diagnosis of depression accompanying neck pain may require the assessing clinician to decide if action is warranted. Depression is considered an orange flag, that is, it is a diagnosis that can affect the ability to recover from neck pain. In this situation, the assessing clinician must consider at least two factors: (1) In their clinical judgement, does the depression diagnosis affect the onset and/or recovery from neck pain and (2) in their clinical judgement, is a referral to the appropriate healthcare provider warranted? While physical therapists might identify depression, they do not treat it. Referral to a psychologist or back to the referring physician might be an important part of helping the client get better. Self-Assessment Quiz Question #27 Which of the following cognitive factors has NOT been associated with the onset of neck pain? a. Catastrophizing. b. Active coping. scapulae and upper trapezius muscles. When asked about his job duties, he reports that they have gotten much worse since he got a new boss a few months ago. He feels this boss has asked him to do more than he can handle. Question Can you name two possible different categories of factors that might explain this client’s neck pain? Discussion Mechanical factors might be influencing this client’s neck pain. He does a repetitive job (sorting mail) and has some musculoskeletal findings (levator and upper trapezius muscle tightness). In addition, the client discusses some work factors that have been known to increase the probability of neck pain: Low work control, low ability to influence working conditions, low job satisfaction, and high job strain are all present, per the client’s report. c. Low self-efficacy. d. Passive coping. vertebral foramen, bilateral transverse processes, and pairs of superior and inferior articular facets. There are three elements that distinguish the cervical vertebrae: (1) Bifid spinous processes, (2) triangular shape of spinal cord, and (3) the presence of transverse foramen that allow for transmission of the vertebral arteries (Rahman et al., 2021). are considered one of the most common and controversial injury types in the cervical spine, with an associated high incidence of nonunion, morbidity, and mortality (Carvalho et al., 2019). Healthcare consideration: Odontoid fractures occur with low-energy falls in the elderly (as compared with high-energy trauma in younger patients). These fractures are the most common cervical fracture in the elderly. Unfortunately, patients older than age 80 have a high morbidity and mortality rate with this type of injury, regardless of whether it is treated operatively or nonoperatively (Moore et al., n.d.).
Work factors and neck pain The work factor most commonly associated with neck pain is awkward/sustained postures. Workplace factors such as perceived high job demands, effort–reward imbalance, and lack of coworker support are all significant risk factors for the development of neck pain. Neck pain is also associated with low job control, routine work, lack of decision-making opportunities, low ability to influence working conditions, low job satisfaction, and high job strain (Kazeminasab et al., 2022). Case Study: John Jackson Mr. Jackson is a 50-year-old postal worker who presents to physical therapy complaining of posterior and lateral neck pain. He states that his pain is minimal in the morning but gets worse throughout the day as he performs his mail sorting duties. He has noticeable tightness in the levator Relevant cervical anatomy The cervical spine supports the head and contains the upper cervical spinal cord as well as the vertebral arteries that contribute to circulation in the posterior brain. There are seven cervical vertebrae along with accompanying intervertebral discs, nerve roots, and blood vessels. Each vertebra in the spine typically has a body, spinous process, The atlas (C1) and axis (C2) are called the upper cervical spine , and they have some distinctive anatomical features. The atlas articulates with the occiput (head) via the occipital condyles and the lateral mass of the atlas. The atlas is ring-shaped and does not have a body or spinous process. It articulates with C2 at the anterior arch of the axis at the atlantoaxial joint. The axis contains the dens or odontoid process, which is a vertical projection from the anterior aspect of C2. The odontoid process has a transverse ligament that runs posterior to the dens, preventing anterior subluxation of the atlas on the axis (Rahman et al., 2021). Odontoid fractures Cervical spine structure and function Upper cervical spine (C1–C2)
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