Friday, December 10, 2010

Waking-up with Neck Pain and Stiffness:

Waking-up with Neck Pain and Stiffness:

Studies suggest that neck pain and stiffness affects as much as 71% of the population. Cervical pain occurs almost as frequently as low back symptoms, and is the second most common cause of visits to pain clinics. However, much less is known about neck pain (in contrast with low back pain).
People with neck pain often report pain and stiffness first thing in the morning upon waking. Some have suggested that posture issues or sleeping position during the night is to blame.
A study by Gordon et al. set out to document “prevalence, duration and frequency of waking cervical pain, cervical stiffness, headache and scapulae or arm pain and the association between the prevalence of these symptoms, gender and age.”

These researchers surveyed a wide population and reported several interesting findings:
• Prevalence:
o 46% of respondents woke at least once in a usual week with symptoms
o Subjects most commonly reported waking with scapular or arm pain (27%) followed by headache (19%), cervical pain (18%) and cervical stiffness (17%).
• Duration of symptoms:
o 43.5% of those with waking symptoms reported symptoms lasting an hour or less
o More than half (52.5%) reported symptoms lasting half or all day (suggesting that a considerable number of people spend at least some of the morning with waking symptoms)
• Demographic associations:
o Women were significantly more likely than men to suffer waking cervical pain and headache.
o Subjects aged 40 to 59 years were significantly more likely to wake with cervical pain and subjects aged 60 years and over were significantly less likely to wake with cervical stiffness.
o Women aged 40 to 59 years were significantly more likely to wake with headache, while women aged 60 years and over were significantly less likely to wake with headache than was predicted by age and gender alone.

This study is interesting in several respects. We have all woken up with a “crick” in our neck. These numbers suggest that we are not alone in our affliction. The numbers, though, do not necessarily point to a source of the pain or stiffness. A number of different possible causes have been thrown out as potential explanations:
• Medical conditions
• Medication
• Mental health
• Nocturnal bruxism
• Disruption to sleep
• Alcohol intake
• Pillow type ( )
• Sleep position
Like most things. There is not likely a single issue that causes these symptoms. Rather, the population of people with waking neck pain or stiffness is a mixed bag and likely has mixed sources for these symptoms.

Diurnal Cycles in the Intervertebral Disc

One interesting issues that relates to spine pain and waking symptoms is what happens to the discs at night when we sleep. The disc (more properly the intervertebral disc) is an exceedingly frequent source of pain in our spines. We hear talk about “slipped discs”, “herniated discs”, “ruptured discs.” These discogenic conditions often underlie the ordinary backache we experience so commonly.
In my practice I often talk to people who have pain or stiffness when they wake up in the morning and blame their mattresses. They spend a lot of money and frequently cannot make these waking symptoms go away .
The reason is not to be found in the mattress but rather in the way a disc is hydrated. That is, discs tend to lose water during the course of the day and then at night where there is less pressure exerted on the disc there is an influx of water into the disc.
Studies have shown that people lose 13 to 21 mm of height during the course of a day because of these changes in the discs. At night the discs rehydrate. As a result the tears in disc fibers that are generally a degenerative disc is under more pressure first thing in the morning. It is a function of how the disc works and not necessarily the mattress on which we sleep.
MRI studies have shown that disc bulges are more prominent after a night’s rest. Consequently, people with disc issues often report difficulty tying their shoes first thing in the morning or just having more pain for the first while after getting out of bed.
So, think twice before you rush out and blame your mattress for waking up with pain or stiffness. Sometimes it just happens and we do not always have a good answer. Sometimes it is because of wear and tear in a disc. And sometimes it is because of my kids (since they are the source of most chaos in the world).


Stephen said...

Very interesting and all the more credible from the recognisability of the last sentence!

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