Neck Pain: What causes it? How is it treated conservatively?

William Brightman DC, MS, MEd

Neck pain is one of those conditions that can come out of nowhere or is the result of a trauma such as “whiplash” from a motor vehicle accident or an athletic injury. Oftentimes, neck pain comes on insidiously  and the sufferer usually will attribute it to “how they slept”. While sleeping the wrong way can certainly contribute to a pain in the neck it is often not the cause. Poor posture and repetitive stress are the most common causes of neck pain. Moreover, neck pain can also stem from other parts of the body such as the low back or even the upper back.
Neck pain that comes out of “nowhere” usually stems from that poor posture we all fall prey to when we are seated at our desktop and our head is jutted forward placing an increased strain on the neck. It may start out as generalized stiffness or soreness and progress to pain and loss of motion. This type of pain will mostly impact the muscles and the joints in the cervical (neck) region. However, disc and nerve problems can also occur with prolonged neck pain.  With disc pain the patient may also feel pain, numbness, and/or a tingling sensation radiating down the arm. 
Poor posture will often occur when we are texting or using a tablet and are not focused on the position of our neck. There is a condition called “text neck” that explains how when we are texting our head is usually flexed downward which puts increased strain on the muscles in the posterior region of the neck.  Tablet users who are younger and who do not have a dedicated workspace will find themselves in positions of compromise for hours. Holding one position for extended periods of time is not only bad for the neck but will impact the entire spine. In fact, lying in a face down or prone position up on elbows will strain muscles and joints in the low back and neck. 
A slouched position on the couch will inevitably work its way from low back to the upper back and neck. When all the curves of the spine are impacted then any one of them can result in pain. 
The best approach to treating neck pain is to have a health care professional who specializes in spinal care perform a complete exam of the cervical spine and all associated structures. An exam that includes neurological and orthopedic assessments along with general palpation (clinically feeling) of different muscles and joints will help determine what structures are impacted. Once the exam is complete it is sometimes necessary to order  x-rays to rule out any bony and joint abnormalities. X-rays are not that clinically useful unless there is a suspicion of a bone issue. Misalignments can be diagnosed with a physical exam and plain films are not necessary. If there is radiating arm pain with numbness an MRI may be ordered to rule out a disc injury. This is only necessary if it is clinically prudent and the treatment is not working and further diagnostics are necessary. I am a firm believer in not ordering unnecessary testing out of “fear of missing something”. 
Once the diagnosis is  made a treatment is mapped out to help alleviate the neck pain. With sprain/strain and joint problems I find gentle chiropractic adjustments and muscle work (massage and myofascial release) are very effective at managing the pain. Usually within the first week the patient is feeling much better (1-3 treatments). Physical therapy modalities that combine ice/heat and other modalities may also be helpful. Guided home exercise that includes stretching and strengthening of the neck and upper back muscles is provided to the patient. Advice with postural positioning such as sitting in a chair  with lumbar support and having a tablet just below eye level is recommended. It is best to keep your head upright and have arms relatively close to the body as to not stress shoulder/upper trapezius muscles. It is important not to fall back into the same trap of poor posture from sitting, sleeping, or text neck!

Below are some helpful exercises to help in the management of neck pain secondary to repetitive stress. ​

                                      Gentle stretches followed by slow theraband strengthening exercises for the neck



                            William Brightman DC, MS, MEd
                            Chiropractor
                            Private Practice Mahopac NY
                            [email protected]