Neck pain, pain in the back of your neck up to the base of the skull and down to between your upper shoulder blades, is another common pain for all of us to experience sometime in our lives. It most commonly is the result of some single movement we make or after doing some repetitive activity that requires repeated turning of the neck or looking overhead. It can also occur upon awakening (you slept “wrong”) or just begin as the day wears on. The same structures that cause pain in the low back also are the culprits in the neck, namely the muscles, ligaments, joints or discs. This pain frequently spreads toward one or both shoulders and makes neck movement painful. Once again, the amount of pain doesn’t signify the danger level of the problem.
a. Type of Pain
Whether your pain is sharp, stabbing, deep and boring, burning, throbbing or with some other unique characteristic, the type of pain you have tells us nothing about the cause of the pain. Little anatomical problems can cause a lot of pain, a huge ruptured disc can hurt very little and no one type of problem causes a specific kind of pain.
b. Neck Strain
The most common cause of neck (cervical) pain is a strain of a muscle, ligament, joint or a disc. You can’t strain a cervical vertebra which is a very strong bone that only hurts if it is fractured or has a growth in it (very rare). With that in mind, most neck pain comes on after you have done something active such as keeping your neck turned sharply to one side or the other for a considerable period of time or perform some activity requiring repetitive turning or extension (looking up) of the neck. When you can identify the activity that started the whole thing, you can pretty much be sure you have strained a muscle, joint, disc or ligament.
These strains almost always heal if you give them a little time, reduce your activity some and take pain pills (acetametaphen-Tylenol) and anti-inflammatories (ibufrofen or naproxin-Motrin, Aleve, Advil) which are available at the grocery store or pharmacy without a prescription. Hot baths, Jacuzzi, massage, heating pads, ice packs and stuff you rub on your neck are all OK but probably don’t get directly at the strain itself. They can make you feel less pain and that is just fine. Exercises don’t make much sense with a recent strain since making an unhappy part of you work harder isn’t likely to speed healing.
Let’s be very clear about strains. Though they are not serious in the big picture of bad things that can happen to your body, that does not mean they only hurt a little. They can hurt a lot. They can make it very painful to turn your neck or change its position.
But severity of pain does not equal danger when it comes to neck strains and if you can tough it out for a few days, improvement usually occurs. If decreased activity, over-the-counter medications and one of those spongy neck collars available at the pharmacy don’t cut it for you and you are in too much pain, then that is why we have doctors.
Give one a call and maybe you will be advised to come in for an examination or maybe just be given a stronger prescription medication. Either approach is OK to start with but if the pain hasn’t decreased significantly in a week, then get thee to a doc. Not that you are in trouble, but by then it is time to have an exam, maybe a regular X-ray of the neck and some physical therapy, prescription medication and a neck brace.
c. “Whiplash”
We will probably never know who really coined this term but it is a fairly accurate description of what happens to the neck when the body is accelerated or decelerated and the head and neck are free to move and do so but in a delayed fashion causing a whipping of the neck. These events, most frequently experienced in motor vehicle collisions, often stretch or sprain the muscles or ligaments of the spine and can injure the disc as well. This condition is treated as neck strain addressed in b. above.
d. Neck pain without a strain
If your neck pain begins without a clear relationship to something you did, it probably is still due to a disc or joint problem as these structures can decide to start hurting merely by normal daily use or even simply after a normal nights sleep. The onset of neck pain without some particular activity isn’t usually due to a muscle or ligament problem as those structures just don’t begin to hurt due to normal use. Although stress (anxiety, tension) can cause a lot of symptoms, it usually is not a cause for a lot of neck symptoms other than maybe a little tightness or mild dull ache which is usually relieved by stretching and a good nights sleep.
You are probably not in any danger but neck pain coming on without a pretty good relationship to an activity is where we have to now consider such things as a tumor or bone infection. Doctors can be particularly helpful here as X-rays and scans usually tell the story and guide further evaluation and treatment. If your non-activity related neck pain persists for over a week, see your doctor. If the pain is accompanied by arm or leg weakness or numbness, see your doctor quickly or go to an urgent care center or ER.
d. Neck pain due to a fall
Unlike the lumbar and thoracic vertebrae which are not often fractured by a minor fall, the neck vertebrae can be significantly injured by falls of almost any severity. The cervical vertebrae are not large and are not supported by a lot of thick surrounding structures like the rest of the spine so fractures can occur without huge forces being applied. Also, neck fractures are often more serious because they can be unstable (tend to allow the cervical spine to misalign or “slip”) which can threaten the cervical nerves and spinal cord. Thus, if you take a pretty good fall and have neck pain and particularly if you also have arm or leg weakness or numbness, go to the urgent care center (for neck pain only) or to the ER or call 911 (if arm and/or leg symptoms are also present).
e. Neck pain due to a disc injury
Whether your neck pain started after a strain, blow or whiplash, it could be due to a disc injury rather than a “soft tissue” injury such as a stained ligament or muscle. It is difficult to know what the cause of neck pain is when there is just pain in the neck region without radiation into the arm and most such symptoms are treated as though it is a strain of the soft tissues. If symptoms persist for a month or two without much response to time, therapy and medications, a disc injury may be present and getting a neck scan at that point makes sense since if a disc problem is seen, additional treatment specific to discs may be in order. If the neck pain radiates down the arm into the hand, particularly if it is accompanied by tingling, numbness or weakness, a disc herniation is likely and an early scan or specialist consultation is warranted.
Just to confound us, cervical discs can herniate without any identifiable injury whatsoever so if your neck pain begins without a straining or traumatic incident, it most likely is a disc problem and consultation should be sought after a week or two of symptom onset.