Neck Spasm Treatment
April 22, 2016 7:18 AM   Subscribe

YANMD, but what sort of doctor should I seek out for this neck spasm that seems to be a recurring issue?

I have had recurring neck spasms for about 10 years. I've had treatments from chiropractors and physical therapists with minimal success. Usually the pain just has to subside on its own. Often the pain is brought on by the most benign movements or I'll simply wake up one morning with a crick in my neck. I use a computer for work but I only work part time, so I feel like although this could be postural it is more serious than it should be for my age and the fact that I haven't had a car accident or anything like that.

However this time my neck is in a bad state and it's going on 2 weeks of pretty bad pain. Advil helps but I stopped taking it because I'm afraid of getting an ulcer or something. All my other home care remedies are doing nothing, and the pain seems to be radiating down my arm this time so I'm thinking maybe it's a pinched nerve.

What I want to do is see a doctor that's going to hopefully diagnose this and figure out why this is a recurring issue. I think I might need xrays or an MRI to rule out disc problems or something. I don't want to waste time with my GP because they'll just take my $45 copay and send me to somebody else.

My question is, and maybe you've had personal experience with this, is what kind of doctor or specialist should I look for? I'm thinking an orthopedist, but perhaps there are PTs that specialize in serious diagnostics and won't just throw some tape on me and call it a day. I'm a little scared of chiropractors because I do not want them adjusting my neck (I'm also skeptical of the practice itself).

Or, if anyone has had a similar problem, I'd be curious to know how you went about fixing it.
posted by argylesockpet to Health & Fitness (10 answers total) 1 user marked this as a favorite
In my area there is a clinic devoted to back/spine problems. Ultimately (should surgery be required) you're looking for a neurosurgeon. In this clinic's office there was a doctor I met with initially, who did lots of diagnostic pushing and pulling, etc. Then (after enough time passed that my insurance would allow it) I had an MRI that determined I had a herniated C7 disc. I met with the neurosurgeon at that point, and he recommended surgery. I am getting a second opinion next week from a much better hospital. Still neurosurgery.
posted by clone boulevard at 7:24 AM on April 22, 2016 [1 favorite]

Also: I first went to urgent care, who sent me to PT. After a few weeks of no improvement at PT, they sent me to the spine clinic.
posted by clone boulevard at 7:25 AM on April 22, 2016

With a lot of US insurance situations, one has to go to the GP first, to have them make a certified referral to the specialist. Even if you knew exactly what doctor they'd send you to, you'd still have to go get the piece of paper instructing you to go there, else the insurance wouldn't pay for the specialist visit. I will assume that you you know your insurance well enough to be certain that this isn't the case, but I'd encourage you to go see the GP anyway. The GP's opinion of what your next step should be is likely to be more accurate than our advice.
posted by aimedwander at 7:30 AM on April 22, 2016 [1 favorite]

I used to get neck spasms and related MSK headaches that had me munching on Advil like it was candy, sleeping on rolled up towels instead of pillows, and more than a few times, unable to roll myself up or out of bed. On and off for ~10 years. It's happened maybe twice (because I slept in a ridiculous position, on nineteen or so pillows) since I got active and improved my posture.

(I was in an accident and have a bit of cervical subluxing, but it seems the main contributor was a head-forward posture - when walking; hunching over desks, books, etc - all the time. Also, I think that once a system is compromised, it's just going to be vulnerable from then on.)

What helped with spasms in the short term was a muscle relaxant with methocarbamol (i.e. Robax or Robaxacet), and sleeping with the spine in a neutral position (neck supported by a rolled up towel, as mentioned).

Over the long-term, what helped was addressing desk ergonomics and working out, which - even without specific attention to the neck and shoulders - led to a more spine-neutral standing posture (i.e., head in alignment with shoulders and pelvis, with normal lumbar and cervical curves).

Sorry - type of person to see: a sports med, or physiotherapist.
posted by cotton dress sock at 7:41 AM on April 22, 2016

I've had some bouts of spasmodic torticollis -- does that look at all familiar to you? -- and I also came in to recommend methocarbamol. OTC here in Canada, for what that's worth. I've had it flare up in a few parts of the world and always had a GP diagnose it easily (and sometimes then seen a physiotherapist to treat it if it drags on).
posted by kmennie at 7:48 AM on April 22, 2016 [1 favorite]

perhaps there are PTs that specialize in serious diagnostics and won't just throw some tape on me and call it a day

Yeah, there are better and worse PTs. Sport clinic chains often have PTs running through clients in 15 minute intervals, or working on multiple people at a time, avoid those. I had better luck with an independent clinic that slotted 50 full minutes per patient. Finding it was a fluke, tbh - the materials online didn't distinguish this place from a million other clinics with probably worse treatment available. Look at the bios of individual PTs. I didn't see my crackerjack diagnostic genius PT's bio until later, but she went to the best schools in the country for kin and PT, and was a competitive athlete. She had a few other gold stars that I didn't understand until later (nothing special marking "diagnostic talent", though). Other PTs at this same clinic apparently aren't as good.

That said, I didn't see her for the neck, and neck exercises prescribed by other PTs in the past (some of them just as good) were less effective than doing the other things I mentioned.
posted by cotton dress sock at 7:53 AM on April 22, 2016

the pain seems to be radiating down my arm this time so I'm thinking maybe it's a pinched nerve.

I have this exact thing. It's a herniated disc in my neck (C6, I think) that is pinching a nerve. When it flares up my left arm can be in agony for months.

My PCP sent me to a spine / pain clinic. They gave me an MRI and some nerve pain medication. Mostly he talked me through it and advised me that it would take time. He set me up for an injection but I was showing signs of improvement so he decided not to do it.

A couple years later I'm mostly ok though it's very hard to get my neck in a comfortable position when I sleep and I have constant neck and skull cracking and popping that drives me insane.

Long story short, find a spine specialist.
posted by bondcliff at 7:54 AM on April 22, 2016 [2 favorites]

If you work at a computer constantly, make sure your chair is high enough that your arm rests on the surface of the desk at the length of the humerus bone, that is make sure your elbow rests naturally on the desk. Do not work while constantly lifting your arm onto the desk. Use your mouse with no lift or resistance. I started with a new computer, set it all up, within one day I had horrific neck pain on the mouse side of the situation. By day two I realized I had the chair too low and lifting my arm constantly was killing my neck. If you have a weak neck there is an exercise that can help you. This is not radical, not difficult.

Lie on your back, and make your neck as straight as you can, stretched out, flat on the floor. Rotate your head with breath carefully left to right holding everything perfect for this motion, this means shoulders back, neck perfectly straight. Exhale to the right or left depending and inhale in the middle. Do this 25 times both ways, work up to 50. Never fail to do this until the day you no longer care about having a healthy upper back and neck. The next exercise is the critical piece. After you have warmed up to the reasonable fifty, this is not fast, not whippy, this is a lark. Then you put your fists on either side of your cheeks Palms up, with your forearms perpendicular to your face. Then with the same exhale maneuver, using your neck muscles, turn your head and push into your fist, creating a mild resistance as you turn to both sides. This is added after the neck rotation exercise. Both exercises are fifty full repetitions right to left. Everything has to be loosened and positioned perfectly first. That is why you do the first rotation. Turning left and right you resist the turn with your neck muscles. This is the only exercise I have ever been able to dream up to help with horrific neck spasms. Once you are used to this, and do this daily then the muscles you use to turn your head right to left have been toned and strengthened. This is not an overwrought exercise. It starts out at a reasonable normal breath, then might speed up a bit after you are in tone. The neck muscle exercise against the fist, is not hitting yourself in the face, it is pushing your face against some resistance to strengthen neck muscles, involved with turning the head.

This exercise needs to be done flat on the back, not standing, because one of the benefits of the exercise is postural alignment, and working against ergonomic posture created by unintentional repetitive everyday motion, looking in a rear view mirror, turning at your desk, manufacturing work. In this exercise you align your neck perfectly and use it perfectly aligned, and tighten the neck muscles in perfect alignment. It will help with neck pain if your disc problems are not too far advanced. If I do this and keep at it, I have no neck problems, and I am still standing straight. If I don't, my first grand neck spasm is my reminder, it takes a couple of months of slacking off to experience a return of discomfort. Then I am screaming in a snowstorm, checking the right rear view mirror, or in the shower washing my hair.
posted by Oyéah at 10:23 AM on April 22, 2016 [1 favorite]

I would suggest seeing an orthopedist who specializes in back/neck issues.

Also, this book has helped me with a lot of similar aches and pains:
The Trigger Point Therapy Workbook by Clair Davies. It's about using self-massage to heal myofascial pain.
posted by tuesdayschild at 11:37 AM on April 22, 2016 [2 favorites]

The question is who should treat it, and the answer is most likely a physical therapist. That means that you should see any doctor, such as a family practitioner, who can write the order.
posted by megatherium at 4:13 PM on April 23, 2016

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