Neck Pain

Most neck pain is due to cervical vertebral instability or enthesopathy (microtears in the attachments) of the neck or upper back muscle attachments. Ligaments that hold the cervical vertebrae in alignment can be damaged by sudden trauma, such as a football tackle or whiplash injury, or through the slow stretching of ligaments known as creep, often caused by prolonged poor posture in front of a computer or overuse of a smartphone. Regardless of the cause, this instability needs to be corrected to prevent a degenerative cascade, leading to subluxation (instability) of the vertebral joints and subsequent damage to the discs.

Neck and upper back problems are fairly common presenting complaints in my practice. I often see patients who have chronic neck issues and have either had surgery or have seen an orthopedic surgeon who has recommended surgery. Surgery on the neck is scary and of course, very invasive. My personal success rate using stem cells/PRP is about 85% to solve 80% of the pain and return the patient to a normal lifestyle. As with any other region, the key first step is to make the right diagnosis of the primary pain generators. The only way to do this properly and prioritize the relevant pain generators in order of importance is with a thorough palpation interrogation exam of the whole region. MRI can be misleading and show many abnormalities  including disc issues but as always, the key is to think in terms of stability. Even if the patient has had surgery on the neck I can still work with them. Surgical approaches are anterior and I do my injections posteriorly so I can still inject and avoid any metal. 

The body can actually heal disc protrusions but you must stop the cervical / thoracic spine instability. In most cases this is readily achievable with stem cell/PRP injections in the correct places. In cases of severe instability, one or two primer treatments with dextrose prolotherapy may lay the groundwork for the stem cells and PRP to work optimally.

As with all stem cell cases, follow up is important. If I have a cervical spine stem cell case that comes back after 6-8 weeks and reports less than 50% improvement I will reexamine the patient and usually recommend a PRP booster to help and accelerate the healing. The stem cells remain alive for at least 4 or 5 months as they do their healing. If improvements are sluggish at 8 weeks, the patient may benefit from a PRP booster to reignite the stem cells.

Cervical Instability and Its Implications

Vertebral and facet joint instability in the cervical region is a major cause of chronic neck pain, headaches, migraines, vertigo, ringing in the ears, and other symptoms associated with cervicocranial syndrome. Properly administered Regenerative Injection Therapy is the treatment of choice and offers a safe and effective option for resolving neck pain. By strengthening and tightening the ligament and tendon attachments in the neck, regenerative therapy addresses the root cause of instability.

A comprehensive treatment approach is necessary, targeting all surrounding ligamentous structures of the neck that may have been under additional stress. For severe degeneration, stem cells and PRP are generally used. For less severe damage, PRP or prolotherapy alone may be sufficient, though several treatments may be needed for complete healing. Stabilizing vertebral motion helps cervical discs recover and relieves any potential impingement on the cervical sympathetic ganglion, alleviating associated symptoms.

Importance of Levator Scapulae Attachments

In all cases of neck pain, it is crucial to check the levator scapulae attachments on the superior medial border of the scapulae with palpation interrogation. These attachments are very commonly damaged in association with neck injuries such as whiplash and they are also prone to degeneration due to poor posture. No matter the cause, they can become important pain generators. The good news is these tears and microtears at the attachments are fairly straightforward to be healed with stem cells and or Prolotherapy.

Mid-Back Pain: Addressing the Thoracic Spine

Mid-back pain, often overlooked in discussions of back pain, typically arises from thoracic vertebral instability or weakness at the costovertebral or costotransverse joints. A thorough palpation exam can usually identify problematic structures. I recently saw a patient with previous neck surgery who continued to have significant neck pain. The surgeons were talking about revision (another surgery) but on a palpation interrogation exam the patient had nothing that stood out with the cervical region but he did have significant “jump signs” in the thoracic spine. The patients major pain generators were in the thoracic spine, not the cervical spine area. In other words, the doctors had not correctly diagnosed the real root-cause of the problem and assumed the problem was further breakdown in the cervical region. 

Don’t forget, due to biotensegrity, everything is connected. Where you feel the pain may not be where the root of the problem is located. Pain in the neck/upper back region can often be referred and a doctor needs to do a complete exam to properly diagnose the underlying root-cause of the problem. I am pleased to report that the patient above had a successful stem cell procedure that solved at least 80% of his pain.

To Recap: 

In conclusion, most neck and mid-back pain can often be traced to issues of instability in the vertebral joints and their associated ligaments and tendons. Stem cells/PRP and Prolo is the treatment of choice for most patients and should be considered by all patients with significant issues and should definitely be carefully considered before pursuing surgical approaches.

As always it behooves patients to find an experienced regenerative specialist who can make the right diagnosis of the primary pain generators and inject them properly with the right kind of stem cells, properly prepared and follow up the patient with PRP boosters as required.