Neck pain (cervical spine) is a common problem in society and occurs in about 10% to 20% of the adult population at any given time. Common causes of neck pain include poor posture, degenerative changes of the intervertebral discs and facet joints (small joints in the back of the spine), and trauma. This can lead to strain of the muscles/tendons, ligament sprains, herniated discs, and “pinched” nerves. Serious falls and accidents can cause significant pain and disability due to fractures and injury to the spinal cord. Less commonly, pain can arise from abnormalities in the bones and joints, infections, autoimmune conditions, and tumors.
In the upper/mid-back (thoracic spine) pain is more frequently myofascial (pain related to the muscular and connective tissue) in nature, due to poor posture in the mid-back, shoulders, and neck. This causes increased muscular tension and fatigue with resultant pain. Pain with thoracic extension is suggestive of facet joint (small joints in the back of the spine) dysfunction. Disc herniations and pinched nerves can also occur in the thoracic spine but overall, it is much less frequent compared to the neck and low back. This is due to the stabilizing effect of the rib cage. In traumatic accidents or in individuals with diminished bone density (osteoporosis), the thoracic spine is a common site for compression fractures to occur.
Neck Pain Anatomy
The human spinal column consists of 33 vertebrae interconnected by intervertebral discs, facet capsules, and ligaments that house our spinal cord and its nerve roots The neck, also known as the cervical spine, is composed of the first 7 vertebrae and forms the uppermost part of our spine between the skull and the chest. The mid-back, or the thoracic spine, consists of the next 12 vertebra and are defined by their connections to the ribs.
Each vertebra can be divided into a front portion, known as the vertebral body, and the back portion called the vertebral arch. Vertebral bodies are connected by our intervertebral discs, which are the main shock absorbers when it comes to supporting our bodies in the upright position. They have an inner jelly-like material known as the nucleus pulposus and are surrounded by an outer fibrous ring known as the annulus fibrosus. The posterior portion of our vertebra houses our spinal cord, which is then covered by the vertebral arch. Along the left and right sides of the vertebral arch we have facet joints, also called the zygapophyseal joints, which provide another connection between vertebra. They help limit motion of the spine and are also loading-bearing structures like the vertebral bodies.
Other structures important to the cervical and thoracic spine include an extensive network of ligaments and muscles. They play essential roles in providing flexibility and constraint and allowing humans to be bipedal creatures.
Neck Pain Symptoms
There are many possible causes of neck pain, and so symptoms can be diverse and overlapping depending on the underlying pathology. In addition, it is possible to have neck pain with relatively normal imaging results, and no or minimal pain with significant abnormalities. Neck pain is often categorized as acute (lasting less than 6 weeks), subacute (lasting 6-12 weeks), and chronic (lasting more than 12 weeks).
Symptoms of cervical strain or sprain may include neck stiffness, tenderness in the muscles of the neck, headache and dizziness. Degenerative conditions and arthritis in the neck are frequently achy in nature, worse with inactivity, and can occur with turning the neck. Bone spurs, narrowed discs, and/or herniated discs can sometimes cause irritation to nerve roots, which can produce shooting or burning pain, or numbness/tingling (paresthesias). When irritation or compression of nerve roots causes damage or disturbance to nerve function, it is termed cervical radiculopathy.
Signs of possible serious conditions (i.e. red-flag symptoms) that should not be ignored include: significant preceding trauma or neck surgery; sudden unexplained weight loss, night sweats, fever; new onset weakness or sensory loss; loss of bowel or bladder function; severe headache with inability to bend the head forward with/without fever; unexplained episodes of dizziness and/or nausea and vomiting.
Neck Pain Diagnosis
A detailed history and physical examination is the first step in the evaluation and management of neck and mid back pain. The natural history of neck and mid-back pain is generally favorable and so most patients can usually be successfully treated without the benefit of imaging studies. Whether or not you require further testing depends on your age, symptoms, medical history, and physical examination. If further diagnostic information is needed, X-rays are usually the first study performed to rule out any structural abnormalities. More advanced imaging studies include magnetic resonance imaging (MRI) and computed tomography (CT) scan, which can provide greater detail into the structures of the spine. Other diagnostic tests include electrodiagnostic studies to test and check muscles and nerves.
Neck Pain Treatment
In most cases, neck pain can be treated conservatively with ice/heat, pain relievers, strengthening and/or stretching exercises at home, and massage.
Acetaminophen and nonsteroidal anti-inflammatory medications (NSAIDs) are often used to help relieve mild to moderate neck pain. If pain persists then prescription pain medications, muscle relaxants, and antidepressants may be used.
Exercise and Physical therapy
For individuals with persistent neck and back pain, exercise and physical therapy is the cornerstone of treatment. Stretching, strengthening, and stabilizing exercises assist with decreasing pain, restoring function, and preserving range of motion. Therapists will sometimes use instruments and other modalities to help treat soft tissue injuries. In conjunction with exercise, spinal manipulation and other manual therapies may also be useful in relieving neck pain, back pain, and improve joint and soft tissue movement. Aggressive manipulation/adjustments to the cervical spine should be avoided in individuals with cervical stenosis, cervical myelopathy, cervical radiculopathy, and the elderly. Manual therapy is performed by chiropractors, physical therapists, and physicians.
Injections for the treatment of neck pain allow for targeted treatment to sources of pain including trigger points, arthritis, herniated discs, and pinched nerves. Injections are usually recommended only after conservative treatments such as medications and physical therapy have not brought relief.
If conservative therapy is ineffective, surgery may be recommended depending on your specific signs and symptoms, medical history, and diagnostic studies.
Other Neck Pain Treatments:
- General health measures: smoking cessation, aerobic exercise, weight management.
- Correct posture: use positions and perform activities with an emphasis on a neutral neck position.
- Stress reduction: many people frequently develop increased neck tension due to stress and this may interfere or delay the recovery process. Activities that may help reduce stress include meditation, cognitive behavioral therapy, support groups.
- Psychological and mind-body therapies: examples include yoga, Tai-chi, pilates, cognitive behavioral therapy, etc.
- Massage, acupuncture