Neck pain or cervical pain is something that unfortunately affects almost everyone at some point in their lives. Some lucky people may only have one or two episodes of neck pain in their life while others suffer from chronic pain that is recurrent or never really goes away. Below I discuss two of the more common reasons for neck pain and some of the associated conditions and treatments.
Cervical muscle strain ("whiplash")
Muscle strains in the cervical spine are very common. This can occur from something as simple as sleeping awkwardly to more severe injuries such as that from a car accident or a fall from a height. The pain from cervical muscle strains is usually localized to the muscles of the neck but can occasionally radiate to the back of the head causing headaches and down to the shoulders. People can also feel "knots" in the muscles of the neck and shoulders and these are caused by local muscle injury and spasm. Minor strains rarely require medical attention but people with more severe pain or injuries (such as a car accident or fall from a height) should be seen by their physician to rule out a fracture, dislocation, cervical instability, or any problems with the cervical nerve roots or spinal cord. Once these more serious conditions are ruled out, cervical muscle strains are best treated with anti-inflammatories, muscle relaxers, massage, acupuncture, regular aerobic exercise, and physical therapy. Surgery is not recommended for cervical muscle strains. The pain from a severe cervical muscle strain can often take weeks to months before it fully resolves.
Cervical spondylosis (also known as degenerative disc disease or cervical spine arthritis)
Cervical spine arthritis is universal with aging, with essentially 100% of the population having radiographic signs of arthritis on xray after the age of 70. By the age of 40 many individuals will already have radiographic evidence of the early stages of cervical degenerative disc disease. We do not yet fully understand why some people have more neck pain than others in the setting of cervical spine arthritis. We do know that people that smoke tend to develop cervical arthritis at a faster rate and have more neck pain than people that don't smoke due to the effects of nicotine on the intervertebral discs, which are the cushions between the bones of the spine.
Arthritis of the cervical spine can affect both the intervertebral discs, and the facet joints with are paired joints at each level of the spine in the back part of the neck. People with pain coming from arthritis of the facet joints often have pain with extension of their neck, or looking up, which is relieved by bending the head forward. People with pain that is worsened with rotating their head in one direction or another can have arthritis affecting the joints between the C1 bone and C2 bone which are primarily responsible for this motion.
The most common symptoms caused by cervical spondylosis are neck pain and stiffness. The pain from cervical arthritis waxes and wanes and can be exacerbated from time to time. People with severe arthritis on xrays tend to have more frequent episodes of neck pain and they last longer than people with minimal arthritis on xrays. Grinding and popping noises from the spine with neck movement are also common. If the arthritis causes pressure on the nerves coming from the cervical spine or the spinal cord, it can cause pain, numbness, or weakness going down the arms into the hands (cervical radiculopathy) or problems with hand dexterity or balance problems when walking (cervical myelopathy).
Neck pain from cervical spondylosis usually responds well to conservative treatments such as oral anti-inflammatories, physical therapy, regular aerobic exercise, and activity modification. Regular aerobic exercise is helpful as it encourages increased blood flow to the paraspinal muscles and the spinal discs, in addition to increasing the release of endorphins, which are the body's natural pain fighting molecules. People that smoke often have a decrease in their neck pain simply from stopping smoking. When these conservative treatments fail to help, spinal injections (performed by physiatrists or anesthesiologists) such as trigger point injections, facet injections, or epidural injections can sometimes be helpful. Cervical spondylosis in the absence of pressure on the nerves going to the arms or pressure on the spinal cord rarely requires surgical treatment although in certain situations (especially C1-2 arthritis) it can be helpful.
The optimal treatment of neck pain requires a careful evaluation including a history, physical examination, and usually xrays to come up with the correct diagnosis. If there are any symptoms or signs suggesting pressure on the nerve roots or the spinal cord, then an MRI is obtained to more carefully evaluate these structures.
If you have a condition involving the cervical spine and would like a consultation, please make an appointment to see me in my Raleigh, Garner, Cary, or North Raleigh office. We will discuss your problem in detail in addition to a thorough review of your medical history and how that may affect your condition. After a physical exam and xray evaluation, we will discuss your diagnosis and the possible treatment options. If surgery is recommended, I'll make sure to discuss the procedure and the associated risks, benefits, and alternatives with you in detail and answer any questions you may have.