NECK PAIN
SIGNS & SYMPTOMS
Pain in our neck/spine is experienced when there is a lack of joint motion between the vertebrae, combined with changes in muscle tone and nerve and blood vessel supply. This leads to inflammation in the area, which activates and over-stimulates particular nerve fibers (type-C) and their endings, called nociceptors, whose sole purpose is to detect pain. The combination of joint restrictions, muscle tone changes, and nerve and blood vessel signaling changes cause a reduction in feedback to our brain from the environment and body, which drives the pain pattern.
By improving motion in the joints and muscles, we are able to inhibit the type-C nerve fibers and the over-activation of nociceptors that are sending our brain messages of pain. This is known as the Pain-Gate Theory, and is widely accepted as the cause of pain. It simply states that proper motion in joints, ligaments and muscles activate 1A nerve fibers that send our brain messages of motion, and at the same time, they send inhibitory messages to the pain fibers, which reduces their firing and decreases the sensation of pain. In summary, when your spine moves well, pain is inhibited and you no longer feel it
- Reduced ROM
- Shoulder Pain
- Pain along sides of neck
- Headaches/Migraines
- Upper back pain
- Head Tilt
- Dizziness/Vertigo
- Pain, Numbness or Tingling down the arm (s)
- Jaw pain
Pain in our neck/spine is experienced when there is a lack of joint motion between the vertebrae, combined with changes in muscle tone and nerve and blood vessel supply. This leads to inflammation in the area, which activates and over-stimulates particular nerve fibers (type-C) and their endings, called nociceptors, whose sole purpose is to detect pain. The combination of joint restrictions, muscle tone changes, and nerve and blood vessel signaling changes cause a reduction in feedback to our brain from the environment and body, which drives the pain pattern.
By improving motion in the joints and muscles, we are able to inhibit the type-C nerve fibers and the over-activation of nociceptors that are sending our brain messages of pain. This is known as the Pain-Gate Theory, and is widely accepted as the cause of pain. It simply states that proper motion in joints, ligaments and muscles activate 1A nerve fibers that send our brain messages of motion, and at the same time, they send inhibitory messages to the pain fibers, which reduces their firing and decreases the sensation of pain. In summary, when your spine moves well, pain is inhibited and you no longer feel it
NECK - CERVICAL SPINE
bALANCE & coNTROL
SIGNS & SYMPTOMS
Good balance occurs when the spine, surrounding muscles and brain is communication and signalling effectively. With errors in this feedback loop, balance and equilibrium is affected. Consider a sway to the left, this causes a signal to be sent to the cerebellum on the right side as the muscles of that side are stretched, which then sends a signal to the left cortex, interpreting the information. The left cortex, utilising the corticospinal pathway, signals back down to the right side that has been stretched and contracts the larger spinal and pelvic muscles to contract in a coordinated fashion-pulling us back to center-this is known as balance.
Chiropractors can locate where the signal errors occur and assist to restore normal communication patterns. This may be at spinal, vestibular or cerebellum level which control balance and coordination.
- Vertigo
- Dizziness & Light headed
- Blurry Vision
- Off balance
- Spatial Awareness (feeling disconnected)
- Gait Changes (walking or running abnormalities)
- One sided sway
- Muscle tightness on one side
Good balance occurs when the spine, surrounding muscles and brain is communication and signalling effectively. With errors in this feedback loop, balance and equilibrium is affected. Consider a sway to the left, this causes a signal to be sent to the cerebellum on the right side as the muscles of that side are stretched, which then sends a signal to the left cortex, interpreting the information. The left cortex, utilising the corticospinal pathway, signals back down to the right side that has been stretched and contracts the larger spinal and pelvic muscles to contract in a coordinated fashion-pulling us back to center-this is known as balance.
Chiropractors can locate where the signal errors occur and assist to restore normal communication patterns. This may be at spinal, vestibular or cerebellum level which control balance and coordination.
BPPV (Benign Paroxysmal Positional Vertigo)
SIGNS & SYMPTOMS
BPPV Symptoms are very sudden and alarming and are often mistaken for something more serious!
BPPV is the most common cause of Vertigo, or spinning and is a problem within the inner ear. It typically gives patients a false sensation of spinning or movement, unless it is chronic and has been accommodated for, skewing it's typical presentation. The spinning sensation is caused by an excessive signal from the inner ear as the inner ear solution becomes more viscous and weight inappropriately, sending an excessive signal to the brain stem, causing quick movements of the eyes that give an illusory movement of your environment that results in spinning sensation.
Vertigo is defined as the subjective perception of rotational or translational movement in the absence of an external stimulus (1). BPPV occurs when calcium carbonate crystals (otoconia) dislodge from their normal location, utricle/saccule (sensory organ) and travel into the semicircular canals. If they are freely floating in the SCC, we refer to this as canalithiasis. If they adhere to the cupula, we refer to this as cupulolithiasis. Posterior canal is most commonly affected due to its orientation relative to gravity as the lowest portion of the inner ear The anterior and horizontal canals are affected to a lesser degree. Average onset is at 57 and women are twice as affected as men. BPPV may follow head trauma (concussion/TBI), viral neurolabyrinthitis, labyrinthine ischemia, infection, and prolonged or unusual head positioning (dentist, hairdresser, etc..). Age, dehydration, flying, intense exercise or pounding such as mountain biking on rough trails, and medication are also contributors to BPPV.
(1) You Peng, MD, Instrum Ryan, MD, Parnes Lorne, MD, FRCSC. Benign paroxysmal positional vertigo. Laryngoscope Investigative Otolaryngology. 2019 Feb: 4 (1): 116-123.
- Brief episodes of spinning or vertigo when turning their head abruptly
- Certain head position is worse than others
- Spinning that fatigues or disappears with a minute or two
- Changing positions, or rolling over in bed that causes spinning
- Looking upwards or backing your vehicle up creates spinning
- Bending forward causes imbalance, unsteadiness or spinning
- People can often identify the head position that causes dizziness and tend to avoid activating
BPPV Symptoms are very sudden and alarming and are often mistaken for something more serious!
BPPV is the most common cause of Vertigo, or spinning and is a problem within the inner ear. It typically gives patients a false sensation of spinning or movement, unless it is chronic and has been accommodated for, skewing it's typical presentation. The spinning sensation is caused by an excessive signal from the inner ear as the inner ear solution becomes more viscous and weight inappropriately, sending an excessive signal to the brain stem, causing quick movements of the eyes that give an illusory movement of your environment that results in spinning sensation.
Vertigo is defined as the subjective perception of rotational or translational movement in the absence of an external stimulus (1). BPPV occurs when calcium carbonate crystals (otoconia) dislodge from their normal location, utricle/saccule (sensory organ) and travel into the semicircular canals. If they are freely floating in the SCC, we refer to this as canalithiasis. If they adhere to the cupula, we refer to this as cupulolithiasis. Posterior canal is most commonly affected due to its orientation relative to gravity as the lowest portion of the inner ear The anterior and horizontal canals are affected to a lesser degree. Average onset is at 57 and women are twice as affected as men. BPPV may follow head trauma (concussion/TBI), viral neurolabyrinthitis, labyrinthine ischemia, infection, and prolonged or unusual head positioning (dentist, hairdresser, etc..). Age, dehydration, flying, intense exercise or pounding such as mountain biking on rough trails, and medication are also contributors to BPPV.
(1) You Peng, MD, Instrum Ryan, MD, Parnes Lorne, MD, FRCSC. Benign paroxysmal positional vertigo. Laryngoscope Investigative Otolaryngology. 2019 Feb: 4 (1): 116-123.
CERVICAL DYSTONIA
SIGNS & SYMPTOMS
Cervical Dystonia is also known as Spasmodic Torticollis, it is described as a focal dystonia (or localised) that involves the neck and sometimes the shoulder. Specifically, the Sternocleidomastoid muscle is the main tissue involved, as it contracts to cause a torsionional aspect of the neck and head in a lateral and rotated position. This can be a sustained contraction, or a jerky or clonic movement may be associated, as it will sometimes switch from side to side. It can occur as a primary disorder (not involved with any other neurological condition), or secondary (involving additional metabolic, pharmaceutical or previous injury). The etiology of Cervical Dystonia is unknown, but we now understand that it is associated with the Basal Ganglia and Parietal lobe of the Cortex. Cervical Dystonia can be inherited, as the DYT1 gene has been linked to individuals with this disorder.
- Sensory ticks or geste antagoniste
- Head laterally flexed to one side with head rotation in opposite direction
- Neck and shoulder pain
- Imbalance and Disequilibrium
- Vertigo and dizziness
- Neck pain or previous injury
Cervical Dystonia is also known as Spasmodic Torticollis, it is described as a focal dystonia (or localised) that involves the neck and sometimes the shoulder. Specifically, the Sternocleidomastoid muscle is the main tissue involved, as it contracts to cause a torsionional aspect of the neck and head in a lateral and rotated position. This can be a sustained contraction, or a jerky or clonic movement may be associated, as it will sometimes switch from side to side. It can occur as a primary disorder (not involved with any other neurological condition), or secondary (involving additional metabolic, pharmaceutical or previous injury). The etiology of Cervical Dystonia is unknown, but we now understand that it is associated with the Basal Ganglia and Parietal lobe of the Cortex. Cervical Dystonia can be inherited, as the DYT1 gene has been linked to individuals with this disorder.
CERVICAL RADICULITIS
SIGNS & SYMPTOMS
- Spasms and tightness of neck muscles
- Pain in shoulder, upper arm or forearm causing referred pain
- Burning pain into the arm and hand
- Weakness in muscles of arm
- Electrical or shooting type pain with hypersensitivity
- Numbness of tingling down the arm and hand
- Disc bulges or herniations (a tear in the outer layer of disc)
- Cervical segmental restriction
- Soft tissue injuries
- Spinal stenosis
- Osteophytic changes (arthritis)
- Tumors
- Infections
CERVICAL SEGMENTAL RESTRICTION (Sprain / Strain)
SIGNS & SYMPTOMS
Receptors (signaling structures) within your joints and muscles that comprise every region of your spine, shoulder, elbow, hip, knee et cetera are primary activators of your brain. Through various sensory pathways (Dorsal Column Medial Lemniscus, Spinothalamic, spinocerebellar tracts) we send information to our brain that serves as a monitor of position sense (posture), muscles stretching and pain that keep us from falling over, damaging our tissue or altering our brain's spatial orientation at any given time. As it is performing this, it is simultaneously activating gene expression within the neurons from the receptor activated along its pathway all the way up to the grey matter within our brain (region that contains our neuron cell bodies). As if that wasn't enough, we then process the information that was received (feedback) and send an appropriate signal back down to the region that originally signaled along the corticospinal, vestibulospinal or reticulospinal pathways to make the necessary shift, utilizing the vestibular system, brain stem, visual system, thalamus, basal ganglia and cortex to glean as much information to perform the best job possible. In summary, segmental restriction has dire consequences within the circuitry of our nervous system, affecting many systems.
- Pain in the neck
- Inflammation of the surrounding tissue (painful to touch)
- Reduction in Range of Motion (often associated with tightness of muscles or a pinching sensation)
- Tension within the muscles
- Referred pain
Receptors (signaling structures) within your joints and muscles that comprise every region of your spine, shoulder, elbow, hip, knee et cetera are primary activators of your brain. Through various sensory pathways (Dorsal Column Medial Lemniscus, Spinothalamic, spinocerebellar tracts) we send information to our brain that serves as a monitor of position sense (posture), muscles stretching and pain that keep us from falling over, damaging our tissue or altering our brain's spatial orientation at any given time. As it is performing this, it is simultaneously activating gene expression within the neurons from the receptor activated along its pathway all the way up to the grey matter within our brain (region that contains our neuron cell bodies). As if that wasn't enough, we then process the information that was received (feedback) and send an appropriate signal back down to the region that originally signaled along the corticospinal, vestibulospinal or reticulospinal pathways to make the necessary shift, utilizing the vestibular system, brain stem, visual system, thalamus, basal ganglia and cortex to glean as much information to perform the best job possible. In summary, segmental restriction has dire consequences within the circuitry of our nervous system, affecting many systems.
ADHESIVE CAPSULITIS
SIGNS & SYMPTOMS
Adhesive Capsulitis is more commonly known as frozen shoulder. It often occurs following an injury to the shoulder, upper back or neck. It is also common after surgery in these areas. These injuries will cause painful motion; thus the individual will often limit the use of their shoulder. As they continue to limit usage, the brachial plexus, which is the neurovascular bundle that extends from your neck into your shoulder and upper extremity, becomes constricted by surrounding tissue structures. This leads to even more pain with attempted normal range of motion in the shoulder
It is important to understand that the shoulder mechanics are not limited to muscles, joints or nerves individually, but a combination of all. Therefore, when we diagnose the cause(s) of adhesive capsulitis, we examine and treat multiple systems.
- Shoulder stiffness
- Decreased range of motion of the shoulder
- Pain and stiffness in the lower neck
- Pain and stiffness in scapula (shoulder blade) or upper back
- Pain, occasional numbness or tingling down the affected arm
- Extreme pain during movement of shoulder
Adhesive Capsulitis is more commonly known as frozen shoulder. It often occurs following an injury to the shoulder, upper back or neck. It is also common after surgery in these areas. These injuries will cause painful motion; thus the individual will often limit the use of their shoulder. As they continue to limit usage, the brachial plexus, which is the neurovascular bundle that extends from your neck into your shoulder and upper extremity, becomes constricted by surrounding tissue structures. This leads to even more pain with attempted normal range of motion in the shoulder
It is important to understand that the shoulder mechanics are not limited to muscles, joints or nerves individually, but a combination of all. Therefore, when we diagnose the cause(s) of adhesive capsulitis, we examine and treat multiple systems.
CARPAL TUNNEL SYNDROME
SIGNS & SYMPTOMS
Carpal tunnel syndrome is a condition in which the median nerve is compressed at the wrist in the area known as the carpal tunnel. The carpal tunnel is a passageway formed in the wrist located between the carpal bones and the overlying transverse carpal ligament (called the flexor retinaculum). The tendons for the flexor muscles of the hand also travel through this opening. The median nerve supplies innervation to the palmar surface of the thumb and into the 2nd, 3rd and half of the 4th digits and the fingertips.
- Pain in wrist, hand or forearm that can wake you up at night
- Tingling/numbness in hand (in the area of the thumb pad, thumb, index, middle and half of the ring finger)
- Muscle weakness in the thumb, and first three fingers
- Muscle wasting (a decrease in the prominence of the pad of the hand)
- Associated shoulder pain
- Associated neck pain
Carpal tunnel syndrome is a condition in which the median nerve is compressed at the wrist in the area known as the carpal tunnel. The carpal tunnel is a passageway formed in the wrist located between the carpal bones and the overlying transverse carpal ligament (called the flexor retinaculum). The tendons for the flexor muscles of the hand also travel through this opening. The median nerve supplies innervation to the palmar surface of the thumb and into the 2nd, 3rd and half of the 4th digits and the fingertips.
DIZZINESS
SIGNS & SYMPTOMS
Dizziness has been defined as a sense of disturbed or impaired spatial orientation without a false or distorted sense of motion. Vertigo is defined as a false sense of self-motion without any motion or the feeling of distorted self-motion with normal movement (1)
Sensory mismatch due to errors in the vestibular, proprioceptive and central systems.
(1) Devaraja, K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. European Archives of Oto-Laryngology (2018) 275:2421-2433
- Difficulty Concentrating
- difficulty reading
- difficulty riding in a vehicle
- Dizziness
- Spinning
- Visual Changes
- Vertigo, which is nothing but a false perception of movement of self or surrounding
- Disequilibrium, or imbalance which is an inability to maintain balance
- Presyncope, a sense of losing consciousness
- Lightheadedness, defined as a vague symptom of feeling disconnected from the environment
Dizziness has been defined as a sense of disturbed or impaired spatial orientation without a false or distorted sense of motion. Vertigo is defined as a false sense of self-motion without any motion or the feeling of distorted self-motion with normal movement (1)
Sensory mismatch due to errors in the vestibular, proprioceptive and central systems.
(1) Devaraja, K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. European Archives of Oto-Laryngology (2018) 275:2421-2433
MONONEURITIS / MONONEUROPATHY (NERVE ENTRAPMENT)
SIGNS & SYMPTOMS
Impingement, or compression can occur on a single nerve after it exits the spine, known as Peripheral neuritis or Peripheral Neuropathy. Most commonly they are only irritated as the inflammation reduces the space that the nerves may travel through certain tunnels, but can sometimes be ablative, or damaged. This can occur due to postural changes of limbs, joint angulation, trauma, infection, muscle imbalance, fascial restriction, muscle tightness/spasm, inflammation or cysts amongst others. Typically the patient will notice pain or paraesthesia’s-sensation change (tingling, numbness, burning) occurring in one of their extremities in a traceable pattern. It is important to differentially diagnose between the aforementioned as to determine the most appropriate treatment.
- Burning
- Tingling
- Numbness
- Pain
- Traceable pattern
- Weakness or Atrophy with absent or reduced reflexes (more severe and usually indicates ablative lesions)
- Carpal Tunnel Syndrome (entrapment of median nerve at wrist)
- Cubital tunnel Syndrome (entrapment of ulnar nerve at elbow)
- Peroneal Neuropathy (entrapment at outside of the knee)
- Meralgia Paresthetica (entrapment of the Lateral Femoral Cutaneous nerve at the anterior hip)
- Posterior Interosseous Nerve Syndrome (pain in the medial forearm, or flexor compartment)
- Suprascapular nerve entrapment (pain in the upper posterior shoulder blade region with weakness during the start of abduction and external rotation only-must be differentiated between C5 radiculopathy)
- Tarsal Tunnel Syndrome (entrapment behind the medial malleolus, or inner ankle joint)- uncommon
- Thoracic Outlet Syndrome (entrapment of the lower trunk of the Brachial Plexus at the area behind the clavicle, or collar bone)
Impingement, or compression can occur on a single nerve after it exits the spine, known as Peripheral neuritis or Peripheral Neuropathy. Most commonly they are only irritated as the inflammation reduces the space that the nerves may travel through certain tunnels, but can sometimes be ablative, or damaged. This can occur due to postural changes of limbs, joint angulation, trauma, infection, muscle imbalance, fascial restriction, muscle tightness/spasm, inflammation or cysts amongst others. Typically the patient will notice pain or paraesthesia’s-sensation change (tingling, numbness, burning) occurring in one of their extremities in a traceable pattern. It is important to differentially diagnose between the aforementioned as to determine the most appropriate treatment.
NON EPILEPTIC SEIZURES
These are episodic, paroxysmal events that lead to abnormal responses in behaviour or brain activity that are not related to seizure activity. Individuals often have internal sensations that resemble epileptiform seizures. They differ from epileptic seizures in that they do not respond to medication, they change over time, maintain normal EEG findings, only occur in wakeful states and do not include uncontrollable thrashing of all four limbs
NUMBNESS & TINGLING
SIGNS & SYMPTOMS
Try this at home: Wrap a rubber band around your finger for a moment and notice the color change as blood flow is diminished, this is analogous to nerve compression.
- Tingling/Numbness or Pain down the arms or legs
- Pain in the neck, chest, shoulder blade or rotator cuff when experiencing Numbness or Tingling down the arms
- Pain in the lower back, buttock, hip or pelvis when experiencing Numbness or Tingling down the leg
- More commonly seen in the pinky and ring finger of the upper extremity
- Sciatic pain
Try this at home: Wrap a rubber band around your finger for a moment and notice the color change as blood flow is diminished, this is analogous to nerve compression.
OCCIPITAL NEURALGIA
SIGNS & SYMPTOMS
Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal (2).
- Neck Pain - base of neck
- Shoulder pain
- Headaches
- Foggy Head
Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal (2).
SHOULDER PAIN
SIGNS & SYMPTOMS
Shoulder pain can occur for a variety of reasons, it may come on gradually as a generalized aching in the shoulder itself, tightness in the neck and shoulder muscles, or damage to the tendon, ligaments, or bone from an injury (like a fall, or an athletic injury). There may be associated neck and/or arm pain, numbness or tingling in addition to the shoulder pain.
Shoulder pain can occur for a variety of reasons, it may come on gradually as a generalized aching in the shoulder itself, tightness in the neck and shoulder muscles, or damage to the tendon, ligaments, or bone from an injury (like a fall, or an athletic injury). There may be associated neck and/or arm pain, numbness or tingling in addition to the shoulder pain.
TMJ / TMD ISSUES
SIGNS & SYMPTOMS
CAUSES
- Clicking or popping of the jaw
- Ear ache
- Pain in the face or jaw
- Headaches/Migraines
- Pain at the base of the skull, usually on the side of related TMJ symptoms
- Pain while chewing or yawning
- Neck Pain
- Upper back/shoulder pain
CAUSES
- Traumatic Injury
- Chronic head tilt
- Misalignments in the upper cervical spine (base of skull)
- Postural (Anterior head positioning), often from computer usage or work.
- Tooth misalignment
TRIGEMINAL NEURALGIA
Trigeminal Neuralgia is caused by irritation or compression to Cranial Nerve V, which supplies sensation to the face. It occurs on one side and is often shooting, stabbing, electrical, spasming and is overall quite severe. Patients will often be very sensitive to cold, wind, shaving, touch or otherwise inconsequential sensations that are now causing severe pain as the hypersensitive nerve is overstimulated. Causes can be a loop, or bundle of blood vessels compressing the nerve, Multiple Sclerosis, biomechanical issues (TMJ) or abnormal neurological pattern firing. Treatment is dependent on the cause of the issue, but if it is biomechanical or due to abnormal neurological patterning, then Chiropractic Neurology may be effective in the treatment of this condition.
WHIPLASH
SIGNS & SYMPTOMS
A motor vehicle accident can be very traumatic, but the effects of such an injury can be longer lasting than initially assumed, and symptoms may not even seem to occur for months following the initial injury. The Second Law of Motion states that if an unbalanced force acts on a body, that body will experience acceleration ( or deceleration), that is, a change of speed. This is what causes whiplash, an event that accelerates our neck at violent speeds, injuring the upper back, lower and upper neck as the rest of our body stays somewhat motionless. At impact, our body braces itself, reducing normal range of motion. However, the force of impact, as described by Newton, flexes and extends the neck beyond its normal range, thus injuring tissue and causing acute and eventual chronic symptoms. This is why even at speeds as low as 5mph there can be significant injury to the spine and therefore even seemingly mild motor vehicle accidents need to be taken seriously.
Symptoms are often not experienced immediately after the injury, thus lessening the patient's initial assessment of the severity during the whiplash event. However, even before symptoms appear, there can is damage to tissues of the spine with resultant aberrant signaling occurring in brain function (symptoms begin to appear a few days after the injury, usually affecting the neck, upper back and head). Most people experience a few of these symptoms, and some experience all of them. However, it is important to realize that even in the absence of outright symptoms there can be a change in brain function.
- Tension headaches
- Pain at the base of the skull
- Neck pain or soreness
- Upper back pain
- Pain in the shoulder blade regions
- Chest pain (due to seat belt straining anterior rib joints)
- Lower back and hip pain
- Dizziness/Vertigo
- Loss of normal range of motion, or stiffness
A motor vehicle accident can be very traumatic, but the effects of such an injury can be longer lasting than initially assumed, and symptoms may not even seem to occur for months following the initial injury. The Second Law of Motion states that if an unbalanced force acts on a body, that body will experience acceleration ( or deceleration), that is, a change of speed. This is what causes whiplash, an event that accelerates our neck at violent speeds, injuring the upper back, lower and upper neck as the rest of our body stays somewhat motionless. At impact, our body braces itself, reducing normal range of motion. However, the force of impact, as described by Newton, flexes and extends the neck beyond its normal range, thus injuring tissue and causing acute and eventual chronic symptoms. This is why even at speeds as low as 5mph there can be significant injury to the spine and therefore even seemingly mild motor vehicle accidents need to be taken seriously.
Symptoms are often not experienced immediately after the injury, thus lessening the patient's initial assessment of the severity during the whiplash event. However, even before symptoms appear, there can is damage to tissues of the spine with resultant aberrant signaling occurring in brain function (symptoms begin to appear a few days after the injury, usually affecting the neck, upper back and head). Most people experience a few of these symptoms, and some experience all of them. However, it is important to realize that even in the absence of outright symptoms there can be a change in brain function.
