Neck pain is pain or discomfort in the neck, usually when moved. The pain may be worse when turning the head in one direction.
The neck is the upper part of the spine called the "cervical spine". It is made up of a complex arrangement of bones, muscles, nerve, blood vessels and tendons. Injury or changes to any of these components can lead to neck pain.
The structure of the neck is provided by seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity.
The spine protects the spinal cord that transmits signals between the body and the brain. Between each vertebrae, two spinal nerves exit through small openings called foramina, one on the right and one on the left. These spinal nerves go to the neck, shoulders, arms and hands to control muscle movements and provide a sense of touch.
If neck pain involves significant muscle spasm or a slipped disc there may be a pinching of the spinal nerve resulting in numbness, tingling, or weakness in the arm, hand, or shoulder.
Cause of Neck Pain
The most common cause of neck pain is muscle strain from everyday activities, such as bending over a desk for prolonged periods of time, having poor posture while watching TV or reading, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising.
Other causes of neck pain include the following:
- Traumatic accidents, such as a motor vehicle accident, causing vertebral fractures or whiplash
- Herniated disk
- Spinal stenosis
- Small fractures to the spine from osteoporosis
- Arthritis or spondylosis of the vertebrae
- Other medical conditions, such as fibromyalgia, spinal tumor, meningitis, vascular disorder.
Seeing Your Doctor for Neck Pain
You should consult a doctor for neck pain if:
- It occurs after an injury or blow to the head
- Fever or headache accompanies the neck pain
- Stiff neck prevents you from touching your chin to your chest
- Pain shoots down one arm
- There is tingling, numbness or weakness in your arms or hands
- Neck symptoms associated with leg weakness or loss of coordination in arms or legs.
- Your pain does not respond to over-the-counter pain medication
- Pain does not improve after a week
Diagnosing Neck Pain
Determining the underlying cause of neck pain requires a medical history, a physical examination and, in some cases, diagnostic tests.
Some patients may be treated conservatively at first and then undergo additional tests if the symptoms do not improve. These tests may include:
- Spinal X-rays
- CT or CAT scan of the spine
- MRI of the spine
- Electromyography (EMG)
- Nerve Conduction Studies (NCS)
- Selective Nerve Root Block
Nonsurgical Treatment Options for Neck Pain
The recommended treatment will depend on several variables including the underlying cause, the severity of pain, whether or not the spinal nerve is involved, and responses to past treatment.
Although neck pain can be quite painful and impact a person's life, nonsurgical treatment can be very effective for many cases of neck pain. Conservative treatment options may continue for up to 6-8 weeks.
The treatments may be recommended for those with mild to moderate neck pain that does not involve the nerves.
- Stop normal physical activity for the first couple of days. This helps calm your symptoms and reduce inflammation.Then slowly resume your usual activities.
- Avoid the vigorous activities or exercises that involve heavy lifting or twisting of your back or neck for the first 6 weeks after the pain begins.
- A physical therapist can help you decide when to begin stretching and strengthening exercises and how to do them.
- Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin), naproxen, acetaminophen (Tylenol).
- Apply heat or ice to the painful area. One method is to use ice for the first 48 - 72 hours, then use heat after that. Heat may be applied with hot showers, hot compresses, or a heating pad. Note: Do not fall asleep with a heating pad or ice bath.
- Perform slow range-of-motion exercises to gently stretch the neck muscles. Having a partner gently massage the sore or painful areas. Note: the massage should be gentle and not lead to more pain.
- Sleep on a firm mattress without a pillow or with a special neck pillow.
- Use a soft neck collar for a short period of time to relieve discomfort. Using one too long can make your neck muscles weaker.
- Trigger point injections can temporarily relieve pain.
- Occasionally, epidural steroids may be recommended.
If you are experiencing any weakness or numbness in your arms or legs, you should seek medical advice. If you have had any trauma and are now experiencing neck pain with weakness or numbness, you should consult your doctor.
Surgery for Neck Pain
When conservative treatment for neck pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:
- Conservative therapy is not helping
- You experience progressive neurological symptoms involving your arms and legs
- You experience difficulty with balance or walking
- You are in otherwise good health
There are several surgical treatments available to treat cervical neck pain. Factors that help determine the type of surgical treatment include underlying cause and its location, and the presence or absence spinal cord damage.
Other factors include your age, how long you have had the pain or underlying medical disorder, other medical conditions you have, and whether you have had previous cervical spine surgery.
In a small percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Various devices (like screws or plates) may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of neck pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
Preventing Neck Pain
The following steps can prevent neck pain or help your neck pain improve:
- Use relaxation techniques and regular exercise to prevent unwanted stress and tension to the neck muscles.
- Learn stretching exercises for your neck and upper body. Stretch every day, especially before and after exercise. A physical therapist can help.
- Use good posture, especially if you sit at a desk all day. Keep your back supported. Adjust your computer monitor to eye level. This prevents you from continually looking up or down.
- If you work at a computer, stretch your neck every hour or so.
- Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
- When reading or typing from documents at your desk, place them in a holder at eye level.
- Evaluate your sleeping conditions. Make sure your pillow is properly and comfortably supporting your head and neck. You may need a special neck pillow. Make sure your mattress is firm enough.
- Use seat belts and bike helmets to prevent injuries.
- If you smoke, you should quit. Smoking damages the structures and architecture of the spine and slows down the healing process following injury.
- If you are overweight, you should try to lose weight.