Along with low back pain Low Back Pain Low back pain and neck pain are among the most common reasons for health care visits. The pain usually results from problems with the musculoskeletal system—most notably the spine, including... read more , 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 Introduction to Meningitis Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space). Meningitis can be... read more , 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. Thus, 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 Sore Throat Sore throat is pain in the back of the throat. The pain can be severe and is usually worsened by swallowing. Many people with sore throat refuse to eat or drink. Sometimes pain is also felt... read more .
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 Spinal Cord The spinal cord is a long, fragile tubelike structure that begins at the end of the brain stem and continues down almost to the bottom of the spine. The spinal cord consists of bundles of nerve... read more . 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 Compression of the Spinal Cord Injuries and disorders can put pressure on the spinal cord, causing back or neck pain, tingling, muscle weakness, and other symptoms. The spinal cord may be compressed by bone, blood (hematomas)... read more can cause numbness and weakness of both arms and both legs and sometimes loss of bladder control (urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting about 30% of older women... read more ) and bowel control (fecal incontinence Fecal Incontinence Fecal incontinence is the loss of control over bowel movements. Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum (fecal impaction)... read more ).
Causes of Neck Pain
Most of the disorders that can cause low back pain Causes Low back pain and neck pain are among the most common reasons for health care visits. The pain usually results from problems with the musculoskeletal system—most notably the spine, including... read more can also cause neck pain, and most involve the spine, the tissues that support it, or both.
Common causes of neck pain include
Cervical spinal stenosis
Injuries to muscles and ligaments
Spasms of the neck muscles are common and may occur on their own or after an injury, even a minor injury.
In cervical spondylosis Cervical Spondylosis Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck. Osteoarthritis is the most... read more , the vertebrae in the neck and the disks between them degenerate, usually because of osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more . 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, often the spinal cord, and/or its nerve roots. The usual cause is a combination of osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more , disk degeneration, and thickening of the soft tissues in the neck.
Herniated disks Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more 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.
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.
Fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more 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 heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more or angina Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more (chest pain due to an inadequate blood supply to the heart muscle )
Spasmodic torticollis Focal and segmental dystonias 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.
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
Lethargy or confusion
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.
If people without warning signs have severe pain (particularly if it is not relieved by acetaminophen or a nonsteroidal anti-inflammatory drug Nonsteroidal Anti-Inflammatory Drugs In some cases, treating the underlying disorder eliminates or minimizes the pain. For example, setting a broken bone in a cast or giving antibiotics for an infected joint helps reduce pain.... read more [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 Some Causes and Features of Neck Pain ).
The physical examination focuses on the spine and nervous system (neurologic examination Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. Examination of the nervous system—the... read more ) to look for signs of nerve root or spinal cord compression Compression Fractures of the Spine In a compression fracture of the spine, the drum-shaped part (body) of one or more back bones (vertebrae) collapses into itself and becomes squashed (compressed) into a wedge shape. Most compression... read more . 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 Urinary Retention Urinary retention is inability to urinate or incomplete emptying of the bladder. People who have incomplete emptying of the bladder may have urinary frequency or urinary incontinence. If the... read more , and incontinence of urine Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting about 30% of older women... read more or incontinence of stool Fecal Incontinence Fecal incontinence is the loss of control over bowel movements. Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum (fecal impaction)... read more . 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 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 Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more or a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more .
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.
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 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 Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) or computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (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 Plain X-Rays X-rays are high-energy radiation waves that can penetrate most substances (to varying degrees). In very low doses, x-rays are used to produce images that help doctors diagnose disease. In high... read more can often identify common abnormalities in bone (such as arthritis Joint Disorders ), so if doctors suspect such an abnormality, x-rays may be done first.
Occasionally, electromyography and nerve conduction studies Electromyography and Nerve Conduction Studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more 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
Taking drugs that relieve pain
Applying heat or cold to the painful area
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 analgesic Overview of Over-the-Counter Drugs Over-the-counter (OTC) drugs are those available without a prescription. OTC drugs enable people to relieve many annoying symptoms and to cure some diseases simply and without the cost of seeing... read more , such as acetaminophen or an NSAID, to relieve the pain is all that is needed. Symptoms usually resolve completely. If inflammation is not contributing to the pain (as with sprains, spasms, and other injuries), acetaminophen can be used because it is thought to be safer than NSAIDs. Ice Cold therapy (cryotherapy) Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more or heat Heat therapy Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more may also help (see Treatment of Pain and Inflammation Treatment of Pain and Inflammation Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more ).
If more pain relief is needed, doctors may prescribe opioid analgesics 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 Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance despite having problems caused by its use. The substances involved tend to be members... read more . Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes used, but their usefulness is controversial. Muscle relaxants are not recommended for older people, who are more likely to have side effects.
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 Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more 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 Traction Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more can help. Corticosteroids, given orally and occasionally by epidural injection, have been used to reduce symptoms.
For spasmodic torticollis, physical therapy or massage can sometimes temporarily stop the spasms. Drugs (including the antiseizure drug carbamazepine and some mild sedatives such as clonazepam, taken by mouth) can usually relieve the pain. But drugs control spasms in only about one third of people. If the pain is severe or if posture is distorted, botulinum toxin (a bacterial toxin used to paralyze muscles) may be injected into the affected muscles.
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 about Neck Pain
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.