Neck Pain FAQs
What is neck pain?
Neck pain is a common condition that most people will experience at some point in their life. It is more frequently seen in women than men.
Neck pain is a general pain that’s located in your neck area and is also associated with a stiffness in your neck muscles. The pain may radiate down to your shoulder or between your shoulder blades. You may feel a prickly or tingling sensation in your arms and fingers, and pain in your arm, hand and up into your head that causes a one-sided or double-sided headache. Your muscles in your neck often feel tense, sore and hard to the touch.
What are the different types of neck pain?
Neck pain can range from mild discomfort to a severe, burning pain.
Acute neck pain is sudden and intense such as a crick in the neck. It is normally the result of trauma, injury, or extreme tension. It can be caused by facet syndrome (affects the facet joints of your spine) or muscular rheumatism.
If your pain has lasted more than three months, it is termed 'chronic' neck pain.
What causes neck pain?
Neck pain can be caused by many things. However, for most people, no specific reason for the pain can be found. Some of the more common causes of neck pain include:
- inappropriate working posture.
- abnormalities in your soft tissues (muscles, ligaments and nerves) and in your spinal bones and joints. The most common causes of neck pain are soft-tissue abnormalities due to injury, or prolonged wear and tear of your bones and joints that result in cervical (neck) disc bulges.
- trauma or injury such as whiplash.
- worry and stress.
- falling asleep in an awkward position.
- prolonged use of a computer keyboard.
- torticollis (twisted neck) when you wake up and your head is forced to turn to one side due to an injury to your neck muscles. This is normally acute pain and should get better within the week.
When should you seek medical care?
You should seek immediate medical care if you have an injury that causes pain in your neck and radiates down your arms and legs. You should also seek medical care if you have pain and numbness in your arms or legs that is making them weak even if you don’t have significant neck pain.
If you haven’t had an injury, you should seek medical care when your neck pain is:
- continuous and persistent
- accompanied by pain that radiates down your arms or legs
- accompanied by headaches, numbness, tingling or weakness.
SYMPTOMS & CONDITIONS
What is cervical spondylosis?
Cervical spondylosis is a type of arthritis that causes neck pain due to the wear and tear of your bones and joints. Cervical spondylosis is often used to refer to neck pain.
There are three types of cervical spondylosis known as:
- Cervical spondylosis without radiculopathy or myelopathy (neck pains only)
- Cervical spondylosis with radiculopathy (neck pains and arm symptoms) - a slipped disc or bone compresses or irritates a nearby nerve.
- Cervical spondylosis with myelopathy (neck pains and cord compression) - your spinal canal (bones that surround and protect your nerves) becomes narrower and compresses your spinal cord inside.
What are the symptoms of cervical spondylosis?
If symptoms develop, they can range from being mild to severe. Symptoms depend on the type of cervical spondylosis.
- Cervical spondylosis without radiculopathy or myelopathy (neck pains)
This type of cervical spondylosis causes pain in your neck which may spread to your shoulders and the base of your skull. Movement of your neck may make the pain worse.
Pain tends to come and go, with flare-ups from time to time. You may have a flare-up of pain after an unusual use of your neck, or if you sprain a neck muscle or ligament. However, a flare-up often develops for no apparent reason. Some people develop chronic (persistent) neck pain.
You may feel some neck stiffness, particularly after a night's rest and headaches may occur. Headaches often start at the back of your head just above your neck and travel over the top to your forehead.
- Cervical spondylosis with radiculopathy (neck pains and arm symptoms)
If you have cervical spondylosis with radiculopathy you will have neck pains the same as those described above without radiculopathy or myelopathy. Additionally, sometimes the pain spreads down an arm to your hand or fingers due to the irritation of a nerve that runs from the spinal cord in your neck to your arm.
You might develop 'pins and needles' in part of your arm or hand due to irritation of a spinal nerve as it leaves the vertebral area. If you lose feeling (numbness) or develop weakness in a part of your hand or arm, then you must advise your doctor. These symptoms suggest more pressure on a nerve and is called a 'cervical radiculopathy'.
Cervical radiculopathy is the compression of a nerve root in your neck caused by a cervical disc herniation and/or the formation of bone spurs resulting from disc degeneration or cervical spondylosis.
What are the symptoms of cervical disc herniation?
The inner core of a herniated cervical disc can bulge out and irritate or pinch your nerve root. Depending on the location of the cervical disc herniation various symptoms may occur including:
- shoulder pain, deltoid (shoulder muscle) weakness, small amount of shoulder numbness, and/or diminished biceps reflex.
- weakness in the biceps and wrist extensors, radiating arm pain/numbness in the thumb, and/or diminished brachioradialis reflex (mid-forearm).
- radiating arm pain/numbness to the middle finger and/or a diminished triceps reflex.
- hand dysfunction pain/numbness on the outside of the hand.
What are the symptoms of Cervical spondylosis with myelopathy (neck pains and cord compression)
Again you will have neck pains as with cervical spondylosis without radiculopathy or myelopathy.
More rarely, you may also have symptoms including: hand clumsiness and lack of coordination, problems with walking and loss of bladder control. This is due to pressure from a worn vertebra or disc that compresses your spinal cord and in doing so causes interference in the signals from your brain to your body. This is called 'cervical myelopathy'. Again, it is important to report these symptoms to a doctor.
A doctor's examination may show changes to the sensation, power and tendon reflexes of your legs and arms. You are likely to be referred to a specialist for further tests, usually an MRI scan. This will show how your spinal cord is affected and if surgical treatment to relieve the pressure is likely to help.
Your doctor will suspect that you have cervical spondylosis if you have neck pain symptoms and stiffness. The following tests may be used to help rule out other conditions and confirm a diagnosis of cervical spondylosis.
Your specialist (consultant neurosurgeon or spinal surgeon) will check:
- if you have a limited range of movement in your neck. They may ask you to try and rotate your head from side to side and tilt your head towards your shoulders.
- the reflexes in your hands and feet and check you have full sensation in all of your limbs. Problems with your reflexes or a lack of sensation could indicate nerve damage.
- how you walk, as cervical myelopathy can often affect walking and balance.
An X-ray may be used to see if you have any characteristic features of spondylosis, such as the presence of osteophytes (lumps of extra bone).
However, X-rays do not show the spinal cord, nerve roots or a herniated disc.
MRI uses a magnetic field and radio waves to produce detailed, cross-sectional images of your spine. The spinal cord, nerve roots and a herniated disc can be seen on an MRI scan.
Magnetic resonance imaging (MRI) scans are arranged if your radiating arm pain is severe and not settling, or if your specialist is concerned about cervical myelopathy.
Computerized Tomography (CT) scans
A CT scan of your spine uses X-ray technology, but produces a more detailed image than an X-ray.
A CT and MRI scan may help your doctor determine the extent of damage to your cervical spine.
A myelogram involves injecting an X-ray dye inside your spine to make your spinal cord and nerve roots more visible during an X-ray or CT scan.
It is an invasive test (involves going into the body) and requires admission to hospital as a day case. It is only done if an MRI scan is not possible, or occasionally after an MRI scan when a specialist requires additional information and surgery is being considered.
An EMG test measures the electrical activity in your nerves as they transmit messages to your muscles, both when the muscles are contracting and when they're at rest. It is used to assess the health of your muscles and the nerves that control them.
Nerve conduction study
For a nerve conduction test, electrodes are attached to your skin above your nerve that is being studied. A small shock is passed through your nerve to measure the strength and speed of your nerve signals.
TREATMENT OF NECK PAIN
Non-surgical treatment options
For most people who have their first experience of neck pain, the main question that they often ask is, "will I be able to get better without surgery?" Fortunately, not all patients with neck or back pain require surgery and the numbers are on your side. In fact, more than 95% of people find symptom relief through non-surgical therapies such as exercise, medication, physical therapy and chiropractic care together with the natural healing process, and do not need surgery.
Non-Steroidal Anti-Inflammatories (NSAIDS)
Inflamed ligaments and joints can cause pain directly, or by irritating your nerves as they leave the spine. NSAIDs work by reducing inflammation and providing pain relief. They must be taken on a regular basis at therapeutic dosing to have a true anti-inflammatory effect. Over-the-counter NSAIDs include Ibuprofen and Naprosyn. The most common side effect of NSAIDs is irritation of your stomach. Please consult with your doctor if you are taking long-term therapeutic dosing of NSAIDS.
A newer alternative to standard NSAIDs are termed Cox2 inhibitors. These are available on prescription only. They are less likely to cause irritation of your stomach, and have the benefit of once per day dosing.
Physical Therapy (PT)
Physical therapy can involve the use of different treatments. These can include:
- alternate applications of heat and cold during a therapy session. Heat will increase blood flow and could improve your range of motion. Cold pads will decrease blood flow and will help limit inflammation.
- therapeutic massage to help alleviate pain and stiffness.
- an exercise plan to build strength in your neck muscles and increase your range of motion.
- advice on correct posture and relaxation techniques.
- gentle cervical traction to help: take pressure off the discs between your vertebrae (spinal bones) in the neck, relieve pressure from a compressed nerve, and stretch the muscles and joint structures around your neck.
Chiropractic care seeks to prevent and treat back pain and other health problems through the correction of misalignments, or subluxations, in your spine.
Manual spinal adjustment is the key component of chiropractic care. Other chiropractic therapies include: muscle stimulation, TENS (transcutaneous electric nerve stimulation), ultrasound and/or ice and heat therapy. Chiropractic care may also incorporate therapeutic exercise, stretching and massage therapy.
In the treatment of neck pain, exercise plays an important role in recovery. Regular exercise is also an essential part of maintaining a healthy neck.
You may be advised to combine stretching to relieve stiffness, strengthening exercises to improve posture, and aerobic conditioning to help loosen your muscles, increase your range of motion and to produce endorphins (your body’s natural painkillers) to help reduce neck pain.