Neck Pain Causes, Types, Symptoms, Diagnosis, and Treatment

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The Universal Guide to Neck Pain: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Neck Pain?   |    Neck Anatomy   |    Causes   |    Types   |    Symptoms   |    Diagnosis   |    Nonsurgical Treatments  |    Surgery Options    |    Living With   |    Sources

A pain-free neck is a lot like the carefree days of our youth — we don’t appreciate it ‘til its gone. Neck pain can make life feel pretty unbearable and affect your social life, family time, hobbies and even work productivity.

If you’re reading this, chances are you’re familiar with neck pain. Whether you’ve just woken up with a whopper of a crick in your neck, sustained an injury or have been dealing with chronic neck pain, this handy guide can help you understand the anatomy of your cervical spine, different causes and types of neck pain, and learn more about the common treatments for neck pain.


Female tailor holding her neck in painAlthough neck pain is commonly caused by strain, prolonged pain may be an indication of something more serious. Photo Source: 123RF.com.

What is Neck Pain?

Neck pain is the worst kind of overachiever. It's so common that it's the fourth-leading cause of disability globally, following ischemic heart disease, cerebrovascular disease, and lower respiratory infection. Nearly 30 percent experience it each year.

And it's not always centralized in the neck. It can radiate across your whole upper body, affecting your shoulders, arms and chest and can even cause headaches. Living with neck pain can be miserable, making it hard to focus and get through the day.

Neck pain can be debilitating and may interfere with day-to-day life, including your ability to sleep, feel productive, and enjoy time with friends and family. And it affects more than just your physical body. Studies have shown that chronic pain can have an impact on a person’s mental health; up to 85 percent of patients with chronic pain are affected by severe depression.

What Do I Need to Know About Neck Anatomy?

You don’t need to memorize the physiology and anatomy of your neck to improve its function and reduce pain, but it’s helpful to have a general understanding of your cervical spine.

Neck mobility is matchless. Although you won’t get any Exorcist-style head spinning, it is capable of moving the head in many directions: 90° of flexion (forward motion), 90° of extension (backward motion), 180° of rotation (side to side), and almost 120° of tilt to either shoulder.

But all that mobility comes at the cost of complexity. First you’ve got your seven vertebrae (C1 through C7), each cushioned by an intervertebral disc and connected by facet joints. There are also 32 muscles, plus the tendons that attach them to bones, that help move and stabilize the neck, as well as a number of ligaments attaching bones to each other. That’s a lot of action in a comparatively small area.  

What Are Common Neck Pain Causes?

“Neck pain tends to peak in middle age, and is slightly more common in women and in patients with a family history of neck pain,” says NYC-based interventional pain physician and physiatrist, Benjamin Bonte, MD. “Smokers, patients with psychological diagnoses such as depression and anxiety, and patients with a sedentary lifestyle are also more at risk.”

Neck pain is most common in people over the age of 50. But beyond good old aging, the causes of neck pain are as varied as the list is long. Speaking of – here’s a list of some of the more common causes of neck pain:

  • Injury and Accidents:
    • Whiplash is a common neck injury sustained when the head is forced to move backward and/or forward beyond the normal range of motion. The unnatural and rapid movement of the neck affects the muscles and ligaments, which tighten and contract. This creates muscle fatigue resulting in pain and stiffness. Whiplash is most commonly sustained due to a car accident, but can also result from traumas such as a fall or a sports accident.
    • Nerve Compression: “When a [cervical] nerve becomes compressed, it can cause [radiating]pain that moves up into the head, behind the eyes, into the jaw, down the arms,” says Dr. Penhollow. Herniated discs are the most common cause of nerve compression and spinal stenosis (crowding of the spinal canal), but bone spurs can also compress nerves.
  • Health Conditions:
    • Osteoarthritis: Called spondylosis when it’s in spinal facet joints—is the most common form of arthritis. It’s caused by wear and tear and aging, and can create osteophytes (bone spurs) that crowd the spinal canal and compress nerve roots in the neck.
    • Other Forms of Arthritis: Many types of arthritis, particularly the inflammatory forms like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis, can affect the cervical spine. Chronic inflammation in the neck causes damage of the joints that allow movement in the neck.
    • Other Disease Processes: Although neck pain is most commonly caused by strain, prolonged pain and/or neurologic deficit may be an indication of something more serious. These symptoms should not be ignored. Spinal infection, spinal cord compression, tumor, fracture, and other disorders can occur. If you have sustained a head injury, your neck has likely been affected, too. Seek medical attention promptly.
  • Lifestyle Issues:
    • Extra weight: Extra pounds put undue stress on the spine and weak abdominal muscles can fail to support it, both of which may disrupt the spine's balance and cause the neck to bend forward to compensate.
    • Stress: If you’re stressed—and who isn’t?—you may be clenching the muscles that move your neck without realizing it, potentially leading to a stiff, sore neck.
    • Poor Posture: Prolonged poor posture—looking at you, excessive smartphone usage—can lead to neck pain. “Clenched teeth, improper lifting, prolonged periods of sitting at the computer, and reading in bed may lead to neck pain,” says Scottsdale, AZ-based anesthesiologist and pain specialist Tammy Penhollow, DO.

What are Some Different Types of Neck Pain?

Types of Neck PainThe most common types of neck pain.

There are different neck pain profiles. Some people experience only one type, while others experience a combination.

Neuropathic neck pain: Stemming from the nerves or nerve roots in the cervical spine,  neuropathic neck pain could result from conditions such as a herniated disc that presses against a nearby nerve, or other causes of nerve compression.

Mechanical neck pain: This pain stems from the spine and its supporting structures (e.g., muscles, ligaments, bones, or cartilage). Typically, mechanical pain is caused by poor posture, neck strain caused by work or sporting/physical activities, and even stress.

Central neuropathic pain: Most commonly a result of a stroke, spinal cord injury, or multiple sclerosis. It may also be a result of injury to the central nervous system, caused by traumatic injury to the brain/spinal cord or infection (e.g., abscess, encephalitis, myelitis)

What Are Neck Pain Symptoms?

Other than neck pain itself, you may notice other symptoms that accompany the pain. Some of the more common symptoms of neck pain include:

  • Neck muscle stiffness: Tight muscles in the back of the head or a “muscle knot” in the neck. This may spread to your shoulders, upper back and arms.
  • Headache: Experiencing headaches in the occipital region (back of the scalp) is very common but can also extend to the top of the head, causing "tension" headaches from muscle tightness.
  • Pain and/or weakness that shoots down the arm: This may be caused by muscle fatigue or nerve compression. Very often along specific nerve roots (i.e., vertebrae C6, which extends to the thumb and index finger and vertebrae C5, which extends to the deltoids and bicep).
  • Loss of neck mobility: Inability to turn your head and neck easily.
  • Paraesthesias: A sensation of numbness and/or tingling in the arms, most often caused by nerve compression at the level of the spine, or as the branching nerves pass through tight, inflamed muscles.

If your neck pain is caused by nerve compression, you may experience the following symptoms:

  • Weakness in the shoulder, arm or hand
  • A feeling of numbness or “pins and needles” in arm, fingers or hand
  •  Sharp, burning pain near the pinched nerve that radiates outward

Some conditions, such as coronary artery disease (angina) or even lung tumors may mimic these conditions, notes Stewart G. Eidelson, MD. “It is best to have a skilled physician perform a thorough physical examination when the symptoms described are present,” he says.

Senior man in pajamas feeling pain in his neckDaily life (and night life) can take its toll on your neck. You may have slept wrong last night, causing your neck muscles to tighten. Photo Source: 123RF.com.

How Can You Get a Neck Pain Diagnosis?

Neck pain is most often diagnosed by a primary care provider. “The most important aspect of treatment is to try to identify the underlying cause of the pain, as this will direct the treatment,” explains Dr. Bonte.

“For example, if the cause is due to a muscle imbalance or poor ergonomics (e.g. while working from home at a makeshift desk!), it is important to address these underlying issues when thinking through the overall treatment plan.”

To assess your neck pain, your healthcare provider will:

  • Ask for your medical history
  • Ask questions to determine the source of your pain, including:
    • When did the pain start?
    • What activities preceded the pain?
    • What have you tried to relieve the neck pain?
    • Does the pain radiate or travel into other body parts?
    • What makes the pain less or greater?
  • Perform a physical exam to determine whether your pain is related to muscle, joint or ligaments. This exam will include:
    • Observation of your posture
    • Palpating/feeling the curvature of your spine, vertebral alignment and muscle spasms
    • An assessment of your neck mobility, including the strength and sensation felt in your neck and arms
  • Diagnostic testing: to rule out certain conditions (e.g., infection, fracture or tumor).

Your doctor visit may include a neurological examination that tests your reflexes, muscle strength, sensory and/or motor challenges, and pain distribution in order to help them make the correct diagnosis.

This exam is most often performed if you are experiencing numbness or tingling in your shoulder, arms or neck, or if you have focal weakness that indicates nerve damage. Your doctor may also order a nerve conduction study (also known as electromyography/EMG) to check how quickly your nerves send and receive signals to and from your brain. Slower speeds in the nerve conduction study could indicate nerve damage.

Imaging studies can help your doctor narrow down the cause of neck pain. An X-ray can reveal narrowing of disc space, fracture, osteophyte formation, and osteoarthritis. An X-ray won’t show soft tissue like muscles, ligaments or intervertebral discs, though; you’ll need an MRI or CT scan for that.

What Are the Most Common Nonsurgical Treatments for Neck Pain?

If you are experiencing chronic pain (2+ weeks), it is important to seek medical attention for further evaluation and treatment. Treatments for neck pain vary, depending on the cause and duration of the neck pain you are experiencing. Many neck pain patients find relief in using one or a combination of these therapies. The most common treatments include:

Medications: Both over-the-counter and prescription medications may help manage neck pain, reduce inflammation, and decrease muscle spasm and sleep disturbance. The first line of treatment when it comes to neck pain medication is typically non-steroidal anti-inflammatory medications (NSAIDS), such as ibuprofen and naproxen, and acetaminophen (Tylenol). Some NSAIDS can be applied topically to the skin, such as Voltaren Gel and Aspercreme; other topical treatments include Icy-Hot, lidocaine based patches, and CBD creams/ointments.

“Prescription medications such as muscle relaxers and nerve pain medications are sometimes considered,” says Dr. Bonte. Muscle relaxants are used more often for acute pain rather than chronic pain.

If you’re using medicines to treat neck pain, remember to take all medications as prescribed by your doctor and report any side effects. Some pain medications — such as opioids — are highly addictive and should be used only as prescribed. If you are experiencing neck pain of a degenerative origin, no medicine will ‘cure’ the pain, but it will help with pain control. For more information, you can read our article just on medications to relieve neck pain.

Interventions: Interventions such as injections of pain-relieving medicine into the affected joints or nerves are sometimes an option for relieving neck pain. “Depending on the cause of neck pain, injections such as trigger point injections, epidural steroid injections, and radiofrequency ablations can be performed,” says Dr. Bonte. Botox injections are sometimes given at the site of pain, or dry needling into tight bands of muscle, though studies show mixed results of its effectiveness.

For those with neuropathic neck pain, injections including a steroid and pain reliever may be effective, especially if done in conjunction with physical therapy. Ablation (burning) of the nerves near the neck joints may improve mobility and reduce pain, too.

Neck pain injectionsSteroid injections may help neck pain. For those who do not want (or should not have) corticosteroids or ablation procedures to the neck but still seek an option for pain relief, regenerative treatments such as platelet rich plasma (PRP) and/or stem cells from bone marrow aspirate concentrate (BMAC) may be appropriate.  

“All of the other traditional injections, ablations, and surgeries are destructive,” says Dr. Penhollow. “For the first time we have a treatment that is reversing the process—not covering it up—and is thereby constructive.” It is widely held that these treatments need more research before they can be considered standard, and most insurances will not cover them.

Cervical collar and/or cervical pillow: If you’ve sustained a neck injury, a cervical collar is used to provide support and limit motion while you are healing. It also helps keep your cervical spine in proper alignment. Cervical pillows are designed to place the right amount of curvature in your neck during sleep. They help decrease pressure on the nerves in your neck to help you sleep better — much needed when living with pain!

Complementary therapies: Alternative treatments may be helpful in managing neck pain. Some of the more popular complementary therapies for treating neck pain include:

  • Acupuncture: Acupuncture practitioners work to restore a healthy flow of your “qi” — your body’s energy force. Some people find relief after one acupuncture treatment, though others require a few sessions to feel less neck pain.
  • Herbal remedies: Topical herbal remedies such as capsaicin cream can temporarily reduce pain when applied to the skin. Devil’s claw and/or white willow bark are both commonly used to reduce inflammation and pain.
  • Massage: Whether your neck pain is caused by stress, injury or misuse, a massage can help release muscle tension and reduce pain and inflammation. Regular massages may also be an effective neck pain prevention measure. 
  • Yoga and pilates: These exercises can increase your core strength, improve balance and posture and reduce stress — all fantastic ways to help you prevent and/or reduce neck pain. If your pain is caused by tense muscles or weak core muscles, yoga and pilates can be particularly helpful.

Chiropractic care:  A chiropractor may help reduce your neck pain through the use of chiropractic neck adjustments, called cervical manipulation. These adjustments loosen up the joints of the cervical vertebrae in the neck to help reduce the pain caused by muscle spasms and pinched nerves. Your chiropractor may employ several techniques to reduce joint restrictions or misalignments in order to reduce inflammation, improve function and eliminate neck pain.

Physical therapy: Most physical therapy treatments for neck pain involve an exercise program that will strengthen and stretch the neck to reduce pain and stiffness. Research shows that physical therapy is often a better treatment for neck pain than surgery or pain medication. Your physical therapist will work with you on exercises and treatments you can do at home to help you return to your normal activities and lifestyle.

Will I Need Surgery for Neck Pain?

Most patients with neck pain respond well to non-surgical treatments, so cervical spine surgery is seldom needed to treat it. In fact, less than 5% of neck pain patients need surgery.

“Surgery is typically a last resort,” explains Dr. Penhollow, “unless it's an acute disc herniation compression on the spinal cord where it's a neurosurgical emergency, such as when someone experiences loss of bowel or bladder control, or extreme weakness in the limbs where decompression of the cord is imperative.”

You may need cervical spine surgery if:

  • Non-surgical treatment is not helping. That is, you've tried a combination of medication, chiropractic care, physical therapy, massage, exercises, and more, and you're still in pain.
  • Your pain is worsening. A pinched nerve in your neck — called cervical radiculopathy — can lead to pain, numbness, and weakness in your shoulders or down your arms. If your pain is worsening, surgery can remove the source of pressure on your nerves (often caused by a herniated disc).
  • Your spinal cord is being compressed. Certain neck conditions can put pressure on your spinal cord. You may experience pain or stiffness, problems with balance, or have difficulties with fine motor skills.
  • You experience progressive neurological symptoms. If you are feeling numbness, tingling and weakness in your arms and legs and/or are having trouble with balance or walking.

Generally, surgery is done for degenerative disc disease, trauma, or spinal instability. These conditions may put pressure on your spinal cord or on the nerves coming from the spine, and surgery is the only option for relief.

What Kinds of Surgery Are Used For Neck Pain?

There are two common types of cervical spine surgeries performed to relieve neck pain:

  • Decompression: removing the tissue that is pressing against a nerve structure
  • Stabilization: limiting the motion between vertebrae. Spinal fusion (including cervical spinal fusion), involves the surgeon using plates, screws, bones and other materials to limit motion between the vertebrae in order to stabilize the spine.

There are different types of decompression procedures, including:

  • Discectomy: the surgeon removes all or part of a damaged disc
    • Anterior cervical discectomy and fusion (ACDF):Often thought of as the “gold standard” in cervical spine surgery, ACDF involves removing a damaged disc to relieve nerve root or spinal cord pressure. Your surgeon will insert a graft to fuse together the bones above and below the disc.
    • Cervical disc replacement: Also known as artificial disc replacement or total disc arthroplasty, this procedure involves removing the damaged cervical disc — along with any bone spurs —  and replacing it with a metal or polymer prosthetic.
  • Corpectomy: the vertebral body is removed to access whatever is compressing the spinal cord or nerve.
  • Transcorporeal Microdecompression (TCMD): the surgeon accesses the cervical spine from the front of the neck. TCMD is performed through a small channel made in the vertebral body to access and decompress the spinal cord and nerve. This restores normal spacing in the spinal cord while preserving the disc.
  • Foraminotomy: removes bone spurs that are pressing on a nerve

Your surgeon will work with you to determine what's best for your condition.

Stabilization surgery is sometimes—but not always—done at the same time as a decompression surgery. In some forms of decompression surgery, the surgeon may need to remove a large portion of the vertebra or vertebrae. That results in an unstable spine, meaning that it moves in abnormal ways, which puts you more at risk for serious neurological injury. In that case, the surgeon will restabilize the spine. This is typically done with a spinal fusion or implantation of an artificial disc.

Some patients are at high-risk for poor bone healing or unsuccessful fusion. Smoking and diabetes are two of several risk factors that impede bone healing and fusion. A bone growth stimulator may be recommended and prescribed for patients with certain risk factors.

Preventing and Living with Neck Pain

While avoiding neck pain isn’t always possible, you can keep your neck muscles strain- and stress-free by creating healthy habits. Instead of in front of a computer all day, for example, take stretch breaks throughout the day.

If your neck pain feels worse at the end of each day, consider your posture. Are you sitting up straight? Sitting in your chair with your feet flat on the floor?

If your neck pain feels worse in the morning, check your sleep position and pillow. Use a pillow that supports your neck and keeps it straight. Avoid sleeping on your stomach with your neck twisted, if possible.

What if you go to sleep feeling fine and wake up with neck pain? Daily life (and nightlife, even if it’s just spent on your pillow!) can take its toll on your neck. If you wake up with neck pain, the best thing to do is give your body time to heal on its own. To get through the day without letting the pain interfere with your normal activities, you have a few options.

  • Gently stretch your neck: the Spine Universe Exercise Center offers a video with 3 neck stretches and exercises to help relieve a stiff neck.
  • Take over-the-counter pain medications, such as Tylenol or Advil.
  • Alternate between heat and ice treatments on your neck: 20 minutes of heat followed by 20 minutes of ice should help relieve the pain and expedite the healing process.
  • Rest: take a few days off from any strenuous activities that aggravate your symptoms, such as sports and heavy lifting.

Already dealing with neck pain?

While there are many options for relieving neck pain, there is currently no treatment that has been scientifically proven to cure chronic neck pain. Even common treatments have conflicting evidence around their effectiveness at eliminating pain and increasing neck function.

Sometimes, people must learn to manage their pain on a daily basis through lifestyle changes and self-management.

Here are a few strategies to help reduce chronic neck pain and improve your quality of life:

  • Stay active every day: stretch and walk and do light exercises that don’t make your pain worse
  • Pace yourself: don’t feel like you have to ‘do it all’. Allow time to rest throughout the day each day.
  • Advocate for yourself: learn how to communicate how you’re feeling with your care providers and friends and family. Set limits on what you can and cannot do and allow people in your life to support you.
  • Get plenty of sleep: being well-rested can help you cope better with your pain.

Sources

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Mayo Clin Proc. 2015. Epidemiology, diagnosis, and treatment of neck pain. Available at: https://pubmed.ncbi.nlm.nih.gov/25659245/

Open Orthop J. 2016. A Qualitative Description of Chronic Neck Pain has Implications for Outcome Assessment and Classification. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301418/

Anesth Pain Med. 2017. Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study. Available at: https://pubmed.ncbi.nlm.nih.gov/27846187/

Neural plasticity. 2017. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494581/

Man Ther. 2016. Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts. Available at: https://pubmed.ncbi.nlm.nih.gov/27507590/

IASP Terminology. International Association for the Study of Pain. 2017. Available at: https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698

Central Neuropathic Pain Syndromes. Mayo Clinic. 2016. Available at: https://www.mayoclinicproceedings.org/article/S0025-6196(16)00073-2/fulltext#:~:text=Central%20neuropathic%20pain%20can%20result,cord)%2C%20or%20neoplastic%20disorders 

Asian Spine J. 2017. Neuropathic Pain Related with Spinal Disorders: A Systematic Review. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573862/

Toxins (Basel). 2020. Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232231/

Medicine (Baltimore). 2020. Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220152/

J Neurol. 2018. Advances in understanding nociception and neuropathic pain. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808094/

Phys Ther. 2018. A Mechanism-Based Approach to Physical Therapist Management of Pain. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256939/

Evid Based Complement Alternat Med. 2015. Complementary and Alternative Medicine for the Management of Cervical Radiculopathy: An Overview of Systematic Reviews. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541004/

Mind and Body Approaches for Chronic Pain: What the Science Says. 2019. National Center for Complementary and Integrative Health. Available at: https://www.nccih.nih.gov/health/providers/digest/mind-and-body-approaches-for-chronic-pain-science

 

Updated on: 03/30/21
Stewart G. Eidelson, MD
SpineUniverse Founder
Orthopaedic Surgeon
Southpalm Ortho-Spine Institute
Tammy J. Penhollow, DO
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