The atlas is the uppermost vertebra of the spine, and sits in the neck. It's shaped like a ring with two wings jutting out on either side. Named after the Titan of Hellenic mythology who was thought to be holding up the world, the atlas bone supports the skull, which could be compared with a globe.

Below the atlas lies the axis, the second cervical vertebra. This neck bone is also roughly circular, except that it has a large upright 'tooth', the 'dens', upon which the atlas and, therefore, the whole head, turns.

Persistent neck pain is often associated with problemsin the joints between the base of the skull and the atlas, or between the atlas and axis bones.

Osteopathy

Manipulative techniques like osteopathy are among the more effective treatment options for neck pain. The practitioner uses short, sharp movements to push a joint slightly further than it would usually move, producing a 'cracking' noise.

One study found that manipulation works better than less active physical treatments, such as massage (BMJ, 1992; 304: 601-5). But combining manipulation with neck-strengthening exercises may work even better (Spine, 2001; 26: 788-97).

Osteopathic treatment for atlas-related neck problems generally involves a variety of techniques. For example, the high-velocity, low-amplitude (HVLA) thrusting technique is used to increase range of motion, improve function and decrease pain (DiGiovanna EL, Schiowitz S. An Osteopathic Approach to Diagnosis and Treatment. Philadelphia: Lippincott-Raven, 1997: 123).

However, these techniques are not to be used if the patient suffers from certain other conditions-in particular, rheumatoid arthritis or osteoporosis. Luckily, there are alternative options.

Homeopathy

For patients who have osteoporosis or arthritis, or raised levels of uric acid, there is Urarthone, a homeopathic combination remedy produced by Laboratoires Lehning SA, based in Metz, France. Although it's not been tested in controlled trials, there is credible evidence (published by Lehning itself) that it can be beneficial for inflammatory joint conditions. I have used this remedy in my practice since 1972 and have found it to be reliable.

Acupuncture

According to Oriental medicine, neck problems are due to an attack of Wind and Cold, which usually enter the body's energy channels during sleep. Alternatively, the normal flow of Qi (chi) and Blood may be disturbed, and the muscle channels strained when the sleeper assumes an awkward position in bed.

Numerous studies show that acupuncture is an effective treatment for neck pain and dysfunction (Pain, 2006; 126: 245-55; Spine, 2007; 32: 236-43; BMJ, 2001; 322: 1574-8). Different forms of acupuncture may be used, including:

- standard acupuncture. The principal acupoints to be needled are the Luozhen (M-UE-24) and the point(s) of pain ('ouch' points). This may be followed by Tuina therapy, a kind of Oriental osteopathy (O'Connor J, Bensky D, transls/eds. Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press, 1984: 661)

- auricular (ear) acupuncture. The practitioner inserts the needle in the notch located where the antehelix and antitragus of the ear meet (along the inner curved ridge of the outer ear) (O'Connor J, Bensky D, transls/eds. Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press, 1984: 482)

- pedal (foot) acupuncture. For pain and rotation restriction in the neck, the practitioner inserts the needle (straight or slanted) into acupoint 23 on the foot (O'Connor J, Bensky D, transls/eds. Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press, 1984: 506).

Cupping

Cupping is another technique from traditional Chinese medicine (TCM) that can help patients with neck problems. Using a small, sterile multispiked mallet, the practitioner taps along the affected area until there is slight bleeding. Suction cups are then applied to the site to create a vacuum on the patient's skin to draw more blood to the area (O'Connor J, Bensky D, transls/eds. Acupuncture: A Comprehensive Text. Seattle,

WA: Eastland Press, 1984: 661). This type of therapy is used to relieve what is referred to as 'stagnation' in TCM terms.

Neural therapy

This gentle healing technique was developed in Germanyand can also be used to treat problems in the neck area. It involves the injection of local anaesthetics into the problem sites, such as the autonomic ganglia (neural clusters), peripheral nerves, scars, glands, acupuncture points, trigger points, skin and other tissues.

For neck pain, the practitioner injects a 25-per-cent magnesium-sulphate solution combined with 2-per-cent procaine hydrochloride into the sites of tenderness as well as the affected muscle(s) (O'Connor J, Bensky D, transls/eds. Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press, 1984: 661).

Heat treatment

In all of the above-mentioned therapeutic approaches, any beneficial effects can be enhanced by the subsequent application of heat packs.

Harald Gaier

Harald Gaier, a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London, and the Irish Centre of Integrated Medicine, Co. Kildare (www.drgaier.com).