What are the structures of the neck?
The neck contains the top end of the spinal column or spine, which supports the head and also protects the spinal cord. The spinal cord is the main nerve, which runs from the brain, through the neck and down the back, and connects with nerves to the rest of the body. The spine is made up of 33 bones called vertebrae stacked one on top of another to form a column.
The 7 bones in the neck are known as cervical vertebrae. Between the bones are discs of cartilage known as intervertebral discs. The sides of the bones are linked by facet joints. Many ligaments and muscles are attached to the spine and fan out from the neck to the shoulder blades and back. The muscles control movements of your head. The spine protects the spinal cord from outside damage while still allowing you to move your head in any direction.
What are the types and causes of neck pain?
About 2 in 3 people develop a bout of neck pain at some time in their life.
Types and causes of neck pain include:
- Non-specific neck pain is the most common type. 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.
- A ‘whiplash’ jolt to the neck, most commonly due to a car crash, can cause neck pain.
- Acute torticollis. 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. It is common for people to go to bed feeling fine and to wake up the next morning with an acute torticollis.
- Degeneration (‘wear and tear’) of the spinal bones and the ‘discs’ between the vertebrae is a common cause or recurring or persistent neck pain in older people. This is sometimes called cervical spondylosis. However, most people over the age of 50 have some degree of degeneration without getting neck pain.
- Cervical radiculopathy is when the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck region. As well as neck pain, there are symptoms such as loss of feeling, pins and needles, pain and weakness in parts of an arm supplied by the nerve.
- More serious and rare causes include: rheumatoid arthritis, bone disorders, infections, cancers, and serious injuries that damage the vertebrae, spinal cord or nerves in the neck.
What are the symptoms that are associated with neck pain?
You may feel pain in the middle of your neck or on one side or the other. The pain may travel to the shoulder and shoulder blade or to the upper chest. In tension headaches the pain often travels to the back of the head and sometimes to the side of the head and behind the eye or even into the ear. If a nerve root is pinched, then as well as the pain you may have numbness or tingling that can be felt down the arm right to the fingers.
You may find it painful to move and your muscles feel tight. Stiffness is often worse after long periods of rest or after sitting in one position for a long time. You may also have muscle spasm or, in cervical spondylosis, you may lose movement because of the changes to the bones and discs.
You may hear or feel clickingas you move your head. This is caused by roughened bony surfaces moving against each other or by ligaments rubbing against bone. The noises are often loudest at the top of the neck. This is a common symptom and can be upsetting.
Dizziness can sometimes happen when bony changes in cervical spondylosis cause pinching of the vertebral artery. You may feel dizzy when looking up, or you may occasionally have blackouts.
Do I need any tests?
Your doctor will usually be able to diagnose non-specific neck pain from the description of the pain, and by examining you. Therefore, in most cases, no tests are needed.
What are the symptoms of more serious causes?
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.
- If you develop any problems with walking or with passing urine.
What are the treatments for non-specific neck pain?
- Aim to keep your neck moving as normally as possible. At first the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able.
- You should not let it ‘stiffen up’. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction.
- Paracetamolor NSAID can be used alone or combined with paracetamol.Examples of NSAID are diclofenac or naproxen needs a prescription.
- A stronger painkiller such as codeine is an option if anti-inflammatory do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fiber.
- A muscle relaxant such as Flexeril or diazepam is occasionally prescribed for a few days if your neck muscles become very tense and make the pain worse.
- A firm-supporting pillow seems to help some people when sleeping.
- A physiotherapist may advise various treatments. These include traction, heat, cold, manipulation, etc.
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