A pain in the neck is just the same as a pain anywhere else in the rest of your back: the causes vary. It could be a result of a sprain or strain. Just like back injuries, neck injuries usually go away over time, eased using over-the-counter and at-home treatments. However, pain—no matter where it is—can also be a sign of something more serious which requires medical attention.
As neck pain accompany back problems, it’s a good idea to understand a little bit about the neck, what kind of activities can cause problems, and the treatment options which you can use. Lots of people who suffer lower back pain also suffer neck pain as the same disease process can occur in both. In the same way that hypertension influences your entire body; degenerative disc disease can damage your entire spine, which, obviously, includes your neck.
However, there are also some problems which only affect your neck. Understanding some basic neck anatomy will be beneficial. As you’ll see, this area of your spine shares similarities with its lower vertebral neighbours, but there are also important differences between them.
Your neck is the upper region of your spine; it is known as the cervical spine. The cervical spine comprises of seven vertebrae, numbered C1 to C7. C1 is the very top vertebra; C7 the last. C7 can often be felt with your hand as it tends to stick out a little bit. Your neck quite a challenge, first, it needs to hold up your head, which on average weighs 8 pounds, and can weigh as much as 11 pounds! Walk around with a bowling ball all day and you’ll get an idea of the muscular exertion required. Just like the rest of the spine, the cervical spine is also required to protect your spinal cord.
An issue with the cervical vertebrae can sometimes be the cause of lower back pain. The culprit is commonly a poor head position. With poor posture, your head can cantilever out over your shoulders and result in added strain to your middle and lower back. It’s simple body mechanics. If you hold a weight closer to your body, there’s better leverage and joint support. Lengthen out your arms away from you and try to life the weight again, it’ll be far harder and more stressful on your joints. Consider the strain that holding a bowling ball out at arm’s length would cause. You probably wouldn’t be able to do it for long.
The cervical vertebrae are exposed to the same traumas as the rest of the spine, such as joint deterioration, bulging discs, and muscle/ligament strain and sprain.
In contrast to the vertebrae in the rest of the spine, the cervical vertebrae specifically intended to allow your head to move in lots of directions: up and down, side to side, and rotating. This makes the neck a very complex piece of machinery, but all this flexibility can make it vulnerable to injury.
The Atlas and the Axis
There are two vertebrae located in the cervical spine which unlike the others and they have special names. C1 is also called the Atlas, and, like the Greek god who held up the weight of the world, C1 slots into your skull, holding up your head. The atlas is shaped in a certain way so that it can interact with the groove in your skull, allowing you to nod your head up and down.
The Axis, or C2, is shaped to permit the side to side movement that you do to signify “no”. Importantly, there is no intervertebral disc between C1 these two vertebrae. These joints notoriously enlarge and become painful in patients suffering from rheumatoid arthritis, but, remarkably, they are not usually affected by osteoarthritis. However, they are commonly injured in severe trauma incidents, such as motor vehicle accidents.
Discs and Facet Joints
Intervertebral discs are present between the rest of the cervical spine, C2 to C7, to act like a cushion. Just like elsewhere in the spine, these discs can bulge and press on nerves, causing pain. The facet joints which are cushioned by these discs have lots of nerve endings, and so if something goes wrong, can result in a tremendous amount of pain. Cervical facet joints can deteriorate from ailments such as arthritis, or they can be damaged if the head is suddenly moved forward and back such as in whiplash.
The majority of patients suffering from degenerative disc disease of the lumbar spine usually have some degree of the disease in the cervical spine. This is because, as we’ve mentioned, degenerative disc disease isn’t selective—it can affect any disc in the spine.
Muscles, Tendons, and Ligaments
The cervical spine is strengthened by a complicated network of ligaments, tendons, and muscles. Due to its high degree of mobility and flexibility, it’s quite easy to strain these muscles, which is why posture and ergonomics (you can find out more here) are particularly important.
Tendons link muscles to bone and ligaments link bone to bone. There are tendons and ligaments which stabilize the cervical spine. Either one or both of these types of tissue can be damaged, causing pain. Long bands of both ligaments and tendons stretch from the base of the skull all the way down to the tailbone.
These bands are the targets of cranio-sacral massage. They also allow us to understand why lower back pain can spread tension to your neck and cause headaches. It’s all linked. This interconnection is another reason why patients who have neck pain often have some degree of lower back pain too. While we sometimes treat the body as separate parts to be “fixed,” keep in mind that the body is interrelated.
Cranio-sacral massage is a soothing massage technique which promotes the movement of the spinal cord. This fluid runs the entire length of your spine, all the way from your head to your tailbone area (sacrum). The cranio-sacral theory believes that if there are blockages, the central nervous system will be out of balance. Consequences of which include muscle and joint pain in addition to emotional problems. Massage therapists, physical therapists, and chiropractors are the main health-care professionals who conduct this technique. This treatment is covered by some health insurance policies, but not all.
Cervical Spondylotic Myelopathy
This condition is similar to cauda equina syndrome, essentially it’s when the bundle of nerves in lumbar region of the spine is damaged, pain, numbness, weakness, and loss of function in the lower part of the body results.
Cervical spondylotic myelopathy (CSM) is another serious condition which occurs in the upper spine. The spinal canal reduces in size, causing the nerves to become compressed. It can happen for a number of different reasons, such as degenerative disc disease, bone spurs, or changes in ligaments. Ligaments can bulge and perhaps thicken to narrow the spinal canal, or can weaken, allowing the bones to move. Nerve compression in the upper region of the spine affects strength and sensation in arms, trunk, and legs, and causes issues with gait, balance, dexterity, coordination, and fine motor skills. It can even alter breathing, as the nerves which travel in the spinal cord at C3 to C5 control breathing.
Similar to the lower back, some people are at more risk to injury of the cervical spine because they are born with narrower spinal canals. The aging process can narrow the spinal canal further, causing compression. This myelopathy can require decompression if patients become weak, falls frequently, or loses function.
The choices for decompression are the same as for other parts of the spine. There is anterior (surgical entry from the front of the body) decompression via discectomy and fusion, or posterior (surgical entry from the back area of the body) decompression through procedures including laminectomy or laminoplasty.
Radicular Arm Pain
This is similar to sciatica, but in the cervical spine. The spinal nerves which leave the cervical vertebra control the upper half of the body. If the nerves become compressed, it can feel like painful electrical shocks shooting down your arm and into your hands and fingers. This condition results in numbness, weakness, and/or tingling sensations. Typically just one arm is affected, but symptoms can occur in both. Additionally, moving the head from side to side can cause pain with this condition.
The most common source of radicular arm pain is a bulging disc. Other causes include bone spurs or, in rare cases, a tumour or infection. Electromyography and nerve conduction velocity (EMG/NCV) tests provide information to conclude which nerve is affected.
Lots of people improve with conservative treatments, such as anti-inflammatory and pain meds, and a soft cervical collar. Steroid and nerve-block injections can be used for in cases where the pain continues. If those measures don’t work, surgery may be the next logical step.
If all else fails and pain continues, surgery provides relief for lots of patients. Neck surgery is usually more successful than lower back surgery, for a number of reasons. Firstly, whilst the head is relatively heavy, overall, the forces on the neck are far less than that on the lower back.
Secondly, the neck is far easier to reach surgically. Surgeons can expose the neck discs with much less difficulty and cause a lot less damage to the surrounding tissues, which also makes recovery from neck surgery a lot less painful. As a result, patient satisfaction is greater. The lower back is affected by pain generators such as the hips, sacroiliac (SI) joint, and coccyx. In the neck, the shoulders are too far away to cause any serious issues.
The available surgical options include the following:
- Artificial disc: This procedure involves replacing the natural disc with an artificial one. Results are generally more successful in the cervical spine as opposed to the lumbar spine. It’s also safer as the area is easier to get to if more surgery is required. Complications include hoarseness, problems swallowing, and persistent pain.
- Discectomy: This refers to removing most or the whole intervertebral disc. The surgeon makes an incision on the front of the neck to access the disc. Fusion accompanies the majority of discectomies as there is very little disc and usually a lot of it has to be removed. Without fusion, there is a larger rate of nerve-root compression when the bones drop into the empty space previously taken by the disc.
- Posterior cervical fusion: In this procedure, the surgeon goes through the back (posterior) of the neck to fuse two or more vertebrae together. Hardware is utilised in order to immobilize the neck. The surgery is most commonly used for neck pain resulting from movement which has caused the vertebral bones to become unstable.
- Cervical laminectomy: Just like the lumbar spine surgical procedure, a laminectomy is a procedure in which most of the bone known as the lamina is removed. This releases the pressure on the nerves which are causing pain.
- Cervical laminoplasty: If there is compression on several levels of the neck, a laminoplasty is a surgical option. The surgeon works from the back of the neck, but instead of removing the bone (lamina), they detach and elevate the bone on one side to prop open the canal. This increases the area for the spinal cord.
More Distinctions in the Cervical Spine
The cervical spine is differs from the rest of the spine in a number of ways:
- Spine disease in this area is a common cause of headaches.
- Degenerative discs in the neck often result in more bone spurs.
- As the intervertebral discs are smaller, fusion is more common in the neck.
- Heat and ice treatments are more successful as there is less tissue to heat or cool and you are closer to the muscle and joints which are causing the pain.
- Although the whole body can be thrust forward in a rear-end collision, the neck is more susceptible to whiplash because the head is a heavy weight on a small fulcrum.
- The neck is home to a more complex amount of of muscles than the rest of the spine.
Neck Pain Causes and Treatments
Plenty of us have woken up with a crick in our necks or even headaches. Sleeping in a bad position, such as on a train during a long commute home can cause this. Also, using too many pillows or unsupportive pillows can cause neck pain upon waking.
Specially made cervical pillows mould to the natural curves of your neck and correctly support it whilst you sleep. If you put your hand under your head or if your head sinks to the bed as soon as you put it on your pillow, it’s could be time to consider a more supportive option.
Supporting a phone to your ear using your shoulder is a sure way to cause neck strain. Doing it with a small cell phone can make this problem worse. Lots of hands-free phone devices are available on the market. This by itself could eliminate a lot of your neck pain. We highly recommend the small investment for home and cell phone use.
Computer workers, surgeons, and jewellery repair people are definitely at risk of muscular neck strains. Activities such as these cause your head to jut forwards, putting tremendous strain on your muscles, causing them to become tight. The trapezius muscle in particular is often the one which tenses up. Making your workspace more ergonomic (you can find out more information here) can help and even eradicate this type of neck pain.
The trapezius is a large muscle which fans out from the back of your skull and reaches down to your shoulders. It is the largest of the extensor muscles (those which permit backward movement of the head). When you massage someone and feel small knots underneath your fingers, it’s most likely in the trapezius muscle.
Your neck can become sore as a result of overhead lifting or reaching, for instance, painting a ceiling or lifting boxes onto high shelves. Painters, drywall installers, and mural artists are particularly susceptible to neck pain. Massage can help relieve this type of pain as it’s usually muscular in nature.
Lower your risk of spinal-cord injury by correctly adjusting the height of the head rest in your car. It is advised that so called weekend warriors who play football or drive race cars should use a neck brace. Another way to alleviate neck pain is by doing some simple stretches. You can simply tilt your ear toward your shoulder (do not raise your shoulder) to get some fast relief. Similarly, if you gently move your chin toward your chest, you’ll feel a stretch all the way down between your shoulder blades.
When doing neck stretches, always do them in an isometric fashion. This means you’re not attempting to see how far you can push your head forward. You’re just trying to push against some small resistance to improve muscle tone. It’s never a good idea to see how far you can make it go. Small range-of-motion exercises are the idea.