Overview

Neck pain results when the spine is stressed by injury, poor posture, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that subsides after a period of days or weeks. It can also radiate to the head, shoulders, arms, or hands. It typically resolves with rest, exercise, and other self-care measures. Some people suffer from chronic pain that continues despite treatment.

You play an important role in the prevention and healing process of neck pain. Strong, flexible muscles help to promote a healthy neck that maintains good alignment, allows movement, and provides structural support.

Anatomy of the neck

The neck region of the spinal column is called the cervical spine. Protected within the cervical spine are the spinal cord, nerves, and blood vessels. The seven cervical bones, called vertebrae (C1 to C7), are cushioned by shock-absorbing discs (Fig. 1). Each disc contains a rigid outer layer that surrounds a gel-like inner layer. The vertebra is held in place by muscles and ligaments that function to support and move your head. Exiting from the spinal column through the holes (foramina) on either side of the vertebra are the spinal nerves. The cervical region has the most range of motion because of two specialized vertebrae that connect to the skull. These special vertebrae allow your head to bend, turn, and move side to side. The neck can also be a prime location for injury and pain (see Anatomy of the Spine).

Types of neck pain

Neck pain ranges from mild to severe, and is classified as either acute or chronic.

Acute neck pain often relates to soft tissue injury (e.g., sprains of muscles, tendons, or ligaments) or disc herniation.  Acute pain usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves with over time.

Chronic neck pain persists (lasts more than 3 months) and its source may be hard to find. Chronic pain may be present all the time, or worsen with certain activities, poor posture, and improper body mechanics. Other contributing factors may be related to nerve cell changes, tissue scarring, arthritic changes, or psychological effects of chronic pain. In some cases, the complexity of chronic symptoms requires consultation with a pain management specialist (see Pain Management).

What are the symptoms?

Signs and symptoms of neck pain may be stiffness, tightness, aching, burning or stabbing or shooting pains, pressure, or tingling. Muscles can feel sore or tense in the neck, face, or shoulders. Muscles spasm when they go into a state of extreme contraction (e.g., after whiplash). Movement may be restricted—perhaps you cannot turn your head past a certain point. If nerves are involved, tingling, numbness, or weakness may develop in your arms or hands. Where and how the symptoms manifest in the body can also indicate the level (from C1 to C7) and type of injury or disease. 

Several situations signal the need for prompt medical attention. If nerve compression is severe, symptoms can include numbness and/or loss of coordination in the arms or legs, or loss of bladder or bowel control.

Neck pain accompanied by a headache, fever, or nausea could be a symptom of meningitis (an infection of the membranes around your brain) or of a hemorrhage in the brain. If your neck is so stiff that you can’t touch your chin to your chest, you should seek immediate medical attention.

What are the causes?

Neck pain can result from injury, poor posture, stress, natural wear, disease, and other sources. Poor spinal alignment (e.g., slouching, sleeping on the stomach) and improper movement (e.g., poor lifting technique) stress the cervical spine and make injuries more likely. Neck pain can result from:

• Injury or trauma: A significant force can stress the structures of the neck, for example, a whiplash injury, sports injury, or fall. Fractures, such as vertebral compression fractures, can result. A tear in the muscles and ligaments of the neck may predispose the discs to bulge or herniate.
• Bulging and herniated cervical disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve. In severe injuries, the gel bulges out and causes the outer rim of annulus to rupture or tear. 
• Pinched nerve: When a spinal nerve is compressed (radiculopathy), pain may run down your arm into your hands or fingers. Pinched nerve pain differs from carpal tunnel symptoms, which usually involve numbness.
• Osteoarthritis (degenerative disc disease): As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.
• Stenosis: Narrowing of the spinal and nerve root canals occurs as facet joints enlarge and ligaments stiffen over time. As the spinal canal narrows, it presses the cord and nerves, causing them to swell and inflame.
• Spondylolysis: A weakness or stress fracture develops in one of the bony bridges that connect the upper and lower facet joints.
• Spondylolisthesis: A weakness predisposes the vertebra to slip out of normal position.

What treatments are available?

Self care: Most neck problems resolve with self-care measures such as rest, ice or heat, massage, over-the-counter pain relievers, or gentle stretches (see Self Care for Neck and Back Pain). If home treatments aren’t working within the first couple of days, see your doctor.

In developing a treatment plan, your physician or healthcare provider will assess the type of disease or condition, and its impact. A team approach for treatment of neck problems is often the most effective. Medical treatments include surgical or nonsurgical care and self-care strategies that aim toward restoring a healthy neck and preventing future re-injury.  

Physical therapy and exercise: Neck pain typically resolves with nonsurgical care with options such as massage, traction, or gentle exercises for the neck. Other options are physical therapy, chiropractic care, massage therapy, acupuncture, trigger point injection, or other treatment. Maintaining good posture and proper body mechanics during activities and sleep complement treatment.

Medications: Your doctor may prescribe nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) to reduce inflammation and relieve pain. If you have spasms, a muscle relaxant may be prescribed for a short time (3 to 4 days). If the pain is severe, an analgesic that can be taken with the NSAID or muscle relaxant may be prescribed.

Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period or as an injection directly into the source of pain (see epidural steroid injections and facet injections). Steroids have the advantage of providing almost immediate pain relief within 24-hours.

Surgery: Surgery is rarely recommended unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or if the pain is severe and not resolved after a reasonable course of nonsurgical treatment.

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