What’s in this booklet?
In this booklet we explain how the neck works and the common causes of neck pain and related conditions. We describe simple ways of dealing with neck pain as well as the main medical and complementary treatments. At the end are some useful addresses and a list of medical terms with explanations.
What’s inside the neck?
The neck contains the top end of the spinal column or spine, which supports the head and also protects the spinal cord. The spinal cord is the nervous tissue which runs from the brain, through the neck and down the back to the rest of the body. This is shown in the diagram opposite.
The spine is made of bones called vertebrae stacked one on top of another to form a column. Between each bone there is a disc of gristle and the sides of the bones are linked by facet joints. Many ligaments and muscles are attached to the spine and fan out from the neck to the shoulder blades and back. The muscles control movements of your head. The spine protects the spinal cord from outside damage but allows you to move your head in any direction.
At the level of each disc, nerves come out from the spinal cord (see diagram opposite) through an opening in the side of the spine. These are called nerve roots. The nerve roots in the neck join to form the nerve trunks that run into the arms. Impulses travelling through these nerves send sensations such as touch and pain to the brain and messages from the brain to the muscles.
The vertebral artery carries blood from the heart to the brain. It runs inside the bones of the spine and supplies the part of the brain that controls your balance.
What causes neck pain?
Non-specific neck pain
Many people develop a stiff and painful neck for no obvious reason. Often it disappears after a few days. It may happen after sitting in a draught or after a minor twisting injury, for example while gardening. The underlying cause for this type of neck pain is not fully understood, so it is called ‘non-specific neck pain’. Having non-specific neck pain does not mean that your neck is damaged and often it happens in people whose necks would appear completely normal under an x-ray. It is the most common type of neck pain.
With everyday use over many years the discs and the facet joints become worn. This wear varies from person to person. The discs become thinner and this causes the spaces between the vertebrae to become narrower. Also, ‘spurs’ of bone, known as osteophytes, form at the edges of the vertebrae and the facet joints. These changes are called ‘cervical spondylosis’. They can be seen on x-rays and are present in almost everyone by the age of 65 years old. However, many people have no neck pain despite having quite significant changes in the neck on their x-rays.
Pain may come from the linings of worn joints or from stretched ligaments. Occasionally bulging discs or osteophytes pinch the nerve roots and this causes pain or numbness that travels into an arm. If the vertebral artery is pinched, this reduces the blood supply to the area of the brain that controls balance and this may lead to dizziness. Very rarely, in severe spondylosis, the spinal cord can be squeezed which causes weakness and numbness in the arms and legs.
This type of injury often follows a rear-end collision in a car. In this type of collision, first the body is carried forward and the head flips backwards. Then, as the body stops, the head is thrown forwards. Following a whiplash injury there is often a delay before the pain and stiffness start. Although whiplash can badly damage your neck, the majority of people who suffer these shunt accidents do not have major damage. In most cases injuries feel better within a few weeks or months. Seat belts and properly adjusted head rests in cars have significantly reduced the damage from whiplash injuries.
Most muscles of the body relax completely when they are not being used but some muscles (known as anti-gravity muscles) have to work all the time in order to keep your body upright. Muscles at the back of your neck must always be tensed otherwise your head would fall forwards when you are sitting or standing. When these muscles work too hard it can cause neck pain and tension headaches. People who are worried or under stress often tighten their muscles more than is necessary to hold their head upright – in other words, they are literally ‘tense’. Tension headaches are very common and are often wrongly called migraines.
Sometimes if you have neck pain, you also have muscle spasms that turn the head to one side. This is called torticollis. Although not very common, it is an unpleasant side-effect of neck pain. It usually occurs only briefly, although it is possible to have longer-lasting torticollis.
What are the symptoms of neck problems?
You may feel pain in the middle of your neck or on one side or the other. The pain may travel to the shoulder and shoulder blade or to the upper chest. In tension headaches the pain often travels to the back of the head and sometimes to the side of the head and behind the eye or even into the ear. If a nerve root is pinched then, as well as the pain, you feel numbness or tingling that can be felt down the arm as far as the fingers.
This is common. It is painful to move and your muscles feel tight. Stiffness is often worse after long periods of rest or sitting in one position for a long time. You may also have muscle spasm or you may lose movement because of changes to the bones and discs in cervical spondylosis.
You may hear or feel clicking or grating noises (called crepitus) as you move your head. The noises are caused by roughened surfaces moving against each other and by sliding ligaments – and are often loudest at the top of the neck. This is a common symptom which can be upsetting.
Dizziness and blackouts
These may be caused by pinching of the vertebral artery by bony changes in cervical spondylosis. You may feel dizzy when looking up and occasionally have a blackout.
If you have long-lasting neck pain and stiffness, particularly if your sleep is disturbed, then you may feel excessively tired and this can cause depression.
How can I help myself?
Most attacks of neck pain settle down within a few days and do not need medical treatment. Resting for a few days is often all you need.
You can take simple painkillers such as paracetamol. Anti-inflammatory tablets such as ibuprofen, available at chemists, often help but sometimes cause indigestion, so be careful if you have a history of stomach upsets. You can also rub anti-inflammatory gels or creams onto tender areas with less risk to the digestion.
Gentle massage of the neck muscles often helps, particularly with aromatic oils. Or, rubbing the area with liniments can also help – these produce a feeling of warmth and reduce pain. Some liniments, available over the counter, contain extracts of the capsicum plant – and a similar but stronger preparation is available on prescription.
Simple excercises can help to restore your range of movement, promote strength, break down localised stiffness and help your neck get back to normal. You should start by exercising very gently and gradually build up. You can expect to feel some slight discomfort at first.
The diagram opposite shows some simple stretching and strengthening exercises. Gently tense your neck muscles for a few seconds in each position. If you do this every day, the neck movements will increase your muscle strength.
Stress can make neck pain worse (see ‘Tension headaches’). One way of reducing the effects of stress is to learn how to relax the neck muscles. Relaxation and exercises are not mutually exclusive – they complement each other. You can sometimes get audiotapes to help with relaxation from your doctor or a physiotherapist. They can also be bought from the Pain Relief Foundation.
What can I do if the pain stays?
If pain lasts for more than a few days or if pain radiates into the arm then you should see your doctor (GP). He or she will examine your neck and may arrange physical treatments. Sometimes an x-ray helps at this stage but this is not usually needed.
What treatments are available?
Physiotherapists, chiropractors and osteopaths are all trained to treat neck problems. Manual treatments carried out by one of these therapists may often be all that is needed. Sometimes manipulation is uncomfortable at the time so it is important that you understand what is involved. Make sure you talk to your therapist about the treatments before they start.
There is no evidence that these are any help for short-lived or long-lived neck pain. Some people find they help at night to keep the neck in a good position while they are asleep. An alternative for use at night is a ‘neck pillow’ which is a specially shaped piece of moulded foam. These are available from most good department stores.
Acupuncture can help relieve neck pain. At the moment there is no evidence that reflexology or a change in diet are effective.
What about posture?
Pain and stiffness can be caused by poor standing posture or too soft a bed or the wrong thickness of pillow. If your desk is too low so that your head is bent forward for long periods then the neck may be stretched and develop muscle pain. Check your desk height and chair design at work and in the home – this is important to prevent problems (see the diagram below). Similarly, if you work at a VDU screen it is important to have screen, desk and chair set at the correct heights. Many firms employ experts (ergonomists) to check that their employees are sitting properly.
Alexander Technique – The Alexander Technique is a method of teaching bodily awareness and reducing unwanted muscle tension. Lessons are given by qualified teachers who will assess you and advise you on things such as your standing and sitting posture and your patterns of movement.
Do I need to see a specialist?
This is only needed occasionally. Your GP will send you to a specialist if your pain is very bad or if it spreads into your arm or you have dizzy spells. The specialist may be a rheumatologist, orthopaedic surgeon or neurosurgeon depending on the problem. Further tests may be needed such as x-rays, blood tests, or scans which can show up the structures of the neck (for example magnetic resonance imaging or MRI – see picture opposite). A specialist may recommend injections into certain parts of the neck but only if it is certain that this is the cause of the pain. Surgery is very rarely needed – only in severe cases of nerve or spinal cord involvement.
What research is going on?
Many research teams throughout the world are studying neck pain. In the UK there have been advances in our understanding of the composition and biochemistry of the discs. Research has also indicated that a large part of the normal wear of the spine is genetically determined (that is, there are inherited factors).
Discoveries about the effects of pain on the functioning of the back and neck muscles, the effect of stress and workplace conditions and the importance of exercises in maintaining neck function are changing the ways in which neck pain is perceived.
New imaging techniques, such as MRI scanners, allow a clearer understanding of the anatomy of the spine, and can guide treatment, such as injections into the facet joints.
Brachalgia – pain, numbness or pins and needles in the arm caused by nerve compression in the neck.
Capsaicin – a substance found in hot peppers (capsicum) that has pain-relieving properties if rubbed into painful muscles.
Cartilage – strong material on bone ends that acts as a cushion.
Cervical – neck.
Crepitus – crackling sound sometimes caused by the rubbing together of roughened bony surfaces. It can also be due to rubbing of ligaments against bone.
Facet joint – side joint connecting two vertebral bones.
Intervertebral disc (disk) – a circle of fibrocartilage with a pulpy centre found between spinal vertebrae.
MRI scan – magnetic resonance imaging scan that shows up the soft-tissue structures in the neck as well as the bones. Often used in cases of arm pain. For an MRI scan to be done, you have to lie in a tube and it may be unpleasant for those who suffer from claustrophobia.
Osteoarthritis – a condition which can affect any joints in the body, in which the cartilage becomes damaged and the bones deform. Often referred to as ‘wear-and-tear’ or ‘degenerative changes’.
Osteophyte – outgrowth of new bone around the sides of osteoarthritic joints, also known as ‘spurs’.
Radiated pain – pain that is felt some way away from the neck although caused by a neck disorder.
Spondylosis – osteoarthritis of the small joints in the neck and back.
Traction – a treatment in which the head is pulled in a direction away from the body in order to relieve pressure on nerve roots.
Vertebra – any one of the 33 bones that make up the spinal column.
Vertebrobasilar insufficency – dizziness on looking up caused by pinching of the vertebral artery. Blackouts sometime happen.