Neck pain

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 28, 2015
StartSymptomsNeck pain

The neck is the most flexible part of the human spine. Compared to the rest of the spinal column, the neck has less protection and is more vulnerable to injury, which can lead to neck pain. In some cases the pain is minor and can be self-managed, while in others, medical treatment is necessary.

Contents

Definition & Facts

The seven vertebrae, or bones, of the neck support the head and attach it to the rest of the spinal column. Between each of two adjoining neck vertebra is a spongy disk of cartilage that acts as a shock absorber and prevents the bones from rubbing together. The muscles, tendons and ligaments of the neck support the vertebrae, allow movement and attach the spinal column to the skull.

Neck pain can occur in the soft tissues of the neck, the nerves that run from the spinal cord or from pressure on the spinal cord itself. The pain can vary from a mild ache to a burning pain that is continuous and severe. Sometimes neck pain is accompanied by pain radiating down the arms or by numbness in the shoulders, arms or hands. Radiating pain or numbness can indicate a nerve injury or compression.

Causes

Neck pain can result from chronic muscle stress, neck injuries, degenerative problems, infections or tumors. The human head weighs up to 11 pounds (5 kg) and derives all of its support from the neck. Poor posture - such as thrusting the head forward while looking at a computer screen - can result in constant muscle tension as the neck tries to support the weight of the head.

Eventually, spasms and inflammation of the muscles develop. Trauma such as automobile accidents or diving injuries that cause whiplash can stretch or tear ligaments in the neck or even fracture neck bones. An infection in the neck vertebra or spinal canal can also cause neck pain. Tumors may also grow in neck bones or on the spinal cord. In these cases, the pain usually results from increasing pressure caused by an abscess or increasing size of the tumor.

Cervical discs can rupture as the result of an injury, or the material that encases the disc can degenerate over time. The latter is known as degenerative cervical disc disease. The discs can eventually protrude into the spinal canal, where they cause pressure on the spinal cord, pain and numbness. As the pressure increases, people may lose strength or motor control in the arms and hands. As they age, some people develop painful bony overgrowths of the vertebra called bone spurs.

When to see a doctor

Neck pain may occur in the absence of an injury. For example, chronic poor posture or degenerative disc disease may cause slowly increasing neck pain over a long period of time. Many people try to self-manage this sort of pain, often for years, and seek medical care only when the pain becomes more severe.

Pain after an injury may require medical care. Generalized soreness that seems to be responding to self-care strategies often does not require medical care. Neck pain that continues more than a week after an injury and doesn't respond to self-management strategies usually means medical care is required. Severe, continuous pain, pain that radiates into the shoulders and arms, and pain that is accompanied by numbness in the neck, shoulders, hands or arms may be an indication of a serious problem.

All of these symptoms indicate prompt medical attention is necessary. Although a family physician may be able to handle the initial assessment, a referral to a specialist like an orthopedic surgeon or neurosurgeon may be necessary for serious cases of neck pain.

Treatment & Therapy

Neck pain from poor posture or “sleeping crooked” can often be self-managed with over-the-counter medications such as ibuprofen, ice packs or heat. In some cases, chiropractic treatment may be helpful. For more severe neck problems, a physician may prescribe muscle relaxants or narcotic pain medications, physical therapy or other conservative treatments.

After six to twelve weeks of conservative care, if diagnostic tests such as MRIs and CT scans indicate degenerative disc disease or bone spurs, surgery may be recommended. If the pain is caused by an infection, antibiotics are usually required, and in some cases, surgery may be necessary to drain an abscess. For a ruptured disc, bone spurs or fractured vertebra, surgery is usually required. A fractured spine may be treated with metal implants or a special external brace called a halo.

Bone grafts may also be necessary for neck fractures or in cases where the bone has degenerated. Tumors of the spine may be treated with surgery, radiation, chemotherapy or a combination of these strategies. No matter what the condition, physical therapy is usually necessary after surgery, and occupational therapy may be necessary if the neck condition has caused impairments in hand function. Some surgeons recommend a hard brace or soft cervical collar after surgery, especially if bone grafts are required.

Prevention & Prophylaxis

Stretching exercises help keep the muscles limber, and exercises that help strengthen the neck and shoulder muscles help protect the neck. Staying well-hydrated helps keep the cervical disks - which have a high water content - from drying out. Using good posture at all times helps assure the spinal column remains properly aligned.

Good posture also helps prevent excessive stress on the muscles, tendons and ligaments. A cervical or neck pillow that provides adequate neck support also helps protect the neck when sleeping, as does sleeping on the back. Computer screens should be properly positioned to prevent neck stress, and the use of a telephone headset can also help.

Although whiplash injuries are very difficult to prevent, wearing a seat belt when operating heavy equipment or driving a vehicle may prevent neck fractures from impacts on the dashboard. Many cars have head restraints fitted into the seats, which can help prevent neck injury form a whiplash. These must be properly adjusted to be effective; instructions are usually located in the owner's manual.