By Seth Joseffer, MD
The idiom “a pain in the neck” is a funny way of describing something that is annoying. Yet for many people, neck pain is no laughing matter.
Neck pain affects one in three people annually, according to the National Institutes of Health. The pain can and range from nuisance-level to so severe that it interferes with everyday activities.
Typically, neck pain is not life-threatening and can be resolved with time and treatment. In rare cases, however, neck pain may be a sign of something more serious that requires emergency care.
The Penn Medicine Princeton Medical Center for Spine Care provides high quality, comprehensive, individualized care, for patients experiencing neck pain. The Center brings together all aspects of diagnosis, treatment, surgery, rehabilitation and wellness to minimize pain and improve function.
Causes of Neck Pain
Neck pain can involve tissues, nerves, bones, joints, ligaments or muscles in the neck. Pain can occur locally in the neck, or it may radiate down one or both arms and even into the legs.
Some of the most common reasons people experience neck pain, include:
• Osteoarthritis. A degenerative joint disease, osteoarthritis is typically caused by wear and tear on your joints as you age. Osteoarthritis of the neck affects more than 85% of people over the age of 60, according to the American Academy of Orthopedic Surgeons.
• Herniated disk. The bones or vertebrae that make up your spine are cushioned by small, round disks that act as shock absorbers for the spinal bones. In all, your spine has 24 of these bones, seven of which comprise your cervical spine or neck, and each of which is separated by a protective disk. Like a jelly donut, these disks have a firm outer layer that surrounds a jelly-like center. If the outer layer is damaged (think if you were to bite into a donut) the jelly-like substance squeezes out. When this happens, it is considered a herniated disk.
• Overused or weak neck muscles. Poor posture or sleeping in an awkward position can result in acute neck pain. Sitting at a desk for a long time with slightly tensed muscles can also cause stiffness or pain in the neck and shoulders. Further, activities that require placing your head in a fixed position, such as painting a ceiling, can also lead to pain.
In addition, sudden injury can cause neck pain and in rare cases a disease, such as cancer or meningitis, may be the cause.
Symptoms
Symptoms of neck pain may include:
• Stiffness, headache, facial pain or dizziness.
• Pain, weakness or numbness in the arm.
• Tingling sensation in the hands or fingers.
• Trouble with balance.
• Weakness in the legs or difficulty walking.
Neck pain may be localized to a particular spot or deferred to another part of the body due to pressure placed on a nerve or the spinal cord.
If you experience symptoms that persist for several days without relief, consult your doctor. Seek emergency care for pain that is severe, sudden, or is accompanied by severe headache, fever, or loss of bodily functions, as these can be a sign of a serious medical problem.
Diagnosis
Neck pain that lasts for one to two weeks is described as acute, whereas symptoms of neck pain that last longer than three months are considered chronic.
Your doctor will likely ask when the pain began, exactly where it hurts and whether you were in an accident. They will then perform a physical examination that includes feeling your neck and assessing how well you can move your head. In some cases, imaging tests such as X-ray, CT, or MRI scans may be needed.
Treatment
Most neck pain can be addressed with non-invasive treatments, such as rest, physical therapy and medication. Your doctor may prescribe an anti-inflammatory to help relieve pain. Sometimes, injections of corticosteroids or an epidural steroid may be recommended.
In certain circumstances where conservative therapies such as rest and medication do not help, surgery may be recommended.
Surgical procedures that are commonly used to treat neck pain are:
• Traditional spinal fusion, which involves removing any damaged disks and fusing two or more vertebrae together. In some cases, a screw or plate is used to enhance the fusion and support unstable parts of the spine. Patients can usually go home on the same day as the surgery or after staying one night in the hospital.
• Artificial disk replacement, in which surgeons remove the damaged disk and replace it with an artificial disk that functions like a natural disk and helps maintain normal range of motion in the neck. The minimally invasive surgery is performed through one-to-two-inch incisions along the neck crease and usually takes no more than hour. Patients are normally able to return home the same day.
Prevention
Because neck pain is commonly caused by poor posture and lifestyle habits, there may be simple adjustments you can make to protect your spine and prevent pain.
• Practice good posture. Stand and sit up straight. Ensure that your shoulders form a straight line over your hips and that your ears sit directly over your shoulders.
• Take breaks. When sitting for long periods at a computer, in the car or elsewhere, be sure to give your body breaks. Stand up from your desk or pull the car over to walk around and stretch.
• Adjust your workstation. Set your computer monitor to eye level and adjust your chair so that your knees are slightly lower than your hips. Make sure your chair has armrests and use them.
• Exercise. Exercises that strengthen your neck, back, and core muscles can help you maintain proper posture and prevent pain. Pilates, yoga and swimming can all benefit your neck.
• Don’t smoke. If you smoke, try to quit. Smoking accelerates degeneration, which can increase pain.
• Follow an anti-inflammatory diet. Many patients report that a diet that limits processed foods, red meat and alcohol, and is rich in fruits, vegetables, lean proteins, whole grains and healthy fats has resulted in reduced pain.
• Sleep well. When you sleep, your head and neck should be aligned with your body. Use a small pillow and try sleeping on your back and elevating your legs, which can help flatten spinal muscles.
• Watch what you carry. Heavy bags, especially with straps that go over the shoulder, can place unnecessary strain on the neck.
To find a physician affiliated with Penn Medicine Princeton Health, call 888-742-7496, or visit princetonhcs.org.
Seth Joseffer, MD, is board certified in spine and neurological surgery. He is the co-director of the Penn Medicine Princeton Medical Center Center for Spine Care.