Neck Pain

The neck is made up of the first seven spinal bones (C1-C7) called cervical vertebrae, which comprise the uppermost part of the spine and connect it to the skull. These vertebrae support the head and allow its movement in different directions.

Neck pain is the pain and discomfort that may result from the problems in the vertebrae of the neck, muscles, tendons, ligaments, or other soft tissues surrounding them. It may be continuous, which appears as a dull throbbing pain in the neck, or a sharp pain that develops suddenly. The intensity of the pain generally worsens on moving the neck. The accompanying signs and symptoms include stiffness, swelling, and tenderness in the neck and the surrounding area; muscle spasms or uncontrolled contraction of the muscles; involuntary movements of the hands; disturbances in walking and balance; and a feeling of numbness or a tingling sensation in the neck area. Dizziness, headache, pain in the jaws, and a ringing sound in the ears (tinnitus) are also frequently linked to neck pain. Neck pain, like most other pains, can involve just the neck or can spread to other areas, such as the shoulders, upper back and arms.

Neck pain can be broadly classified as acute and chronic.

• Acute pain
  Neck pain that develops in a short period of time and resolves within 15 days is called acute pain. It typically starts suddenly and resolves quickly with adequate treatment. e.g., neck pain due to a whiplash injury.
• Chronic pain
  Chronic neck pain lasts for a few weeks to several months or years. Long-term treatment along with physiotherapy might be needed to manage the pain e.g., neck pain due to cervical spondylosis.

Neck pain can result from several causes and a few of them are mentioned below:

• Weak and overused muscles
  Sitting for a long time with tensed muscles leads to stiffness and pain in the neck and shoulders. Overusing weak muscles in physical activities, such as cycling or swimming, can also lead to pain in the muscles of the neck.
• Wear and tear of the neck tissues
  Age-related wear and tear of the tissues in the neck may lead to cervical spondylosis and neck pain. Cervical spondylosis is a condition where the gaps between the bones shrink and small bony growths form along the edges of the bones.
• Spinal disc changes
  Wear and tear of the spine may cause the spinal discs to lose their elasticity. Occasionally, a slipped disc may occur due to a bulging of the spinal disc tissue.
• Narrow vertebral canal
  A narrow vertebral canal compresses the nerves and can cause neck pain that may also radiate to the shoulder or arm.
• Physical injury or trauma
  In an accident, the neck may get seriously injured following a sudden jolt or jerk. This is known as a whiplash injury.
• Wrong posture
  Sitting in a wrong posture, such as slouching for long hours, can put a lot of strain on the neck and cause neck pain. Also, at times, the neck may get flexed for hours while sleeping. This may lead to an intense pain and stiffness in the neck, leading to a difficulty in moving the head.

Risk factors

A study assessing the risk factors for neck pain showed that certain people were more prone to neck pain than others. All the people in the study were adults aged between 18 and 75 years. People who suffered from psychological distress had a poor health along with a history of pain. As per the study, those who were at a greater risk of developing neck pain included women, adults who were divorced or separated, were unable to work due to ill health, and have many children.

Also, people with a history of neck injury were at a greater risk of developing neck pain than those who did not report any such experience.

Neck pain is mostly caused due to the stress and strain of the muscles and ligaments of the neck and can be effectively prevented, managed, and improved by taking certain precautions.

• Posture
  A good posture is a key to keeping your neck and spine in a comfortable and relaxed position. Sit straight and upright. While using a computer, adjust the height of the monitor to your eye level, so that you do not have to strain your neck. Place your smartphone at eye level while using it to avoid neck strain.
• Exercise
  Stretching is one of the best ways to keep your neck strong and flexible. Make sure that you stretch your neck before and after all exercises. Gently stretch your neck upwards, downwards, and sideways frequently during the day.
• Pillow thickness
  A thick pillow misaligns your neck and can strain it leading to pain. Use a thin flat pillow that supports your neck and keeps it straight.
• Protective gear
  Diligent use of protective gear, such as helmets and seatbelts while riding and driving, reduces the chances of neck injury in case of an accident.

• The diagnosis of neck pain is made on the basis of your medical history and lifestyle along with a physical and neurological examination.
• Your doctor will ask you a number of questions to assess the exact location of the pain. He/she will also ask whether you have had an accident or are going through a physical or mental stress to determine its role in causing neck pain.
• The doctor will assess your muscle strength, reflexes, and range of head movement.
• Your doctor may advise imaging tests, such as an X-ray or a computed tomography (CT) scan, based on your case to detect any possible fractures and other abnormalities to confirm the diagnosis.

Most cases of neck pain are effectively treated by lifestyle modification combined with medication. Some treatment options that your doctor may suggest include medications, such as painkillers and anti-inflammatory drugs, muscle relaxants, spinal injections, physical therapy, use of braces to restrict movement, and chiropractic care.

• Strength training
  There is growing evidence regarding chronic neck pain that does not respond to other treatments and can be resolved by muscle strength training. These exercises loosen the stiff muscles of the neck and help them relax. In a study, it was found that specific exercises designed to strengthen neck muscles when practised regularly provided long-lasting relief from neck pain. If you have an untreated chronic neck pain for several months, talk to your doctor about strength training to help you manage pain. Remember that a doctor's approval is required before you begin any exercise programme, particularly if you are already having pain. In case you have a condition that may worsen on exercise, the doctor will advise you against it.
• Physiotherapy
  If you have a persistent neck pain, your doctor may refer you to a physiotherapist. A physiotherapist will provide you with information on various exercises and will help you understand and cope with your pain. Physiotherapy helps people get back to their daily routine.
• Surgery
  Doctors rarely recommend surgery, and it is usually the last option when all other alternatives have been exhausted. It is necessary in severe cases, such as cervical spine instability or neurological dysfunction.
• Chiropractic therapy
  Chiropractic is a form of alternative medicine where neck pain is treated using a controlled pressure application at specific spots.

Self-care

• If you are unable to move your neck, it is recommended that you avoid activities, such as driving or riding, as these can worsen your condition.
• Do not immobilise your neck or wear a neck collar unless your doctor asks you to.
• You can try using hot or cold packs on your neck for pain relief.
• Painkillers, such as paracetamol or ibuprofen, can also be used to relieve pain. Remember, self-medication can be dangerous and can cause problems. If your pain does not become better within a week, consult your doctor.

Lifestyle management

A healthy lifestyle helps prevent the development of long-term neck pain. According to a study, certain habits, such as being physically active, controlling or avoiding alcohol consumption, avoiding smoking, and eating healthy play a protective role and prevent neck pain. A healthy lifestyle may not only prevent neck pain but may also help in its management. If you have debilitating neck pain and no therapy benefits, lifestyle management may play a role in relieving your neck pain.

Chronic neck pain has been linked to stress, anxiety, depressed mood, and a poor psychological health. If you have frequent episodes of stress and anxiety, then dealing with them may help in reducing chronic neck pain. Spend more time outdoors and be physically active. Develop and practice a hobby to deal with stress in a better way.

Prognosis

Neck pain tends to become a recurring problem in one out of ten people. Mostly, neck pain is cured within days or weeks, but sometimes it can become chronic. Neck pain due to injuries, such as whiplash, can cause symptoms even after years of injury. Around 5% of individuals affected with neck pain experience severe disability.

Complications

Most cases of neck pain resolve within a few weeks or months and do not cause any complications. The possible complications of neck pain may be arthritis, or other debilitating conditions, such as cancer, or a bacterial or viral meningitis. Consult your doctor if your neck pain does not seem to improve or your condition seems to deteriorate.

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