Neck Pain

The cervical spine can support a head weighing 15 or more pounds while moving in several directions. It has a greater range of movement than any other region of the spine. As a result, this makes the neck susceptible to pain and injury.

Anatomy

The neck is made up of 7 vertebrae, intervertebral discs, joints, the spinal cord, 8 nerve roots on each side, blood vessels, 32 muscles, and ligaments.

The nerve roots stem from the spinal cord and exit through foramen in the vertebrae. Each nerve root transmits signals (nerve impulses) to and from the brain, shoulders, arms, and chest. Joints, muscles, and ligaments support movement and stabilize the neck.

The mobility of the neck allows the head to move in many directions: 90° of flexion (forward motion), 90° of extension (backward motion), 180° of rotation (side to side), and approximately 120° of tilt to either shoulder.

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Causes

  • Trauma: Whiplash is a common injury sustained during a motor vehicle accident. It results in a hyperextension and/or hyperflexion injury because the head is forced to move backward and/or forward suddenly past the neck's normal range of motion. This leads to sprains and strains of the muscles and ligaments in the neck. Muscles react by tightening and contracting creating muscle fatigue, pain, and stiffness. videoplayClick to watch an educational video about Whiplash »
  • Aging Related: Osteoarthritis, spinal stenosis (central canal and foraminal) and degenerative disc disease are degenerative disorders which affect the spine. These conditions can also occur secondary to trauma and overuse.

    Osteoarthritis is a gradual deterioration of cartilage in joints. The body reacts by forming new bone called osteophytes (bone spurs) that decrease joint mobility.

    Spinal stenosis causes the foramen (nerve passageways) to narrow. This can lead to compression and entrapment of nerve roots. Stenosis can also result in narrowing of the central canal where the nerve roots originate. Stenosis may cause pain, numbness, tingling, weakness, and itching in the neck, shoulder and arm when these nerves become compressed and/or inflamed.

    videoplayClick to watch an educational video about Spinal Stenosis »

    Degenerative disc disease (DDD) can lead to decreased hydration in the intervertebral discs resulting in rigidity and decreased height. Over time, a disc may bulge or herniate causing upper extremity pain, weakness, tingling, numbness, and itching.

    videoplayClick to watch an educational video about Degenerative Disc Disease (DDD) »

  • Lifestyle: Poor posture, obesity, and weak abdominal muscles disrupt the spine's balance often causing the neck to bend forward to compensate. Stress, emotional tension, purses, chronic texting and chronic telephone use without a headset or earpiece can cause muscles to tighten and contract resulting in pain and stiffness.
  • Other Disease Processes: Although neck pain is commonly caused by strain, prolonged pain, weakness and numbness may be an indication of something more serious. These prolonged symptoms should be discussed with your physician. Spinal infection, spinal cord compression, tumor, and fracture are serious disorders that require immediate medical attention.

Diagnosis

A proper diagnosis is important to determine the correct plan of treatment for neck pain. Many of these questions will be asked by your physician:

  • When did the pain begin?
  • What activities occurred before the pain?
  • What remedies have you tried to decrease the neck pain?
  • Is there radiation of the pain to other body parts?
  • What improves or worsens the pain?
  • Is numbness, tingling or weakness present in your hands or arms?

Observing your posture, range of motion, and general condition is an important part of your physical examination. Observing movements that generate pain is crucial. Your physician will feel the curvature of the spine, vertebral alignment, and search for trigger points and/or muscle spasm.

Testing your reflexes, muscle strength, sensory and/or motor changes, and pain pattern is part of the neurological examination.

X-rays can reveal narrowing of disc spaces, fractures, spur formation, and osteoarthritis. MRIs are needed to detect bulging discs, protrusions and herniations.

Nerve conduction studies and/or electromyography may be ordered if nerve damage is suspected. They measure how quickly nerves conduct impulses.

Neck Pain Upon Awakening

Normal activities of daily living can place undue stress on your neck. Sleeping in an odd position can cause your neck muscles to tighten. Your body should be given time to heal on its own. These remedies can help you get through the day without letting the pain affect your normal activities.

Stretch your neck gently during a warm shower.

Over-the-counter pain medications, including but not limited to Tylenol or Aleve, may provide relief. Neither should be taken if you have a history of kidney problems. Also, Aleve and other non-steroidal anti-inflammatory medications (NSAIDs) should not be taken if you have a history of gastritis or stomach ulcers.

Heat and ice treatments on your neck should be alternated as 30 minutes of heat followed by 30 minutes of ice to decrease the pain. This can be performed up to four times every twenty-four hours.

Surgery

Most patients with neck pain respond well to non-surgical treatments, therefore, cervical spine surgery is usually not needed. Less than 5% of neck pain patients need surgery. The following are situations when spine surgery may be necessary:

  • Physical therapy, medication, massage, exercises, chiropractic care and injections are not decreasing the severe and constant pain.
  • The numbness, tingling, and weakness in your arms and legs progressively worsen.

Trauma and spinal instability are common causes of cervical spine surgery because of pressure on your spinal cord or the nerves coming from the spine.

Types of Surgery

Decompression involves removing tissue pressing against a nerve structure. Stabilization or fusion involves limiting motion between vertebrae.

There are different decompression procedures including:

  • Discectomy: All or part of a damaged disc is removed.
  • Corpectomy: The vertebral body is removed to reach the cause of spinal cord or nerve compression.

Your condition will determine which option is best for you.

Stabilization surgery is occasionally performed with a decompression surgery. Artificial cervical discs instead of fusion and spinal instrumentation are becoming more common.

Non-Surgical Treatment

Less than 5% of neck pain patients will need surgery. Alternative treatments such as acupuncture, Pilates, herbal remedies, yoga, and massage may be effective. Physical therapy, chiropractic care, low dose medication, trigger point injections and spinal injections may help.

Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).

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