Back and Neck Pain

Causes, Symptoms, and Treatment of Neck Pain

An Overview of Neck Pain

Neck pain is surprisingly the 4th leading cause of disability. The good news is, it's entirely possible that your neck pain will go away on its own. That's not a guarantee, of course, so it's best to be informed of all the ins and outs of neck pain types, causes, and treatments.

The Challenge of Diagnosing and Treating Neck Pain

Coming up with the cause of neck pain and treating it successfully is not the easiest task for a doctor.

For one thing, determining the source of pain can be challenging. Even with the many tests and exams available to doctors today, differentiating between likely causes can be elusive. Plus, lots of spinal damage doesn’t always equate to lots of pain—and vice versa.

As for treating neck pain, one of the challenges your health team faces is keeping the spine stable. This is particularly true when the pain results from some sort of trauma.

The reason stability is so critical after you’ve injured your neck is that it helps protect the spinal cord from further damage. Other neck pain management and treatment challenges include preventing deformity (or preventing it from getting worse) and relieving pain and/or discomfort.

As with back pain, anatomical causes of neck pain are not always fixable. This is true, for example, when you’ve sustained age-related changes in your discs or facet joints. In such cases, members of your health team may try to help you modify your lifestyle as a way of managing pain. Your posture, muscle strength levels, sleeping positions, and the way you respond to stress are among the things they’ll likely try to address with you.

Causes and Types of Neck Pain

Neck pain can result from injury, trauma, and/or from conditions that develop over time, like spinal stenosis. Such conditions are often due to degenerative changes in the spine related either to aging, injury, or both. Here are the most common causes or types of neck pain:

Cervical Strain

Strain to neck muscles, called cervical strain, can be due to muscle spasm following an injury. Whiplash, poor posture, psychological stress that causes you to tense your muscles, poor sleeping habits, and/or sports injuries are common causes of cervical muscle spasm. 

Symptoms associated with this type of neck disorder can include pain, stiffness, and/or tightness in muscles that lasts up to six weeks. Doctors often treat spasms with muscle relaxers, physical therapy referrals, and stretching exercises. Many people also turn to massage and other holistic therapies.

Myofascial Pain

Myofascial pain—pain that comes from tight, tender areas of a muscle that are also sensitive to pressured touch—can develop after a neck injury or because of chronically poor posture.

It often comes in the form of trigger points which can be felt as hard nodules in the muscle under your fingers. 

When pressed (or even simply touched in some cases,) trigger points are not only locally painful, but they refer to other areas as well. Trigger points have specific pain referral patterns based on the muscle they're in and their location in that muscle.

Myofascial pain may be treated with trigger point therapy as well as myofascial release. Both are types of manual therapy given by massage therapists and physical therapists. More conventionally, some doctors give trigger point injections for their patients with this type of neck pain.

Facet Joint Pain

Facet joint syndrome is a very common type of neck pain. Located on either side of your spine, facet joints help keep the spine aligned and from moving excessively—which may lead to injury or pain. The development of spinal arthritis is routinely found at facet joints. They are also the area where whiplash-related symptoms tend to occur the most.

If your job requires you to repeatedly extend your neck or tilt your head back, you may be at a higher risk for this type of neck pain. Symptoms of facet joint syndrome include neck pain especially at the sides and/or middle of your neck as well as pain in your shoulders, in one arm, and/or at the base of your skull.

A variety of treatments for facet joint pain exist, from physical therapy to chiropractics, injections, rhizotomy (a pain management treatment that destroys the nerve endings in the area), and more.

Whiplash

Whiplash is an event that takes place where an external force causes your neck to suddenly go into hyperextension followed quickly by a hyperflexion move (think of what a whip does.) If you're wondering, hyperextension is an extreme amount of neck and back arching, while hyperflexion is an extreme amount of forward bending. (The prefix "hyper" refers to excessive or over the normal amount. Flexion and extension describe forward and back movements respectively into which the neck can go.)

While the most common cause of whiplash is a rear-end car accident, shaken baby syndrome is also known as a cause.  Symptoms of whiplash include severe pain, neck and shoulder muscle spasm, and reduced neck flexibility range of motion.

Cervical Discogenic Pain

Cervical discogenic pain may be the most common of all neck pain causes. It is brought about by changes in the structure of one or more of the cervical intervertebral discs, which can happen because of an injury or age-related spinal degeneration, or both.

When the tough outer fibers of the intervertebral disc (called the annulous fibrosus) fray, they may irritate nearby nerves. This is what often causes discogenic pain. As a degenerative condition, discogenic pain tends to occur with aging, but it may also be brought on by an injury or by chemical changes on the inside of the disc, known as internal disc disruption.

Common symptoms of discogenic pain include pain in the neck when turning or tilting the head. Pain may be worsened when the neck is held in one position for prolonged periods, like when you drive, read, or work on a computer. There may also be associated muscle tightness and spasms. Discogenic pain can refer pain or odd sensations into the arm or shoulder, as well.

Interestingly, though, disc degeneration—one of the main causes of cervical discogenic pain—often doesn’t have any symptoms at all!  Treatment generally consists of physical therapy, stretching and strengthening exercises, posture training, and pain medications. Spinal injections and, more rarely, surgery may also be given.

Cervical Radiculopathy

Cervical radiculopathy occurs when a spinal structure (generally abnormally) puts pressure on or otherwise irritates a nerve root. Nerve roots are groups of nerves that branch off the spinal cord and exit the spine via holes on the sides known as foramina. There are 31 sets of spinal nerve roots in all. 

Usually, the culprits that cause cervical radiculopathy are protruding or herniated discs, bone spurs, and/or arthritis or cysts. The most common causes of irritated spinal nerve roots include herniated discs and degenerative changes in the discs.  

Symptoms of cervical radiculopathy include pain, weakness, and/or electrical sensations such as pins and needles, shock, and burning that go down one arm. You may also get weakness and/or numbness in one arm. To learn how cervical radiulopathy is diagnosed, read Diagnosing Cervical Radiculopathy.

Cervical Spondylosis

Cervical spondylosis is the name given to degenerative changes in the cervical (neck) spine. An easy way to understand these types of degenerative changes is to think of them as abnormal wear and tear with consequences.  

The main consequences include a gradual reduction of the height of your disc(s), bone spurs that develop at the vertebral end plates (up to 90 percent of pinched nerves in the neck are caused by bone spurs) and other edges of spinal bones, and changes in the shapes of spinal bones.

It’s only natural to experience some of these types of changes as we age, but if you have many, this may indicate a problem for which you should seek treatment. Symptoms may include pain, weakness, and/or numbness, weakness, or electrical sensations in your arms or shoulders. Also, your range of motion may become limited and/or you may possibly get headaches.

DISH

When it comes to spinal troubles, DISH is not something you whip up in the kitchen. But what it stands for as an acronym is indeed a mouthful: Diffuse Idiopathic Skeletal Hyperostosis.  

Basically, DISH is a hardening of the ligaments and tendons that run along the spine. The hardening is due to a calcifying process that affects those structures. Some people with DISH get symptoms while others will not. These symptoms can include stiffness, reduced range of motion/mobility, and pain. Along with the neck, DISH can affect your mid and lower back.

Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy occurs when degenerative spinal changes affect, and subsequently narrow, the spinal canal. Located in the center of the spinal column, the spinal canal is the main throughway that runs from the top of your neck to the bottom of your lower back.

The spinal canal houses the spinal cord—a very delicate, yet complex and powerful part of your nervous system. When degenerative changes in the bone around the canal start to encroach on the passageway, the spinal cord can be injured or impaired. This can be a more serious problem than radiculopathy which affects only your spinal nerve roots and not your spinal cord.

Symptoms of spondylotic myelopathy may include the usual types of things that occur with spinal problems, like pain and reduced motion. But, in addition, you may also experience more systemic malfunctions, such as difficulty walking, difficulty coordinating your movements, difficulty controlling your bowel or bladder, sexual dysfunction, and more.

What to Do About Your Neck Pain

As you can see, neck pain can be caused by a variety of things. If you've been in an accident, or otherwise have experienced trauma to your cervical spine, you should see your doctor as soon as you can.  

If your pain is mild and/or comes on more slowly, the rule of thumb is to seek conventional medical attention if the pain lasts for more than seven days, keeps you up at night, and/or you have or have had cancer.

Sources:

Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N, Hadley MN. Subaxial cervical spine injury classification systems. In: Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2013 Mar. http://www.guideline.gov/content.aspx?id=44336&search=cervical+spine#Section420

Cohen, S., M.D. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings. Feb. 2015. http://www.mayoclinicproceedings.org/article/S0025-6196(14)00833-7/abstract

Issac, Z, M.D., Dec, K., M.D. Patient Information: Neck Pain (Beyond the Basics) UpToDate Feb 2016.http://www.uptodate.com/contents/neck-pain-beyond-the-basics

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