An In-Depth Look at Neck Pain

An In-Depth Look at Neck PainNeck Pain affects 39 million Americans and is often an excruciating, if not debilitating, condition. Neck pain seems to be fairly common in 12% of adult females and 9% of adult males and is typically the cause of 50% of cases of lower back pain. Out of 1,000 cases registered with physicians, between 18-23 of those cases are neck pain related. About 10% of those who report neck pain end up having chronic pain in their neck throughout their life. Most sufferers of neck pain describe the ailment as muscles that are commonly strained from various external reasons (poor posture, sudden or long-term injury, etc.), or pain arising in the joints, bones, muscles, tendons, ligaments with any movement of the neck.

Neck pain can even travel from the neck to other areas of the body, spreading symptoms, as well as large amounts of pain. The pain is described in various ways, depending on the area of the neck that is most greatly afflicted. Some who have pains in the joints or vertebrae along the spine consider the pain to be a stiff, numbing pain, that occurs for long periods of time (sometimes lasting as long as several hours). Neck muscles that are damaged can have a lasting, “nagging” effect for those who have stretched certain neck muscles beyond capacity, or who have over-pronated and torn other moving parts of the neck, such as tendons or ligaments. Both of these types of neck pains can lead to immobility when it comes to turning their head, or have difficulty moving the neck in any way without experiencing pain of some sort. Not only can neck pain cause lower back pain, it can also cause pain in the shoulders. However, sometimes neck pain is a result of a shoulder injury, such as in the case of soft tissue damage in the shoulders or an injury to the shoulder tendons or ligaments. Neck pain can stand alone by itself, or be a symptom of other pains throughout the entire body. There are also a variety of conditions that affect the heart, the spinal cord, and the lungs, and which can lead to pain in the neck.

A Look at the Causes

Neck pain can stem from many different causes. Among most first-time reports, the reason is often due to poor posture, a strain in the neck from an athletic or occupational injury, or a symptom of anxiety or depression. Most injuries to the ligaments, tendons, and muscles typically heal within a couple of days or weeks. These soft tissues have great blood circulation and bring the essential nutrients and proteins for healing. However, this occurs in instances of minor damage to the neck caused by small injuries. Severe or long-lasting pain in the neck can be very serious and should be treated and monitored by a physician. The second most common reason for neck pain, especially with those who visit their physician often because of neck pain, are those with musculoskeletal conditions or those who have bone and joint disorders or diseases. Such conditions include but are not limited to rheumatoid arthritis, osteoarthritis, osteoporosis, spinal stenosis, fibromyalgia, cervical spondylosis, spine infection, specific types of bone cancer inside the spine, and even whiplash. There are also several other conditions and illnesses that can create pain in the neck, especially those that affect the lungs and heart. Such illnesses include cardiovascular problems, ailments in the respiratory or gastrointestinal systems, meningitis, and acute upper respiratory infections. One common but under-examined cause of neck pain is torticollis. This is when the neck becomes slightly twisted and creates a small musculoskeletal irritation which leads to pain and even spasms in the neck. Torticollis can happen easily, usually by sleeping in an awkward position, but usually clears up after a couple of weeks. Torticollis can also arise from upper respiratory infections in the neck that cause inflammation and can also happen with sudden trauma or injury to the spine.

Is It Just a Stiff Neck?

Some people believe a stiff neck is a normal occurrence for simply sleeping wrong or in an awkward position. However, to determine whether your neck is “just a little sore” or something else, it really depends on the duration, severity, and persistence of the pain. Those who have a stiff neck and also have high fever, headaches, nausea, vomiting, or drowsiness could, quite possibly, be experiencing a case of meningitis. This is a bacterial infection that causes the membranes of the spinal cord and brain to become inflamed. These membranes help protect the brain and spinal cord. This disease can cause quite a lot of damage, especially to the cervical spine, if not found and treated immediately.
Posture
Neck Pain can arise from a variety of situations and events. Some of the most common reports of neck pain are occupationally related. Those who are not supporting the neck muscles while they work, leaving the muscles and other support systems in the neck to bolster the neck improperly. This usually has to do with the amount of time we are sitting or standing at our jobs with poor posture. Poor posture can be related to any position that the body is in and which puts unnecessary stress on certain areas of our bodies. The longer the body remains in this poor posture, the  more damaging it can be. We can exhibit poor posture during standing, sitting, and with our every movement. Other culprits of poor posture may be conditions that cause a misaligned spine, muscle imbalance, spine degeneration, or osteoarthritis.

Who Is Most at Risk for Developing Neck Pain?

The biggest risk factor for developing neck pain seems to be work-related (Neck Pain affects around 45% of workers today). Not only the way we move, lift, carry, haul, climb, kneel, crawl, stand, or walk, but also by the way the workplace is designed and what risks for injuries are present in the work environment. So it’s not just about how long you are sitting at your desk or the posture used to stand or sit but also about the equipment we use and the environment that we work in. Those whose jobs have them working with vibrating machinery (like jack-hammers, weed-eaters/push-mowers, etc.) not only experience and report muscle pain in the neck but also various other parts of their body. Those who sit in a chair all day at a computer, may not be receiving the support they need for their lower back, spine, and neck and can eventually lead to problems. Other factors that are not work-related but may lead to neck pain are things like using too many pillows to sleep on during the night or psychological factors such as anxiety (especially for those who worry a lot about their health, which can exacerbate their conditions).
There are also cases where neck pain may not be very identifiable, nor the reason why it appeared in the first place. These non-specific pains may be caused by a variety of reasons and could develop suddenly or over long periods of time. Certain pains in the neck may stem from previous injuries which are aggravated by certain motions or body movements. These types of “flares” or sudden pains typically resolve themselves over the course of time, especially if you give the area rest or even perform some stretching exercises. Some sufferers of neck pain claim that the pain experienced may radiate or travel from the shoulders and upper back to the neck, to the back of the head, and even down to the arms. Some indicators of sensory disturbances may be sudden sharp/piercing noises or bright, flashing lights. However, sensory disturbance may typically only cause pain, rarely causing loss of muscle function or mobility. Other typical symptoms include dizziness, migraines, and sometimes chest pain.

Treatment Options

Physicians

Seeing your physician for neck pain that has lasted for more than a week, or after a sudden traumatic injury is one of the first steps you should take to start feeling better. There are different types of physicians and specialists that treat neck and back pain, and you should consider a few things before talking to your doctor about your neck pain. Often, your first visit will be with your general practitioner. You will want to inform them of:

  • the severity of the pain you experience in your neck,
  • how long the pain has been occurring,
  • if there is a time of day that the pain is worse or better.

If your pain lasts longer than a few days, it never hurts to see your family doctor. In fact, if the pain is something that needs to be looked into further by a specialist, many insurance carriers often require a visit to your general doctor before they will authorize any payments to visit a specialist. If you do end up seeing a specialist, your general practitioner will be able to update them on your pain records, family history, etc. Since neck pain can stem from injuries, nerve disorders, or other types of diseases, these factors will all be considered before your physician decides which specialist you should see.

Who Are These Specialists?

Once your doctor decides on a diagnosis, they will be able to refer you to a specialist if needed. If your neck pain originates from a bone or muscle disorder, you may be referred to an orthopedic doctor. These specialists are trained in addressing and managing conditions such as sciatica, degenerative disc disease, herniated or bulging discs, and other spinal or musculoskeletal conditions. If the pain from your neck is nerve related, you may be required to visit a neurologist. They will help to determine if the pain is arising from a nerve condition and may conduct a series of test to measure nerves, reflexes, balance, movement, and sensation. A neurologist may be able to tell if the pain is coming from an issue with the central nervous system, such as a problem with the spinal cord, spinal column, or the brain. This type of cause is usually determined when all other factors have been ruled out. If you are suffering from an autoimmune disease or tissue disease and you are experiencing neck pain, you will most likely be referred to a rheumatologist. A rheumatologist deals with non-infectious inflammatory disorders that affect the joints and soft tissue surrounding the areas of the joints. The majority of patients who experience minor neck pain are referred to a chiropractor. These specialists are able to manipulate and adjust the spine if that seems to be the main cause of their neck pain. Patients are usually referred to a chiropractor if their neck pain lasts between 2 weeks-3 months and if the symptoms include numbness or tingling, arm pain, or other anatomical pain other than the neck. The chiropractor will perform an evaluation of the patient and make certain adjustments or corrections to attempt to relieve the pain and resolve the misalignment.

If after evaluation, your doctor believes your neck pain may be stemming from psychological factors, a different kind of treatment may need to take place. It is not uncommon for psychological stressors such as anxiety or depression to create physical pain in certain areas of our bodies. Stress and anxiety can be two major culprits of neck pain. Psychological treatment may be necessary or be combined with other treatment options. If your neck pain seems to be stress-related, other factors will be considered including home life, family life and history, work-related stress, and other external factors that may contribute to everyday anxiety.

Pain Management Options

Heat therapy

Much of the pain felt from certain problems in the neck are the result of tension in the muscles and skin, which results in poor circulation and leads to pain. Spasms may also occur. Heat therapy is able to relieve these spasms and tightness in the neck because it dilates the blood vessels in the muscles. This increases the flow of oxygen and other nutrients in the blood to the damaged or tight muscles and allows them to heal faster and properly. Heat can also stimulate the sensory receptors in the skin and diminish the transmission of pain signals to the brain, allowing for a decrease in pain and discomfort. Applying heat can ease stiffness and increase flexibility in the neck muscles. There are several ways to apply heat to the neck. One of the most common and popular ways is a heating pad. They are easy to use while sitting or standing, can be placed directly on the affected neck muscles, and provide the same constant temperature to the area. When using a heating pad, it is advised to remove the pad after 30-45 minutes of use to prevent damage to the skin (NEVER sleep with a heating pad on). Another way to obtain heat for the neck muscles is a nice warm bath that completely surrounds the neck and its muscles. If you don’t have time or the ability to soak in a long bath, a warm towel at just the right temperature can be draped over the neck and can give you the same desired results. You don’t have to worry about leaving a warm towel on your neck like in the case of a heating pad since it will decrease in heat over time. When the heat is gone, simply soak the towel in hot water again or even warm it up in the microwave for a few seconds. Be aware of the temperature of the towel you are using, especially if you used the microwave to reheat it. Make sure that the towel is not scalding or hot to the touch. You are trying to make your neck feel better, so you don’t want to burn yourself. Do not use heat therapy for sudden injuries that are inflamed or have swelling. Heat therapy will only make the swelling worse. This is an instance that you should use cold therapy (such as ice packs, ice bags, or cold cloths) to constrict the blood vessels and lessen the amount of blood flow to decrease inflammation and swelling.

Pain Management Devices

There are a variety of devices on the market that are able to help with neck pain. These devices are primarily focused on the comfortability of the neck while in resting position and typically keep the neck immobile so that a certain injury does not become more painful. These devices include neck pillows to use during long periods of sitting or rest. Neck supports that wrap around the neck reduce neck mobility so that the injured areas have a chance to heal properly. Neck braces are designed to do the same thing as supports, but they can allow more mobility, as well as more comfortability. There are also specifically designed neck pillows that serve as massaging units and also heating pads. Many of these products can be found online or in certain medical shops or store aisles. Their price ranges from high to low, depending on what your needs are. They are just one of the things you can do independently to manage or control the pain you experience in your neck.

Stretches for Neck Pain

Corner Stretch

This exercise stretches the chest and shoulder and is performed in the corner of the room.

  1. Stand in any corner of the room with your feet together.
  2. Place your forearms on the wall so that your elbows are a little below the height of the shoulders.
  3. Lean in as much as possible without any sudden pain arising, you should feel a stretch in the front of the shoulders, as well as the back.
  4. Hold this stretch for 30 seconds and repeat a few times each day, or as much as necessary without pain arising.

Levator Scapula Stretch

The Levator Scapula is a neck muscle that connects to our shoulder blade and may become tight and sore to the touch. This stretch helps alleviate this neck pain and can be performed sitting or standing.

  1. Simply raise the elbow above the shoulder of the side that you want to stretch.
  2. Rest the elbow against a support structure like a doorway or tall chair.
  3. Then, rotate the outside of your shoulder blade upwards, and the inside of the shoulder blade downwards. This helps to stretch out the Levator scapula and relieve tension and stiffness in the area.
  4. While rotating the shoulder blade, turn the head away from the side that is being stretched and bring the chin down to your chest. This move will also stretch the muscles in the back of the neck.
  5. Hold this stretch for about 30 seconds and repeat as much as needed.
  6. You can also use your free hand to tug slightly on the back of the neck, increasing the depth of the stretch. Stop immediately if you feel any sudden pain while performing this exercise.

Chin Tuck

The chin tuck strengthens the muscles that connect the shoulder to the neck and back of the head, as well as the scalene muscles in the back of the neck. This exercise is very easy to do and can be performed sitting almost anywhere. However, it is recommended to perform this stretch standing up to get the full results.

  1. Simply align your spine evenly against a wall or doorway, with the feet out about 3 inches from the bottom of the wall/doorway.
  2. With your spine even with the wall, start to bring the back of the neck and head to lay flat on the wall as well.
  3. The entire time, try keeping your chin as low as possible so that you fully stretch out the muscles that are in the back of the head and neck.
  4. Try to hold this position for 15-20 seconds and repeat about 5-10 times, or as needed.

Massage Therapy for Neck Pain

Massage Therapy may be one of the leading methods for controlling and managing chronic or acute neck pain. One study from a research institute in Seattle, WA, suggested that massage therapy greatly influenced the amount of neck pain that the participants in the study felt. The study showed that those who received a massage 3 times a week, were almost 5X as likely to have a “clinically meaningful” improvement in function and were “over twice as likely to report a clinically meaningful decrease in pain.” (See References) Massage therapy is becoming extremely popular for reducing neck pain. Just like with your physician, training and expertise from the massage therapist is a must for getting the most out of your sessions.

Acupuncture

Acupuncture has been on the rise in western culture for well over a century and for good reason. With all the benefits that western medicine has provided for people, there is just something to be said for eastern medicine when it comes to treating chronic pain conditions. A study conducted at the University of Munich concluded that participants who were treated with acupuncture over the course of 5 treatments in a week showed greater improvement in motion-related neck pain. Acupuncture works in the same manner as massage therapy; they both manipulate and relieve pressure and tension in areas of the body. Acupuncture works by placing tiny hair-thin needles on certain areas of the body where there is a channel of energy flowing, and it connects to other anatomical parts of the body where that energy also flows. Acupuncture is hard to research without having the placebo effect appear in one’s research. However,when it comes to testimonials from people who have received acupuncture, many believe that it is an effective form of treatment. For this reason, acupuncture is gaining popularity in the United States, and for those who are in chronic pain, acupuncture seems like a treatment that is worth exploring.  

References:

 

  • David J, Modi S, Aluko AA, Robertshaw C, Farebrother J. Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. British Journal of Rheumatology 1998;37:1118-1122.
  • Coan RM, Wong G, Coan PL. The acupuncture treatment of neck pain: a randomized controlled study. Amer J Chin Med 1982;9:326-332.
  • Karen Sherman, Ph.D., M.P.H., senior scientific investigator, Group Health Research, Seattle; Jeanette Ezzo, Ph.D., M.P.H., research director, James P. Swyers Enterprises, Takoma Park, Md.; Fred Wilson, D.O., spine specialist, Cleveland Clinic, Cleveland, Ohio; March 10, 2014, Annals of Family Medicine
  • Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, Sterling McPherson. Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey. The Journal of Pain, 2014; 15 (10): 979 DOI:10.1016/j.jpain.2014.05.009
  • Vos C, Verhagen A, Passchier J, et al; Management of acute neck pain in general practice: a prospective study. Br J Gen Pract. 2007 Jan;57(534):23-8.
  • Neck pain - non-specific; NICE CKS, January 2009 (UK access only)
  • Tomczak KK, Rosman NP; Torticollis. J Child Neurol. 2013 Mar;28(3):365-78. doi: 10.1177/0883073812469294. Epub 2012 Dec 26.