Along with low back pain, neck pain is a very common reason for health care visits. The pain usually results from problems with the musculoskeletal system—the spine, including the bones of the spine (backbones, or vertebrae) and the muscles and ligaments that support it. Some disorders cause only neck pain. Other disorders can cause neck and low back pain. Occasionally, neck pain results from a disorder, such as meningitis, that does not involve the musculoskeletal system.
The neck's flexibility makes it susceptible to wear and tear and to injuries that overstretch it, such as whiplash. Also, the neck has the critical job of holding up the head. Poor posture makes that job more difficult. Neck pain, like back pain, is common and becomes more common as people age. For pain located in the front of the neck, see Sore Throat.
The part of the spine that is in the neck is called the cervical spine. It consists of seven back bones (vertebrae), which are separated by disks made of jelly-like material and cartilage. The cervical spine contains the spinal cord. Along the length of the spinal cord, spinal nerves emerge through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is the spinal nerve root. Muscles and ligaments in the neck support the spine.
Neck pain can involve damage to bones, muscles, disks, or ligaments, but pain can also be caused by damage to nerves or the spinal cord. A spinal nerve root can be compressed when the spine is injured, resulting in pain and sometimes weakness, numbness, and tingling in an arm. Compression of the spinal cord can cause numbness and weakness of both arms and both legs and sometimes loss of bladder control (urinary incontinence) and bowel control (fecal incontinence).
Causes of Neck Pain
Most of the disorders that can cause low back pain can also cause neck pain, and most involve the spine, the tissues that support it, or both.
Common causes
Common causes of neck pain include
Muscle spasms
Injuries to muscles and ligaments
Arthritis (usually osteoarthritis)
Spasms of the neck muscles are common and may occur on their own or after an injury, even a minor injury.
Injuries may occur during routine activities (for example, lifting, exercising, moving in an unexpected way) or result from trauma such a fall or car crash. Often no specific injured structures are identified with imaging tests, but doctors presume that some muscles and/or ligaments have been affected.
In cervical spondylosis, the vertebrae in the neck and the disks between them degenerate, usually because of osteoarthritis. As a result, the nerves that emerge through the vertebrae may be pinched. Sometimes the spinal canal is narrowed (cervical spinal stenosis), and the spinal cord is compressed.
Cervical spinal stenosis describes the condition in which the space inside the spine canal becomes narrowed. In the cervical spine this results in compressing the thecal sac (the outer covering of the spinal cord), often the spinal cord, and/or its nerve roots. The usual cause is a combination of osteoarthritis, disk degeneration, and thickening of the soft tissues in the neck.
Herniated disks can cause neck pain. The disks between each of the vertebrae have an outer layer of cartilage (a tough, fiber-like tissue) and a soft, jelly-like interior. If a disk is repeatedly squeezed by the vertebrae above and below it, the outer layer may tear (rupture), causing pain. The interior of the disk can bulge out through the tear (herniate). The bulging disk can push on or even damage the spinal nerve root next to it. Rarely, the disk compresses the spinal cord.
Fibromyalgia is a common cause of pain, sometimes including neck pain. This disorder causes chronic widespread pain in muscles and other soft tissues in areas besides the neck.
Less common causes
Less common causes of neck pain that are serious include
A tear in the lining of a neck artery (dissection)
A spinal tumor or infection
A heart attack or angina (chest pain due to an inadequate blood supply to the heart muscle )
Spasmodic torticollis is also a less common cause but is not as serious as some causes. It is a severe type of spasm of a specific neck muscle that causes the head to tilt and rotate into an abnormal position. Sometimes the spasms are rhythmic, causing the head to jerk. The cause may be unknown or may be due to certain drugs or hereditary disorders.
Evaluation of Neck Pain
The following information can help people with neck pain decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In the evaluation, doctors first try to identify serious disorders.
Warning signs
In people with neck pain, certain signs are cause for concern. They include
Loss of strength or sensation in the arms and legs—possibly a symptom of nerve damage
Fever
Night sweats
Headache
Lethargy or confusion
Chest discomfort
Sudden sweating or difficulty breathing
Pain that is triggered by exertion or worsens during exertion
When to see a doctor
People with warning signs or difficulty or pain when swallowing should see a doctor immediately.
nonsteroidal anti-inflammatory drug [NSAID]), they should see a doctor within a day or so.
Other people can wait a few days or call their doctor to discuss how soon they need to be seen.
What the doctor does
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and examination often suggests a cause of the neck pain and the tests that need to be done (see table Some Causes and Features of Neck Pain).
The physical examination focuses on the spine and nervous system (neurologic examination) to look for signs of nerve root or spinal cord compression. Signs of nerve root compression include muscle weakness, abnormal reflexes (tested by tapping the tendons around the elbow and wrist), decreased sensation in parts of the body other than the head, inability to urinate, and incontinence of urine or incontinence of stool. Doctors may ask the person to move the neck in certain ways.
With information about the pain, the person’s medical history, and results of a physical examination, doctors may be able to determine the most likely causes:
Loss of strength or sensation may indicate damage to the spinal cord or nerves exiting from the cervical spine.
Pain on the front or on one side of the neck usually is not caused by a problem with the spinal cord.
Neck pain that radiates down an arm is usually caused by cervical disk herniation, cervical spinal stenosis, or spondylosis with compression of the spinal nerve root.
Pain in the chest that travels up into the neck or into the arm may be caused by a heart disorder such as angina or a heart attack.
Pain that is constant, severe, progressively worse, and unrelieved by rest, particularly if it keeps the person awake at night and is accompanied by sweating, may indicate cancer or an infection.
Testing
Often, testing is not necessary because most neck pain is caused by muscle spasm and strains, which doctors can typically diagnose based on the examination. Testing is usually done if doctors suspect certain other disorders (see table Some Causes and Features of Neck Pain).
If people have symptoms of nervous system malfunction (neurologic symptoms), such as weakness or numbness, magnetic resonance imaging (MRI) or computed tomography (CT) is usually done. MRI provides clearer images of soft tissues (including disks and nerves) than CT. CT provide better images of bones than plain x-rays. However, plain x-rays can often identify common abnormalities in bone (such as arthritis), so if doctors suspect such an abnormality, x-rays may be done first.
Occasionally, electromyography and nerve conduction studies are done to evaluate possible nerve root compression or to determine an alternative explanation for weakness or tingling and numbness.
Treatment of Neck Pain
Specific disorders are treated.
General measures for neck pain
Measures include
Taking drugs that relieve pain
Applying heat or cold to the painful area
Modifying activities
Light exercise as tolerated
Most often, a sprain, muscle spasm, or other musculoskeletal injury is the cause of neck pain, and an over-the-counter analgesicIce or heat may also help (see Treatment of Pain and Inflammation).
If more pain relief is needed, doctors may prescribe opioid analgesics, but, if prescribed, opioids should be used only for a short duration because long-term use of opioid analgesics can actually increase sensitivity to pain and cause side effects, such as drowsiness, confusion, and constipation, and risk the development of a substance use disorder
Avoiding aggravating activities, such as sitting for extended periods of time (particularly when also using a computer, phone, or other electronic device), may help. Using good posture and body mechanics when standing, sitting, lying down, or doing any activity is important. People are taught how to stand, sit, and sleep in ways that do not strain the neck. People who sleep on their side should use a pillow to support the head and neck in a neutral position (not tilted down toward the bed or up toward the ceiling). People who sleep on their back should use a pillow to support, but not raise, the head and neck. People should avoid sleeping on their stomach. People may also wear a neck brace (cervical collar) to keep the neck still and help relieve pain. Doctors or physical therapists may suggest stretching and strengthening exercises, including strengthening exercises for the upper back.
Other measures to reduce neck pain
People with pain that radiates into one arm and involves symptoms of nerve damage, such as arm and leg weakness, may require more intensive treatment. Traction can help. Corticosteroids, given orally and occasionally by epidural injection, have been used to reduce symptoms, but corticosteroid injections are controversial because they may not result in long-term improvement and can have side effects.
Surgery for neck pain
People who have a compressed spinal cord or spinal nerve due to a herniated disk in the neck and severe weakness or pain may require surgery. Surgical removal of the disk (diskectomy) and surgery to fuse vertebrae together (called cervical or spinal fusion) are the most common treatments. However, success rates are about the same for people who are treated with either nonsurgical or surgical options. The effectiveness of surgery for neck pain due to other disorders depends on the cause.
Key Points
Most neck pain is caused by sprains and muscle spasms and resolves completely.
Many of the disorders that can cause low back pain can cause neck pain.
People with warning signs, such as numbness or arm and leg weakness, should see a doctor immediately.
Most neck pain can be relieved by over-the-counter analgesics and modification of activities.
