subtle neck issues
 

i have neck issues (for sure, because every time my neck muscles spasms i get dizzy or if i work out that part of my body), MRI and X-ray don't show any abnormality. when people on this forum talk about subtle neck issues, what are they specifically? what medical abnormality has been found objectively?

I have mentioned subtle neck injuries many times. They are rarely found with imaging because, 1. The imaging does not show soft tissue strains. 2. The doctors do not believe there can be anything wrong if there are is not a fracture or visible tear.

But, neck instability can be diagnosed in many ways. If the muscles spam, that can indicate radiculopathy or other irritation of nerves. They are usually not a "Hey Physical Therapist, Fix this." condition. It takes discipline on the patient's part to follow a PT program for an extended period and let the neck heal. No 'I'm just going to play touch football on Thanksgiving then I will rest.' Instead, it takes an 'I am not going to do anything to risk aggravating my neck for 3 to 6 months while I strengthen it by following the PT's orders.'

Working out that part of the body should be about healing, not building strength.

It took me years of discipline and gentle treatment, PT and chiro, to get stability back. But, I still have a neck that requires care. I have crepitus when I move it. But, I don't get the muscles spasms and inflammation I used to get frequently.

There is an old anecdote.
A patient says to the doctor, " It hurts when I do this...."
The doctor responds, "Stop doing that."

what do you mean by "neck instability"?

what PT exercises did you find helpful? i have only been prescribed stretches which i'm doing but my neck remains extremely vulnerable to new injury. any thoughts on improving "stability" or resilience there?

look into some soft tissue therapy... maybe stretches are not what you need to be doing..or perhaps over doing them??

look up -
trigger points
massage / hands on tissue work

Neck instability means your neck can exhibit symptoms even though you have not traumatized it. You may have slept in a bad position or turned your head and caused a pinch or strained as you tensed to do a lift. Your neck should be able to tolerate normal positions and movements without becoming symptomatic.

An unstable neck may have a torn or stretched ligament or injured articular surface where each vertebra seats with the next.

It can be difficult to find a specialist who can diagnose and treat or help you heal the instability. Some may use range of motion measurements or muscle tension or things like myofacial release.

You can also try to diagnose the specific movements that cause symptoms. I learned that sleeping with my head elevated/tipped forward caused symptoms and poor sleep. Once I learned to sleep without aggravating my neck, my sleep got better. My headaches reduced. And my days were better.

The PT helped reduce the lower neck issues that went down to T-1 and some TOS. She did some TMJ myofacial release to reduce those tensions and she did some gentle traction and mobilization to help things settle in.

My chiro tried to help but realized that I needed different skills and techniques. A physiatrist (Physical Medicine and Rehabilitation MD) directed me to the PT. I had tried a couple PTs without success. A PT with well known skills with whiplash can be a good start. But, if that PT wants to push range of motion, I'd keep looking.

But, I had to avoid causing a relapse by sleeping in bad posture or making bad moves. It took a lot of discipline because I made my living working on kitchen and bath sinks so I had to reach under and even climb under them without tweaking my neck. I learned to slow down and plan my moves.

It was worth the effort because I am much better. I don't have the chronic problems but I still take precautions.

Understand. Did you find the right PT by simply trying a few? A lot of PTs don't accept any insurance, is this generally a sign that they are good or is there really no correlation?

I have tried 2 PTs so far and both simply stretched my neck to increase range of motion. One only gave me a printout of stretches without doing anything, the other stretched my neck with his hands. I'm still looking.

I don't think insurance has any direct correlation to skill set. But, some PTs that are very good have a high patient load so they do not need to accept insurance that discounts their fees. But then again, some insurance programs are just a pain for providers to deal with so they drop them. Too much paperwork, slow pay, etc.

A physiatrist (Physical Medicine and Rehab) usually accepts many insurance programs. Maybe you can find one who is good with whiplash and concussions who could be a good start. Some osteopaths (DO's) are good. It is hit and miss.