Introduction

The neck or cervical spine is an extraordinary design of interconnected muscles, vertebrae, joints, tendons and ligaments, all of which function to provide support to the neck while allowing it to have a wide range of movement. 

The neck is designed for stability, strength and nerve communication, while supporting the weight of the head (which is about the weight of an 11 pound bowling ball). The neck also protects the nerves that carry sensory and motor information from the brain down to the rest of the body. These anatomical structures can wear away or get injured, triggering neck pain. 

When is neck pain serious?

Most instances of neck pain will go away within a few days or weeks, but neck pain that persists for months could signal an underlying medical cause that needs to be addressed. Additionally, irritation along the neck’s nerve pathways can cause pain to extend into the shoulder, head, arm and hand. 

Neck pain can develop suddenly, such as from Whiplash (an injury caused by a severe jerk to the head, typically in a car accident), or it may develop progressively over time from years of poor posture, wear and tear or aging.

Neck pain should be examined by a medical professional if the following symptoms are present:

  1. Sharp pain that radiates into the arms or hands.
  2. Numbness, tingling or weakness in the shoulders.
  3. Neurological problems with balance, walking, coordination or bladder and bowel control.
  4. Fever or chills.

On the whole, neck pain can usually be alleviated with self-care, such as with rest or icing the area, or improving posture, however, non-surgical medical treatments are sometimes needed, such as medication or physical therapy. 

Neck Anatomy

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The cervical spine or neck has the important job of providing support and mobility for the head, which can weigh about 11 pounds (5 Kilograms).

The cervical spine begins at the base of the skull and through a series of seven (7) vertebral segments, named C1 through C7, connects to the thoracic spine at the C7-T1 level. This is where the cervical spine or neck connects to the thoracic spine or upper-back.

Most levels of the neck or cervical spine can be described as follows:

  • A pair of facet joints connect two vertebrae, enabling forward, backward, and twisting motions.
  • In between the vertebrae is a disc, which provides cushioning, spacing and coordination.
  • Nerve roots in the neck stick out from the spinal cord and exit through the neural foramina (holes in the bones) located on the left and right sides of the spine

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Neck Pain Symptoms by Anatomy

Below are some symptoms that can occur depending on which nerve root is being compressed in the cervical spine:

  1. C1 and C2. These two nerve roots at the top of the cervical spine controls the head. An irritation to these nerves could cause headaches.
  2. C3 and C4. These nerve roots assist in controlling the diaphragm which is instrumental to breathing. An irritation to these nerves could harm breathing. If the C4 nerve root is compressed pain can radiate to the lower neck and shoulder.
  3. C5. If this nerve root is irritated, weakness and pain in the shoulder and at the top of the upper arm can be experienced.
  4. C6. Weakness can be experienced in the biceps and wrist if this nerve root is impinged. Furthermore pain, numbness and tingling can radiate through the arm to the thumb.
  5. C7. Compression of this nerve root can cause weakness in the back of the upper arm, or pain can radiate down the back of the arm and into the middle finger.
  6. C8. Compression of this nerve root can cause weakness with handgrip, along with numbness and tingling pain that radiates down the arm to the little finger.

Neck Pain Symptoms

Neck pain can develop suddenly, such as from an injury like Whiplash, or it may develop slowly over time, such as from years of poor posture, or wear and tear associated with aging.

Common Neck Pain Symptoms

Neck pain symptoms usually involve one or more of the following:

  • Stiff neck. Pain and difficulty moving the neck, especially when trying to turn the head from side to side.
  • Sharp pain. This can be pain localised to one area and might feel like it’s stinging or stabbing. This type of pain often occurs in the lower levels of the neck.
  • General soreness. Pain is experienced mostly in one spot or area on the neck, and it’s described as tender or achy, not sharp.
  • Radiating pain. With this neck pain symptom, pain can radiate from the neck into the shoulders and arms. The intensity can vary and this nerve pain might feel like it’s burning or searing.
  • Tingling, numbness or weakness. These symptoms can radiate into the shoulder, arm or finger, like “pins-and-needles” sensation. Usually this pain radiates down the arm and is felt in only one arm, not both.
  • Trouble with gripping or lifting objects. These symptoms can happen if numbness, tingling or weakness in the fingers is present.
  • Headaches. Irritation in the neck can sometimes also affect muscles and nerves connected to the head resulting in tension headache, such as from neck muscles tightening or Occipital Neuralgia. This is where a pinched occipital nerve in the neck causes pain to radiate up into the head’s sides and scalp.

Medical attention should immediately be sought if any of the following neck pain symptoms are experienced:

  • Radiating arm or leg pain
  • Numbness, tingling, or weakness in arms or legs
  • Problems with balance or coordination
  • Loss of bowel or bladder control
  • Unintended weight loss
  • Fever or chills

Causes of Neck Pain

The most common causes of neck pain heal within a few days or weeks. Such as a strain, where a muscle or tendon has been irritated by over-extension or overuse. A sprain can also cause neck pain. This is where a ligament is twisted violently that is causes pain and swelling but not dislocation.

Common causes of neck strains and sprains include:

  • Sleeping in wrong position. A person might wake up in the morning with neck pain due to sleeping in an awkward position that overextended the neck.
  • Sports injury. A person could suddenly move the neck in an unusual way, or a player could have a collision or fall affecting the nerves in the neck/shoulder causing pain, numbness, and weakness to radiate down the shoulder, arm and hand. 
  • Poor posture. A head tilted forward or to the side for long periods of time strains the neck causing the neck’s muscles, tendons and ligaments to work harder. Poor posture can be problematic during any number of activities, including working at a computer, reading a book, gardening and more. Text neck, for example, is an increasingly common problem that develops from hours spent looking down at the mobile phone.
  • Repetitive motions. Overuse of the neck’s muscles, tendons and ligaments from turning the head in a repetitive manner, such as side to side while training or swimming.
  • Holding the head in unusual position for long periods of time could cause neck strains and sprains. For example, spending an afternoon looking up at an air show or having a long conversation while cradling a phone between the head and shoulder. 
  • Whiplash. This is where the head and neck are forced suddenly backward and immediately forward with a great deal of force. This can tear or rupture the soft tissues along and near the cervical spine.

If neck pain persists for more than 3 months it is considered chronic and tend to stem from problems in the cervical spine either with a disc or facet joint. Common causes include:

  1. Cervical degenerative disc disease.
    Everyone experiences wear and tear on the cervical spine over time. It’s natural for the discs to gradually lose hydration and the ability to cushion the spine’s vertebrae. If a disc degenerates enough, it can lead to painful irritation of a cervical nerve in various ways, such as from a herniated disc, pinched nerve or changes in the facet joints that can cause arthritis. 
  2. Cervical herniated disc
    A cervical disc is herniated when its jelly-like inner layer, the nucleus pulposus, leaks out through a tear in the disc’s protective outer layer. This could result from an injury or aging. A herniated disc may press against or pinch a cervical nerve, or the inflammatory proteins of the nucleus pulposus may come close enough to a nerve to cause irritation.
  3. Cervical osteoarthritis
    When the cartilage in a cervical facet joint wears down enough, it can lead to cervical osteoarthritis, also known as cervical spondylosis where instead of the facet joints moving smoothly along the cartilage as intended, they might grind bone on bone. Resulting in the joint becoming enlarged from inflammation and bone spur growth, causing nearby nerves to become pressed or pinched. 
  4. Cervical spinal stenosis with myelopathy
    Spinal stenosis occurs when the spine’s degeneration leads to a narrowing of the spinal canal, such as from a herniated disc that pushes into the spinal canal or bone spurs that grow into the canal.

When the spinal canal narrows enough to compress the spinal cord—a large bundle of nerves that runs inside the spinal canal—myelopathy can result. Myelopathy is when compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or feet.

Other Causes of Neck Pain

  • Emotional stress
  • Infection. One example would be meningitis.
  • Myofascial pain. This is a chronic condition that has trigger points from achy muscles and surrounding connective tissues, usually in the upper back or neck. Trigger points can be chronically painful or only painful to the touch. The pain might stay in one spot or it can be referred pain that spreads to/from another area in the body. 
  • Fibromyalgia typically involves pain in the muscles, tendons, and ligaments in several areas of the body, including in the neck.
  • Spinal tumor. A tumor from cancer
  • Spondylolisthesis. This condition occurs when one vertebra slips over the one below it. This can be caused possibly from advanced disc degeneration, or ligament laxitya or a tiny fracture in the vertebra.
  • Ankylosing spondylitis. This progressive arthritis of the spine and pelvis can cause widespread inflammation, pain and stiffness throughout the spine, including the neck.

Neck Pain Diagnosis

The development of neck pain usually develops in one of the following ways:

  • Slowly over time. Neck pain can start out as mild pain or only occur toward the end of a work day, however it may recur and worsen with time.
  • Immediately following an injury. For instance, neck pain could start right after a bike accident or having slept awkwardly on the neck.
  • Delayed reaction after an injury. Neck sprain symptoms such as after a car accident, might begin hours or a few days after the injury occurred. Some neck injuries can get worse over time.

There are three general types of neck pain:

  • Acute. Pain that lasts less than 4 weeks.
  • Subacute. Pain that lasts 4 to 12 weeks.
  • Chronic. Pain that lasts 3 or more months.

Typically a doctor will take a thorough history of the patient as a first step to diagnosing the specific cause of neck pain. 

  • Description of neck pain. When did the pain start? Does it come and go? Is the neck pain in only one spot, does it radiate into the shoulders, arms, or fingers? 
  • Occupation. What does the person do for work? 
  • Lifestyle. Does the person tend to be more active or sedentary—for instance, do hobbies include gardening, watching TV, or swimming?
  • Posture & Sleep habits
  • Recent injuries. Maybe the person had an accident or fall? 
  • Old injuries. Perhaps a car accident, a hard fall or an old sports injury?

Physical Exam of Patient

After taking the patient history, the doctor will do a physical examination. This typically involves:

  • Observation. Examining posture, particularly the neck and shoulders.
  • Palpation. Feel the neck’s soft tissue for indications of muscle spasms or tenderness.
  • Range of motion test to see how the person’s neck moves up and down, side to side, and rotates compared to what would be considered normal.
  • Reflexes. Tests done with a rubber hammer to examine reflexes in the forearm, biceps, and triceps, shows whether nerves in the neck are sending signals as intended.
  • Muscle power. Testing for any signs of weakness
  • Sensation. Check for tingling that goes into the arm, shoulders or fingers.

Diagnostic Testing

Diagnostic testing options could include:

  • X-ray
  • CT scan 
  • Myelogram: Injecting dye through a spinal tap, which enables better viewing of the spinal canal, discs and neural foramina. 
  • MRI scan 
  • Electrodiagnostic testing 
  • Bone scan 

Neck Pain Treatments

In order to effectively treat neck pain, it’s important to understand the underlying medical condition that’s causing the pain. 

While acute neck pain commonly results from a sprain or strain, chronic neck pain is often caused by injury to the facet joints and intervertebral discs in the lower cervical spine 

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Risk Factors for Developing Neck Pain

Some research indicates that getting unhealthy amounts of sleep, being inactive, and smoking, working longer hours or being in a labor-intensive occupation, may increase the risk for neck pain.

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Self-Care for Neck Pain

  • Rest. Going easy for a few days is all that is needed while the muscles and tendons heal on their own. It is important to avoid strenuous activities or awkward movements that can cause more pain.
  • Ice and/or heat. Ice can work as an anti-inflammatory reducing swelling and pain. Apply ice or cold packs initially for neck pain because they can prevent swelling from becoming worse by temporarily closing small blood vessels. After a couple days, ice or heat can be applied on an alternating basis. Applying continuous heat can cause increased swelling. 
  • Massage. A massage can soothe muscle tension and spasms, reducing pain. 
  • Better posture. This may involve improving the setup of workstations to become more ergonomically friendly; or learning to sleep on an ergonomically-friendly pillow and mattress.
  • Modify lifestyle. If certain activities are found to cause neck pain that keeps coming back, then those activities might need to be limited or avoided.
  • Over-the-counter medications. These are available to either reduce inflammation or hinder pain signals from reaching the brain. These drugs must however be used with caution so read the entire label for directions and warnings.

Consult a medical professional for an evaluation if neck pain keeps coming back, lasts for more than four weeks, or if there are other troublesome symptoms. 

Care for neck pain typically starts with nonsurgical treatments such as one or some combination of the following: 

  • Physical therapy. Usually includes some form of physical therapy to improve neck strength and flexibility. 
  • Prescription pain medications. Prescription-strength medications may be tried if an over-the-counter pain reliever hasn’t been effective. 
  • Cervical epidural steroid injections. Injections can help reduce the pain and enable the person to return to normal activities and/or make progress with a physical therapy program. 
  • Cervical facet injections. Injections of steroids into the specific joints can reduce the neck pain that is caused by irritation of the facet joints. 
  • Trigger point injections Injections designed to reset the normal orientation of irritated muscle bundle. 
  • Manual manipulation. A health professional such as a chiropractor may make manual adjustments to the spine in an effort to improve range of motion and reduce pain. 

In addition, anything the individual can do to lead a healthy life will also positively impact neck pain. Moderate aerobic activity for example several times each week, or stopping smoking, can be beneficial for most types of neck problems.

If nonsurgical treatments fail to reduce neck pain then surgery may be considered.

Reasons for Neck Surgery

There are 3 common reasons to have surgery for a problem in the neck:

  • To remove the damaged disc and/or other structures irritating a nerve root
  • To stabilize the cervical spine
  • To decompress the spinal cord

The surgeon is responsible for education the patient about the full range of the patient’s options, both surgical and non-surgical.

Neck Pain Exercises

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