The symptoms of neck pain often overlap. We explain the causes, how different structures in the neck can be involved with the pain that you feel.
Neck pain can result from disorders of any of the structures in the neck, including the cervical vertebrae and inter-vertebral discs, nerves, and muscles. It may either be a dull or sharp ache which is worsened by certain movements. There may be limited neck movement and may radiate into head, shoulders, shoulder blades and arms.
There is a reason that the saying “someone/something is a pain in the neck” rings so true. Neck pain can be very debilitating. You will be reminded of it with movement, looking down to your phone, checking your blind spots when driving, or looking up at a sign post. So for all practical reasons you will be reminded of your pain constantly throughout the day, which is such a pain in the neck.
Structures in the neck
To find the culprit causing the pain we have to look at the different structures in the neck. The neck joins your head to your body and enables you to move the head and eyes to see and avoid obstacles when you are walking, turn to see what caused the noise you heard….ect. Your neck is made out of different structures that can get injured or damaged that leads to neck pain.
Neck joints (Cervical Vertebrae)
There are seven cervical vertebrae, stacked from the bottom of the skull down to the first thoracic vertebra. The vertebrae are named and counted from the top down. C1 (atlas, named after the Titan warrior condemned to carry the heavens on his shoulders by Zeus) and C2 (axis) are unique in the pivot joint they form to enable rotary movement from side to side, which comes in handy when following the ball during a tennis match. C3 to C7 look fairly similar, they predominantly move the neck to look up and down or bend the ear to the shoulder. All the joints need to work in harmony to allow full, pain free movement. The cervical vertebrae naturally form a curve, called the cervical lordosis.
Between each cervical vertebra is a disc (except for C1 and C2). The disc has a fibrous outer layer, the annulus fibrosus, that encloses the gel like inner part, the nucleus pulposus. Almost like a few layers of onion surrounding a jelly like substance inside. The discs act as shock absorber in the neck and they are prone to tear and bulge into the space where nerves run. A Neck disc injury or slipped disc can be very dangerous.
The cervical vertebrae and neighbouring discs are connected to each other with different ligaments to aid in stability. Ligamentous injury would be the result of trauma, for example a whiplash injury, fall or tackle. Except for allowing movement the bony bits, discs and ligaments protect the spinal cord.
Spinal cord & nerves
Seen from above the vertebrae have a fairly round shaped hole in which the spinal cord runs from the brain down to the lower back, ending approximately between the first and second lumbar vertebra. From the spinal cord nerve roots exits above each vertebra, forming nerve roots C1 – C7, with the C8 nerve root exiting the spinal cord below the 7th cervical vertebra. The nerve roots then merge and divert into the brachial plexus, that supply the arm to allow movement and relay messages of sensation to the brain.
These nerves can become scratched by surrounding structures that irritate the nerve, or they may be completely compressed. Pinched nerves in the neck is very frightful, but if it is treated promptly there will be no lasting effects.
Neck blood vessels
Alongside the vertebrae important blood vessels run to supply the brain of oxygen from the heart and lungs and return deoxygenated blood to the heart. Any interruption of blood supply to the neck tissues can be devastating. The most superficial being the external carotid where you can feel your pulse if you press your index finger just below the jaw bone.
Muscles attach in different layers to the vertebrae and skull to generate force on the vertebrae to allow movement. Neck muscle spasms, weather it be protective or tension related, neck muscles react quite fast if the source of the neck pain is established. The neck muscles may be injured causing a neck muscle strain or even whiplash injury. Our Physios can diagnose and treat your neck muscle injury.
As seen by the countless structures in your neck, the cause of the pain can come from anywhere.
Causes of neck pain
Neck pain can be caused by a wide variety of pathology of the different structures in the neck or by stupidity, some serious in nature, others quick to fix. You could have flipped your hair back while drying is, turned your head quickly to admired the passing jogger, finally got to painting the ceiling, washing and hanging the curtains, fell asleep on the couch, caught badly in a scrum, turned your head in shoulder-stand, been in a accident…We have heard it all before. We can treat the cause and get rid of the problem.
Most neck pain develops suddenly with no specific event that you can remember. Neck pain is a symptom not a disease or illness. Neck pain can be due to a traumatic or a-traumatic, meaning from a fall, direct blow to the neck and shoulder or a from just getting up out of bed with sudden neck pain. The neck has so many structures surround it affecting each other that it is important to firstly identify the muscle, ligament, tendon, joints, nerve, and other connective tissues where the problem may be.
Nerve pain from the neck can be complex
Pinched nerves and disc problems could give you pain radiating down the back, into your shoulder or down your arm. This type of presentation will take a much longer process. Physiotherapist identify the structures (which ligaments, muscle, joints, discs), movements (Flexion, Rotation etc.), and other factors that may be involved with your specific problem. Then we determine the relationship between all these structures and how they have been affecting each other in order to get to the core problem, because pain that just doesn’t want to go away must be identified and treated correctly to prevent it from coming back again.
Your shoulder is also involved
Neck pain is always associated with some form of shoulder dysfunction. The symptoms of neck pain and shoulder disorders often overlap, making it difficult to determine whether an individual has a neck problem, a shoulder problem, or both.
Common neck pain symptoms
Except for the obvious pain in the neck you are experiencing, pain may be referred elsewhere in the body too. Pain from cervical disc injuries can refer to the shoulder and shoulder blade area. This type of referral is known as Cloward areas. If the disc has sustained an injury to cause a bulge or protrusion and is compressing the nerve root, you will experience more pain down the arm in the specific area that the compressed nerve in the neck supplies.
If the cervical facet joints are injured you will experience pain in specific areas around the joint to where they refer. With all these problems your neck pain will most likely be on one side only. The joints can also lock, which will be extremely painful and you may not be able to turn your head at all. Then the poor over blamed ‘muscle spasm‘ may be part of your neck pain too. Neck pain can even lead to headaches.
Sudden neck pain
- Sharp shooting pain
- Unable to turn your head
- Severe neck stiffness
- Pain running to the shoulder blades
- Moving your head into a certain direction brings on the pain
Types of Neck Pain
Accident or injury – with trauma
Stiffness after a few hours after a fast movement of the neck, fall or direct force to the head. The most common cause is usually a fall or accident where the head is rapidly forced into a forward position further than the neck’s normal range of movement. This unnatural forceful movement triggers the muscles to react by contracting while in an over stretched position causing small tears in the muscles of the neck. This is not to mention the squash and crushing of the small joints between the neck vertebrae.
This type of neck pain usually gets worse and develops into sharp stinging pain, especially when the Cervical facet joints are involved. These are small hand-like joints that connects the neck vertebrae to one another, they need to slide and glide over each other to move your neck in all the directions.
When these surfaces are crushed together they injure the tissue around and inside those joint, your body attempts to heal the injured tissue by sending inflammatory sells into these joint, that in turn causes severe swelling in a confined space which results in loss of normal movement of your neck which results in you not being able to turn your head.
Acute (sudden neck pain – with NO trauma)
Waking up with sudden neck pain especially when turning your head, looking to one side?
In most cases there is a pinching or locking feeling at the end of the range. This can be attributed to a lock facet joint, meaning the joint connections between the Cervical vertebrae are injured. One one side of your neck the joint surfaces are being squashed together because you kept your neck in a extreme position for a long time(like falling asleep on your stomach with your head turned to the one side).
On the other side of the neck, the joint capsule is trapped between the joint surfaces, meaning you will have no pain in certain positions, but when you turn your head to a certain position you will feel a sharp stinging pain shoot through your neck. Usually one side is more painful than the other. Stiffness in the neck muscles increase as the day progress until you can barely move your head in any direction.
Physiotherapist are very effective at treating this, it involves spinal joint mobilization to release the joint capsule, relieve the muscle tightness and restore normal movement of the joints.
Slow progressing neck pain
Prolonged postures and maintaining a certain position for long periods of time. Ever sat at the computer and lost track of time while browsing and working? Stop, be aware of your posture right now: Are your elbows supported, are you looking up or down at your screen? Are your hips facing forward or slightly rotated (putting strain on your upper back? To which side are you tilting your head? left or right? All of this makes a difference… If you continue to put more strain on certain structures you will wear out certain joints more than the opposite side, and your pain will get worse.
This type of pain mostly increase and stays for longer periods (Pain from 3/10 to 7/10 and going from pain only in the afternoon to pain throughout the entire day) It may even start affecting other areas like moving down to your shoulder blades or upwards to give you headaches.
Chronic neck pain
Constant or fluctuating headaches are usually a side effect of this main problem. Bearable but irritating burning pain or dull ache over the skull to the eye sockets.
The primary problem is a long standing instability in the building blocks of the neck, by either the structure(bones), cables (ligaments), and mechanics (muscle activity, balance and activation timing) The most important factor to remember is that this type of neck pain consist of more than one problem.
Physiotherapists are trained to systematically address each structure and problem individually in order to relieve pain, correcting posture, providing stability to the neck and altering your movement patterns. If you are feeling constant neck pain, please don’t leave your neck pain for a few days and hope it gets better… You will only cause yourself more discomfort and agony.
Physio:”So how long have you had the pain?”
That’s when you know it’s going to be a long process.
Symptoms of neck pain
- Mild to moderate pain
- Pain looking to one side
- Pulling or muscular pain with movement
- Stiffness when moving the neck
- Dull ache or a sharp pain
- Moderate to severe pain
- Pinching pain looking to the side
- Neck stuck or locked in certain position
- Accompanied with headache
- Numbness, pins and needles radiating into one arm
- Pain when coughing or sneezing
- Weakness and sensation changes in one hand
- Pain with breathing
- Numbness or pins and needles radiating into both arms
- Left sided pain radiating into the little finger with difficulty breathing and chest pain
- Difficulty with swallowing or speaking
- Very stiff neck with flu-like symptoms and sensitivity to light
- Weakness and sensation changes in both hands
- Severe, constant pain not improved by any change in position, heat, medication
- Severe pain at night
- Unplanned/uncontrolled weight loss
- Pins and needles/tingling of both hands at the same time
Structures causing sharp neck pain
- Mild to moderate dull or aching pain with stretch
- Intermittent pain aggravated by looking down and/or to the opposite side
- Neck movements restricted by painful stretch sensation
- Pain is not well defined but generally doesn’t radiate down arm
- Mild to severe sharp pain with certain movements
- Intermittent or constant pain aggravated by looking up and/or to the same side
- Neck movements restricted by pain and locking sensation
- Pain area is very specific and well defined
- Constant mild to severe sharp pain
- Constant pain aggravated with neck movements to same side possibly radiating down the arm
- Neck movements restricted by sharp, electrical type pain in specific movement
- Pain is not well defined but radiates down a specific nerve course
- Constant mild to severe dull pain.
- Minor incident results in severe pain
- Constant pain aggravated with neck movements to end of range possibly radiating down the arm
- Neck movements are generally restricted in all directions
- Pain area is well defined and radiates down arm with possible sensation and weakness
There are a lot of structures in the neck that may be responsible for your specific symptoms. We are able to accurately evaluate your neck and find the structures responsible for the pain you are experiencing. If X rays or scans are necessary, we will see to it that you are referred to the right place.
Physiotherapy treatment focuses firstly identifying the structures that produce the pain. We will guide you to avoid or limit certain activities or movements. During the initial phases when the pain is severe, we can use Electrotherapy to block the pain impulse and desensitize the nerve endings, Ultrasound and Laser can help relieve the pain and accelerate the healing. We use Acupunctureor Dry Needling to help the healing of the surrounding tissue cells and we use different types of Strapping and Taping to unload and redistribute the forces in your neck.
Massage, Soft tissue mobilization and muscle Stretches helps to break down fascia restrictions and improve flexibility of the muscles. Myofascial release of some dominant Cervical mobilizer muscles are quite painful, but the result speaks for itself.
We very rarely advocate using a neck brace, due to the secondary complications and bigger problems it could cause, rather than help. We will gradually progress neck and postural training exercises as your pain improve, we monitor this very closely so we can make sure it won’t happen again.
Physiotherapy will aim to reduce your pain and will be different for each person, depending on the cause of your problem. One problem may cause a next, for example a locked joint will cause a lot of protective muscle spasm. Therefore; treatment will focus on mobilising the joint and relieving the muscle spasm to ultimately reduce the pain.
Our professional experience on severe neck pain
Treating sudden and severe neck pain is the second most common symptom that we see in our practice. We have compared our approach to other protocols realized we can treat neck pain fast and effectively if the underlying cause is determined before it becomes chronic. Rarely its cause for serious alarm, but it needs to be looked at. Muscle strain and inflation of the joints can give you considerable amount of discomfort but the faster we attend to it the faster the relief.
The bigger problem with neck pain however lies in reoccurring or chronic neck pain, which could be due to poor posture and habitual movements. When these neck pain ‘episodes’ becomes more frequent and more intense, you should have it checked out.