It is likely that at some point during your lifetime you will experience aches and pains in your neck and cervical spine. Even someone in the best of physical health may experience a traumatic injury to the neck that leads to an acute incident of pain. For others, the natural aging process lends itself to the development of degenerative changes that may end in neck pain. This article will look at some of the main causes of neck pain as well as the symptoms for recognizing such. We will also look at some of the treatment options that may be recommended by medical personnel.
At Tulsa Disc Center, we have many patients ask us why do they have neck pain and some patients ask why do they have chronic neck pain. We explain that by targeting the hidden cause of the problem and understanding basic anatomy, we are able to help patients recognize the symptoms and causes of neck pain.
Let’s begin by looking at some basic cervical spine anatomy. The structure of the neck begins at the top of the thoracic spine and continues up the neck to the base of the skull. Within that small area is found seven vertebrae, nerves, the spinal cord, and the vertebral discs. In addition there are various muscles, tendons and ligaments designed to enable the neck to flex, to turn in different directions, and to hold up the weight of the head.
The vertebrae are made up of small bones that are lined up on top of each other. The vertebrae, starting at the top, are listed as C1, C2 and so on, until you reach the bottom vertebrae, C7. If you have ever been told that you sustained an injury, your physician may have referred to the injury site by its cervical segment location.
The vertebrae are separated by vertebral discs. The discs have three main purposes:
•They are flexible cushions, acting like shock absorbers
•Are strong enough to actually connect the spinal vertebrae together
•Serve as joints, giving the spine a little mobility (1)
Another purpose of the vertebrae in the cervical spine is to protect the spinal cord. There are eight nerve roots that are number C1-C8 in the cervical spine as well, and these nerve roots control specific motor functions and/or sensations in various areas of the body. For example, if there is an injury in the area of the C8 nerve root, which controls part of the function of the hands, pain or numbness could be experienced in the hand.
Now that we have a basic picture of the physical anatomy of the cervical spine, let’s address some causes of neck pain.
Mechanical neck pain refers to pain that is triggered by movement of the cervical spine itself. The pain results because something is either not functioning properly in the cervical spine or because there is something wrong within the muscles, ligaments, etc. Mechanical neck pain can be acute (resolving within a few weeks) or chronic (lasting 3 months or more). Over 100 million people in the United States, and 1.5 billion people around the world, suffer from chronic pain. (2)
In general, the exact source of the mechanical neck pain is not known, although strains and sprains often contribute towards this type of injury. Some other causes of mechanical pain include:
•Holding head at an odd angle
•Working for long period of time on computer where monitor is not at proper eye level
•Repetitive motion (3)
Some mechanical neck pain can resolve itself over time. If a strain or sprain is suspected, applying ice to the affected area may alleviate inflammation. Other treatment options include resting the affected area and applying heat after inflammation has abated to help relax the muscles.
If a physician is consulted, the patient may expect to receive a prescription for anti-inflammatory medication, muscle relaxers or pain medication. In addition, physical therapy may be warranted. In cases of chronic pain, epidural injections or other options may be explored.
Another cause of neck pain may be the discs located in the cervical spine.
Intervertebral discs are found between the vertebrae, where they act like small shock absorbers. These discs are filled with a jelly-like substance called mucoprotein gel. When the vertebrae move, the gel redistributes itself to absorb pressure caused by the action.
There are several mechanical things that can go wrong with the intervertebral discs, resulting in pain. First we will look at some of the reasons these discs may tear or rupture. Then we will look at the two resulting conditions that can lead to serious pain issues: bulging discs and herniation of the discs.
In a typical adult, the gel within the discs are comprised of almost 90% fluid. (4) Over time, the gel gradually decreases. The loss of fluid within the disc decreases the efficiency of the disc’s action as a shock absorber between the vertebrae. You may hear this referred to as degenerative disc disease. As the discs become thinner due to loss of fluid, the space between the vertebrae decreases.
The outer layer of the intervertebral disc will also slowly deteriorate over time. As an individual ages the disc can weaken. If the disc begins to flatten and lose its shape, it can lead to pain issues caused by a bulging disc. A disc could also actually develop small tears or ruptures, which can lead to pain issues causing by a herniated disc.
A bulging disc results when there has been a loss of fluid inside the disc but there was no tear in the outer wall. The flattening of the disc caused by the decreased content causes the disc to bulge outward.
The symptoms of a bulging disc in the cervical spine are:
•Tingling and/or numbness in neck, shoulder, arm, hand, fingers
•Loss of Fine Motor Skills (in the fingers)
•Problems with walking can also result from compression of the spinal cord
The treatment for bulging discs in the cervical spine includes the application of ice and heat to the area, pain medication, steroid injections, exercises and/or physical therapy.
In severe cases or cases where several months have passed after conservative treatment options have been exhausted, a physician may want to explore surgical options.
Herniated discs can result when the outer layer of the disc ruptures and some of the gel actually squeezes out through the tear. The disc can place undue stress on a nerve, causing a pinched nerve.
Symptoms of a pinched nerve include pain at the site of the nerve that is impinged upon as well as tingling and/or numbness in the neck, shoulder, and arm.
Treatment for a pinched nerve can include:
•Hot and cold therapy
•Stretching and strengthening exercises
In extreme instances where the herniated disc actually presses on the spinal cord itself, there can be a resulting weakness in the legs causing difficulty with walking. This type of compression can even cause problems with bowel control. This type of problem requires immediate medical assistance.
Pressure placed on the nerves or the nerve roots can lead to serious problems. One of the most common nerve pain that developed in the cervical spine is a pinched nerve.
The medical term for a pinched nerve is cervical radiculopathy. As discussed above, this is often a result of changes that occur as a person ages. Herniated or bulging discs can often result in a pinched nerve. In younger individuals, it can be caused by an injury that resulted in a herniation of a disc.
A pinched nerve may also occur as a result of thinning discs. When the discs lose fluid, they begin to flatten, narrowing the space between the bony vertebrae. The body creates more bone to protect the disc. The bone spurs that are created make the spine stiffer, which leads to some increased levels of pain and stiffness in the neck. In some instances, the bone spurs cause a narrowing of the opening through which the nerve roots extend from the spine, leading to a pinched nerve. (5)
Symptoms of this type of medical issue include local pain at the site of the entrapment, or pain that radiates down the arm. Physicians usually begin treatment of these types of pain with conservative medical treatment. In instances where it is clear that the bone spurs are compressing the nerves, a surgical procedure may be necessary to correct the problem.
There is another cause of pain that can develop as a result of changes within the area of the vertebrae: facet joint pain.
As discussed above, the cervical spine has vertebrae that are separated by intervertebral discs. On each side of the back of a particular vertebra, there are two facet joints. The purpose of the facet joints is to enhance stability and allow for the neck to turn smoothly. The facet joints are lined with cartilage; the cartilage is covered with a capsule of fluid.
When the cartilage begins to break down a degenerative arthritis results. This is referred to as cervical facet osteoarthritis. This condition creates pain and stiffness in the neck. Pain from cervical facet osteoarthritis can be felt in the shoulders, between the shoulder blades and radiate into the upper area of the back. Another symptom includes headaches that are often felt in the back of the head.
Inflammation in this area also leads to pain in the facet joints. As cartilage breaks down, bone spurs, called osteophytes, may also develop which can compress nerve roots.
Symptoms of osteophyte impingement include:
•Pain in the immediate area
•Weakness or tingling that follows the path of the nerve that can be felt down the arm or even all the way into the hand. (6)
Although there are many non-surgical interventions that your medical professional will try first, such as hot/cold therapy and various medications, your physician may decide that facet injections are warranted.
Facet joint injections may be referred to as a facet block by your doctor. A steroid medication can be injected directly into the capsule that protects the joint in order to facilitate the application of strong anti-inflammatory medication.
Earlier we mentioned degenerative disc disease, the medical condition that results when the discs deteriorate due to normal aging and wear-and-tear. As the discs experience degenerative changes, the resulting condition is referred to as arthritis or spondylosis. Half of the individuals who develop worn discs do not experience pain whereas others do. (7)
Once a diagnosis of degenerative disc disease has been reached, your physician may put you on a course of medication designed to reduce pain. Some of the commonly prescribed medication include:
•NSAIDS (non-steroid anti-inflammatory drugs)
•Anti-depressants (lower pain signal sent to the brain and raise endorphin level, also enhancing pain relief)
•Neuropathic agents that specifically target nerve pain
•Epidural steroid injections that send steroids—very strong anti-inflammatories—right to the inflamed nerve root(s)
The above-referenced mechanisms leading to neck pain are a result of mechanical problems within the structure of the cervical spine. The last cause of pain we will look at involves the soft tissue located around the cervical spine and neck.
Some instances of neck pain occur due to overuse, misuse or injury to the soft tissue located in the cervical spine. By soft tissue, we mean the muscles, tendons, or ligaments.
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An episode of sudden pain may occur if you are rear ended in a car accident; the violent forward-and-backward-and-the-forward-again movement can create an injury referred to as whiplash.
Typically when we think of whiplash, we think of car accidents; however, there are other causes of whiplash injuries to the neck. These can include sports injuries (football in particular), bungee jumping, and even having the neck injured while riding on a rollercoaster. But how do you know if you may have suffered a whiplash injury? Here are some symptoms to be aware of:
•Dramatic change in range of motion
•Pain in shoulder and/or upper back
•Pins-and-needles feeling radiating into the shoulder or down the arm
If you suspect that you have suffered whiplash, early medical intervention is important. (8)
Other instances of neck pain can result from things as simple as sleeping in an awkward position or even hauling around a heavy object like a loaded suitcase. For simple muscle sprains and strains caused by minor injuries, treatment may include hot/cold therapy, pain medication, anti-inflammatories, and rest.
In instances where neck pain lasts for an extended period, medical professionals may do further diagnostic testing to determine if there is a specific mechanical issue that is underlying the pain.(9)
Even before someone begins to experience neck pain, developing the habit of maintaining good posture and doing simple stretching exercise to keep the neck limber is one way to try to avoid neck problems in the future.
With all of the numerous possibilities for the origination of neck pain, it is essential to consult with a medical professional in order to determine the cause of the pain and to develop a course of treatment that is appropriate for one’s lifestyle and medical condition. With so many options available for treatment, it is a matter of determining which combination works best to alleviate the pain and discomfort that any one individual is experiencing.
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