Neck Pain
Like low back pain neck pain is very common and will affect a significant proportion of adults at some point during their life, The first thing to remember is don’t worry, in the vast majority of patients the neck pain has no sinister cause, and does not require surgery. In most patients the pain settles with no specific treatment, or gets better with a combination of painkilling medication and physiotherapy
What Is The Cervical Spine?
The neck or cervical spine is a very mobile structure. The bones, muscles, ligaments and discs have to allow adequate flexibility whilst supporting the weight of the head. It is made up of 7 vertebra, the top 2 allow rotation of the head and have a peg and socket arrangement, the remaining 5 vertebra allow the flexion and extension of the spine together with lateral flexion (putting your head on your shoulder) and some rotation.
What Causes Neck Pain?
Muscular Sprain and Strain
The muscles of the spine provide the power and strength for everyday activities such as standing, lifting, and walking or running. If these muscles are poorly conditioned, or overworked then a muscular strain can occur. The ligaments in the cervical attach muscles to the bones of the spine, and give support and stability to the bones and discs in the spine. A sprain of these ligaments can occur when a sudden forceful movement injures the ligaments which have been previously weakened by poor conditioning or overuse. Occasionally this can happen after your neck has been in an uncomfortable position for some time, and thus can occur on waking if your head isn’t supported well during sleep
This type of pain usually lasts less than 3 months.
Both of these conditions cause relatively acute neck pain without sciatica. The pain almost always settles with painkillers such as diclofenac or ibuprofen, and physiotherapy may help.
The best means of avoiding this type of pain is regular exercise aimed at strengthening the neck muscles, maintaining a healthy weight, good lifting techniques, and not smoking
‘Wear and Tear’
This is also a very common cause of neck pain. The effects of aging on the spine are universal and in many people result in episodes of neck pain. This process is variously called degenerative spinal disease, osteoarthritis of the spine, cervical spondylosis and ‘worn cervical discs’
The process usually begins at a relatively early age with dehydration of the discs, this changes how forces are transmitted through the spine and leads to additional forces being put on the facet joints and ligaments. This in turn leads to degeneration of the facet joints and disc spaces with extra bone formation and a reduced range of movement or ‘stiffness’ of the spine. In addition to this the elasticity of ligaments and the tone of spinal muscle decreases with age.
The pain caused by this problem can last much longer than 3 months
If you have pain going into the arms see the section on arm pain (cervical radiculopathy)
Rare causes of neck pain
In rare cases pain is caused by more serious pathology such as rheumatoid disease of the neck, infection, a tumour of the spine and after a spinal fracture
Investigation of neck pain
Plain Xrays
These may show wear and tear changes, or suggest instability in rare instances. They do not allow the nerves or discs to be seen. The XRay on the right shows narrowing of the lower disc spaces with extra bone formation known as ‘osteophytes’
Flexion/ Extension Xrays
Xrays of the neck with your head bending forwards and backwards, can be useful if instability is suspected
CT scan
This is a good way of looking at the bony structures of the spine, and can show disc prolapses and narrowing of the spinal canal called stenosis, MRI however gives a much cleared picture of the non-bony structures
MRI scan
The best way of getting pictures of the spine if nerve or spinal cord compression is suspected
Myelogram
In some where cases an MRI scan may not be possible this may be required, now very rare
Nerve Conduction Studies
These can be useful in differentiating problems coming from the neck with a trapped nerve in the arms such as carpal tunnel syndrome
Treatment of neck pain
The vast majority of people suffering with neck pain do not need surgery, sometimes your GP may refer you for assessment in a surgical clinic because you have not responded as well as hoped with the conventional non-surgical treatments. Just because you have been refered to a surgical clinic does not mean you will be having an operation, it may be that you need further investigation, or referal to a more specialised clinic such as a pain managment clinic.
Types of treatment:
Cervical Collar
Generally not recommended now. A soft collar can help initially with pain but has the disadvantage of promoting loss of strength in the muscles of the neck supporting your head if used lon-term
Excercise
Walking, cycling, yoga and pilates and excercises guided by a physiotherapist. Swimming is not as useful as you have to extend your neck during the exercise
Medication
Non-steroidal medication such as Neurofen, diclofenac, naproxen are all effective. Additional drugs that may aid pain control include paracetalmol/ codeine preparations, tramadol, and muscle relaxants
Manipulation
This can be performed by either a chiropractor, osteopath or physiotherapist, but only if there is no suggestion of spinal cord compression
Treatment in a Pain Clinic
This involves assessment by a pain specialist, and may lead to novel pain modifying drugs being tried, spinal injections of steroid and local anaesthetic and use of a TENS machine
Surgery for Neck Pain
This is only needed in a small percentage of patients, and is usually performed if there is instability in the cervical spine, or if there is a danger of spinal cord compression or nerve root compression
Things You Can Do To Prevent Neck Pain
- Remain as physically active as possible
- Make sure that you have your computer and chair are adjusted properly
- Take regular exercise
- Keep your weight down
- Stop smoking
If you have arm pain with neck pain otherwise known as ‘cervical radiculopathy’ please go to the arm pain webpage