Neck pain is one of the most common conditions that our physiotherapists treat at Central Performance. Many neck pain problems are able to be managed effectively in the acute stage however, just like low back pain, neck pain has a relatively high recurrence rate – almost 50% as reported by the Mayo Clinic Symposium On Pain Medicine in 2015. So finding the underlying cause of your pain and reducing your risk of ongoing problems is an important part of effective treatment.
Looking for advice on how to treat your neck pain can be confusing because there are lots of conflicting views, myths and shams out there. But going back to basics, keeping things simple and looking at the evidence provides clear guidelines on how to best manage your neck pain.
Everyone’s neck pain is unique so an individual assessment and treatment plan is the gold-standard for effective management. However, this article gives you some clear advice on diagnosing the 3 different types of neck pain. In following posts we’ll cover treating neck pain, and then how to stop the pain from coming back.
How Common Is Neck Pain?
Neck pain is REALLY common. The Global Burden of Disease (2010) study reported that neck pain is the fourth leading global cause of disability, ranking behind low back pain, depression, and arthralgias. Approximately half of all individuals will experience a clinically important episode of neck pain at some time during their life, with an average of 37% of people having an episode of neck pain in any given year. It is more common in women than men, and peaks around middle age.
What Causes Neck Pain?
Many neck pains come on for no specific reason, and this is called insidious onset neck pain. Often these cases are related to poor posture (desk work), being sedentary, stress and tension, age-related changes like degeneration and arthritis, and sometimes exercise factors like poor form at the gym can be the underlying cause. More traumatic causes can be a whiplash injury from a car accident, impact during contact sports like rugby or AFL, and heavy jarring during a fall. Whatever the initial cause of your neck pain, a common feature that we need to address is reducing your risk of having more pain episodes in the future.
Will My Neck Pain Go Away?
Whilst neck pain can be quite severe and debilitating, the good news is that the majority of cases of neck pain DO NOT involve serious damage and WILL improve within a few weeks. On the flip side, as outlined above, unfortunately there is a high recurrence rate (50%) for neck pain. This means that if you have one episode you are very likely to have another one. Reducing this risk of future pain episodes is one of the major goals of physiotherapy treatment for neck pain.
Why See A Physio For My Neck Pain?
Similar to back pain, even though most cases of neck pain will improve within a few weeks, seeing a physiotherapist early can help you in three major ways;
1. Early Assessment And Diagnosis Can Rule Out Any Serious Pathology Or The Need For Investigations Like X-Rays Or An MRI (See Below)
2. Starting Treatment And Getting The Right Advice Early Can Speed Up Your Recovery And Get Rid Of Your Pain Faster
3. The Right Treatment Program Can Help Minimise Your Risk Of Future Pain Episodes – This Is A Key Element Of Effective Neck Pain Treatment!
Two Important Facts About Imaging (X-Ray, MRI And CT) For Neck Pain
Once again, similar to back pain research, there are two very important research findings to keep in mind when looking at the use of radiology investigations like x-rays, MRI’s and CT’s for neck pain;
1. Most neck pains DO NOT need radiology investigations. Except in certain circumstances (see below), x-rays or other scans are NOT needed to diagnose or treat neck pain, and therefore they are generally unhelpful. Some research shows that even just having a scan in the first place can make your pain worse or last for longer! This is because x-rays and scans often show things that are unrelated to your pain, but they make people worry more about their pain (see the next point).
2. When you have scans for neck pain the report will often show unrelated “stuff”. Some age-related degeneration here, a degree of wear and tear there, some disc height loss at one level and a bit of a bulging disc at another. These are all very common findings, but extensive research shows that the majority of this “stuff” is not actually related to your current pain. Studies show that people who have NO neck pain OFTEN have some age-related degenerative changes including “arthritis” of their facet joints, sometimes a loss of disc height or a bulging disc at a level or two. As physiotherapists we often treat clients for pain on one side of their neck yet they bring in previous x-rays that show more degenerative changes on their other side. These findings are called incidental findings and are usually just normal parts of the ageing process.
Of course there ARE times when x-rays or scans are necessary and the results they provide can help us treat neck pain, and your physio will discuss this with you if it is required. However, the main thing to remember is that the vast majority of neck pains DO NOT need x-rays or scans. And if you do have an x-ray then your physio will take the time to thoroughly explain your results because most of the long medical-type words are not as scary as they sound, and are often not particularly relevant.
The Three Types Of Neck Pain
The 3-category system we use to diagnose neck pain is essentially the same as what we use for low back pain (see our low back pain blog post). Aside from time-based classification (<6 weeks = acute; 6 weeks – 3 months = sub-acute; >3 months = chronic), the most helpful way to diagnose neck pain for the general population is into the following 3 types;
1. Non-Specific Mechanical Neck Pain: this type covers the great majority of neck pain cases. It is described as pain felt around the neck, which can be on both sides or just on one side. You may also have pain that goes down to your shoulder, around your shoulder blade, and sometimes to your upper arm. In some cases it can include headaches (see our separate blog on Cervicogenic Headaches). The pain can vary from mild to severe, and it can be sharp/pinching, dull/achy, or a mixture of both. There is usually no numbness, pins-and-needles, muscle weakness or loss of strength. It also does not extend far down in to your arm – only to the upper area if at all.
Non-specific mechanical neck pain can be caused by many structures including joints, discs, muscles and ligaments. Often there is no specific incident or trauma to set the pain off, and commonly it is made worse by certain movements like turning to check your blind spot when driving, looking up or down, or carrying a bag over your shoulder. Pain with sitting at a desk, especially in a slouched posture, is another very common aggravating activity. You might wake at night intermittently, especially when turning over in bed. You can even get pain when yawning or moving your head to wash your hair!
In some cases there may be a specific incident like a fall, a whiplash injury from a car accident, or an awkward movement playing sport. If the pain has similar features to those described above then your assessment and treatment program will follow the same guidelines. However, if the trauma incident was more dramatic, eg a higher-speed car accident or a more forceful tackle during sport, then you may need further investigation to rule out any significant structural damage ( see 3. Serious Pathology below). If this is required then it is usually organised at the scene, however if you are unsure then please consult your doctor or relevant medical team for initial assessment.
2. Radicular Neck Pain – Also Called A Pinched Nerve Or Cervical Nerve Root Pain: although we see this type of neck pain quite regularly as physiotherapists, it is far less common than non-specific mechanical neck pain as described above. It produces pain in the neck and also usually down the arm, sometimes as far as the hand and fingers, depending on which nerve is involved. It occurs when the nerve is compressed as it leaves the spine, causing pain to be referred along the course of the nerve as it travels down the arm. The lower cervical spine (neck) levels (C5-7) are most commonly affected, but the upper levels can also be involved.
The most common way that a nerve can be pinched or compressed is by degenerative changes in the neck that narrow the canal where the nerve leaves the spine. This can be due to changes in the bony shape of your vertebra called osteophytes, or sometimes due to disc bulges or a loss of disc height. Often certain postures (slouching), positions or movements that further reduce the size of the canal can increase the pain, and may make it spread further down your arm.
As well as pain, the nerve compression often also produces neurological symptoms including muscle weakness, numbness, and tingling/pins-&-needles. Often the pain is reported as sharp and shooting, and can be severe at times. Testing of nerve function in the clinic often shows muscle weakness, absent or reduced reflexes, and sensation changes like numbness or reduced sensitivity to light touch or pin-prick testing. We also use Upper Limb Tension tests to check the mobility of different nerves, and if the nerve is trapped then these tension tests become positive.
If you have radicular neck pain then you should start treatment to relieve the pressure from the nerve as quickly as possible, especially if the pain is accompanied by numbness, weakness or pins and needles. This is because nerves can be damaged by ongoing compression, and as a general rule the longer a nerve has been compressed then the longer it will take to recover, plus there is an increased risk of some permanent damage.
Similar to non-specific mechanical neck pain, radicular neck pain can also be due to a specific incident or for no real identifiable cause.
3. Serious Neck Pathology: this is very rare – less than 1% of cases of neck pain. It includes spinal fractures (broken bones), cancer/tumors, and certain inflammatory conditions or infections. There are well-researched screening tests that doctors and physiotherapists use to identify potential serious neck pathology, and they will refer you for further investigation if they are concerned.
So, now you know about the 3 types of neck pain. In the next post we will look at how physiotherapists treat neck pain, and then finally we will review the all-important process of how physiotherapy and exercise can help you reduce your risk of having neck pain in the future.
Our physio’s are always happy to help you with information and answers to questions about neck pain (or anything else physio-related for that matter!), so please feel free to contact us on 9280 2322 or email us at any time.