Dr. Allan Horowitz, published newspaper article, The Liberal, Copyright March 20, 1991

For the last few weeks I have been discussing the anatomy and physiology behind various neck disorders. In other words, what is it about the structure of the neck which causes some people neck pain and headaches. When the anatomy of the neck is clearly understood, the source of pain can also be understood.

Last week I described the front part of the vertebra, the disc, the curve of the neck, its ligamentous support and the infamous joints of Von Luschka. (If you didn’t read last week’s column you will never know the real story behind the man they called Von Luschka.)

The back part of each unit is composed of the bumps one feels when the back of the neck is felt (spinous processes), two transverse processes (the bumps on the sides of the neck), the Vertebra’s arches and its ‘true’ joints.

These joints are ‘real’ joints because they are lined with cartilage and contain fluid, unlike the joints of Von Luschka. These true joints allow a gliding motion to occur between two adjacent vertebrae.

The greatest degree of motion in the neck should occur between the skull, the first bone (atlas), and the second bone (axis). The joint between the skull and the atlas will allow 10 degrees of flexion and 25 degrees of extension (bending your head down and back) and therefore a combined 35 degrees is possible in this one joint alone, even without the rest of the neck.

The greatest range of motion in the entire neck is allowed at the joint between the atlas and the axis.

Unlike flexion and extension, pure rotation is not allowed between the skull and the atlas, but between the atlas and axis 90 degrees of rotation (between full right and full left motions) is allowed.

This is 50 per cent of all rotation which occurs in the neck and it all happens at one level.

Between the second and seventh vertebrae, movements of lateral flexion, flexion, extension and rotation are all possible.

DISC DISTORTS

When the neck flexes or extends, the disc must distort slightly (recall last week’s lesson) and the ligaments must relax suffidently to allow for this motion. Also, when the neck is flexed, the holes where the nerves exit from the spine are made a bit wider and when the neck is extended these holes close up slightly. These holes also close slightly if the head is turned to that side.

What does all of this mean and why am I boring you with all of these facts?

If you have been paying attention over the last few weeks you should all know what it means when: you cant turn your head to check the blind spot when you are driving (atlas-axis problem), you can’t bend your head down to look toward the ground (skull-atlas problem), you get tingling in your arm every time you look up or to one side (closing of the holes where the nerves exit and nerve irritation), your neck feels stiff and you get headaches (not enough motion in your neck joints, usually caused by degeneration, arthritis, poor posture), you have pain and headaches but not stiffness (too much or inappropriate motion in the neck joints, usually caused by trauma).

OVERSIMPLIFIED

Yes, I have oversimplified it. No, it doesn’t really mean that if you can’t rotate your head the problem must be at the level of the spine. It doesn’t mean that if your neck is stiff, you have arthritis.

But it should be seen that there is a relationship between the anatomy (how it looks), physiology (how it works) and pathology (what goes wrong with it).

We know the anatomy and physiology, and therefore the pathology really isn’t too hard to figure out by using the diagnostic methods I outlined last week.

These last few lessons were not intended as a guide to home chiropractic care, and the neck is the last place you should ‘fool around’ with, but the original reader’s question (four weeks ago) which asked if his neck problems could be the cause of his headaches has certainly been answered.

Not just by me answering ‘of course’, but by me proving it; with the aid of such notable celebrities as ‘Pascal’ and ‘Von Luschka.’

Allan Horowitz, D.C., is a chiropractor and writes this public service column. He will attempt to answer readers’ questions on a variety of topics including back pain, headaches, nutrition, sport injuries and preventive medicine.

Address your questions to Allan Horowitz, care of The Liberal, Box 390, Richmond Hill, L4C4Y6.