Neck Pain, What is it?
Neck pain is one of the most common problems people experience. The neck, also called the cervical spine, is considered the area between the head and the top of your shoulders, and is a common area for pain in the body. The neck is a well-engineered structure that is highly mobile, yet strong enough to support the full weight of the head.
Seven vertebrae, or bones, make up the cervical spine. Each is stacked upon one another which allows for mobility, stability, and protection for the spinal cord and nerves. They are named in order from top to bottom, C1 to C7.
The largest of the cervical bones, C7, is the bottom of the cervical spine. It takes on a significant amount of the weight of the head, has more muscles attached to it than any other cervical vertebrae, and its shape is slightly different so that it connects perfectly with thoracic spine.
Each of the cervical vertebrae gets smaller as it moves up the spine. C3-C6 are structured the same and function the same to help with neck movements and to protect the cord. C1 and C2 are different in their design as they sit just below the skull and the mechanics of movement are different than the other vertebrae. C2 is called the axis and has a hook that fits neatly into C1 which sits just above it.
C1 is called the atlas and is the connection point of the spine to the skull. It is also uniquely designed to fit perfectly with the back of the skull.
Many muscles, ligaments, and cartilage attach to and control what happens in the cervical spine. The soft tissue is meant to help with movement, stabilization, and cushioning the space between each vertebra. The cushion is made of fibrocartilage, is called the disc, and is extremely important as it relates cervical radiculopathy and its effect on nerve roots and maintaining the space between the bones.
A nerve root is where the nerve extends off the spinal cord, and exits in a space created by two vertebrae as they stack on top of each other. The spinal cord is the structure of nerves that exits from the skull and is surrounded by the vertebral bodies as protection. Eight cervical nerve roots (C1-C8) are present. The name of the root relates to the vertebral level between which it exits. C8 extends out of the bottom of C7.
Muscles are the powerhouses of movement. By contracting and lengthening, the muscles of the neck help with movement of the neck including: flexion (forward bending), extension (backward bending), rotation, and lateral bending (sideways or ear-to-shoulder movement). The muscles of the neck are strong, but can sometimes become overworked or injured, resulting in pain symptoms.
Ligaments are thick bands of soft tissue, with their role being to keep the bones attached to each other, and yet allow movement.
What causes neck pain?
Rarely is neck pain, also called cervicalgia, serious. It can originate from any of the structures within or around the neck area. One of the most common forms of neck pain relates to wear and tear, or overuse. Another common neck injury is related to trauma such as whiplash.
Some of the other conditions that can contribute to pain in the cervical area are:
- Ankylosing spondylitis
- Autoimmune diseases, such as rheumatoid arthritis
- Brachial Plexus injuries
- Cervical Radiculopathy
- Excessive force or stress, such as whiplash injuries
- Frozen shoulder
- Infection such as meningitis
- Herniated disc
- Muscle strains
- Pinched nerve
- Poor posture
- Poor sleeping posture
- Shoulder joint instability
- Sports injuries
- Thoracic Outlet Syndrome
- Torticollis/Wry Neck
The most common origin of pain usually relates to the muscles, tendons, ligaments and cartilage; however, some conditions require medical care quickly. Symptoms of numbness, tingling, severe or sharp pain that radiates down the arm warrant an evaluation by a medical professional or physical therapist.
Symptoms of Neck Pain
Neck pain symptoms will vary, based on the cause and origin of the pain. For some, symptoms can be as mild as a dull ache or stiffness, or may be as severe as numbness, tingling, weakness in the arm, and intense sharp pain. Additional symptoms may include:
- Difficulty swallowing (seek immediate medical attention)
- General soreness
- Loss of range of motion
- Pinching pain
- Radiating pain, from neck down to the shoulder and arm (seek immediate medical attention if symptoms go down your left side and include jaw pain, chest pain, or mid back pain)
- Trigger point pain
In terms of duration of symptoms, neck pain is categorized into three general types:
- Acute: pain less than one month
- Subacute: one to three months
- Chronic: pain lasting more than three months, possibly intermittent over the years
How is neck diagnosed?
A comprehensive evaluation by a physical therapist is a great place to begin. The examination includes a thorough medical history, review of systems, and a clinical examination in which the therapist will assess movement quality and amount, strength, reflexes and sensation, and ask the patient to perform movements to help identify movements that may affect pain symptoms. Based on the findings of the evaluation, a treatment plan and goals are developed.
If the PT suspects there is a more complex medical issue involved, he or she will communicate directly with the patient’s physician and discuss the findings. The physician may wish to see the patient.
In some cases, imaging or nerve conducting testing may be required. Imaging may include an X-Ray, CT scan, or an MRI. The imaging studies will look at the bone structures, the soft tissue, discs, and nerves within the neck area. Based on the imaging findings, conservative treatment may continue. Other medical management may be included, possibly with medication to reduce pain or inflammation in the area. In rare cases, injections or surgery are needed.
Treatment of Neck Pain
For acute neck pain, this can be often managed without significant medical intervention. Reducing the activity that seemed to trigger the symptoms can help, as can using ice or heat. Apply ice the first 24-48 hours of onset. After that, heat can be applied to the back of the neck and upper shoulder area or alternate between ice and heat. It is important to protect the skin from extreme temperatures and limit the application to 10-15 minutes.
If the symptoms persist and a person’s functional activities are impaired, a consult with a physical therapist is a great next step. Based on the exam findings, he or she will establish a plan of care with the patient and determine goals. Managing pain, restoring function, and achieving a return to previous activities are likely to be addressed.
PT’s are very skilled at determining the factors that can influence symptoms and typically include education about posture and ways to improve it. Developing an exercise program most appropriate for the individual patient based on the clinical findings of that patient is also key to long-term improvement.
Sometimes, additional treatment beyond that which a physical therapist can provide is needed. Physical therapists do not prescribe medications, nor do they perform injections and surgeries. In the circumstances that those treatment techniques are needed, the physical therapist and medical provider work together with the patient to achieve the best possible outcome for the patient. If surgery is needed, the surgeon will discuss the risks and benefits of any procedure with the patient. After surgery, PT is recommended to help safely recover and achieve the goals of returning to the best function possible.
Early intervention for neck pain is the key to managing the health of neck, shoulders, and arms. The sooner that one starts to address symptoms, the more likely conservative care will be helpful.
Find A Clinic will help identify a PT that has excellent outcomes in treating neck pain including cervical radiculopathy. In all states, patients can see a PT first, without a physician’s order. However, each state has different guidelines for this. More information on direct access can be found on the American Physical Therapy Association’s webpage Physical Therapy Direct Access By State.