Neck pain : Causes and Types

➡️ Click here to learn and explore more topics on Healthcare Rehabilitation blog

Neck pain is the most common problem faced by majority of the population throughout the world. Everyone might have experienced neck pain and discomfort associated with it. Nerve supply of the entire body is travelled via neck to rest of the body parts. Neck is a mobile structure through which all the sensitive ascending and descending nerve pathways are passing. It has the high potential to get injured due to sudden jerk, accidents, muscle strain or ligament sprain (due to heavy lifting or awkward postures). 

Causes of cervical/neck pain :

Common injuries or stress in the neck occur with flexion or extension trauma or cumulative stresses. Impairments of cervical vertebrae, intervertebral disc, muscle or ligament can be graded from mild to severe. 

• Severe and serious cervical trauma or injuries may result in vertebral fractures and spinal cord injury, thus leading to quadriplegia. For example in car accidents (whiplash injuries), fall from a height, gun-shot or knife injury, heavy and fast blow on the neck etc. 
• Serious cervical injuries can occurs due to vehicle accidents causing :
• Extension injuries : when the head rapidly accelerates into extension, if nothing stops it, the occiput is stopped by the thorax.
• Flexion injuries : When the head rapidly accelerates into flexion and nothing stops it, the chin is stopped by the sternum.
• Both type of injuries cause sudden, jerky pulling stretch and compression of the cervical tissues leading to strain, sprain and tear in muscle or ligament fibers.
• Fall from a height can cause cervical vertebrae fracture or dislocation or both. It can cause direct injury to spinal cord, neck muscles or ligament and spinal blood vessels.

Fig : Cervical injuries due to acceleration or deceleration injuries.

• Potential musculoskeletal disorders of neck region due to cumulative trauma are thoracic outlet syndrome, tension neck syndrome, prolapsed intervertebral disc, cervical disc disease, cervical spondylosis etc.
• Strain in the posterior cervical, scapular and upper thoracic muscles and fascia is common with postural stresses such as prolonged sitting at a computer terminal, drawing table, or desk. Labourers working at construction site or industries also face cumulative stresses on the neck and shoulder due to wrong pattern of lifting and carrying loads, awkward body positioning while working, inappropriate environmental conditions, lack of man power or lack of machineries at worksite.
• Emotional stress is often expressed as increased tension headache and pain in the posterior cervical area. 
• Healthcare workers mainly Surgeons, Dentist, Physiotherapist, Occupational Therapist also experience neck pain and stiffness. While treating patients, Physiotherapist or Occupational Therapist unknowingly adopt various  awkward or static postures involving neck, spine, shoulder and lower limbs joints. During a long surgical procedure and unfavourable environment conditions (light level, temperature) the Surgeon unknowingly display poor posture commonly like forward head, excessive neck flexion more that 30 degree, shoulder protracted and elevated, excessive leaning and hunched back, etc. All these wrong and static postures adopted in working hours can cause stress on the dynamic and static supporting structures of neck, shoulder and upper back.

Fig : Increased neck flexion posture directly leads to increased pressure on intervertebral disc and stretch weakness of neck extensors.

Fig : Strain on cervical supporting structures of Dentists due to frequent positioning of neck and spine in wrong alignment for prolonged duration.

• Other causes of neck pain includes : 
• Neurological cause : Meningitis, Dystonia, Arnold Chiari malformations
• Orthopedic cause : Rheumatoid arthritis, Ankylosing Spondylitis, Cervical vertebral tumor, cervical Hemangioma (rare), Atlanto-axial dislocation etc

Progression of symptoms due to stress and strain on dynamic and static supporting structures of cervical bodies (cumulative stresses): Initial symptoms of cervical/neck strain includes neck pain, neck muscle spasm or tightness or stiffness (trapezius muscle spasm or soreness), trigger points over neck or upper back or upper trapezius, tingling or numbness sensation of upper-limbs, dizziness, weakness of upper-limbs mainly hands (sign of progressive cord compression and increasing severity).

In the beginning, the symptoms may recover quickly without much worry but as the same working behavior patterns and postures continues for many week then the symptoms will become chronic and sustained. Therefore, primary and secondary prevention is essential to stop the symptoms to occur (primary) and/or to prevent them from getting worse later (secondary).

Types of Neck Pain : 

1) Radicular pain : radiating pain along the nerve pathway i.e. from neck to shoulder, to arm and/or till hand. 

• Person experience electric shock like feeling in upper limb, starting from neck, during certain movement or after prolonged static and awkward posture of neck or arm.
• Radicular pain is caused due to impingement of the existing spinal nerve. The symptoms can be experienced unilaterally or bilaterally depending upon which side nerve root or spinal nerve is being compressed.
• The radicular pain generally follow dermatomal distribution pattern. 
• Causes of radicular pain can be due to prolapsed intervertebral disc, cervical disc degeneration, spinal canal stenosis, spinal tumor, vertebral bone fracture etc.

Fig : Radicular neck pain

2) Axial or mechanical neck pain : the pain can be dull, achy or throbbing or can be sharp pain and non-radiculating.

• This type of neck pain occurs due to neck muscles strain or ligament sprain. The pain is located in the neck, base of skull or occipital area and back of the shoulder. If one muscle or supporting structure becomes weak then other surrounding muscles comes into play in order to compensate for the original muscle weakness, thus overall group of muscles become stressed and fatigued while performing activity.
• The pain is generally in one part or region. Patient might be experienced in shoulder, upper back along with trapezius soreness and tightness. 
• Person experience pain during certain movements or static and prolonged positioning of neck and shouder, or lifting and carrying heavy weight overhead etc
• Cumulative stresses can lead to or even become a cause of prolapsed intervertebral disc, cervical disc degeneration, atlanto-axial dislocation, vertebral bone fracture, facetal arthropathy, Arnold Chiari malformations. Other causes of neck pain includes cervical spinal tumor, throat cancer etc.

Fig : Mechanical or axial neck pain

3) Referred neck pain : The pain is experienced in a location other than its source and the cause is not nerve root impingement. 

• It is usually experienced as deep, achy, cramping or throbbing sensation. Pain area is more diffused and spread out rather than radiating. 
• Pain can be referred to the neck in various ways such as from heart in myocardial infarction (heart attack), injured spleen, liver cyst,  from temporomandibular joint disorder, from compressed trigger point.

Fig : Referred neck pain

4) Myelopathic pain : it occurs due to compression of the spinal cord. It occurs at the level of compression causing neck pain and along with this peripheral symptom of spinal cord compression (below compressed spinal cord level) is observed like weakness in feet or leg, loss of sensation, bowel or bladder dysfunction etc. Example in cervical cord segment tumor (intramedullary and extramedullary tumor) , spinal stenosis, syringomyelia, Arnold Chiari malformations.

Fig : Myelopathic neck pain

Thankyou for reading!!!

Dr.Pallavi Khadse-Kolhe, Dr.Ashwini Sangar, Dr.Sheetal Tatar-Dhande