Neck pain is one of the most complicated pains as it is a symptom of underlying injuries of any of the neck structures. The pain can be acute or severe based on the source of injury and its impact.
There are a lot of treatment options but patients need to be responsible enough to choose safer treatment techniques for a good health.
The article also unpacks the causes, symptoms, diagnosis and various treatment options for neck pain.
Structure of the neck
The head and the body is joined by a neck to enable the movement of the head and eyes. The neck assists the body to move the head in response to some body senses like the hearing, sight, smell, touching and taste as stimulants respectively.
Looking at the different structures making up the neck is the way to go when looking for the causes of neck pain. The damage to any of these structures can literally cause neck pain. These are the structures that may impact the neck in one way or another;
- neck joints,
- discs,
- ligaments,
- nerves,
- blood vessels,
- and muscles.
Neck joints
This is also called cervical vertebrae. When any of the seven cervical vertebrae are damaged, neck pain can follow. These vertebrae are important for assisting people with bodily movement, bending of any sort particularly moving your neck up and down.
Moreover, these structure form a cervical lordosis which is in a curve form to enforce joints are harmonized carrying out the movements and bindings of the neck to the body. Consequently, cervical lordosis curve displacement or any sort of injury disturbs the natural harmony and thus lead to sore or neck pain.
Neck discs
These are situated in-between the cervical vertebrae. The tough stringy outer layer of these circular discs protect the inner gel-like discs. The discs tend to absorb tension when the neck is abruptly twisted, bended or put under any other pressure thus absorbing any shock.
Neck discs can tear easily and as such people need to be careful not to put unnecessary pressure on them. The space meant for nerves can be limited by either pinching a nerve or a bulging neck disc. When a disc is pinched we refer to that as slipped disc and that is very dangerous.
Neck ligaments
These are useful for connecting the cervical vertebrae or neck discs. Also, ligaments bring stability to the head and body and help you move. Movements are severely affected by loose ligaments as the ligaments struggle to keep your movement steady.
As such, ligaments can be potentially damaged by stretching and compressing and thus causing to neck pain. Furthermore, whiplash, falling or tackling are also the most common neck pain injuries caused by ligaments. The cervical vertebrae, neck discs and ligaments must be taken care of as the safety of your spinal cord depend on it.
Spinal cord & nerves
When looking at the spine from above, a channel is seen which runs from the brain to the lower back making space provision for the nerves. The roots of the nerves supply and relay messages of sensation by merging and diverting from the limbs to the brain.
However, the surrounding structure tend to scratch and irritate the nerves which result in nerve pinching. That’s another way that can cause neck pain.
Neck blood vessels
Essential blood vessels supplying oxygen rich blood to the brain run alongside the vertebrae. Pain can be caused here by vessels blockages, or pooling of blood.
Neck Muscles
The skull and the vertebrae attach to the neck muscles in layers. To create movement, muscle must pull and stretch in harmony. When there is a sudden or prolonged tension, neck muscles spasm for protection.
Causes of Neck Pain
Having pain on your neck is not a disease but a symptom. For example, forcefully blowing the neck is traumatic and can cause neck pain, or uncomfortable sleeping can yield neck pain. Moreover, neck pain is a result of injury to one of the seven structures of the neck. These are the most common causes of neck pain;
- Joint – Degeneration of the joint of the neck (cervical spondylosis)
- Muscles –spasms on the neck.
- Discs – Cervical Disc injury caused by slipped neck disc
- Ligaments – sprained inter-spinous ligament.
- Pinched neck nerve.
- Bone – twisted cervical facet joint
- Neck pain coming from other areas
Other causes
- A sudden flip while drying the hair
- A quick turn of the head to look at something interesting.
- Celling painting
- House chores like laundry or rather hanging curtains. washing and hanging their curtains
- Sleeping uncomfortably on a chair or couch.
- Trauma caused by car accidents.
- Persisting bad coughs
Types of Neck Pain
Accident or injury – with trauma
During an accident, the neck’s normal range of movement is stretched beyond the normal function when the head is rapidly forced into a forward position. Thus, the muscles react to the forceful movement by contracting while in an overstretched position which unfortunately cause neck muscle tearing.
After few hours of accident, the victim will feel all their neck structures stiff. Moreover, in accidents with a huge impact, the small joints between the neck vertebrae get squashed and crushed causing great pain.
Naturally, when the neck moves, they do it well through the cervical facet joints. This is because the cervical facet joints are like a hand that join and connect the neck vertebrae to one another by gliding and sliding over each other to move your neck in all the directions.
When the cervical facet joints are involved, the neck pain only gets worse with time and patients affected often complain of sharp stinging pain.
Acute neck pain
This type of neck pain happens without any accident or trauma triggering them. Affected people only notice and realize they have the pain as they move their head for whatever reason. The pain is characterized by locking feeling at the end of the range and also pinching. The locking of facet joint is an indication that the cervical vertebrae are injured.
This pain can also happen if one puts the neck in an extreme position for too long, usually when sleeping with your head turned to the one side while the whole body is lying on the stomach. This poor position traps the joint capsule the joint surfaces resulting in sharp stinging pain which is usually just felt on one side of the neck which was exposed.
Slow progressing neck pain
The pain is progressive over time due to poor posture that is done by many people without realizing the bad impact these bad postures have on their health.
This particularly affects “white collar” people who spend most of their days in front of a computer not caring about their posture. This is supported by most review that have started some intervention strategies to help people sit carefully to avoid musculoskeletal symptoms which include neck pain. (source)
Due to poor posture, continuous strain on vital neck structures will definitely wear out the joints and thus worsen the pain. Moreover, untreated and continuous habit of poor posture will not only affect the neck, also the shoulder blades and this can also lead to headaches. In essence, slow progressing neck pain lead to chronic neck pain.
Chronic neck pain
This is characterized by fluctuating headaches with dull ache over the skull to the eye sockets. Chronic neck pain is mainly caused by constant instability of the neck’s building blocks like the bones, ligaments or the muscles mechanics.
Patients with chronic neck pain usually complain of many other symptoms and it is advisable for them to consult their physician as soon as they have neck pain that won’t get better for over 3 weeks. Treatment with the will entail movement patterns alteration, posture correction, pain relief, and providing stability to the neck.
Symptoms of neck pain
The symptoms slightly vary with the severity of the pain as indicated below;
Mild neck pain
- Neck pain is moderate
- Only one side of the neck with have pain
- Neck is stiff when it is moved.
- Sharp pain on the neck
- Dull ache on the neck
- Painful muscles
Moderate neck pain
- Pain is getting severe
- When looking to the side patients feel a pinching pain
- Certain neck position lead to neck locking
- Lots of headaches
- One arm will have a feeling of numbness, pins or needles
- Painful coughs or sneezes
- One hand weakness or strange sensation
Dangerous neck pain
- Left sided pain radiating into the little finger accompanied by difficulty breathing and painful chest.
- Both arms have a feeling of numbness, pins or needles
- Swallowing and speaking difficulty
- Feverish
- Light sensitivity
- Both hands are weak and have a weird sensation with pins and needles causing uncomfortable tingling.
- Severe pain untreatable by medication and other therapies
- Night pain
- Weight loss without dieting
Structures Causing Sharp Neck Pain
Since neck pain is caused by various structures on the neck, it is important to look at each structure to see how sharp pain happen with all these structures;
Muscle
- When stretching, one feels a mild to moderate dull or aching pain.
- Looking down or to the opposite side aggravate an intermittent pain.
- painful stretch sensation restricts neck movements
- the pain does not radiate to the arm, ever.
Joint
- Certain movements induce mild to severe sharp pain.
- Looking down or to the opposite side aggravate an intermittent pain.
- There is a lot of locking sensation restricting neck movements
- Pain well defined pain
- Pain area is very specific pain.
Nerve
- mild to severe sharp pain constantly
- neck movements to same side aggravate constant pain radiating it down the arm
- sharp and electrical type of pain in specific movement restrict neck movement
- radiation of pain down a specific nerve course
- pain cannot be defined well.
- Severe pain is usually caused by minor incidences
- Restriction of neck movement in all directions
Diagnosis of Neck Pain
Before tests are done, the doctor will assess the severity of the pain by checking how far you can move the head. Diagnosis also look which structure in the neck is causing the pain. The doctor will also check if the neck is numb, tender, muscle weakness. These are the tests that can be done;
Imaging tests
- X-rays- Detect if there is any pinching of the nerves
- CT scan- CT scans details the cross-sectional views of the neck using the X-ray scans.
- MRI– Detailed images of the bones and soft tissues are created using radio waves and a strong magnetic field. MRI also give images of the spinal cord and the nerves around the spine.
Other tests
- Electromyography (EMG)– the EMG is used for patients with pinched nerve. Fine needles are inserted into a muscle to measure the speed of nerve conduction. This test determines the functionality of some specific nerves.
- Blood tests- these reveal evidence of inflammatory or infectious conditions that might be the underlying cause of neck pain.
Neck Pain Treatment
There are a lot of treatment options to choose from like; medications,
- physiotherapist treatments,
- surgical and other procedures,
- lifestyle and home remedies,
- and alternative medicine.
More importantly, self-care treatment can ease neck pain especially if the pain does not persist for over 3 weeks. However, persisting pain beyond 3 weeks need professional care.
There are various treatment options for neck pain which could be treated by;
General medicine physicians
- Family medicine doctors
- ENT specialists,
- physiatrists,
- neurosurgeons,
- neurologists,
- emergency physicians,
- orthopedists, rheumatologists
- and chiropractors
Other ancillary health professionals
These are auxiliary practitioners who uses therapies to relieve neck pain;
- physical therapists,
- massage therapists,
- and acupuncturists.
Physiotherapist treatment
The plan is to identify the structures that produce the pain first and foremost. Patients are guided on which proper movements to adopt and which are some of the activities to stop. The electrotherapy is used at an initial phase to block the pain impulse and to also desensitize the nerve endings.
Moreover, healing is accelerated by relieving the pain through the use of ultrasound and Laser. For the healing of the surrounding tissue cells, acupuncture or dry needling is used. Physiotherapist also unload and redistribute the forces in the neck using different types of strapping and taping.
In order to break down fascia restrictions and improve flexibility of the muscles, the physiotherapists use massages, soft tissue mobilization and muscle stretches techniques. Due to its efficiency, releasing the myofascial of some dominant cervical mobilizer muscles is essential to do although is quite painful.
More importantly, the use of neck braces is out of the question in order to prevent and avoid bigger problems that might yield secondary complications.
Surgical and other procedures
Steroid injections
Injection is used to help deal with the pain where corticosteroid medications are administered by the doctor to patients. There are three areas where the injection may be administered;
- near the nerve roots
- into the small facet joints in the cervical spine bone
- or neck muscles.
Surgery
Patients with chronic pain rarely need surgery. However, where nerve roots and spinal cord
Is compressed, surgery might be the best option.
Clinical trials
There is a lot of clinical studies done to test new treatments and intervention. However, patients need to be careful which studies they participate on, in order to prevent complications and even death.
Lifestyle and home remedies
There are other home care remedies to relieve neck pain that are convenient. These are;
Over-the-counter pain relievers.
Using the non-steroidal anti-inflammatory drugs (NSAID) which are available over-the-counter e.g.
- ibuprofen (Advil, Motrin IB, others),
- naproxen sodium (Aleve)
- and acetaminophen (Tylenol, others).
Alternate heat and cold.
The most effective way to reduce inflammation is the application of ice pack, or towel wrapped ice on the affected neck area to reduce inflammation and swelling. This can be placed for 20 minutes to effectively do the work.
Heal treatment through the heating pad, or warm sowers can be applied to alternate with cold treatment. It is important to always keep the heating pad at low temperature setting to avoid burning yourself.
Home exercises.
These are done when neck pain has subsided with the therapist’s supervision. This is important because without the right technique the patient could injure their neck again and we don’t want that.
How it is done
- daily stretching gently
- warming the neck and back using a heating pad or warm shower/ bath.
- Gently tilt the head
- Gently bend and rotate the neck.
- This procedure could be repeated as long as the patient deem necessary.
Unconventional Medicine
All alternative medicine need to be supported by the doctor for them to monitor the patients. These can be very effective especially if they are supplemented or backed up by mainstream medicine in a holistic manner. The alternative medicine includes; chiropractic (spinal manipulation), acupuncture, and massages.
Spinal Manipulation for Cervical Joint Dysfunction
Chiropractic therapy deals with treating mechanical musculoskeletal disorders using unconventional methods. Patients are treated manually, using special techniques like the spinal manipulation therapy (SMT). Other joins and soft tissues are also manipulated in this therapy treatment.
How it is done;
- the chiropractor’s index or 3rd finger is used to manipulate the vertebra when the patient is fully relaxed. The weight of the head is comfortably supported by the other hand.
- The combination of rotatory technique and break technique is employed to rotate the head and flex it sideways.
- Then a traction direction is employed. Ensuring that the patient is still comfortable.
- Then follows the manipulation and mobilization.
- The chiropractor applies a high-velocity, low-amplitude thrust (HVLA)
Instrument Assisted Adjustment
Other tools could be used as part of the adjustment technique. A spring-loaded hand-held device called the activator is used to adjust a cervical vertebra. There are many other tools that can be used to manipulate and adjust the spine.
Cracking sound during the adjustment
Cavitation release is a result of the high-velocity, low-amplitude thrust (HVLA) manipulation. When the joint is moved quickly within its passive range of motion, cavitation is created in part by gas escaping from the joint capsule.
A typical cracking sound is created when this type of chiropractic adjustment called joint manipulation is done. Moreover, more patients find the HVLA manipulation cracking sound very uncomfortable.
There are however, people who find the manipulation effective, in providing immediate relief of painful symptoms. While some patients complain of soreness, stiffness, or aching feeling after treatment which only last for few hours. It is on these bases that ice packs are recommended to soothe inflammation and the new symptoms.
There are patients who just cannot tolerate the cracking sound that comes with the HVLA manipulation, and as such gentle, less forceful approaches such as mobilization may be preferred.
Risks associated with cervical manipulation
The controversies on the association between HVLA cervical manipulation and stroke have some clinical backing.
However, some reports show that stroke is caused by pre-existing risk factors rather than the chiropractic treatment. Moreover, the occurrence of stroke during HVLA is said to be very rare.
The truth is any treatment option comes with risks like for example, the use of ibuprofen or other NSAIDs (non-steroidal anti-inflammatory drugs have bleeding from a gastric ulcer, as well as liver and/or kidney disease as possible contraindications that could lead to death.
It is always safer for patients to choose to remain safe when taking any treatment, and the safety is usually dependent on patient’s conviction. Until more studies are conducted to rule out the association between stroke and HVLA manipulation, I would rather settle for the lighter, less forceful approaches just to remain safe. And also focus on clinically proven treatments that is backed up by many years of research.
Acupuncture
Thin needles are inserted into various points of the body. However, there is no conclusive evidence on the efficiency of acupuncture treatment for neck pain. there are many other kinds of pains that are effectively treated by this therapy though.
Patients who consider this alternative medicine should ensure that they visit ONLY the certified practitioners for their own protection. It will also need more sessions for patients to start experiencing the relief.
Massage
Muscles around the neck are manipulated using the practitioner’s hands. This treatment might need to be combined with doctor’s medication so it can supplement the medicines. Even here, ONLY a professional massage therapist for safety.
Other Therapies for neck pain
Physical therapy
- Teach patient to improve and correct bad posture.
- Focus is to correct alignment
- Using neck-strengthening exercises as part of treatment.
- Application of heat, ice, electrical stimulation and to help ease your pain
- The main focus is to prevent a recurrence of neck pain.
Transcutaneous electrical nerve stimulation (TENS)
- Application of Electrodes on you’re the skin near the painful areas.
- delivering tiny electrical impulses that may relieve pain.
Traction
- stretching the neck using weights, pulleys or an air bladder.
- this is done under physical therapist supervision.
- It is effective for treating pain related to nerve root irritation.
Short-term immobilization
- Using a soft collar to support the neck
- The collar must be applied for any time less than three hours at a time to avoid doing more harm.
- Gives relief to other structures of the neck.
Summary
It is a good practice for patients using conventional treatments to always keep their medical doctors posted about their treatment just to be safe. We all need to be aware of the habits like poor posture, pinching, etc in order to prevent chronic neck pain.
