Cervical disc herniation is most likely to affect adults below the age of 55 with a peak incidence in the fourth decade. Cervical disc herniations are slightly more common in males. Activities that are thought to predispose patients to cervical disc problems include repetitive stressful workstation postures (i.e. maintaining a prolonged forward head posture), repetitive cervical flexion, improper sleep postures, trauma, frequent heavy lifting, cigarette smoking, and driving or operating vibrating equipment- including motor vehicles. The risk of cervical disc herniation increases as cervical lordosis decreases.
Upper crossed syndrome is a direct result of "flexor-dominated" postures (i.e. forward use of the arms and head). This process begins in the classroom as a child and progresses with age throughout the working years. Most occupations, from computer operator to manual labor, are "flexor-dominated". Workstation users are particularly predisposed from prolonged static flexor dominated postures. Research has shown that the upper crossed-inducing posture associated with prolonged Smartphone use may carry a six- fold increased risk of neck pain. Sedentary lifestyles may contribute to the problem. Non-mechanical factors like low self-esteem or depression may trigger upper crossed postures.
Poor posture can negatively affect proprioception, balance, gait, muscle activity, the pattern of breathing, and functional performance. Poor posture has been associated with increased mortality rates in older adults. Upper crossed syndrome places excessive stress on the upper thoracic region and has been linked to T4 syndrome – a cause of chest pain and pseudo angina.
Cervical spine stenosis is narrowing of the central spinal canal or neural foramina due to changes in bone or soft tissue. Stenotic compression may involve one nerve root, (monoradiculopathy), multiple nerve roots (polyradiculopathy) or most significantly, the central cord (myelopathy). Cervical spine stenosis is present in almost 5% of the adult population. The condition shows age-related progression, affecting nearly 7% of the over 50 community, and 9% of those over 70.
Cervicogenic vertigo is suggested by a history of dizziness associated with cervical movement and concurrent neck pain. Complaints of light-headedness, floating, unsteadiness, or general imbalance, but rarely true “spinning” vertigo. A sensation of “spinning” (i.e. true rotary vertigo) suggests a non-cervicogenic origin, possibly Benign Paroxysmal Positional Vertigo (BPPV). Cervicogenic symptoms are generally episodic, provoked by movement and eased by maintaining a stable position. Continuous symptoms suggest a more central origin. Occipital headaches may accompany cervicogenic vertigo, but clinicians should be alert for the presence of a “severe” or “different” headache suggesting a cerebral origin.
Temporomandibular Joint Disorder (TMD) describes a complex group of muscular and articular disorders affecting the TMJ, leading to pain, dysfunction, and eventually degeneration.
Most causes of TMD can be divided into either myogenous (muscular) or arthrogenous (articular). TMD of myogenous origin is more common and may arise from muscular hypertonicity, trigger points, fascial restrictions, and/or functional muscle imbalance of the muscles of mastication. One of the most commonly involved muscles is the masseter. Other recognized triggers for myogenous TMD include bruxism, clenching, cervicocranial dysfunction, postural syndromes, especially a forward head posture, and trauma. TMD symptoms may occur in up to one-third of those patients involved in a whiplash injury.
