Understanding & managing neck pain
What can be causing the pain
Neck pain is quite a common problem affecting two thirds of the population at some time in their lives. In most cases the neck pain is not related to a serious health issue. Usually symptoms begin to improve after a few days, and in most cases, are gone within a few weeks. However, the time taken for symptoms to settle depends on the cause of neck problem and also it varies from person to person. The most common causes of neck pain that we see in our clinic are as follows:
Non specific mechanical neck pain
This is the most common type of neck pain. Often the exact cause or origin of the pain is not known but it may include minor strains and sprains to muscles or ligaments in the neck.
Sudden onset (acute) torticollis
A torticollis, also called ‘wry neck’, is a condition in which the head becomes twisted to one side and it is very painful to move the head back straight. The cause is often unknown but it may be due to a minor strain to a muscle or ligament in neck. Sleeping in a draught may be the reason, when certain muscles of the neck have been exposed to cold. The pain usually clears away without any treatment over a few days.
Cervical radiculopathy occurs when the root of a nerve in the neck is pressed or damaged as it comes out from your spinal cord. As well as neck pain, there are symptoms such as loss of feeling (numbness), pins and needles, pain and weakness in parts of the arm supplied by the nerve. The most common causes of radiculopathy are cervical spondylosis and a prolapsed disc.
Wear and tear (degeneration or cervical spondylosis)
With age the discs of the spine can dry out and shrink, and ligaments can stiffen. This is a common cause of recurring or persistent neck pain in older people. It is important to note however that many people over the age of 50 with some degree of degeneration never experience any symptoms. Cervical spondylosis occurs when the natural balance between wear and repair is lost, and the body is unable to adapt to the stresses and strains of normal everyday life. As your body tries to compensate for the wearing of the joints it produces small lumps of extra bone to better support your neck and stiffen the spine. These lumps of additional bone are known as osteophytes. Osteophytes can cause the spine to become too rigid leading to stiffness and neck pain. The changes in bone structure can also compress nearby nerves and spinal cord causing or increasing further symptoms. There are other risks apart from age that can increase chance of developing cervical spondylosis such as a lack of exercise and obesity, previous neck or spinal injuries, post neck or spinal surgery and severe arthritis.
A ‘whiplash’ jolt to the neck
This is most commonly due to an accident involving a vehicle, such as a car crash, but may also occur after a sporting injury, or even with everyday activities such as jolting the neck when you trip or fall. A whiplash neck sprain happens when your head is suddenly jolted backwards and forwards (or forwards then backwards) in a whip-like movement, or suddenly forcibly rotated causing some neck, muscles and ligaments to stretch too far. The symptoms of ‘Whiplash’ are:
- Pain in the neck increasing with turning or bending as well as with arm movements.
- Pain or stiffness in the shoulders or down the arms.
- Pain or stiffness in the upper and lower back.
- Dizziness, blurred vision, pain in the jaw or swallowing, unusual sensation to facial skin.
- Tiredness, irritability and difficulty with concentration.
How to help yourself
The importance of posture
Taking care of your posture will be of great help. You can implement some changes to improve your posture when sitting, driving, walking or even relaxing at home. It is important to make sure that your head is not flexed forward and also that your back is not stooped when seated. You should make sure that you sit and walk up-right.
Pilates classes or another form of supervised activity will support you to develop awareness of your posture. It is crucial to learn how to feel and control your body with exercises and with everyday tasks. Regular sessions with a knowledgeable Pilates instructor can guide you to achieve this. By changing bad habits, you will speed up your recovery and help to prevent the reoccurrence of the neck pain in the future. Pilates teaches you how to feel, control and strengthen main muscle groups as well as supporting postural muscles to restore the balance, increase body strength and flexibility. Where possible choose a physiotherapist to teach your Pilates.
Aim to keep your neck moving as normally as possible. There may be pain at first and you may need to rest for a day or so, however, try to gently exercise the neck as soon as you are able. Gradually increase the range of the neck movements by moving the neck in each direction several times during the day. You should continue with normal daily activities. You will not cause damage to your neck by moving it.
Sleep with your neck in a good position
Pain can disrupt sleep, contributing to a vicious cycle of pain disrupting sleep and sleep problems contributing to pain. By securing a good position for your neck at night, neck muscles can relax and allow healing that normally occurs during sleep. Please note that sleeping on your stomach is not good for your spine, because the back is arched and your neck is turned to the side. If you sleep on your side keep your spine straight using a pillow that is higher under your neck than your head.
Choosing the right pillow
The best pillows have a more rounded cushion to support the natural curve of your neck but are flatter to cushion your head. You can make your own by tucking a rolled towel into your pillowcase to support your neck keeping the flatter pillow under your head. It may take few nights to adjust to the new position as well as few attempts to adjust a proper position. Some memory foam pillows come with a built-in neck support with an indentation for the head to rest in.
Painkillers are often helpful and there is a wide range available. Paracetamol at a full strength is often sufficient for neck pain but over the counter anti-inflammatory painkillers may work better than Paracetamol for some people. A stronger painkiller such as codeine or prescribed NSAID is an option on prescription if over the counter medication do not suit or are not effective but prescription medication is not advisable for everyone.
A physiotherapist will often prescribe gentle neck exercises to help you with pain relief and will advise on various treatments. Among others these include traction, heat, cold, acupuncture, mobilisations and massage. Treatment will always include advise on what can be done at home to quicken recovery.
When to seek help
If your neck problem is difficult to cope with due to high level of pain or persistent pain it is a good idea to get advice from your GP or physiotherapist on the available treatments and specific exercises that will help you to feel better. You should always seek a doctor or health professionals’ opinion if you suffer from any of the symptoms below:
- Pain that becomes progressively worse despite efforts to improve pain.
- Pain that is combined with weakness, or clumsiness of a hand or arm, persistent loss of feeling.
- Feeling generally unwell & having symptoms such as weight loss or high temperature with neck pain or neck pain that develops when you are ill with another problem such as cancer.
- Worsening headaches, dizziness or fainting.
- Extreme tenderness or pain over the neck vertebrae.
- Drowsiness, confusion or blurred vision.
- Difficulty swallowing, slurred speech or vomiting.
- Difficulty with walking or with passing urine.
Investigations for neck pain
Your doctor or physiotherapist will usually be able to diagnose your neck pain from the description of the pain and by examining you. Therefore, in most cases, no tests are needed. In fact, some argue that tests can actually do more harm than good when the diagnosis is nonspecific neck pain. For example, the technical jargon used to report on X rays and scans can sometimes sound alarming, when in fact it just shows what would be normal for a given age and does not cause pain.