Neck Pain

Updated: Nov 26, 2020

The neck or cervical spine has the important job of providing support and and mobility for the head, but sometimes it can become painful.


The cervical spine is a coordinated network of nerves, bones, joints, and muscles which provides support and mobility for the head, but sometimes due to various reasons it can become painful.



There are a number of problems that cause pain in the neck. Irritation along nerve pathways in the neck can cause pain in the shoulder, head, arm, and/or hand. Additionally, irritation of the spinal cord can cause pain into the legs and other areas below the neck.


Neck pain usually goes away within a few days or weeks, but pain that persists for months could signal an underlying medical cause that needs to be addressed. In some cases, early intervention may be necessary for the best results.


Most episodes of neck pain are due to muscle strain or soft tissue sprain (ligaments, tendons), but it can also be caused by a sudden force. These types of neck pain often improve with time and non-surgical care such as medications and hot fomentation. But if neck pain continues or worsens, there is often a specific condition that requires treatment, such as cervical degenerative disc disease, cervical herniated disc, cervical stenosis or cervical arthritis.


Neck Pain Range of Symptoms


Neck pain can range from being minor and easily ignored to excruciating and interfering with daily activities, such as the ability to dress, concentrate, or sleep. Sometimes neck pain can lead to a stiff neck and reduced range of motion. The duration of neck pain is commonly classified as follows:

  • Acute. Pain that lasts less than 4 weeks.

  • Subacute. Pain that lasts 4 to 12 weeks.

  • Chronic. Pain that lasts 3 or more months.

Neck pain may be sharp and located in one spot, or it might feel less intense but spread across a broader region. Sometimes the pain gets referred up to the head or accompanies a headache. Other times it can be accompanied by muscle spasms in the neck, upper back, or around the shoulder blade. Less commonly, shock-like pain or tingling may radiate down into the shoulder, arm, and/or hand.


Neck pain usually involves one or more of the following symptoms and signs:

  • Stiff neck. Soreness and difficulty moving the neck, especially when trying to turn the head from side to side.

  • Sharp pain. This pain may be localized to one spot and might feel like it is stabbing or stinging. This type of pain typically occurs in the lower neck.

  • General soreness. This discomfort is typically felt in a broader area or region of the neck. It is described as tender or achy, not sharp.

  • Radicular pain. This pain can radiate along a nerve from the neck into the shoulder and arm. The intensity can vary and this nerve pain might feel like it is burning or searing.

  • Cervical radiculopathy. Neurological deficits—such as problems with reflexes, sensation, or strength—may be experienced in the arm due to nerve root compression. Cervical radiculopathy may also be accompanied by radicular pain.

  • Trouble with gripping or lifting objects. This problem can happen if numbness or weakness goes into the arm or fingers. 

  • Headaches. Sometimes an irritation in the neck can affect muscles and nerves connected to the head. Some examples include tension headache, cervicogenic headache, and occipital neuralgia.

If neck pain symptoms progress, it can become difficult to sleep. Neck pain may also interfere with other daily activities, such as getting dressed or going to work, or any activity that involves turning the head, such as driving.

Onset of Neck Pain Symptoms


Neck pain typically develops in one of the following ways:

  • Slowly over time. Neck pain might start out as mild or only occur toward the end of a work day, but then it might recur and get worse with time.

  • Immediately following an injury. For instance, neck pain could start right after a bike accident or having slept awkwardly on the neck.

  • Delayed reaction after an injury. Neck sprain symptoms, such as after a car accident, might begin hours or a few days after the injury occurred. Some neck injuries can get worse over time.

  • Suddenly without any prior signs. Sometimes neck pain can start in the middle of a normal day for no apparent reason.

Neck pain symptoms might be constant, go away quickly, come and go regularly, or return intermittently. Certain activities or movements, such as sneezing or coughing, could make the pain worse.


When Neck Pain Is Serious


Some signs and symptoms associated with neck pain could indicate the health of a nerve root or the spinal cord is at risk, or perhaps there is an underlying disease or infection. These “red flag” signs and symptoms may include pain or tingling that radiates into the arm(s) or leg(s), problems with balance or coordination, or other troublesome signs. A doctor must be consulted for an accurate diagnosis and effective treatment plan. Severe neck pain from a trauma, such as a hard fall or car crash, needs emergency care.


When Neck Pain Needs Medical Attention


While neck pain usually goes away on its own, sometimes an underlying cause must be treated in order to alleviate the symptoms. When neck pain continues to interfere with routine activities or persists for days without improvement, it is advisable to schedule a doctor appointment. Sometimes neck pain is caused by a serious underlying medical condition, such as a spinal cord compression, cancer, meningitis, or any number of infections.

Neck pain requires immediate medical attention if it is accompanied by any of the following:

  • Radiating pain into both arms or legs (myelopathic pain)

  • Numbness, tingling, or weakness in arms or legs

  • Problems with balance or coordination

  • Loss of bowel or bladder control

  • Unintended weight loss

  • Fever or chills

  • Severe headache with stiff neck

When severe neck pain results from major trauma, such as a car accident or falling from a ladder, it must be treated as a medical emergency. To reduce the risk for paralysis, the patient should be immobilized by a medical professional and then transported to emergency care.


Diagnosing Neck Pain


When neck pain does not improve after a few days or weeks, some medical treatment or guidance is likely needed to alleviate symptoms. Getting an accurate medical diagnosis for the cause of neck pain can help set up a more effective treatment plan.


Complete Medical History


A thorough medical history is the first step in diagnosing the specific cause of neck pain. In addition to learning about the person’s health history, the doctor asks questions about:

  • Current symptoms. When did the pain start? Does it come and go? Is the pain in one spot, or does it radiate into the shoulders, arms, or fingers? Are there any other symptoms in addition to neck pain?

  • Occupation. What type of work does the person do? Is the day spent performing manual labor or sitting in front of a computer? What is the commute like?

  • Lifestyle. Does the person tend to be more active or sedentary? For instance, do hobbies include more moving around, such as gardening or swimming, or more sitting, such as watching TV or reading?

Many other topics may be reviewed, such as posture, sleep habits, and recent or old injuries. As more information is collected, the doctor can narrow the list of likely diagnoses and point to the next course of treatments.


Physical Exam for Diagnosing Neck Pain


After a medical history, the doctor performs a physical examination that includes:

  • Observation. Examine the posture, particularly the neck and shoulders, and inspect the neck for any lesions or abnormalities.

  • Palpation. Feel along the neck’s soft tissue for signs of muscle spasms, tightness, or tenderness.

  • Range of motion test. Check to see how the neck moves side to side, up and down, and rotates compared to what would be considered normal. Even if the neck has full range of motion, the doctor will note whether that is achieved with ease or if certain movements cause pain or struggles.

  • Reflexes. Perform simple tests with a rubber hammer to examine reflexes in the biceps, triceps, and forearm, which can show whether nerves in the neck are sending signals as intended.

  • Muscle power. Test muscles in the shoulder, arms, or hands for any signs of weakness.

  • Sensation. Check for unusual sensations, such as tingling that goes into the shoulders, arms, or fingers.

Many cases of neck pain are diagnosed based on the patient’s medical history and physical exam. When more information is need, advanced diagnostics may be needed to reach an accurate diagnosis.


Imaging Studies


Various imaging technologies are available to give a better view of what might be causing neck pain.

  • MRI scan. An MRI uses radio waves and a strong magnet to create a series of detailed cross-sections of the soft tissues and bones. If available, MRI is typically the first imaging option for viewing soft tissues because it does not have the risks associated with the additional radiation dose and myelography.

  • X-ray. Using electromagnetic radiation, an x-ray (radiograph) shows a good picture of the neck’s bones. X-ray images can be used to identify spinal degeneration, vertebral fractures, or even certain tumors.

  • CT scan. A CT scan uses x-rays and a computer to provide a series of cross-section images, which enables better viewing of the bones than a regular x-ray. CT scans are particularly useful for identifying subtle bone changes.

Other imaging options are available, such as a bone scan or ultrasound. Sometimes an imaging study can show damage or degeneration at a spinal level that does not correspond to the reported symptoms. In such cases, it is important to treat the symptoms and not the imaging study.


Common Acute Neck Pain Causes


The most common causes of neck pain—muscle/tendon strains and ligament sprains—heal within a few days or weeks. Many cases of strains and sprains result from overuse or overextension, such as from:

  • Poor posture. Long periods of time spent slouching or hunched over a computer screen can lead to forward head posture, which places extra stress on the neck. Repeatedly looking straight down at a phone or tablet may also cause pain, sometimes called text neck.

  • Sleeping in an awkward position. If the head is held at a bad angle or twists wrong during the night, a stiff neck might be present in the morning.

  • Repetitive motions. Turning the head in a repetitive manner, such as side to side while dancing or swimming, may lead to overuse of the neck’s muscles, tendons, and ligaments.

  • Trauma. Examples include any type of fall or impact, such as a sports collision or whiplash from an auto accident.

Sometimes a muscle strain or spasm is not just a soft tissue injury. In some cases, a problem in the cervical spine could be causing a neck muscle to spasm in response.


Common Chronic Neck Pain Causes


When neck pain lasts or keeps coming back over a period of several months, it is typically due to spinal degeneration from wear-and-tear over time (also called cervical spondylosis).

  • Cervical degenerative disc disease. All discs gradually lose hydration and the ability to cushion the spine’s vertebrae over time. If a disc degenerates enough, for some people it can lead to pain in various ways, such as a herniated disc, pinched nerve, or changes in the facet joints that can cause osteoarthritis.

  • Cervical osteoarthritis. When the cartilage in a cervical facet joint wears down enough, it can lead to cervical osteoarthritis. Cervical osteoarthritis is one of the most common causes of chronic neck pain.

  • Cervical herniated disc. When an intervertebral disc’s protective outer layer (annulus fibrosus) partially or completely tears causing Cervical Herniated Disc, some of the jelly-like inner layer (nucleus pulposus) may leak and cause inflammation and pain.

As spinal degeneration progresses, there is an increased risk for a narrowing of the foramen (cervical foraminal stenosis) and/or the spinal canal causing cervical central stenosis. If the nerve root and/or spinal cord becomes impinged, pain, tingling, numbness, and/or weakness may radiate into the arms or legs.


Other Neck Pain Causes

Other causes of neck pain could include:

  • Emotional stress. Stress, anxiety, and low social support have all been linked as potential causes or contributors to neck pain.

  • Infection. If part of the cervical spine becomes infected, inflammation could cause neck pain. One example is meningitis.

  • Myofascial pain syndrome. This chronic condition has trigger points, which result from achy muscles and surrounding connective tissues, typically in the upper back or neck. Trigger points can be chronically painful or acutely tender to the touch. The pain might stay in one spot or it can be referred pain that spreads to/from another area in the body.

  • Fibromyalgia. Fibromyalgia is hard to diagnose, but it typically involves pain in the muscles, tendons, and ligaments in several areas of the body, including in the neck.

  • Spinal tumor. A tumor, such as from cancer, could develop in the cervical spine and damage tissues or press against a nerve.

  • Spondylolisthesis. This condition occurs when one vertebra slips over the one below it. It can be due to a tiny fracture in the vertebra, ligament laxity, or possibly from advanced disc degeneration.

Treatment for Neck Pain

Most neck pain can be treated with nonsurgical methods, such as self-care at home and/or with guidance from a medical professional.

Before starting self-care, home remedies or physiotherapy, always consult a medical Doctor (spine specialist) and follow doctor’s instructions to reduce the risk for serious complications.

Self-Care for Neck Pain


If neck pain is not debilitating and was not caused by trauma, the pain can typically be treated with self-care.

  • Short period of rest. While strenuous activities and movements that worsen pain are to be avoided for a few days, some movement is typically encouraged to prevent the neck from becoming weaker and/or stiffer.

  • Ice and/or heat. Applying ice can help reduce swelling and pain. Applying heat may help relax muscles and bring more blood flow and healing nutrients to the injured area. For ice or heat therapy, applications are limited to 15 or 20 minutes with at least a 2-hour break in between to give the skin time to recover.

  • Gentle stretches. Some forms of neck pain or muscle tightness are alleviated with gentle range-of-motion stretches. If a particular movement or stretch exacerbates pain, stop and try another movement instead.

Other self-care remedies are available for neck pain. In addition, lifestyle changes can play a role in reducing neck pain. Some examples include adopting a more physically active lifestyle, quitting smoking, and using correct posture throughout the day.


Physical Therapy

Many treatment plans for persistent neck pain include some form of physical therapy to improve neck strength and flexibility. The physical therapy program’s structure and length can vary depending on the specific diagnosis and situation. Multiple sessions per week with a trained physical therapist may be recommended to start. In time, prescribed exercises may be continued at home.


Medications

Over-the-counter (OTC) pain relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, are typically tried first for neck pain. Before taking any medication, read directions carefully and follow doctor’s instructions to reduce the risk for serious complications.


Alternative Treatments for Neck Pain


Alternative or complementary treatments tend to have less rigorous scientific backing, but many people have reported benefiting from them when treating neck pain.

  • Massage therapy. A massage can soothe muscle tension and spasms, reducing pain and promoting relaxation. Some people may prefer self-massage or a massage from a willing friend or partner, whereas others may find more relief when massage is performed by a trained professional.

  • Manual manipulation. A chiropractor, osteopath, or other health professional may use the hands to adjust the spine for improved range of motion and reduced pain. Spinal manipulation involves a high-velocity manipulation, whereas spinal mobilization involves techniques that are more limited in their range of motion. Before having a high-velocity neck manipulation, it is important to rule out any spinal instability or underlying medical condition to reduce the risk for rare but serious complications, such as stroke.

Surgery for Neck Pain


If nonsurgical treatments fail to reduce neck pain and associated signs and symptoms, especially those related to compression of the spinal cord or nerve roots, surgery may be considered.


Reasons for Neck Surgery

Surgery to relieve neck-related pain is typically performed for one or more of the following reasons:

  • To decompress a nerve root (by removing a damaged disc and/or other problematic structure)

  • To decompress the spinal cord

  • To stabilize the cervical spine

If imaging and diagnostic tests cannot confirm one of these reasons for the neck pain and/or related signs and symptoms, such as pain, tingling, or weakness that goes into the arm, surgery is unlikely to help and is not recommended.


Common Types of Surgery for Neck Pain


The two most common surgery options for neck pain are designed to remove a damaged disc and restore normal spacing within the vertebral level to decompress a nerve root and/or the spinal cord.


Anterior cervical discectomy and fusion (ACDF)


The most common surgery for neck pain involves a discectomy, which is the removal of a problematic disc in the cervical spine. Typically, the surgery is performed through the front of the neck, called anterior cervical discectomy. This procedure is done in conjunction with a cervical spinal fusion to maintain spinal stability where the disc was removed.


Another way to do a discectomy is through the back of the neck, called ‘posterior cervical decompression or microdiscectomy, where only part of the disc is removed and no spinal fusion is needed. The location of the cervical disc herniation must be accessible with minimal manipulation of the spinal cord. If the location is too central, it is safer to use the ACDF approach.


Cervical artificial disc replacement (ADR)


A somewhat newer option is discectomy with artificial disc replacement. This surgery involves removal of the damaged disc and replacement with an artificial disc, rather than a fusion.


Other Surgical Options for Spinal Decompression


Sometimes other surgical options may be used instead of or in conjunction with a discectomy to help relieve signs and symptoms related to cervical nerve root or spinal cord compression.

  • Posterior cervical laminectomy is done through the back of the neck and involves the removal of a lamina, which is the back part of a vertebra. A potential advantage to this surgery is that more flexibility in the neck can be retained if a spinal fusion can be avoided. Sometimes a spinal fusion is still done in conjunction with laminectomy.

  • Posterior cervical laminoplasty is similar to the laminectomy, except the lamina is not completely removed. Rather the lamina is cut and restructured to make more space in the spinal canal.

  • Posterior cervical foraminotomy is performed through the back of the neck and a small part of the foramen is removed. If a nerve is irritated by a herniated disc, the surgeon might remove part of the disc. If a nerve is irritated by a bone spur, the surgeon chisels away that bone spur. No spinal fusion is needed.

  • Anterior cervical corpectomy is similar to anterior cervical discectomy, except that it involves the removal of at least one vertebral body (the cylindrical bone at the front of a vertebra) along with the adjacent discs above and below that vertebra. After the removal, a bone graft and/or cage is placed to fill the space and set up a favourable environment for the bones to fuse together into one solid segment. This surgery is rarely done, but it may be an option for spinal cord compression at multiple spinal levels.

Similar to the discussion about posterior cervical discectomy, the location of bone spur must be approachable without significant manipulation of the spinal cord.

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