Neck Pain (Cervical Pain, Cervicalgia)

Picture of a Women With Neck Pain

There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical spine) that surround the spinal cord and canal. Between these vertebrae are discs, and nearby pass the nerves of the neck. Within the neck, structures include the skin, neck muscles, arteries, veins, lymph nodes, thyroid gland, parathyroid glands, esophagus, larynx, and trachea.

Diseases or conditions that affect any of these tissues of the neck can lead to neck pain.

What are the neck muscles called?

Several muscles are present in the neck to allow the movement of the neck and maintain its shape and structure. One of the major muscles in the neck is the trapezius. The trapezius muscles are the large muscles of the upper back. The trapezius muscles function to move, rotate, and stabilize the scapula (shoulder blade). Many muscles around the neck that help to support the cervical spine, which allows you to move the head in different directions.

• Longus colli and capitis: Responsible for flexion (lowering the chin toward the chest) of the head and neck.
• Rectus capitis anterior: Responsible for flexion of the neck.
• Rectus capitis lateralis: Helps the neck to bend to the side.
• Scalene muscles: Responsible for lifting the first and second ribs, assisting with breathing.
• Levator scapulae: Responsible for the movement of the scapula (shoulder blade) in an upward and downward motion.
• Rectus capitis lateralis: Allows the neck to flex from side to side.
• Obliques capitis superior: Allows the neck to extend and flex to the side.
• Obliques capitis inferior: Assist with head/neck rotation.

Pain located in the neck is a common medical condition. Neck pain can come from a number of disorders and diseases and can involve any of the tissues in the neck. Examples of common conditions causing neck pain are degenerative disc disease, neck strain, osteoarthritis, cervical spondylosis, spinal stenosis, poor posture, neck injuries such as whiplash, a herniated disc, or a pinched nerve; (cervical radiculopathy).

Neck pain can come from common infections, such as viral infections of the throat, leading to lymph node (gland) swelling and neck pain. Neck pain can also come from rare infections, such as tuberculosis of the neck, infection of the spine bones in the neck (osteomyelitis and septic discitis), and meningitis (often accompanied by neck stiffness).

Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica as well as from uncomfortable positioning of the neck while sleeping with the head on a pillow. Neck pain is also referred to as cervical pain or cervicalgia.

Risk factors for neck pain include injury from involvement in contact sports, motor-vehicle accidents, or falls, etc. Prevention of neck pain in the context of these activities should include neck strengthening exercises, neck bracing, wearing safety equipment (such as seat belts or restraints), and using proper techniques while doing activities (such as proper tackling techniques in football).

Neck pain is a symptom commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck or turning the head. Other symptoms associated with some forms of neck pain include

• numbness,
• tingling,
• tenderness,
• sharp shooting pain,
• range-of-motion difficulties,
• fullness,
• difficulty swallowing,
• pulsations,
• swishing sounds in the head,
• dizziness or lightheadedness, and
• lymph node (gland) swelling.

Neck pain can also be associated with symptoms such as 

• headache,
• facial pain,
• shoulder pain, and
• arm numbness or tingling (upper extremity paresthesias).

These associated symptoms are often a result of nerves becoming pinched or inflamed in the neck. Depending on the condition, sometimes neck pain is accompanied by symptoms such as upper back and/or lower back pain, as is common in inflammation of the spine such as in spinal degeneration or arthritis or ankylosing spondylitis.

Doctors who treat neck pain can include general medicine physicians, including family medicine doctors and internists, as well as orthopedists, rheumatologists, neurosurgeons, neurologists, ENT specialists, emergency physicians, physiatrists, sports medicine physicians, and chiropractors.

Other ancillary health professionals who treat neck pain include physical therapists, massage therapists, and acupuncturists.

In diagnosing the cause of neck pain, it is important to review the history of the symptoms. In reviewing the medical history, the doctor will note the location, intensity, duration, and radiation of the pain. Is the pain worsened or improved with turning or repositioning of the head? Any past injury to the neck and past treatments are noted. Aggravating and/or relieving positions or motions are also recorded. The neck is examined at rest and in motion. Tenderness is detected during palpation of the neck. An examination of the nervous system is performed to determine whether or not nerve involvement is present.

Further testing of undiagnosed neck pain can include

• X-ray evaluation,
• CT scan, bone scan,
• MRI scan, myelogram, and
• electrical tests such as electromyography (EMG) and nerve conduction velocity test (NCV).

Could neck pain be a sign of something serious?

If you have any of the following symptoms along with neck stiffness, talk to your doctor or go to an emergency department to identify the cause and start treatment:

• Fever
• Night sweats
• Headache
• Swollen glands
• Throat pain
• Chest pain or discomfort
• Difficulty breathing
• Confusion
• Numbness, tingling, or loss of sensation in your arms or legs
• Severe pain
• Persistent pain
• Pain that stems from an injury

The treatment of neck pain depends on its precise cause. 10 Medical treatment options include

• rest,
• heat or cold applications,
• traction, soft-collar traction,
• physical therapy (ultrasound, massage, manipulation),
• local injections of cortisone or anesthetics,
• topical anesthetic creams,
• topical pain-relief patches,
• muscle relaxants,
• over-the-counter anti-inflammatory drugs, and
• surgical procedures.

Self-care measures for treatment, such as Jacuzzi treatment, neck pain relief exercises and stretches, and neck pain relief products such as neck pillows for sleep and hot pads can be very beneficial for relief of some forms of neck pain.

There are many treatment options, depending on the particular neck problem and past treatment experiences. Alternative treatments that have been used for the relief of chronic neck pain include acupuncture.

Severe neck pain or pain associated with acute nerve injury causing weakness or numbness of your arms or legs may require surgery.

How do you treat a strained neck muscle?

For Grade I and II strains, doctors usually prescribe the RICE method—Rest, Ice, Compression, Elevation—to treat the muscle, followed up with physical therapy to re-strengthen the torn muscle and the surrounding fibers.

The doctor may give you a neck brace to help support your neck. The brace can either be a soft, supportive type or be rigid to provide more support.

A Grade III strain is a complete tear, so it will need to be treated by immobilizing the muscle with a cast if possible. Neck muscle strains are rarely Grade III unless there is severe trauma accompanying the strain.

The prognosis for neck pain depends on the precise cause. Most forms of neck pain can resolve with conservative measures including

• rest,
• avoiding reinjury, and
• gradual rehabilitation.

Some more severe causes of neck pain may require more invasive treatments or surgery. Cortisone injections, trigger point injections and electric stimulation units may help with moderate to severe neck pain. Neck pain associated with acute weakness or numbness of your arms or legs may require surgery. These moderate to severe causes of neck pain have a guarded prognosis and may re-occur frequently or cause long-term disability.

How long before a strained neck muscle heals?

A neck strain is an injury to the muscles or tendons of your neck muscles and tendons — two types of soft tissue. The strain can vary in severity. The greater the damage, the longer it takes your neck tissues to heal.

It typically takes days to weeks for strains to heal. Your symptoms should gradually improve over this time — provided you fix any underlying causes and follow an appropriate treatment plan.

An exception to this timeline is whiplash — a common cause of soft-tissue damage in your neck. It results from sudden and sharp forward and backward movements of your head and neck. It may take you much longer to heal from this injury. Around 40% of people still report symptoms 15 years after the injury.