Neck pain is very common and I’m sure that all of us have suffered from this condition at least once in the past. The neck functions to support and stabilize the head and allows motion of the head in different directions. The foundation of the neck’s complex anatomy is the cervical spine and associated ligaments. The cervical spine is made up of seven vertebrae (bones) and the intervertebral discs which are situated between consecutive vertebrae (except C1 and C2). The spine protects the spinal cord, nerve roots and spinal nerves and vertebral arteries. The spinal nerves originating in the cervical spine supply sensation to the back of the head, neck and upper limbs (shoulder to hand) and power to the muscles of the upper limb. The vertebral arteries supply blood to the brainstem and parts of the brain. There are multiple muscles around the neck which act to produce motion of the neck and the head.
There are multiple causes of neck pain but we will discuss the three most common causes today. These causes are:
1) Strains (muscle injury) and sprains (ligament injury)
2) Cervical facet joint mediated pain
3) Cervical radiculopathy (pinched nerve root in the neck)
Cervical strains have different causes such as sustained abnormal postures (hunched forward or leaning to the side), sleeping in a bad position or carrying a heavy object on one side of the body. Trauma which impacts the neck, such as whiplash in a car accident, can also cause strains as well as sprains. Such injuries typically cause pain in the neck and possibly shoulder muscles as well as neck stiffness. Symptoms typically resolve within a few days with appropriate management but in the case of whiplash, symptoms may persist for much longer and require more intensive and prolonged treatment.
The facet joints are the joints between consecutive vertebrae in the spine. Pain originating from these joints may be a result of osteoarthritis or post-traumatic in origin (such as from whiplash). It can therefore have a gradual onset or a sudden onset. The symptoms experienced depend on the level of the joint affected – in addition to neck pain, patients may have headaches and pain in the area of the posterior shoulder and around the shoulder blades. This condition is more challenging to treat and in the case of osteoarthritis, the pain may recur in the future.
Cervical nerve roots exit the cervical spine through the neural foramina (passages between the vertebrae) and join each other to form networks which divide into peripheral nerves that supply sensation and motor power to the upper limbs. Cervical radiculopathy refers to dysfunction of a nerve root caused by compression by a herniated intervertebral disc or osteoarthritic changes. Symptoms include neck pain which radiates into the upper limb, sensory disturbances (numbness, tingling or burning sensation) and weakness in the upper limb. This condition can be challenging to treat and needs urgent attention, especially if there is weakness of the upper limb.
The physiatrist plays an important role in the management of neck pain. A thorough history and proper physical examination are crucial to making the correct diagnosis of the cause of the pain. Investigations may also need to be ordered to help make the diagnosis- these include cervical x-rays and/or MRI and possibly nerve conduction studies and EMG. Appropriate treatment will be instituted by the physiatrist in a timely fashion as required by the urgency of the underlying cause of the neck pain. Treatment will include medications to control pain and muscle spasms, physical therapy for almost all patients and soft tissue or spinal injections as needed. Some patients with cervical radiculopathy and those who have spinal cord compression of the spinal cord will require surgery to decompress the cervical spine. These patients would be referred to the spine surgeon as soon as the physiatrist makes the diagnosis.
Any person with neck pain lasting more than a few days or with other associated symptoms should seek to have a thorough evaluation done so appropriate treatment can be started. This will lead to improved pain and restore function.
(Dr Shane Drakes is a Specialist in Physical Medicine &Rehabilitation and Sports Medicine.
He can be contacted firstname.lastname@example.org)