Neck pain
Neck pain is one of the most common reasons to go to the doctor. Did you know that:
  • annual prevalence ranging between 30% and 50%1
  •  54% of individuals having experienced neck pain within the last 6 months (2)
  • 50% to 85% of those who experience neck pain reporting neck pain again (1) to 5 years later(3)
  • An estimated $87.6 billion was spent on back and neck pain in the United States as of 2013.4  

To better understand the causes of neck pain, it’s helpful to know more about what the neck actually is.

Spine Anatomy

The spine is a series of 26 individual bones called vertebrae stacked on top of one another. There are 7 bones in the neck, 12 in the mid-back, 5 in the low back, 1 called the sacrum, and 1 known as the coccyx, or tail bone. Between each vertebra is a disc. The intervertebral disc acts as a cushion to keep the vertebrae spaced apart. I like to imagine the disc like a jelly donut. The outer layer of the disc is called the annulus. The annulus is home to a lot of crisscrossing bands, which allow it to endure some amount of force. Inside the disc is a gel-filled center called the nucleus, like the jelly inside of a donut. The bony connection between two vertebrae is called the facet joint. These give the spine a hard limit to how far you can move the spine.

 

Spinal Cord Anatomy

In the center of the vertebrae is the spinal canal. This is a hollow area that houses the spinal cord. The spinal cord connects your brain to your body and vice versa. That connection controls how you sense and interact with the world. Spinal nerves branch off the spinal cord and travel to different parts of your body. They act like “electrical wire” carrying information from your body back to the brain.

Common Diagnoses
At Capital Sports Medicine, we see many different types of neck complaints. Here are a few that are most common:

Muscle strains and ligament sprains:

Muscles and ligaments in the neck can over stretch or tear due to overactivity or overuse. Sprains and strains may experience stiffness or pain in the lower back, or even muscle spasms. Whiplash is a specific type of sprain and strain injury to the neck. It is a sudden acceleration and deceleration of the head and neck. Whiplash is often caused by car accidents and other acute traumas.

Disc bulge/disc herniation:

The disc can become injured as it is the part of the neck that undergoes the most movement. This risk increases with age as its flexibility decreases. As it becomes stressed, the outside of the disc can “herniate,” or tear. A disc bulge/disc herniation, also known as a slipped disc, occurs when the disc pushes against the nerves that run through the spinal canal. This compression of the nerves can create localized pain or pain that shoots into your arm or hand. The area of the arm/hand that feels pain can also be dependent on which nerve root gets irritated.

Thoracic Outlet Syndrome:

Thoracic outlet syndrome can imitate the symptoms of a disc bulge or herniation.  It can create pain in the neck/shoulder, changes in sensation in the arm and hand, as well as weakness of the arm.  It happens when you get compression of nerves or blood vessels that feed the arm.

Cervical spinal stenosis:

Stenosis means narrowing. This narrowing puts pressure on your spinal cord and spinal nerves. Stenosis is often caused by advanced arthritis between the vertebrae. The compression of the spinal nerves can cause numbness, cramping, or weakness in the arm. In severe cases, you may experience problems with bladder or bowel control.

Do I need x-rays?

The quick and easy answer is probably not. The more nuanced answer is “it depends.”

For the average neck pain, x-rays and imaging is not needed. Imaging identifies disc bulges, disc herniations, and joint/disc degeneration. Yet, these are normal findings in healthy, pain-free patients. The numbers below represent 20 year olds with no pain5.

·       37% of people aged 20-years had disc degeneration

·       30% of people aged 20-years had disc bulges

·       29% of people aged 20-years had disc protrusions In older populations, the numbers are even higher!

·       96% of people aged 80-years had disc degeneration

·       84% of people aged 80-years had disc bulges

·       43% of people aged 80-years had disc protrusions

While imaging may be beneficial, it should be used to rule out more serious causes of neck pain. We call those serious causes “red flags,” as they do not respond to conservative treatment. As chiropractors, we use our examination to spot those “red flags.” If one is present, we refer you to speak to a primary care physician or appropriate specialist.

Causes to seek specialist intervention
If our examination makes us think that you have one of the following, we will get you to the right specialist ASAP.
  • Fractures: direct trauma can cause fractures. In some cases of no trauma, there might be some underlying process that leads to the bone weakening.
  • Cancer: if cancer spreads to the bone, sometimes the bone will change in density. The change in density can make the bone more brittle, leading to fracture. How we "look for" cancer is by listening for subtle clues in your story. Clues like rapid weight loss without any change in diet or activity, or excessive night sweats. If cancer starts in the spinal cord, you may experience less common symptoms affecting sensation and muscle strength.
  • Infection: bone infections can cause a lot of pain and can have dangerous consequences if not treated soon enough.
  • Syrinx: a fluid-filled cavity within the spinal cord or brain stem.  You may have flaccid weakness of the hands and arms and changes in the sensation of pain and temperature in the back and neck. 
  • Meningitis: Inflammation of the tissue around the brain and spinal cord. It is most often caused by infection. 
  • Proper evaluation and understanding of the cause of your pain is critical so that you can get to the appropriate specialist as soon as possible.
How is neck pain diagnosed?

 During an evaluation, your doctor will review your medical history with you. Then, they will conduct a thorough physical examination. This process is to rule out any serious causes of neck pain.

If symptoms are going into the arm, it is our job to determine where the nerve is being irritated. For example: determining if it is a central irritation (disc bulge) or a peripheral irritation of the nerve (thoracic outlet syndrome).

Finding out the “what” is only half the job. The “what” is the structure that is causing you pain. Finding out the “why” of your back pain is of utmost importance. We need to find out “why” the “what” is being irritated. The sooner the “why” is answered, the sooner you can figure out how to move so that the “what” is no longer irritated.

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References

1.       https://pubmed.ncbi.nlm.nih.gov/20357682/

2.       https://www.jospt.org/doi/pdf/10.2519/jospt.2008.0303

3.       Kenneth Olson. The Cervical Spine. Chapter 6 In: Olson, K. Manual Physical Therapy of the Spine. Elsevier, 2015.

4.       https://jamanetwork.com/journals/jama/fullarticle/2594716 5.       https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/