Axial Neck Pain Symptoms, Causes and Treatments

What is axial neck pain?

Axial neck pain—also called uncomplicated neck pain, whiplash, neck strain, or cervical strain—refers to pain along the posterior (back of the) neck. By definition, axial neck pain is pain that remains localized to the neck and immediate surrounding structures and does not involve dysfunction of the arms, hands, fingers, or other body regions. It is important to distinguish axial neck pain from two other common neck conditions, cervical radiculopathy and myelopathy.

woman with neck pain sitting on the couch at her laptopAxial neck pain is very common and affects approximately 10% of the population at any time. Photo Source:

Cervical radiculopathy refers to irritation or compression (“pinching”) of the nerve as it leaves the spinal cord. The nerves that branch off the cervical spinal cord are called peripheral nerves and are responsible for conducting signals to and from the brain to a specific location in the arm or hand. Signals transmitted from the brain are used for muscle movement, while signals transmitted to the brain allow for sensation. When a peripheral nerve is irritated, it can result in muscle pain, weakness, numbness, tingling (“pins-and-needles” sensation), burning, or other unpleasant altered sensation in the arm, hand or fingers.

In contrast to compression of the peripheral nerves seen in radiculopathy, cervical myelopathy refers to compression of the spinal cord. Unlike peripheral nerves that transmit information from a specific part of the body, the spinal cord is responsible for carrying information to many places in the body. This results in a wider range of symptoms. In addition to the symptoms of radiculopathy, patients with myelopathy can exhibit balance and coordination problems, loss of fine motor skills, and bowel or bladder incontinence.

How common is axial neck pain?

Axial neck pain is very common, affecting approximately 10% of the population at any given time. Fortunately, the majority of these people do not have symptoms severe enough to limit their daily activity.

What are the symptoms of axial neck pain?

Pain in the posterior neck is the primary symptom of axial neck pain. The pain can sometimes travel to the base of the skull, shoulder, or shoulder blade. Other symptoms include neck stiffness, headaches, and localized areas of muscle pain, warmth, or tingling.

What are the risk factors for developing axial neck pain?

Poor posture, ergonomics, and neck muscle weakness can increase the risk of developing axial neck pain. Risk factors for developing chronic pain include: older age, pain that began as a result of trauma, having low back pain in addition to neck pain, headache, depression, severe neck pain, and pain interfering with sleep.

How is axial neck pain diagnosed?

Most axial neck pain is diagnosed based on symptoms and physical exam findings. “Red flag symptoms” may indicate a more sinister cause and should prompt an immediate visit to a physician for evaluation. The physician may order an x-ray, CT, or MRI of the cervical spine to rule out infection, cancer, or fracture. These symptoms include prior trauma (eg, fall, car accident), fever, weight loss, night sweats, and persistent night pain.

Rheumatic causes of neck pain include morning stiffness that improves over the course of the day. If symptoms persist for more than 6 weeks, spine imaging may be warranted, particularly in patients that have had previous neck or spine surgery or if there is concern for cervical radiculopathy or myelopathy.

How is axial neck pain treated?

There is a wide range of treatment options for axial neck pain. Most patients with axial neck pain do not require surgery. Early return to normal activities is one of the most important things a patient can do to prevent acute axial neck pain from becoming chronic. First-line medical treatments usually include acetaminophen and anti-inflammatory medication. Sometimes a muscle relaxant is prescribed.

Gentle stretching and strengthening is encouraged in the form of self-directed exercises or formal physical therapy. Unless a cervical spine fracture has been diagnosed, the use of neck braces in axial neck pain is controversial. A soft collar may be used if the pain is severe but should be discontinued within 3 days of pain onset.

There is conflicting evidence regarding the other treatment options available for people suffering from neck pain. Fortunately, the majority of these treatments are unlikely to be harmful. Other noninvasive treatment options include transcutaneous electrical nerve stimulation (TENS), electromagnetic therapy, chiropractic manipulation, Qigong, acupuncture, low-level laser therapy, and cognitive-behavioral therapy. More invasive treatments such as injections, neurotomy (nerve ablation), and surgery are rarely required but can be beneficial in select cases.

What are the causes of axial neck pain?

There are a variety of anatomical structures that can cause axial neck pain. Injury to the muscles and ligaments supporting the skull and cervical spine is a common cause of pain and can be precipitated by poor posture, ergonomics, or trauma. As we age, degeneration and arthritis can affect the vertebral bodies, vertebral discs, or facet joints and cause neck pain.

Shoulder arthritis or rotator cuff tears can mimic axial neck pain. Rarely, axial neck pain can be caused by dysfunction of the temporomandibular joint (joint that allows jaw movement) or blood vessels of the neck. In the majority of cases, the exact pain generator is not identified. Given that axial neck pain is usually self-limiting, and that the first-line treatment is similar regardless of what anatomic structure has been irritated, this should not be cause for concern.

What is the prognosis for someone with axial neck pain?

Symptoms usually resolve within 4-6 weeks from the onset of pain. Pain that persists beyond this time frame should prompt a visit to a physician.

How can axial neck pain be prevented?

  • Keeping your neck muscles strong can help prevent the development of axial neck pain.
  • Proper posture while sleeping includes sleeping on your back or side with a pillow that supports the natural contour of your neck.
  • When using a computer, ensure that your eyes align with the top third of your screen.
  • When reading, avoid extended periods of neck flexion (looking down) by keeping your arms supported in the arm rests and ensuring your glasses, if you use them, are pushed up on the bridge of your nose.

Key points to keep in mind about axial neck pain:

  • Axial neck pain is common and rarely requires surgical treatment.
  • Axial pain is characterized by pain that localizes to the cervical spine without motor or sensory dysfunction in the hands or lower extremities.
  • Optimizing posture, ergonomics, and muscle strength can prevent the onset and help mitigate the symptoms of axial neck pain.
Updated on: 10/07/19
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Cervical Radiculopathy: Radiating Neck Pain
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Cervical Radiculopathy: Radiating Neck Pain

Cervical radiculopathy occurs when a pinched or compressed spinal nerve in the neck causes pain to radiate down to the shoulders, arms and fingers.
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