What is causing my Neck Pain?
Neck pain is such a common problem that 1 in 5 readers of this article probably already suffers neck pain. In fact, the chance that you will have neck pain at some point over your lifetime is nearly 50% (1). It tends to peak in middle age, and has a higher incidence in females than males (2). For the majority of people, an acute episode of neck pain will resolve in approximately 6-8 weeks with conservative management but chronic neck pain persists in 10-34% of people (3, 4). So, what causes neck pain and how is it relieved?
Physiotherapists use a thorough assessment and reasoning process to understand the cause of neck pain so that they we can offer the most effective form of treatment for the individual.
Mechanical neck pain is the most common type of neck pain. It occurs when movement or sustained postures strain the neck causing pain in the discs, tendons, muscles and/or joints of the spine. In occupations that require high mechanical exposure, the incidence of neck and shoulder pain is heightened in both sexes (2). In one study on occupational risk factors for neck pain, the most consistent risk factors were role conflict and working with arms raised to or above shoulder level (2).
Referred neck pain is pain originating from the neck that presents as headaches or pain in the arm, shoulder and mid back (4). It is important that the source of referred pain is identified by a health professional so that treatment is directed to the right area.
Radicular arm pain occurs when neck problems cause nerve compression or inflammation. Nerve injury presents as severe arm discomfort, numbness, tingling and weakness. It often occurs in association with degenerative disc changes in the cervical spine, causing pressure or inflammation of the spinal nerves(5). Without proper treatment nerve compression can lead to long term problems, so it is important to seek treatment if you have these symptoms.
What is the best treatment for neck pain?
A multimodal approach has been found to be the most effective approach in treating neck pain (3, 4, 6). That is, a combination of strength and mobility exercises, postural and ergonomic strategies, hands on treatment and psychological considerations should be addressed when rehabilitating people with neck pain.
Specific strength and endurance exercises have been clinically proven to help reduce both acute and chronic neck pain (6). Gentle repeated neck movements can help loosen stiff joints and muscles. Hands on therapy to ‘mobilise’ or manipulate joints and muscles can reduce pain and improve movement. Soft tissue massage can help alleviate the pain and discomfort of neck pain, but is not a ‘stand alone’ treatment (7, 8).
Psychological stressors are important to consider, as they are often the drivers underlying persistent neck pain. Implementing relaxation strategies can help (3, 5). Acupuncture, dry needling and electrotherapeutic modalities such as TENS have been found to be effective for pain relief, but again, should be used in conjunction with active treatment and postural correction. Simple analgesics can provide relief. Clinically, we find simple measures such as sitting with good posture and using an ergonomic chair can help mechanical neck pain significantly.
If you have neck pain there are many types of treatment and ways that you can help yourself, but effective treatment is only possible with a proper diagnosis. Consult your GP or physiotherapist about what treatment is best for your individual condition.
APMA would like to thank the Fortus Health for permission to reprint this information.
1. Hogg-Johnson S, Van der Velde S, Carroll L, Holm L, Cassidy D, Guzman J, Côté P, Haldeman S, Ammendolia C, Carragee,14,15 Eric Hurwitz E, Nordin, M, Peloso P. The Burden and Determinants of Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eur Spine J. 2008 April; 17(Suppl 1): 39–51.
2. Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, Winkel J, Isacsson SO; Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort. Malmö Shoulder Neck Study Group. J Epidemiol Community Health. 2005 Sep; 59(9):721-8.
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7. Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. Department of Orthopaedic Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Journal of Manipulative and Physiological Therapeutics 1992;15 (9):570-5.
8. Ernst E. Chiropractic spinal manipulation for neck pain: a systematic review. The Journal of Pain, October 2003 4(8): 417-421.