The cervical spine consists of seven vertebrae in the neck region. Positioned between the second and third vertebrae are intervertebral discs, which are cartilaginous tissues. The neck plays a crucial role in enabling us to move our head in various directions and supports the weight of the head. These movements are facilitated by the interplay of discs and joints located between the vertebrae. Within the cervical vertebrae, the spinal cord traverses, while the nerves responsible for arm muscle movement and sensory perception exit through the openings between the vertebrae. Given the highly mobile nature of the neck, it is common for individuals to experience neck pain. In fact, approximately half of adults encounter at least one episode of neck pain throughout their lifetime.
There are primarily two types of neck pain:
Mechanical neck pain and pain related to spinal disorders.
- Mechanical Neck Pain
The most frequently encountered type of neck pain is mechanical in nature. It typically arises from minor traumas affecting the neck or minor injuries to the neck muscles and connective tissues. Poor posture plays a significant role in its occurrence, particularly among individuals who spend prolonged periods in a forward head position, such as desk workers. Mechanical neck pain can manifest as radiating discomfort extending to the head, shoulders, and arms. Pinpointing the precise cause and location of the pain often proves challenging.
- Neck Pain Associated with Spinal Disorders
Neck pain related to spinal disorders is relatively less common when compared to mechanical neck pain. The predominant causes within this category include:
a) Cervical disc herniation (Cervical radiculopathy)
b) Degeneration and wear of the cervical spine (Cervical spondylosis)
c) Spinal cord compression resulting from the narrowing of the cervical spinal canal (Cervical spondylotic myelopathy)
a) Cervical Disc Herniation
Cervical disc herniation occurs when the outer casing of the intervertebral disc, located between two vertebrae, weakens or tears, causing the inner gel-like tissue to protrude and exert pressure on the nerves. While weakness or tearing of the outer layer mainly contributes to neck pain, cervical disc herniation specifically leads to pain radiating to the shoulder and arm due to compression on the nerve root. Arm pain is often more intense than neck pain and may be accompanied by weakness and numbness in the arm and hand.
b) Degeneration and Wear of the Cervical Spine (Cervical Spondylosis)
With age, the water content of the intervertebral discs in the cervical spine decreases, resulting in reduced movement capacity and disc deterioration. The diminished disc height causes increased load on the posterior joints of the cervical vertebrae. This imbalance in load distribution and compromised movement capability leads to degeneration of the vertebrae and the formation of abnormal bony growths. These growths can cause neck pain and exert pressure on the nerve roots and spinal cord, resulting in arm pain similar to cervical disc herniation, as well as weakness and numbness in the arm and hand.
c) Spinal Cord Compression due to Narrowing of the Cervical Spinal Canal (Cervical Spondylotic Myelopathy)
Cervical spondylotic myelopathy refers to the manifestation of symptoms caused by compression on the spinal cord due to spondylotic changes in the cervical spine and narrowing of the spinal canal. Continuous compression of the spinal cord leads to symptoms such as a sensation of tightness, stiffness, difficulty in walking, weakness in the arms, and numbness in the legs.
Evaluation and Treatment of Neck Pain in Patients
Treatment of Mechanical Neck Pain: The prevailing cause of neck pain is commonly known as “mechanical neck pain.” This type of pain tends to diminish gradually within a span of 2-3 days and completely subside within 1-2 weeks. However, there are instances where the pain becomes chronic and intermittently intensifies in acute episodes. The presence of pain or a sensation of numbness that radiates to the arm and hand could be indicative of nerve root compression. In such cases, it is recommended to seek medical attention for an evaluation focusing on cervical disc herniation.
In which situations can the cause of pain be significant?
- If the individual has a serious systemic condition like cancer or rheumatoid arthritis.
- If the pain progressively worsens instead of improving over time.
- If there is a noticeable loss of strength or altered sensation in the arm.
- If there are accompanying symptoms such as fever or unexplained weight loss.
- If there is tenderness specifically in the bones of the neck.
The treatment objective for mechanical neck pain is to restore normal neck movements as swiftly as possible. Initially, individuals may instinctively try to immobilize their neck due to the discomfort. However, it is crucial to gradually increase the range of motion within the limits permitted by the pain to prevent stiffness in the neck. The use of neck collars is not recommended as they restrict neck movements. The early restoration of normal neck movements helps prevent the pain from becoming chronic. Pain relievers are beneficial for alleviating pain. Tablets containing paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can effectively reduce pain and facilitate easier neck movements. If notable muscle spasms are present, short-term use of muscle relaxants may be considered. It is important to commence medication treatment based on the appropriate recommendation from a healthcare professional, considering the potential side effects of the medications.
Treatment of Cervical Disc Herniation: The primary indication of cervical disc herniation is severe pain radiating to the arm due to nerve root compression. The pain typically resolves spontaneously. Initially intense, it gradually diminishes and disappears within 4-6 weeks. Pain management involves the use of analgesic medications to alleviate discomfort. The implementation of a neck collar, under medical supervision, may be considered. For a small subset of patients, pain can persist beyond six weeks. In cases of chronic or severe pain unresponsive to conservative measures, surgical intervention may be contemplated. Persistent weakness resulting from nerve root compression necessitates surgical intervention to relieve the pressure. It is important to note that pain resolution does not imply complete recovery. Patients are advised to adopt neck protection measures and engage in neck exercises to enhance muscle strength and prevent future episodes.
Treatment of Degeneration/Wear in Cervical Vertebrae (Cervical Spondylosis): Cervical spondylosis, commonly encountered among the elderly, is often an incidental radiological finding. It does not invariably induce pain. When symptomatic, neck exercises and muscle strengthening programs are recommended to alleviate discomfort. Additionally, physical therapy modalities can provide beneficial effects.
Treatment of Spinal Cord Compression due to Narrowing of the Cervical Spinal Canal (Cervical Spondylotic Myelopathy): In instances where cervical spondylosis leads to spinal cord and nerve root compression, surgical intervention becomes necessary to alleviate the compression. Prolonged compression on the spinal cord may result in irreversible alterations. Prompt medical attention is warranted if symptoms such as leg stiffness, weakness, or progressive deterioration emerge. Surgical intervention aims to relieve spinal cord compression and prevent disease progression. The surgical approach may vary based on the site and extent of compression, as well as the position of the neck. Swift relief of compression is crucial in cervical spondylotic myelopathy to prevent permanent spinal cord changes.
Ways for Neck Pain Prevention:
Taking measures to avoid excessive strain on the neck and minimizing prolonged periods of working in a forward head position can serve as effective deterrents against experiencing episodes of neck pain. Given the inherent challenges of consistently safeguarding the neck during routine tasks, prioritizing the strengthening of the muscles encompassing the cervical spine emerges as the optimal approach. Regular engagement in targeted neck exercises not only reinforces muscular strength but also acts as a preventive measure against the occurrence of minor traumas that may impact the integrity of the neck spine. During periods characterized by discomfort and restricted neck mobility, it is prudent to exercise caution when engaging in activities necessitating rapid reflex responses, such as operating a motor vehicle.
