The cervical spine, located in the neck, is subject to many of the same problems that plague the lower back—muscle strains and spasms, disk degeneration and denervation, and spinal stenosis. About 10 to 15 percent of people experience neck pain at any given time. Most neck pain is short lived and gets better on its own or with simple self-care measures. But sometimes neck pain is a red flag for a more serious problem.
Neck Pain Causes
The neck supports the weight of the head, which can weigh 10 lbs or more. Although the head should be centered over the spine when we sit or stand upright, countless activities—such as sitting at a computer, reading, watching television, or eating—cause people to slump, rounding their upper back and tilting their head forward. This posture can lead to muscle strain or spasm in the neck. Muscle strain or spasm can also arise from constantly looking over or under one’s glasses, having poor sleeping posture, or taking extended car trips.
General wear and tear from everyday activities and normal aging can cause changes in the disks of the neck that lead to pain and stiffness. For example, herniation of the intervertebral disks in the neck can decrease the space through which nerves exit the spinal canal, leading to pinched nerves and consequent pain. Bony outgrowths on the vertebrae (called osteophytes) also can pinch nerves. Spinal stenosis can put pressure on the spinal cord, causing pain or paralysis. Most people with neck pain do not have a herniated disk, osteophytes, or a disease that affects the spinal cord. Typically, it is the result of muscle strain or spasm.
On occasion, neck pain can result from acceleration/deceleration injuries, commonly known as whiplash. It can also stem from serious problems like arthritis or cancer or from problems that originate in other areas of the body such as the shoulder. Chronic neck pain that is not associated with any physical problem may result from associated stress or depression.
When To See a Doctor
Many cases of neck pain get better on their own. If neck pain is linked to a recent recreational or work-related activity, the pain will likely decrease within two weeks, and treatment from a doctor is usually unnecessary. However, you should see a doctor if your neck pain follows a serious injury or is accompanied by the following:
- headaches, fever, or weight loss
- pain that worsens at night
- difficulty walking, clumsiness, or weakness
- pain, numbness, or tingling in your fingers, arms, or legs
- problems with bladder, bowel, or sexual function
- discomfort or pressure in your chest
- severe pain over a bone that might indicate a fracture or injury to a ligament
- osteoporosis or extended corticosteroid treatment (increases your risk of fracture). Also see your doctor if your pain lasts longer than two weeks.
Waiting too long before seeing the doctor for neck pain decreases the likelihood that the pain will completely resolve.
Neck Pain: Getting a Diagnosis
If you do seek help for neck pain from a physician, your evaluation will include a medical history, a physical examination, and, if needed, imaging tests. During the physical exam, the doctor will likely measure your reflexes, range of motion, sensation, strength, and muscle and nerve function in your neck, arms, and legs.
If pain is the only symptom, and it does not radiate beyond your neck, imaging studies are usually not necessary. In this case, the pain is likely temporary and requires no invasive treatment. However, for people with a traumatic injury, rheumatoid arthritis, or a physical exam that does not pin down the cause of the pain, imaging studies may be needed. Imaging tests include x-rays, MRI scans, and CT scans. Further options may include electromyography and nerve conduction tests to assess the combined function of the muscles and nerves. People with intense pain that lasts for months may need further evaluation to rule out cancer.
Neck Pain: Treatment Options
Early treatment of neck pain is recommended to prevent long-term disability. For neck pain that is not severe, noninvasive measures are generally tried first, beginning with over-the-counter medications such as acetaminophen (Tylenol) to treat pain or NSAIDs for pain and inflammation. Applying cold (especially in the initial stages of pain) and heat (in the later stages) can be helpful. Bed rest, reducing physical activity, and immobilizing the neck with a cervical collar may relieve pain in some people. (Cervical collars are available at surgical supply stores but should be used for no more than 10 days to avoid weakening the neck muscles.)
Neck Strength Training Improves Quality of Life
Strength training may help improve the quality of life in women with chronic neck pain, a recent study suggests.
Researchers randomly assigned 180 women with chronic neck pain to take part in either a strength-training program three times a week for one year, an endurance-training program three times a week for one year, or a single session on neck stretching exercises. Women in the strength-training group performed high-intensity isometric neck strengthening exercises with an elastic band. The endurance-training group performed lighter dynamic neck muscle training.
At one year, women in both exercise groups reported significantly better quality of life compared with baseline. Women in the strength-training group had the greatest improvement. Women in the neck-stretching group had slightly lower scores at the end of the study.
These findings suggest that regularly performing neck exercises may help improve quality of life for chronic neck pain sufferers. If no treatable cause of your neck pain has been identified, ask your doctor to refer you to a physical therapist, who can design an appropriate program.
Range-of-motion exercises and massage also can be helpful for neck pain. A physical therapist can teach you appropriate neck stretches and exercises for the shoulders and upper back to help ease neck pain and prevent future episodes. Your doctor or physical therapist may also instruct you on how to correct detrimental aspects of your posture or the setup of your office.
If two weeks of conservative treatment do not alleviate the pain, muscle relaxants, ongoing physical therapy, or spinal manipulation (chiropractic) may be recommended. Another treatment option is a cervical traction device, which uses a system of weights and pulleys to help relieve pressure on the neck. The device is available at surgical supply stores.
For individuals whose neck pain appears to be caused by stress or depression, stress-management techniques, antidepressant medication, or both are often useful. In addition, your doctor may prescribe corticosteroid medications (either oral or injected), which can help reduce inflammation.
Even people with disk herniation or mild spinal stenosis should be treated first with conservative measures if the pain does not radiate beyond the neck. If no treatment has relieved the neck pain after eight weeks or if imaging studies indicate serious structural problems, you may need to consult with a spinal surgeon (a neurosurgeon or an orthopedic surgeon).
Surgery involves relieving pressure on the spinal cord or the pinched nerve. Up to 90 percent of people who undergo surgery for neck pain experience significant pain relief.