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All About Neck Pain

The neck or cervical spine is a coordinated network of nerves, bones, joints, and muscles. It has the important job of providing support and mobility for the head, but sometimes it can become painful.

There are a number of problems that cause pain in the neck. Irritation along nerve pathways in the neck can cause pain in the shoulder, head, arm, and/or hand. Additionally, irritation of the spinal cord can cause pain into the legs and other areas below the neck.

Neck pain usually goes away within a few days or weeks, but pain that persists for months could signal an underlying medical cause that needs to be addressed. In some cases, early intervention may be necessary for the best results.

Neck Pain Range of Symptoms

Neck pain can range from being minor and easily ignored to excruciating and interfering with daily activities, such as the ability to dress, concentrate, or sleep. Sometimes neck pain can lead to a stiff neck and reduced range of motion.

The duration of neck pain is commonly classified as follows:

  • Acute. Pain that lasts less than 4 weeks.
  • Subacute. Pain that lasts 4 to 12 weeks.
  • Chronic. Pain that lasts 3 or more months.

Neck pain may be sharp and located in one spot, or it might feel less intense but spread across a broader region. Sometimes the pain gets referred up to the head or accompanies a headache. Other times it can be accompanied by muscle spasms in the neck, upper back, or around the shoulder blade. Less commonly, shock-like pain or tingling may radiate down into the shoulder, arm, and/or hand.

The Cervical Spine and What Can Go Wrong

The cervical spine begins at the base of the skull and consists of a series of 7 vertebral segments, named C1 though C7. It connects to the thoracic (chest) region of the spine at the C7-T1 level.

Ligaments, muscles, and tendons help stabilize and move the cervical spine. The most common cause of neck pain occurs when one of these soft tissues becomes strained or sprained from overuse or overextension. This type of injury typically heals within a week or two.

With the exception of the top level of the cervical spine, which primarily provides rotation for the skull, most levels of the cervical spine can be described as follows:

  • A pair of facet joints connect two vertebrae, enabling forward, backward, and twisting motions
  • Between the vertebrae is a disc, which provides cushioning, spacing, and coordination
  • Nerve roots extend from the spinal cord and exit through the intervertebral foramina (gaps in the bones) located on the left and right sides of the spine

Various problems in the cervical spine can irritate a nerve root or the spinal cord, causing longer-lasting neck pain and/or neurological deficits. Some examples include a degenerated disc pushing into a nerve, or a bone spur growing on facet joints that encroach on a nerve.

The Course of Neck Pain

Neck pain is common among adults, but it can occur at any age. In the course of 3 months, about 15% of U.S. adults have neck pain that lasts at least one full day.

Neck pain can develop suddenly, such as from an injury, or it may develop slowly over time, such as from years of poor posture or wear and tear.

The pain can usually be alleviated with self-care, such as rest, icing the area, or improving posture. Sometimes medical treatments are needed, such as medication, physical therapy, or injection therapy. If nonsurgical treatments are not helping, surgical options may be considered. Before deciding on surgery, it is important that the surgeon answer all of the patient’s questions. The procedure’s potential risks, benefits, and possible alternatives must be carefully explained.

A doctor should be consulted if pain persists or continues to interfere with routine activities, such as sleeping through the night.

When Neck Pain Is Serious?

Some signs and symptoms associated with neck pain could indicate the health of a nerve root or the spinal cord is at risk, or perhaps there is an underlying disease or infection. These “red flag” signs and symptoms may include fever or chills, pain or tingling that radiates into the arm(s) or leg(s), problems with balance or coordination, or other troublesome signs. A doctor must be consulted for an accurate diagnosis and effective treatment plan.

Severe neck pain from a trauma, such as a hard fall or car crash, needs emergency care.

Neck pain symptoms can vary widely. The pain may just be a mild nuisance, or it could be so excruciating that a person avoids any excessive movement.

Oftentimes neck pain is located in one spot and goes away on its own within a few days or weeks. Less commonly, the pain becomes constant and/or radiates into other body parts, such as the shoulder and arm.

Common Neck Pain Signs and Symptoms

Neck pain usually involves one or more of the following symptoms and signs:

  • Stiff neck.  Soreness and difficulty moving the neck, especially when trying to turn the head from side to side.
  • Sharp pain. This pain may be localized to one spot and might feel like it is stabbing or stinging. This type of pain typically occurs in the lower neck.
  • General soreness. This discomfort is typically felt in a broader area or region of the neck. It is described as tender or achy, not sharp.
  • Radicular pain. This pain can radiate along a nerve from the neck into the shoulder and arm. The intensity can vary and this nerve pain might feel like it is burning or searing.
  • Cervical radiculopathy. Neurological deficits—such as problems with reflexes, sensation, or strength—may be experienced in the arm due to nerve root compression. Cervical radiculopathy may also be accompanied by radicular pain.
  • Trouble with gripping or lifting objects. This problem can happen if numbness or weakness goes into the arm or fingers.
  • Headaches. Sometimes an irritation in the neck can affect muscles and nerves connected to the head. Some examples include tension headachecervicogenic headache, and occipital neuralgia.

If neck pain symptoms progress, it can become difficult to sleep. Neck pain may also interfere with other daily activities, such as getting dressed or going to work, or any activity that involves turning the head, such as driving.

Onset of Neck Pain Symptoms

Neck pain typically develops in one of the following ways:

  • Slowly over time. Neck pain might start out as mild or only occur toward the end of a workday, but then it might recur and get worse with time.
  • Immediately following an injury. For instance, neck pain could start right after a bike accident or having slept awkwardly on the neck.
  • Delayed reaction after an injury. Neck sprain symptoms, such as after a car accident, might begin hours or a few days after the injury occurred. Some neck injuries can get worse over time.
  • Suddenly without any prior signs. Sometimes neck pain can start in the middle of a normal day for no apparent reason.
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Robert Brown

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