Neck Pain

 

Overview
Most people will suffer from an attack of neck pain at some point in their life. An attack of neck pain can last for a period of days, weeks, or even longer. It typically resolves with time, but rest, exercise, and other self-care measures help. Some people can suffer from chronic pain that continues despite treatment.  You play an important role in the prevention and healing process of neck pain. 

Anatomy 
The neck region of the spinal column is called the cervical spine. Protected within the bones of the cervical spine are the spinal cord, nerves, and blood vessels. The seven cervical bones are called vertebrae and are numbered C1 to C7. Each bone from C2-C7 is separated and cushioned by shock-absorbing discs.  Each disc contains a fibrous outer layer called the annulus that surrounds a gel-filled inner layer called the nucleus. The vertebrae are held in place by muscles and ligaments that provide support and enable movement of your body. The spinal nerves exit from the spinal column through holes called foraminae on both sides of the vertebra. 

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 occurs suddenly and usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves with over time.  The source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues.  Chronic neck pain persists and may be present all the time, or worsen with certain activities, poor posture, and improper body mechanics. In some cases, the complexity of chronic symptoms requires consultation with pain management specialists.  

What are the symptoms?
Signs and symptoms of neck pain may be stiffness, tightness, aching, burning or stabbing or shooting pains, pressure, or tingling.  Most people experience pain primarily in the back of the neck area. The pain may spread to the head, shoulders, and arms.  Many people may also experience muscle spasms. The symptoms are generally more noticeable when bending or turning the neck, when lifting heavy objects, or when sitting at a computer or holding the neck in one position for long periods of time. 

What are the causes?
Neck pain can result from:

• Injury or trauma: A significant force can stress the structures of the spine, for example, sports injury, or fall. A fracture including a tear in the muscles and ligaments of the cervical spine. In addition, the discs may bulge or herniate.

• Bulging and herniated disk: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain and swelling occur when this material squeezes out and comes in contact with a spinal nerve.

• Pinched nerve: When a spinal nerve is compressed, pain may run down your arm, called radiculopathy.

• Osteoarthritis (degenerative disk 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 canal occurs as discs bulge or protrude, facet joints enlarge, and ligaments stiffen over time. As the spinal canal narrows, it compresses the cord and nerves.

 

Other rare causes include cancer, infection, or congenital anomalies.

 

How is a diagnosis made?
A careful medical examination will help determine the type of back problem and its cause, and the best treatment options. Diagnosis requires evaluation that includes a medical history, physical exam, and possibly a diagnostic test such as an MRI scan or CT myelogram.

 

Treatment Options
 

Medical Therapy: 
Most patients will improve with medical management, typically within the first 6 weeks after the onset of symptoms.

Step 1: Pain relievers, muscle relaxers, and possibly oral steroids (Medrol Dosepak) coupled with bed rest or reduced level of activity. 

Step 2: Physical therapy which includes stretching exercises, heat, massage, and ultrasound. Patients need to determine the modality that works best for them. Each session provides short term benefit and ultimately should also be done at home.

Step 3: Pain management including epidural steroid injections (ESI). ESI is an injection of medication directly into the spinal canal. An ESI typically provides benefit lasting one month and can give lasting relief for those patients who are not surgical candidates.

Surgical Therapy: 
Indicated for patients who do not respond to medical management, have large disk herniations, severe symptoms, are unlikely to respond to further non-surgical treatment, and/or have neurologic loss of function.

 

Recovery and prevention
Most people with neck pain respond rapidly to treatment. 

Recurrences of neck pain are common. The key to avoiding recurrence is prevention.  Try the following:

• Proper lifting techniques

• Good neck posture during sitting, standing

• Appropriate exercise program

• An ergonomic work area

• No smoking

• Avoid stress or strain on the spine

 

If you have neck pain, come see us for consultation.  We take an aggressive approach to the treatment of neck pain.  We have the clinical and research experience for great outcomes with a personal touch.