The neck is an important part of the human body as it connects the head to the torso. It encompasses many structures that are responsible for swallowing, breathing, speaking, circulatory and lymphatic inflow, and supporting the brain and Cervical Spine.
The Anatomy and Physiology of the Neck.
Just like any other system in the body, the Neck or Cervical Spine is a network of bones, joints, muscles, tissues, nerves, and ligaments that are interconnected to each other and work in collaboration to support the head and allow an extensive range of movement. There are seven vertebrae from C1-C7 that encircle the spinal cord. In between the vertebrae, there are intervertebral discs that connect the vertebrae and give them the flexibility of motion, act as shock absorbers and protect the nerves that pass down the center of the spine and the intervertebral discs. The facet joints at the sides of the vertebrae allow limited motion and also restrict the range of movement. There are more than 20 muscles connected in the neck that work together to help support the head’s upright position and support movements of the head, neck, jaw, upper back, and shoulders. All these structures in the neck work in unison to perform a variety of functions of the neck.
What Is Neck Pain?
Neck pain has become one of the most common problems for people of all ages and is quite often seen in old as well as young nowadays. It can start as a continuous, dull pain or it can be very excruciating, stabbing pain restricting a person from carrying on with his daily activities.
Neck pain is the fourth leading cause of disability worldwide. With a lifetime prevalence of 71%, most adults can expect to experience an attack at some point during their lifetime. (1)
During any six months, 54% of adults suffer from neck pain. (1)
According to an article published in PUBMED, the prevalence of neck pain is generally higher in women, higher in high-income countries compared with low-income to middle-income countries, and higher in urban areas compared with rural areas. (2)
Like with any other body pain, it is very important to find out the nature and underlying cause of the pain, the time when it started and the severity, and also if it started after a particular incident so it can be treated appropriately.
Neck pain can occur from an injury or disease of any or multiple tissues, nerves, ligaments, muscles, bones, or joints.
What Causes Neck Pain?
Neck Pain can either be acute or chronic. Acute pain usually results from a tear due to a sudden jerk or injury to the ligament or muscle. If the pain doesn’t get resolved and is constant or on and off and has been there for more than 3 months, it is termed chronic.
Several causes lead to neck pain but one thing that shows a strong association to increasing incidence of neck pain in adults and youth equally is the increased use of mobile and laptop habits where a person tends to bend over and hunch the shoulders while using these gadgets. It is very important to find out if your neck pain is caused by an underlying disorder or it is simply due to reasons that can be treated by simple methods.
Bad posture:
A person can easily forget about keeping his neck and overall body in an erect and proper posture when he spends hours on his mobile or in front of a television.
Overuse of the neck muscles:
Traumatic overstretching of the neck muscles can also be caused by chronic improper posture and ultimately lead to pain. Overuse of the neck muscles and keeping it in one position such as working on a computer/mobile or driving for long hours can also lead to neck pain.
Muscle Strain:
A tear in the ligament or neck muscle due to a jerky movement during exercise or an accident can also cause moderate to severe neck pain. Sleeping in a position that causes too much stress on the neck muscles can also make the muscles sore and cause pain. Using a very hard or high pillow or a very flat one while sleeping can also aggravate the pain.
Injury and Trauma:
Neck Pain can be caused by slight or severe injury to the neck muscle. Whiplash is a neck injury that is caused when your car has a head-on collision with another car, physical abuse, or jerky movements such as during a roller coaster ride. It can start immediately or you might feel it days after the incident. The neck pain may or not be associated with shoulders pain, headache, dizziness, hearing, vision, or memory problems.
Diseases such as Degeneration or Herniation of the discs or joints
The discs and facet joints can undergo a tear or injury and hence degenerate or herniate, as a result of which it can compress a nerve root and hence cause pain and numbness and reduced movement.
Other diseases:
Other diseases such as Arthritis, Cervical Stenosis, and Torticollis can also cause neck pain
What Are Symptoms and Signs For Neck Pain?
- Neck muscle spasm and tightness
- Muscle inflammation and swelling
- Decreased mobility in any one or multiple directions
- Headache and neck pain alone or radiating to the shoulders and/or arms
- Neck Pain that worsens in certain positions
- Neck Pain in Static position
What Are The Diagnosis For Neck Pain?
Your Family Physician will usually take a detailed history and then confirm with a physical examination. He will assess the degree of your muscle weakness, numbness, and range of movement. He might give you a treatment regimen or look at the severity of the symptoms and the duration of the pain, might send you for a couple of tests, and then depending upon the results, might refer you to a Physiotherapist, Neurologist, Orthopedic Surgeon, Rheumatologist.
The tests that your doctor might request to assess your Neck Pain.
- X-rays can detect the bony spurs or other degenerative changes that might be causing nerve compression and causing you pain and discomfort.
- CT scans combined with X-ray images will give a detailed picture to your doctor about the internal structures of your neck so that he can decide how to deal with the pain accordingly.
- MRI is a procedure to take detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord by using Radio waves and a powerful Magnetic field to find out the underlying disease.
- Electromyography is another procedure to determine that the nerves are functioning properly. It is performed by inserting fine needles in the muscle to measure the speed of nerve conduction
What Are Treatment For Neck Pain?
Neck Pain can disturb daily activities for an individual and just like any other pain, if left untreated, it can lead to stress and other problems related to absence from work, less productivity at work, the financial burden on the families, and the caregivers, economic burden on Healthcare and the Government. Treating Neck Pain is very important so that you can go back to living a healthy and pain-free life. It is always better to seek professional help if you feel that the occurrence of neck pain is related to a recent serious incident such as an accident or injury. However, if you don’t find any other cause, you can try to do the following remedies to ease the pain. The following activities will not require too much time and effort but they will have a long-lasting impact on the pain and even if you continue doing that, it will keep the pain away.
Improving your posture:
Improving your posture alone can alleviate your pain and stiffness to a larger extent if it isn’t caused by an underlying condition and the only problem causing the neck pain is either improper posture or overuse of the neck muscles. Be mindful of your posture throughout the day, and keep reminding yourself to correct your posture.
Neck Exercises and Stretching:
Exercises that are recommended for neck pain reduce stiffness, improve muscle flexibility and also strengthen the neck muscles and hence reduce the pain. However, certain exercises that are not allowed during pain should be avoided. Always start with mild stretching and move onto exercises after discussing it with your Trainer/Physiotherapist/Doctor. Do not do any jerky movements and immediately stop if you experience pain or discomfort. Always remember exercises should not cause you pain.
Take breaks during your working hours:
Taking breaks while working on your computer or mobile is very important to help your muscles relax. Take a 5-minute break to stretch or do a quick exercise to avoid any kind of pain and stiffness. Roll your neck frontward and backward in a circular motion, also moving it up and down and front and back a few times after every 40-50 minutes. These movements and slight stretching will keep your neck muscles flexible and relaxed during long office hours.
Cold Packs/Heat Packs:
Many cold packs are available at the pharmacies will be kept in the freezer and used when needed. If you don’t have the ready-made ice pack bags, you can even wrap ice inside a towel and apply it to the affected area for 10 minutes, several times a day. You can alternate this with heat packs as well.
OTC Pain killers:
Usually, acute neck pain can be relieved by taking over-the-counter pain killers along with other at-home remedies. A pain rub can also help in reducing acute pain.
Neck Collar:
Neck Collars or neck braces will help your neck supported usually after an injury or a surgical intervention. They help in immobilizing the neck. Depending upon the severity and nature of the pain, you can wear a soft or a rigid collar as recommended by a professional. You can wear it continuously for a week and then reduce its usage gradually.
Physical therapy:
If your neck pain is not associated with any underlying disease and you have tried almost everything at home and the pain is still restricting you from performing your normal daily activities, then it is important to visit a physiotherapist to get rid of the pain. A single visit might not solve your issue but you will feel an improvement in your pain and range of movement after 1-2 visits. After assessing your level of pain and comfort, your physiotherapist will recommend a specific number of sittings for you. He will also suggest a postural correction and also safe neck exercises that you can keep doing at home in-between visits.
“According to a new study by Stanford University School of Medicine and the Duke University School of Medicine, patients with neck, shoulder, low back or knee pain who underwent physical therapy soon after being diagnosed, were approximately 7 to 16 percent less likely to use opioids in the following months”. (3)
Massage:
If not done by a trained massage therapist, the massage can have harmful effects than reducing your pain. A proper massage can relax and improve the flexibility of the muscles, improve the range of motion, alleviate stress, and promote a relaxed mind and body which in turn help in reducing your pain.
Acupuncture:
Acupuncture is a procedure where fine needles are inserted to stimulate certain points in your body to relieve chronic neck pain. There are some studies where people have found acupuncture to help provide short-term pain relief if done by a licensed acupuncturist but its long-term effects are still to be discovered.
Transcutaneous Electrical Nerve Stimulator (TENS):
A transcutaneous electrical nerve stimulator (TENS) sends electrical pulses by low voltage electrodes placed on your skin. They are placed at areas surrounding or on the nerves where you experience pain. There are two theories on which TENS might work, one by blocking the pain signals and the other by releasing Endorphins in the body. The studies are still going on to assess the exact effect of TENS on Pain.
References:
1.Côté, Pierre & McIntosh, Greg & Hall, Hamilton & Alleyne, Julia. (2015). A Pain in the Neck SPINE HEALTH. Journal of Current Clinical Care. 5. 24-34.
2.Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92. doi: 10.1016/j.berh.2011.01.019. PMID: 21665126.
3.Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy with Long-term Opioid Use Among Opioid-Naive Patients with Musculoskeletal Pain. JAMA Netw Open. 2018;1(8):e185909. doi:10.1001/jamanetwork open.2018.5909