The cervical spine, which is located in the neck, is subject to many of the same problems that plague the lower back—muscle strains and spasms, disk degeneration and denervation, and spinal stenosis. About 10 to 15 percent of people experience neck pain at any given time. Fortunately, most neck pain is short lived and gets better on its own or with simple self-care measures. But sometimes neck pain is a red flag for a more serious problem.
Neck pain causes
The neck supports the weight of the head, which can weigh 10 pounds or more. Although the head should be centered over the spine when we sit or stand upright, countless activities—such as sitting at a computer, reading, watching television or eating—cause people to slump, rounding their upper back and tilting their head forward. This posture can lead to muscle strain or spasm in the neck. Muscle strain or spasm can also arise from constantly looking over or under one’s glasses, having poor sleeping posture or taking extended car trips.
General wear and tear from everyday activities and normal aging can cause changes in the disks of the neck that lead to pain and stiffness.
For example, herniation of the intervertebral disks in the neck can decrease the space through which nerves exit the spinal canal, leading to pinched nerves and consequent pain. Bony outgrowths on the vertebrae (osteophytes) also can pinch nerves. Spinal stenosis can put pressure on the spinal cord, causing pain or paralysis.
Most people with neck pain do not have a herniated disk, osteophytes or a disease that affects the spinal cord. Typically, it is the result of muscle strain or spasm.
On occasion, neck pain results from acceleration/deceleration injuries, commonly known as whiplash. It can also stem from serious problems like arthritis or cancer or from problems that originate in other areas of the body such as the shoulder. Chronic neck pain that is not associated with any physical problem may result from associated stress or depression.
Most cases of neck pain get better on their own. If neck pain is linked to a recent recreational or work-related activity, the pain will likely decrease within two weeks, and treatment from a doctor is usually unnecessary.
When neck pain is more serious
You should see a doctor, however, if your neck pain follows a serious injury or is accompanied by the following:
• Headaches, fever or weight loss
• Pain that worsens at night
• Difficulty walking, clumsiness or weakness
• Pain, numbness or tingling in your fingers, arms or legs
• Problems with bladder, bowel or sexual function
• Discomfort or pressure in your chest
• Severe pain over a bone that might indicate a fracture or injury to a ligament
• Osteoporosis or extended corticosteroid treatment (increases your risk of fracture)
Also see your doctor if your pain lasts longer than two weeks.
Waiting too long before seeing the doctor for neck pain decreases the likelihood that the pain will completely resolve.
Tests for neck pain
If you seek help for neck pain from a physician, your evaluation will include a medical history, a physical examination and, if needed, imaging tests. During the physical exam, the doctor will likely measure your reflexes, range of motion, sensation, strength, and muscle and nerve function in your neck, arms and legs.
If pain is the only symptom, and it does not radiate beyond your neck, imaging studies are usually not necessary. In this case, the pain is likely temporary and requires no invasive treatment. However, for people with a traumatic injury, rheumatoid arthritis or a physical exam that does not pin down neck pain causes, imaging studies may be needed.
Imaging tests include X-rays, MRI scans and CT scans. Further options may include electromyography and nerve conduction tests to assess the combined function of the muscles and nerves. People who experience intense pain that lasts for months may require additional evaluation to rule out cancer.