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APM Spine & Sports Physicians

Neck Pain

What is neck pain?

Pain located in the neck is a common medical condition. It is also called cervical pain. When the pain starts, mobility may decrease, particularly to one side, and this may be described as a “stiff neck” or a “crick” in the neck. Neck pain affects 10% of the population each year and occurs slightly more frequently in women than in men.

Pain can be localized to the cervical spine or may radiate down either or both arms (radiculopathy). Neck pain can also be a sign of mechanical problems with the structures of the cervical spine. Only in rare instances is neck pain a sign of a systemic illness. Although the pain may be severe, most individuals with neck pain improve within one to two weeks, and for most the pain will resolve in 8 to 12 weeks.

The diagnosis of neck pain is determined by a medical history and physical examination, and rarely requires expensive or uncomfortable tests. Whiplash from motor vehicle accidents is a common cause of neck pain.

What are the structures of the neck?

There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs, and nearby pass the nerves of the neck. Within the neck, structures include the neck muscles, arteries, veins, lymph glands, thyroid gland, parathyroid glands, esophagus, larynx and trachea.

What causes neck pain?

It can come from a number of disorders and diseases of any structure in the neck, including muscles, nerves, vertebrae and discs between the vertebrae. The pain may also come from the shoulder, jaw, head or upper arms. Causes of neck pain include:

Mechanical disorders

  • Overuse
  • Aging

Muscle strains/tension

  • Prolonged bad posture:
    • Bending over a desk for hours
    • Poor posture while reading, watching TV, sitting at a desk, or using a telephone
    • Placing the computer monitor too high or too low
    • Sleeping in an uncomfortable position
  • Acute strain from an injury
    • Whiplash
    • Falls/accidents

Arthritis

  • Narrowing of the intervertebral discs occurs and bone spurs form in response to the increasing pressure placed on them. The bony growths can cause localized pain in the neck or arm related to nerve compression.

Fibromyalgia

Congenital deformities of the spine, such as scoliosis

Degenerative disc disease

Spinal Stenosis

  • This is the narrowing of the spinal canal that causes compression of the spinal cord. The narrowing can be caused by disc bulging, bony spurs and thickening of spinal ligaments. The squeezing of the spinal cord may not cause neck pain in all cases but is associated with leg numbness, weakness and incontinence.

Systemic disorders

  • Ankylosing Spondylitis
  • Rheumatoid Arthritis
  • Polymyalgia Rheumatica
  • Tumors
  • Infections
  • Sinus infections
  • Meningitis

How is neck pain diagnosed?

In diagnosing the cause of neck pain, it is important to review the history of the symptoms. Your history will be reviewed for the following:

How is neck pain treated?

Most neck pain will improve within a few weeks without medical intervention. Pain relievers, moist heat and/or ice may be all that you need to improve your pain. Cervical collars are not typically recommended as they may weaken muscles. Excessive use of pain relievers may also not be in your best interest, as inflammation is part of the healing process.

If home treatments are not working for you, your doctor may suggest stronger medications or other therapy. It should be noted that the focus of treatment at APM is on restoring function and management without reliance on medications. Your treatment for neck pain will be determined based on your symptoms and treatment history and may include any of the following:

Medications

  • Acute pain
    • Analgesics
    • Muscle relaxers
  • Chronic Pain
    • Antidepressant medications. Low doses of antidepressant medications have been found to have a positive effect on pain. The use of these medications is for pain medication, not depression.
    • Narcotics (opioids). These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor.
  • Topical Creams
  • Pain patches

Physical Therapy

  • Modalities to reduce pain, such as moist heat, ultrasound, massage, and traction
  • Manual techniques to release trigger points and restore muscle balance
  • Strengthening, stabilization and flexibility exercises to restore function and strength
  • Education to prevent further injury or recurrence of pain

Procedures to Reduce Pain

Surgery

  • Laminectomy or foraminotomy
    • These procedures open up the spinal canal or intervertebral space and reduce pressure on the spinal cord or nerves. They can decrease and/or relieve extremity pain caused by bone spurs or disk fragments or calcified ligaments.
  • Fusion
    • This surgery involves completely removing one or more intervertebral discs and joining two or more vertebrae.
  • Discectomy
    • This is a surgical procedure in which a segment of the intervertebral disc that is causing pressure on a spinal nerve is removed.

How do I prevent neck pain?

Neck pain can be prevented as well as improved by learning good pain management techniques and some lifestyle modifications. These can include:

  • Learning and using good posture
    • Avoiding prolonged postures
    • Do not sit at the computer for hours without getting up frequently to stretch the neck and back. Set a timer for 20 minutes in another area to encourage you to get up and change positions frequently.
    • Do not read for long periods with your head forward.
  • Stop smoking.
    • Smoking is a predisposing factor for neck pain.
    •  It causes increased constriction of the blood vessels in the neck, which will cause the neck muscles to tighten.
  • Eating properly
    • Maintain good fluid intake each day
  • Exercising regularly. Your physical therapist or trainer can help you to learn:
    • Stretching exercises – flexibility is important to normalize your posture. Stretch every day, particularly after exercise and any other prolonged activity. Building stretching into your daily routine makes it become part of your lifestyle and not a “chore.”
    • Stabilization exercises – core stabilization
    • Exercises to increase muscle strength
    • Using relaxation techniques to decrease undesirable stress and tension to the neck muscles
  • Using a good mattress and pillow
    • Make sure your pillow supports your head and neck and is comfortable. You may need a special neck pillow, or you may need to alternate pillows through the night.
    • Make sure your mattress is firm enough, take time to find the mattress that is best suited for you
  • Being safe and trying to preventing injuries
    • Use seat belts
    • Wear bike helmets
  • If you work at a desk or a computer:
    • Keep your back supported.
    • Adjust your computer monitor to eye level to prevent you from continually looking up or down.
    • Stretch your neck and upper back at least every hour.
    • Use a headset when on the telephone
    • When reading or typing from documents at your desk, place them in a holder at eye level.

Links

AAOS – Neck Pain
APTA – Neck Pain
National Institute of Health – Neck Injuries and Disorders
AAPM&R – Overview of Neck Pain

 

 

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