Understanding Neck Pain

Article written by Raj Rao, MD

Neck pain has been around for as long as we can tell. There is mention of neck pain in ancient medical texts from 3500 B.C. and it continues to be a frequent cause of visits to doctors offices. The pain is generally in the back of the neck or along the muscles on the sides of the neck.

Neck anatomy
The neck is an amazing structure that is flexible enough to allow us to turn our eyes, nose and ears in different directions, while still being powerful enough to stay upright and protect the spinal cord. The spinal cord travels through seven bones (vertebrae) within the neck. Branches of the spinal cord known as nerve roots leave between the different vertebrae and travel into the arms. Multiple layers of strong muscles and ligaments surround the bones and keep our necks strong.

What causes neck pain?
In many cases, neck pain is a result of poor posture or faulty ergonomics at a computer or a desk. The muscles are overworked in these positions and begin to ache as they fatigue. Neck pain may follow an injury, in which case, it is important to rule out fractures of the bones of the neck or disruption of the soft tissues that hold the bones in normal alignment.

In some people, underlying degenerative changes in the discs or small joints of the neck predispose the muscles to ache. Conditions such as rheumatoid arthritis are particularly known to affect the neck.

Neck pain rarely develops as a result of adaptations to initial pain elsewhere. For example, if there is pain in the shoulder and the head and shoulder are held abnormally for a few days, it is very likely that some of the muscles around the neck could fatigue and start to ache.

What can you do?
In situations when neck pain arises as a result of altered neck posture, such as spending a extra time at a computer, simple modifications can make a world of a difference. Spending less time at a computer or changing the height and tilt of a monitor may help ease pain. Avoid hunching over, stand tall with the chest sticking out and do not spend hours cradling the phone on one side of the neck. Also, try taking warm showers, applying local liniments and receiving light massage. Remember, when the body is relaxed, the muscles are relaxed and this will help muscle aches to get better faster.

When should you see the doctor?
See a doctor if neck pain develops following an injury to make sure that there is not a severe injury. In addition, consider contacting a physician in these situations

  • The pain is severe or lasts for more than a few days
  • Neck pain travels into the arms
  • Neck pain is accompanied by weakness or numbness in the arms or legs, or a severe headache

What will the doctor do?
First, give the doctor an accurate timeline of events. How and when did the pain start, exactly where did the pain begin, and where is it now? This will be of tremendous help to the physician when diagnosing the source of pain. The physician will then check for any obvious skin or tissue abnormalities in the neck, feel the different structures in the neck and check how the neck moves. Treatment may include a short course of medications, a period of modified activities or a brief trial with a soft foam collar.

In some cases, it may be appropriate to obtain further tests. X-rays are helpful in ruling out major injury. They also check the general health of discs and small joints in the neck and point out major problems with alignment. Blood tests will help to rule out certain types of arthritis and in some cases, help screen other underlying problems. A Magnetic Resonance Imaging (MRI) scan provides more information on the health of the discs, and whether the spinal cord or nerve roots are being compressed by changes in the discs or small joints.

Physical therapy helps provide education, specifically how the neck works by reviewing proper ergonomics and posture and teaching simple stretching and strengthening exercises. A short program of ultrasound, massage or electrical stimulation may also help.

Trigger point injections in the neck muscles generally do not provide long-term benefits in the management of neck pain and epidural steroid injections play a very limited role. Surgery is generally more beneficial when neck pain is accompanied by pain radiating into the arms, or when there is tingling, numbness or weakness in the arms or legs.

Summary
Neck pain occurs commonly and usually due to muscular strain. Most episodes of neck pain resolve on their own and within several days. Simple modifications of normal activity usually relieves pain. If pain persists or occurs following a fall or accident, see a physician.