Causes and Diagnosis of Neck Pain

A sudden-onset (acute) bout of neck pain is common. Two out of three of us will have neck pain at some time in our lives. In most cases it is not due to a serious disease or neck problem and often the exact cause for the pain is not clear. This is called 'nonspecific neck pain'. Most are probably due to minor sprains or bad posture. Full recovery occurs in most cases. The usual advice is to keep the neck active. Painkillers are helpful until the pain eases. Persistent (chronic) pain develops in some cases, and further treatment may then be needed.

Understanding the neck

The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae.

• The first two are slightly different to the rest, as they attach the spine to the skull and allow the head to turn from side to side.
• The lower five cervical vertebrae are roughly cylindrical in shape - a bit like small tin cans - with bony projections.

The sides of the vertebrae are linked by small facet joints.

Between each of the vertebrae is a 'disc'. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act as 'shock absorbers' and allow the spine to be flexible.

Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways. (The muscles and most ligaments are not shown in the diagram, for clarity.)

The spinal cord, which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear (posterior) part of the brain.

What are the types and causes of neck pain?

Neck pain is common. About 2 in 3 people develop a bout of neck pain at some time in their lives. One survey done in the UK found that, of adults aged 45-75 years, about 1 in 4 women and about 1 in 5 men had current neck pain. Types and causes of neck pain include:

Nonspecific neck pain

This is the most common type. This is sometimes called 'simple' or 'mechanical' neck pain. Often the exact cause or origin of the pain is not known. It may include minor strains and sprains to muscles or ligaments in the neck. Bad posture may also be a contributing factor in some cases. For example, neck pain is more common in people who spend much of their working day at a desk, with a 'bent-forward' posture.

A 'whiplash' jolt to the neck

This is most commonly due to an accident involving a vehicle, such as a car crash. It can cause neck pain. See separate leaflet called Whiplash Neck Sprain for details.

Sudden-onset (acute) torticollis

This is sometimes called 'wry neck'. A torticollis is when the head becomes twisted to one side and it is very painful to move the head back straight. The cause of acute primary torticollis is often not known.

However, it may be due to a minor strain or sprain to a muscle or ligament in the neck. Some cases may be due to certain muscles of the neck being exposed to cold ('sleeping in a draught'). It is common for people to go to bed feeling fine and to wake up the next morning with an acute torticollis. The pain usually eases and clears away over a few days without any treatment.

How can I tell if the pain is due to a more serious cause?

A doctor's assessment and examination can usually determine that a bout of neck pain is nonspecific and not due to a more serious cause. The following are the sort of symptoms that may indicate a more serious problem:

• If neck pain develops when you are ill with other problems such as rheumatoid arthritis, AIDS, or cancer.
• If the pain becomes progressively worse.
• If some function of an arm is affected. For example, weakness or clumsiness of a hand or arm, or persistent loss of feeling (numbness). (As mentioned, some pins and needles may occur with nonspecific neck pain. However, this is mild and usually goes within four weeks.)
• If you feel generally unwell and have 'general' symptoms such as weight loss or a high temperature (fever).
• If the neck bones (vertebrae) are very tender (which may indicate a bone problem).
• If you develop any problems with walking or with passing urine.This may indicate problems with pressure on the spinal cord

Some other treatments which may be advised include:

 

• A good posture may help. Check that your sitting position at work or at the computer is not poor. (That is, not with your head flexed forward with a stooped back.) Sit upright. Yoga, pilates, and the Alexander Technique all improve neck posture, but their value in treating neck pain is uncertain.
• A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.
• Physiotherapy:

1. Various treatments may be advised by a physiotherapist. These include traction, heat, cold, manipulation, etc. The value of each of these treatments is uncertain, as the results of research studies looking at which treatments work best can be conflicting.
2. However, what is often most helpful is the advice a physiotherapist can give on neck exercises to do at home.
3. A common situation is for a doctor to advise on painkillers and gentle neck exercises. If symptoms do not improve over a week or so, you may then be referred to a physiotherapist to help with pain relief and for advice on specific neck exercises.

Treatment may vary and you should go back to see a doctor:

• If the pain becomes worse.
• If the pain persists beyond 4-6 weeks.
• If other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in part of an arm or hand, as described previously.

Other pain-relieving techniques may be tried if the pain becomes persistent (chronic). A pain management programme may be offered to help you control and live with your pain. Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated.