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About Neck Pain

The neck is made up of many different structures. Cervical ligaments (like thick rubber bands) provide stability to the spine.  The muscles allow for support and motion.  The neck has a significant amount of motion, and supports the weight of the head.  However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion.

Pain in the neck can be due to injury, a mechanical or muscular problem, a trapped nerve caused by a bulge in one of the discs between the vertebrae, or from arthritis of the neck.

It can range from very mild discomfort to severe, burning and disabling pain.

Neck pain is a very common condition, and is more frequently seen in women than men.  Most people will experience pain in the neck at some point in their life.


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Causes of Neck Pain

Neck pain may be due to soft tissues (muscles, ligaments) or the cervical spine (nerves, discs or facet joints and bones). The most common causes of neck pain are soft tissue abnormalities due to injury or prolonged wear-and-tear. Occasionally, infection or tumours may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders or arms.

Many things can trigger neck pain. These include direct injury, stress, awkward position of neck (repetitive strain) and ergonomic strain.

There are several theories about why so many people suffer from neck pain, but they are not supported by scientific proof. Hence, it has spawned an entire industry of neck pillows, supports, collars and other aids. For some people, no specific reason for their neck pain can be found.

Road traffic accidents involving whiplash injury may result in acute or chronic neck pain that takes several months to improve.

People who are under too much stress and work their "anti-gravity muscles" too hard, suffer from neck pain and tension headaches.

Common Causes of Neck Pain:

  • Slipped Disc/Prolapsed Disc (see condition)
  • Nerve Impingement/Compression (see condition)
  • Facet Joint Syndrome (see condition)
  • Muscle and Ligamental Pain Syndrome – Fibromyalgia (see condition)

Non-specific Neck Pain

Many people develop a stiff and painful neck for no obvious reason.  It may happen after sitting in a draught (cold wind of aircon) or after a minor twisting injury, for example, while gardening.  The underlying cause for this type of neck pain is not fully understood, so it is called "non-specific neck pain".  Having non-specific neck pain does not mean that your neck is damaged, and it often happens in people whose necks would appear completely normal under an X-ray.  It is the most common type of neck pain and often disappears after a few days.

"Whiplash"

This type of injury often follows a rear-end collision in a car.  In this type of collision, first, the body is carried forward and the head flips backwards.  Then, as the body stops, the head is thrown forwards. Following a whiplash injury, there is often a delay before the pain and stiffness start. Most common injuries are to the soft tissues, ie, muscles and ligaments. Severe injury, with fracture or dislocation of the neck, may damage the spinal cord and cause paralysis (quadriplegia).

Although whiplash can badly damage your neck, the majority of people who suffer these shunt accidents do not have major damage.  In most cases, injuries feel better within a few weeks or months. Seat belts and properly-adjusted headrests in cars have significantly reduced the damage from whiplash injuries.

Tension

Most muscles of the body relax completely when they are not being used but some muscles (known as "anti-gravity muscles") have to work all the time in order to keep your body upright.  Muscles at the back of your neck must always be tensed, otherwise your head would fall forwards when you are sitting or standing.  When these muscles work too hard it can cause neck pain and tension headaches. People who are worried or under stress often tighten their muscles more than is necessary to hold their head upright – in other words, they are literally "tense".  Tension headaches are very common and are often wrongly called migraines.

Rine Neck

Patients wake up in the morning with a stiff neck which progressively become a painful neck when turning the head.  The natural history is that the neck pain may recover in a week.  However, this pain can be extremely distressing and uncomfortable.  Rine neck is due to tensed neck muscles during sleep, especially disturbed sleep.  Along with poor blood circulation and a cold environment, the tensed muscles will go into spasm and become a trigger knot.


Symptoms of Neck Pain

  • Pain
    You may feel pain in the middle of your neck or on one side or the other.  The pain may travel to the shoulder and shoulder blades or to the upper chest.  In neck-related headaches, the pain often travels to the back of the head and, sometimes, to the side of the head and behind the eye or even into the ear.  If a nerve root is pinched, then, in addition to the pain, you may have numbness or tingling that can be felt down the arm right to the fingers.
  • Stiffness
    This is common. You may find it painful to move and your muscles feel tight.  Stiffness is often worse after long periods of rest or after sitting in one position for a long time. You may also have muscle spasm or, in cervical spondylosis, you may lose movement because of the changes to the bones and discs.
  • Noisy joints
    You may hear or feel clicking or grating (called ‘"crepitus") as you move your head.  This is caused by roughened bony surfaces moving against each other or by ligaments rubbing against a bone surface.  The noises are often loudest at the top of the neck.  This is a common symptom and can be upsetting. Cracking of the neck is the sound of gas released from the facet joints when you “crack the neck”.
  • Dizziness and blackouts
    These can sometimes happen when bony changes in cervical spondylosis cause pinching of the vertebral artery.  You may feel dizzy when looking up, or you may occasionally have blackouts.
  • Other symptoms
    If you have long-lasting neck pain and stiffness, particularly if your sleep is disturbed, then you may feel excessively tired and this can even cause depression.

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Diagnosing Neck Pain

Determining the source of the pain is essential to recommend the right method of treatment and rehabilitation.

Your pain specialist will take a complete history of the difficulties you are having with your neck.  He or she may ask you about other illnesses, whether you have had any injury to your neck and any complaints you have associated with neck pain.  Previous treatment for your neck condition will also be noted. Next, a physical examination may include evaluation of neck motion, neck tenderness, and the function of the nerves and muscles in your arms and legs.

Radiological studies will often be done to allow your doctor to look closely at the structures in your neck.  These diagnostic techniques often help the pain specialists to determine the cause of neck pain and to prescribe effective treatment.

Patients who require further evaluation may undergo one or more of the following examinations:

  1. MRI (magnetic resonance imaging)
    This imaging study allows an evaluation of the spinal cord and nerve roots.
  1. CT (computed tomography)
    This specialized X-ray study allows careful evaluation of the bone and spinal canal.
  1. Myelogram (injection of a dye or contrast material into the spinal canal)
    This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
  1. EMG (nerve conduction and electromyogram)
    This test evaluates nerve and muscle function.

How neck pain is treated depends on what the diagnosis reveals.  However, patients can be treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modifications and non-surgical methods which include minimally invasive pain procedures.

Your pain specialist is a medical doctor with extensive training in the diagnosis and non-surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.


What does neck pain feel like?

  • General pain located in the neck area as well as stiffness in the neck muscles.
  • The pain may radiate down to the shoulder or between the shoulder blades.
  • It may also radiate out into the arm, the hand, or up into the head, causing a one-sided or double-sided headache.
  • The muscles in the neck are tense, sore and feel hard to the touch.
  • Acute pain can give rise to abnormal neck posture in which the head is forced to turn to one side; this condition is known as torticollis.
  • The pain at the base of the skull may be accompanied by a feeling of weakness in the shoulders and arms.
  • There may be a prickly or tingling sensation in the arms and fingers.

 

 

 


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When should you seek medical care?

When the pain is:

  • continuous and persistent
  • severe
  • accompanied by pain that radiates down the arms or legs
  • accompanied by headaches, numbness, tingling or weakness
  • associated with recent trauma.

 

 

 

 


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General Treatment of non-specific neck pain

Physical treatments

Physiotherapists, chiropractors and osteopaths are all therapists treating neck pain relating to muscles. Manual treatments carried out by one of these therapists may be all that is needed.  Manipulation is uncomfortable at times, so it is important that you understand what is involved. Make sure you talk to your therapists about the treatments before they start.

Collars

There is no evidence that these are any help for longstanding, prolonged neck pain.  Some people find they help at night to keep the neck in a good position while they are asleep.  For acute short-lived pain, collars can be used to relax the neck muscles, thereby stopping the pain.  You can only use them for 1 week continuously, after which it shouldn’t be used.  Long-term use of collars can weaken the muscles, causing more problems in future.

Injections

In some cases, an injection may be needed to stop the pain.  The injection may be a long-acting local anaesthetic or a steroid preparation injected into the tender trigger points of the neck or painful ligaments.  Occasionally, platelet rich plasm may be used to inject into the injured muscles or tendons.

Surgery

Only rarely is surgery necessary.  Surgery may help if a nerve is pinched and it is causing weakness or severe pain which won’t go away.  The surgeon will ask for a scan to look at the nerves and bones before discussing with you the need for the operation and the pros and cons of surgery.

Interventional Pain Procedures

Minimally invasive pain procedures can get rid of the underlying pain generators, with no risk and no down time.  Depending on the underlying condition, different MIP can be utilised.  Nucleoplasty decompression can shrink the slipped disc through a specialized needle (see condition).  Facet denervation can treat inflamed facet joints (see condition). Nerve decompression can be treated with neuroplasty (see condition).

Other Treatments

Acupuncture can help relieve neck pain.  At the moment, there is no evidence that reflexology or a change in diet is effective.