Neck Pain – Questions & Answers

Will I Get Neck Pain? What Type Of Neck Pain Do I Have? How Long Will It Take To Get Better?

neck painJust behind back pain, depression, and joint pains, neck pain is the 4th leading source of disability, with about 30% of individuals experiencing neck pain in a given year. Often, new episodes of neck pain resolve regardless of treatment, however, almost 50% of those continue to have ongoing pain or frequent flare-ups of neck pain.

Neck pain is often associated with other existing conditions like back pain, headaches, joint pain and depression. Neck pain is seen more frequently in women and in middle aged individuals, although the use of computers and related devices is associated with neck pain at a younger age.

What Are Risks Of Having Neck Pain?

Risk factors are associated with other muscular and joint conditions in general like a sedentary lifestyle, family history or genetics, sleeping disorders, smoking, psychological symptoms such as anxiety and depression, and obesity. Obesity may be a risk factor because of general increase of inflammation, increased biomechanical stress, altered muscle function and related psychosocial factors.

More specific risk factors are whiplash and traumatic brain injuries, and sports such as football, hockey and wrestling. There are indications that working in awkward postures, desk and computer workers as well as some manual laborers have an increased risk for neck pain. Major workplace risk factors are poor job satisfaction and the perception of a bad working environment.

What Are The Types Of Neck Pain?

There are many types of neck pain, but factors associated with getting better are duration and initial severity of pain. Typically, acute is pain under 6 weeks duration, and chronic is pain lasting more than 3 months. The time period in between is often called sub-acute. For many treatments, a lower initial pain level and shorter duration is associated with a better treatment results than more long standing pain.

One type is mechanical. Mechanical neck pain is related to pain that originates in the cervical spine or supporting structures, like muscles and ligaments. Mechanical pain includes pain from arthritis of the facet joints, disc related pain, and muscle strain.

joint neck pain patterns

Another type pain from a nerve called neuropathic pain, and is due mainly from a disease process or injury to the nerves outside the spinal cord (peripheral neuropathic pain) or more related to the spinal cord (central neuropathic pain). Peripheral types are those like a pinched nerve from a herniated disc or bone spur. This can be from mechanical irritation or chemical response to inflammation of nerve roots, called radiculopathy. The more central types can be related to canal stenosis and often produce symptoms of myelopathy or from the spinal cord. This gets a bit complicated, as there can be mixed types of pain, consisting of both types. Pain from a herniated disc may cause pain from the tear in the disc itself, as well as chemical irritation of the nerve root from inflammation and or direct pressure of the herniation.

Another type is pain referred from organs like the heart or vascular problem, lung or liver.

How Can I Tell Which Type Of Neck Pain I Have?

Neuropathic pain usually presents with symptoms like, stabbing, shooting, electric like or burning paint, while mechanical pain usually is achy or throbbing.

Neuropathic type pain like a disc herniation, or a condition causing pinched nerve symptoms is usually felt as pain radiating into the shoulder, arm, had or fingers. This can include pain, numbness and tingling. Most commonly involved are symptoms from pinching of the 6th nerve (thumb and index fingers) and 7th nerve root (middle finger) and sometimes parts of the first 4 fingers. This is called a dermatomal pain pattern and is usually distinct in location.

Other neuropathic or mechanical causes that can refer pain into the arms are disc and/or cervical joint problems at the C5 & C6 levels, and neck muscles can cause pain extending into the arm. These patterns of pain are not as distinct and can vary. Pain form the discs or joints in the upper part of the neck often refer pain into the back of the head.

Mechanical pain usually get worse with activity while neuropathic pain is not as predictable and the worsening is associated with higher levels of pain. When you turn your head to the side of pain and it gets worse, it could indicate nerve pinching or a problem with the joint, where muscle pain is usually associated with pain when turning the head to the opposite side. With arthritis, morning stiffness is usually experienced. Pain when looking up or bending the head back is usually felt with joint problems like the facet joints or narrowing of the spinal cord area, while pain when bending forward is often felt with disc problems.

types of neck pain

With a pinched nerve, pain may be relieved with placing the painful side hand on the top of the head, where mechanical neck or shoulder pain usually will not experience any relief or it may be worse when doing this.

Usually, neck pain is better with rest or lying down. Any type of pain that is severe and does not get better with changing positions or rest needs to be evaluated by a doctor.

What Is The Prognosis For My Neck Pain?

The prognosis is similar to back pain, where many incidents of pain lasting less than 6 weeks (acute) will get better within a 2 month period, however, almost 50% of those with neck pain will have some level of pain or experience frequent pain after a year.

There are some major factors that stand out to indicate a poor prognosis: symptoms of radiculopathy, psychological problems, older age and gender – women are more prone to neck pain.

Some others factors that are involved in determining chronic or long lasting neck pain are: genetics, headaches, pain related to work factors, back pain and other joint pain issues, poor coping skills, previous neck injury, having poor health, smoking and litigation.

A particular condition associated with the neck and poor prognosis is myelopathy of the cervical spine. This is when the spinal cord is involved from traumatic injury, inflammation, degeneration of the spinal bones (spondylosis) or can indicate a tumor. It typically results in muscle weakness, increased reflexes, muscle spasticity and fasiculations from increased muscle tone, poor control of active motions, usually slow.

So, there are many factors that determine the prognosis in neck pain. But remember, most will get better and resolve in a matter of weeks or months. A high number of individuals will suffer long term neck pain and determining the type is important for the determination of what kind of tests will be done to further diagnose the cause to select a treatment method.


Text Neck – The Next Generation

Text Neck – The Next Neck Pain Generation

We are experiencing an increase in neck pain from using phones. years ago, it was holding a wired phone between the neck and shoulder. With the advent of headsets, this was remedied. However, with new wireless phones comes texting and constantly looking down at the phone, resulting in what is now called “text neck”.

text neckTexting can truly be a pain in the neck. As you look forward, the weight of the head is constantly being held by the neck muscles. The further down you look, the more stress the neck has to deal with. Add hours of texting and the neck muscles get very tight; overstretched in some areas and shortened in others. The muscles don’t get the right supply of oxygen and waste products build up. Joints and discs undergo additional stress, pressure and loss of nutritional lubrication, resulting in stresses leading to early degeneration and arthritis, as the inflammation builds.

Having the head forward, down, and just hanging there can lead to headaches from stressed neck structures as well as eye fatigue. So, with this great new form of communication – texting on smart phones, comes a hunched over posture and the aches and pains that go with it. Rounded shoulders hanging forward stretch the muscles and balance is lost between the neck and shoulders, further aggravating the condition.

In addition to text neck, individuals also experience elbow and thumb pain. This is from pressure and inflammation of tendons, leading to the new tennis elbow or carpal tunnel syndrome. I guess we can call this text elbow and text wrist, because most individuals are not aware what is causing the problem.

You can see a patient sitting on a therapy table with a heating pad on their neck. They are supposed to be lying down, but when you check up on them, they are sitting there using their smart phones and texting! Hunched over, head forward and down, tapping away in this iPosture. I’m treating you for neck pain and you are hurting your neck during treatment! Well, from now on a sign on the therapy room door, “No Cell Phones!” Too bad they are texting while walking into the therapy room and not reading the sign!

ipostureText neck posture is easy to see just about anywhere. At a college campus, stores, waiting rooms, adults, kids, teenagers, seniors…. perhaps we are all guilty of this. Want to see it gone wild? Go to a cell phone store! This new form of communication is now engrained into our culture, and with the benefits of smart phones are impressive, we are going to have to deal with a new generation of musculoskeletal problems due to text neck. It’s the same problem, just a new name and a great increase in frequency and incidence. So, now instead of poor posture, we can give a name to the problem that might help in recognition of it “iPosture”. But I like text neck better, so it is not a new confusing term related to the eyes!

So, now this iPosture results in a pain syndrome called text neck. There is an abundance of scientific literature indicating pain syndromes from computer workers and assembly line workers that look down a lot. Now we are compacting this posture in a more hunched over position, like a turtle, the iPosture. I guess as devices get smaller and smaller, we will have to evolve smaller thumbs. We will hunch over and compact so much, we will turn into diamonds!

It’s not surprising the term text neck originated from a chiropractic patient. Maybe chiropractors are behind this? No, no conspiracy. I’m a chiropractor and I would know. Although, giving out free smart phones might increase business, there’s plenty of reasons for neck pain these days. There has been a gradual increase in ergonomic awareness, including office and home furniture design, however, hand someone a smart phone, and it all goes out the window!

It’s not easy seeing an increase in neck pain in teenagers. Mom brings in her son for treatment. I am reviewing x-rays, showing a reverse in the normal curve of the neck. Moms looks at me and I point to her son sitting there texting on his smart phone! A picture was worth a thousand words. Biomechanics and neuromuscular anatomy is one thing, your kid hunched over his smart phone texting away is another. So, when I say he’s got text neck, Mom understands.

texting neck painThere is a new generation of texters that will suffer from text neck and long term consequences if we don’t do something about it. While I am a somewhat clumsy texter, I see kids texting so fast and so intently, I am amazed! texting has become a way of life.

It’s not going away. I leave my office door open and, after lecturing a patient on the dangers of text neck and the iPosture, the see me sitting at my desk texting, and not very well. But I can say do what I do. Take a break. Look at a distant object to rest the eyes. Get up and stretch. Stretch the neck, upper back and shoulders as well as the hands. Do some strengthening exercises for the neck and shoulders. Try to sit with better posture and have more awareness about it. Keep your chin up! Try to bring your head over your shoulders. Hold the phone at an angle, bringing the phone closer instead of letting the phone drag you out. Squeeze your shoulder blades together, hold for a bit, then relax. Repeat this.

So, we try to educate about ways to make a healthier texter. This needs to be done early and reinforced in creative ways, by parents and educators alike. Texting is obviously not going away, but lets try to help prevent the future generations from suffering the ill effects of iPosture and text neck.