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Cartoonist David Austin dies at 70

1 Cervicalgia is a difficult problem to manage in general practice.This is because it stems from a multitude of different causes ­ traumatic, arthritic and degenerative to migrainous and depressed.

2 Always take a history before making a diagnosis.

3 Encourage patients to think about posture. Stooping at a desk in front of a computer or slouching in the car are unhealthy aspects of today's lifestyle.

Advise patients to sit upright, pull their shoulders back and have their desks and equipment at the right height so they are not overly flexing their neck.

Sleeping posture and pillow support are also important considerations.

4 Teach patients strengthening exercises that involve the whole spine and so address abdominal and lumbar weakness.

Poor stomach muscle tone or the excessive weight of obesity can alter spinal alignment and consequently put additional compensatory strain on the neck.

5 The mainstay of treatment should be regular, at least twice-daily, neck exercises. The following movements should be performed slowly and repeated five times:

6 Don't overlook the importance of simple analgesics, NSAIDs, heat, occasional use of muscle relaxants and alternatives, such as acupuncture.

7 Neck braces or collars can be used to provide relief in the acute phase for a few days.

Although generally frowned upon as they encourage muscle stiffness through disuse, these devices do limit excessive movement and support the head and so take the strain off the neck.

8 Never ignore prolonged pain or neurological symptoms or deficit.

Prolonged pain or neurological symptoms or deficit would suggest a cause other than muscular. They may indicate pressure on the cervical spinal cord and warrant specialist referral.

9 An X-ray is often not clinically warranted and can correlate poorly with clinical symptoms. It may, however, serve to reassure a patient ­ or show the osteophytes of osteoarthritis, a narrowing disc space, a fracture or a tumour.

10 An MRI and/or nerve conduction studies may be inevitable investigations in certain patients.

Alistair Bint is a GP in Reigate, Surrey

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