Neck Pain

Neck pain is a very common condition affecting most of us at some time or other in our lives. Fortunately, this is not often a serious issue. The vast majority of neck pain arises in the connective tissue and muscles around the neck and shoulders but occasionally this is secondary to a structural problem within the spine. Common causes for neck pain include the following: poor posture particularly in relation to work, injury such as whiplash, disc degeneration or herniation and arthritis affecting the facet joints. Very rarely, neck pain arises as a result of tumour, infection or instability (spondylolisthesis)

Neck pain is usually self-limiting with most cases getting better within a number of days. In some cases, when symptoms don’t resolve, this can be an indication of something more serious that may need further investigation and treatment.

What is neck pain?

The neck is made of interlocking bones known as vertebrae that are separated by discs. Each vertebra consists of two parts, a rounded bony part in the front, known as the vertebral body and an arch of bone at the back surrounding a hole known as the vertebral canal. At each level there are a pair of nerves which exit from the spinal canal supplying movement and sensation to the neck, shoulders and arms. As the neck is less protected than the rest of the spine, it may be more prone to injury as well as wear and tear. The vertebrae provide excellent protection for the nerves, but space is tight and the nerves sometimes become pinched between the bones causing pain in the neck, arms and shoulders.

What causes neck pain?

Neck pain can be caused by many different factors; there may be aching and stiffness arising from the muscles, sharp pain caused by spasm or deep pain from the facet joints or the intervertebral discs. Irritation or pinching of the nerve roots can lead to pain that shoots down the arm or into the hand and very occasionally pain may arise from the bones as a result of fracture, infection or tumour.

The most common causes of neck pain are as follows:

• Poor posture leading to myofascial pain syndrome. This typically involves protrusion of the neck forwards in the lower cervical spine with extension of the head in the mid and upper cervical spine. This results in increased tension through the back of the neck with fatigue of the muscles leading to stiffness and pain. This might occur when sitting at a desk for a long period of time in front of a computer. Other postural causes might include occupation (painting a ceiling) or leisure activities (swimming breaststroke or riding a racing bicycle) all of which require forced extension of the neck
• Cervical spondylosis – this involves wear and tear of your neck bones and joints with flattening of the discs and arthritis of the facet joints.
• Cervical stenosis: Degenerative changes within the spine can lead to narrowing of the central spinal canal, which in turn can result in pinching of the spinal cord. When this is severe it may result in cervical myelopathy resulting in pain, weakness or clumsiness in both arms or even legs, balance disturbance or even loss of bowel or bladder control.
• Cervical radiculopathy: This is usually a result of nerve root pinching or irritation as the nerve branches off from the spinal cord. Typical causes include a disc prolapse, spinal or lateral recess stenosis in conjunction with degenerative disc changes.
• Injury: Any injury can result in a sprain of the neck ligaments or muscle strain as a result of overstretching the tissue. This can result in micro tears following repeated overuse, or a single tear following overexertion. At the extreme end of the scale is a whiplash injury, which can also affect the spinal nerves, discs and facet joints.

How is neck pain diagnosed?

If you are experiencing neck pain, you should speak to your doctor and they will discuss your symptoms in detail with you as well as carry out a physical examination alongside diagnostic tests to assist in the diagnosis.

These tests may include.

• MRI scans are an excellent way to view the spinal cord, discs, bones, ligaments and soft tissue in the neck. It has the added advantage of not exposing you to ionizing radiation for example X Ray or CT scan.
• CT scans produce detailed images of the bones and can be helpful in detecting a fracture or bony osteophyte growth, but they do not effectively visualize the soft tissue, discs or nerves.
• X-rays can be helpful in diagnosing an instability but otherwise not very precise as they do not image the soft tissue effectively. Approximately one third of patients with abnormalities on X Ray have no symptoms
• Diagnostic injections are often selected where medical imaging has been inconclusive. These usually comprise of local anaesthetic injections administered within a dedicated imaging suite or operating theatre using ultrasound or fluoroscopic guidance.
• Nerve conduction studies measure the electrical activity of nerves and muscles to assess their function. Fine needles are used to deliver electrical currents to the nerves with electrodes placed over the skin to measure their function. They can be particularly helpful in determining the source of neck pain that radiates into the arm or associated with weakness, numbness or tingling.
• Laboratory tests may be requested to determine whether your neck pain is secondary to illness such as infection, inflammatory arthritis or cancer.

How is neck pain treated?

In recent times there has been a shift in management from passive treatments such as neck collars and extended bed rest to patients playing a more active role in their recovery. This now includes physical therapy (stretching, strengthening and staying physically active) as well as medication and self help techniques. Far less commonly surgery is required to provide relief.

Your doctor will discuss ways to treat your neck pain, which might include following:

• Physiotherapy – you meet with a physiotherapist to learn some gentle stretches, and can then continue at home to help reduce neck pain. Soft tissue release and massage as well as acupuncture may be included in your treatment with a physiotherapist. There is mounting evidence that specific exercises and physical activity in general can help to break longstanding cycles of pain and heal more quickly after injury.
• Ice and/or heat – applying ice helps to reduce swelling and neck pain after injury. Applying heat may relax the muscles where there is spasm or tension.
• Anti-inflammatory drugs and pain relief medications including medication to treat nerve pain or muscle spasm are often used to improve symptoms.
• Topical treatments may include the use of anti-inflammatory medication or local anaesthetic patches.
• Complimentary therapies which may include, yoga, breathing exercises, Pilates or Alexander Technique all have a potential role in the management of neck pain.
• Massage therapy – a massage can improve tension and release spasm, reducing pain and encouraging relaxation
• Mind body therapies such as CBT (cognitive behavioural therapy) biofeedback and ACT (acceptance and commitment therapy) may be included in your treatment plan.
• Manual manipulation – this may be administered by an osteopath or chiropractor who use the hands to adjust the spine to improve alignment, relieve muscle tension and improve movement.
• Rest – this is seldom recommended unless there has been injury to the neck.
• Spinal injections – You may also need therapeutic injections to reduce inflammation and provide pain relief where conservative management has failed.
• Except in the case of an emergency such as a fracture, surgery remains the last resort and should only be considered if non surgical treatment has failed. As most neck surgery is elective and does not require a quick decision you have time to evaluate other therapies beforehand.

If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert specialists are here to help.