What Causes Neck Pain?
The neck (cervical spine) is a complex anatomical area composed of the vertebrae that supports the skull and connects to the thoracic spine. It has multiple layers of muscle and ligament that provide stability and function.
Neck pain may result from abnormalities in the soft tissues – the muscles, ligaments, and nerves – as well as in bones and joints of the spine. It can also be referred from the thoracic area and oral structures. The most common causes of neck pain are soft tissue abnormalities due to injury or prolonged wear and tear. In rare cases, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders or arms.
Degenerative Process – Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in older people as a result of wear of the joints between the bones in the neck. Rheumatoid arthritis can cause destruction of the joints of the neck. Both of these major types of arthritis can cause stiffness and pain.
Cervical disk degeneration also can cause neck pain. The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (typically age 40 onwards), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and cause pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.
Trauma – Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize injury. A “rear end” automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyper flexion, a forward motion of the neck beyond normal limits. Most common injuries are to the soft tissues, i.e., muscles and ligaments. Severe injury with fracture or dislocation of the neck may damage the spinal cord and cause paralysis (quadriplegia).
Much less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.
When Should You Seek Medical Care?
If severe neck pain occurs following an injury (motor vehicle accident, diving accident, fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately. Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek medical care when neck pain is:
- Continuous and persistent
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches, numbness, tingling, or weakness
Initially the patients are usually evaluated by their primary care provider or chiropractor. Most of the conditions causing neck pain can be treated conservatively. Modalities such a as short-term rest, analgesics, muscle relaxants can be use as adjuvants to physical therapy and chiropractic manipulation. If the pain persists, and according to the associated symptoms, additional diagnostic evaluation may be needed.
X-ray studies often will be done to examine the bones in your neck. Conditions such as fractures, degenerative changes and anatomical abnormalities can be diagnosed. Other studies which yield more information about the spinal column and it’s nerves, as well as assessing the nerve functions should be considered.
Patients who require further evaluation may undergo one or more of the following examinations:
- MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.
- CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.
- Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
- EMG (electromyogram). This test evaluates nerve and muscle function.
Your primary care provider or specialist (neurologist, orthopedist, neurosurgeon and pain management) may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.
How neck pain is treated depends on what the diagnosis reveals. However, most patients are treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modifications or a combination of these methods.
For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, rest and a neck collar may be prescribed for a specified period of time, as well as medication to reduce inflammation. If medication is prescribed to reduce pain, it should be used only as directed and should not be taken for extended periods of time.
When neck pain persists or is chronic, a rehabilitation program may be recommended, that includes an exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back.
Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication and physical therapy will relieve neck pain.
Pain Management Interventions such as diagnostic and therapeutic injections are frequently performed to alleviate the inflammation in the muscles, nerve and joint of the neck. More importantly, the diagnostic value will determine future therapeutic interventions in a more precise and effective way. Some of these interventions are epidural steroid injections, facet injections, trigger point injections and discography.
Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by, a herniated disk or bony narrowing of the spinal canal. Surgery may also be required following an injury, to stabilize the neck and minimize the possibility of paralysis such as when a fracture results in instability of the neck.