Neck Pain

Neck pain is a relatively common problem that can adversely affect your quality of life. It can significantly limit your ability to perform your daily activities. It can cause missed days of work.

Usually, neck pain may go away within a few days or weeks. However, pain that persists for months could suggest a serious underlying medical condition that may need addressing.

The neck (cervical spine) is composed of vertebrae (spinal bones) that begin at the base of the skull and end in the upper torso. These bones along with ligaments (similar to thick rubber bands) provide stability to the spine. The muscles allow for support and motion.

The neck allows for significant amount of motion and supports the weight of the head. Since it is less protected than the rest of the spine, the neck maybe vulnerable to injury and disorders that produce pain and restrict motion.

Risk Factors for Neck Pain:

• Age – risk increase with advancing age
• Heavy lifting and twisting – both sudden and chronic
• Obesity
• Poor physical fitness/conditioning
• Poor postural habits
• History of trauma
• Smoking
• Psychiatric history (chronic LBP)

Causes of Neck pain

Neck pain may result from abnormalities in any of the soft tissue components due to injury (a sprain) as well as in bones and disks of the spine by prolonged wear and tear. Rarely, infection or tumors may cause neck pain. Pain in the jaw, head or shoulders may also spread to the neck and cause pain. Conversely, in some people, problems in the neck can also make other parts of the body hurt, such as head, upper back, shoulders or arms.

The important spinal conditions responsible for neck pain are listed below:

• Muscle strains – Excessive use without much change in posture, such as many hours of hunching over your computer or mobile phone, often causes muscle strains. Even simple activities, such as reading in bed or gritting your teeth, can strain neck muscles.
• Nerve compression – Herniated disks (Slipped disc) or bony spurs in the bones of your neck can press on the nerves branching out from the spinal cord. It can also lead to radiating pain the arm if it starts impinging on the nerve and in severe cases it can cause nerve damage as well (Numbness/ weakness).
• Spinal stenosis develops when the spinal canal or a nerve passageway abnormally narrows. This is a result of several degenerative changes in the ligaments, disc and the facet joints. In severe cases, this may even lead to weakness of hands or legs due to compression of the spinal cord.
• Spinal arthritis, also called spinal osteoarthritis (Worn joints), is a common degenerative spine problem. Just like the other joints in your body, your neck joints tend to wear down with age. Osteoarthritis causes the cushions (cartilage) between your bones (vertebrae) to deteriorate. Your body then forms bone spurs that affect joint motion and cause pain It is age related and affects the spine’s facet joints and sacroiliac joints.
• Injuries. High velocity motor-vehicle accidents often lead to whiplash injury, which occurs when the head is jerked backward and then forward, straining the soft tissues of the neck
• Bony fractures (burst or compression types) are often caused by some type of trauma (eg, fall). In elderly patients, it can also be caused spontaneously or even with minor events. This type of pain may not go away, even after weeks.
• Osteomyelitis is a bacterial infection that can develop in one of the spine’s bones. Infection can also spread to the discs or the nerves in some cases
• Spinal tumors are an abnormal growth of cells (a mass) and are diagnosed as benign (non-cancerous) or malignant (cancer). It can affect the vertebral bone, covering of the nerves (Dura) or the nerves themselves.
• Other diseases – Certain conditions, such as rheumatoid arthritis, meningitis or ankylosing spondylitis, can cause neck pain

Treatment options for Neck pain:

Since the causes of neck pain are very varied, the treatment also varies according to the cause.

The first line of treatment (home based) will always consist of

• Bed rest – either relative rest or absolute rest based on the severity of pain – You may benefit from a cervical collar which stabilizes your neck.
• Local application of ice packs followed 24-48 hours later by heat. In the initial phase ice reduces swelling, pain and spasms. Once acute pain subsides, switching over to heat (hot water bag application) reduces spasm and warmth relaxes the muscles.
• Over the counter analgesics – (Paracetamol or Diclofenac) (It is strongly recommended to consult a doctor before self medication)

Of course, it is not recommended to continue home based treatment for prolonged periods, especially when there is no adequate relief.

If these methods are not effective, you may benefit from surgery to correct a

problem in your cervical spine.

The following ‘Red flags’ will help you to decide when to consult a doctor.

When to consult a doctor: The red flags of neck pain

Presence of these symptoms should alert to a more serious underlying cause and a prompt consultation with your doctor is recommended in such cases-

• Arm pain > Neck pain
• Neurological deficits (weakness/ numbness)
• Bladder or bowel dysfunction

• Sudden severe pain not subsiding in 2 days
• Mild to moderate pain not subsiding in 1 week
• Any pain > 6 weeks (on and off)
• Post-traumatic pain
• Pain even on lying down
• Age > 60 yr
• Associated symptoms
• Fever, weight loss, h/o cancer, immunosuppression or steroid use
• Visit the preventive spine topics page to know tips to prevent/ control neck pain