A Pain in the Neck

Raise your hand if you’ve had pain in the neck of some kind before. No I don’t mean your little brother. I mean the pain that you might get when you wake up in the morning having slept in a weird position, or the whiplash after a car accident or roller coaster ride, or the one that gets worse when you sit at work stressed all day long… Yes, I sense your hand went up for one or more of those.

Neck Pain. Why me?

Studies show that neck pain is prevalent in a third or more of the average population. However, we tend to see it more in females and in people in their middle age. Interestingly, here's a short list of some of the factors associated with neck pain: genetics, mental health, sleep disturbance, smoking, and not moving your body enough (AKA most of us with desk jobs).             
Neck pain can sometimes be more debilitating than even lower back pain because it can lead to headaches, dizziness, or lack of focus.  It can affect your sleep, which in itself can cause a multitude of other problems.

There are a host of factors that contribute to neck pain. Here are just a handful to bring to your attention:

1. Lack of Exercise / Poor Posture
    → Deconditioning of muscles in the neck, shoulders, and core

2. Acute Injury
    → Concussions, Whiplash, Sports Injuries 

3. Chronic Pain
     → Herniated Cervical Disc, Stenosis, Fibromyalgia, Myofascial Pain, Arthritis

4. Psychosocially driven
→ Depression and/or Anxiety, Stress, Low Job Satisfaction (yes it happens to be a reason!)

5. Other Medical Conditions / Red Flags!
→ Cervical Myelopathy, Atlantoaxial subluxation, Metastases, Spinal Cord Injury, Infection, Meningitis, Vertebral Fracture, Vertebral Artery Bleeding  
                            
What now?

I could truly write a book on each of the five above, but here are some pointers. 

Lack of Exercise / Poor Posture

1. Move your body! 
Since neck pain is so closely related to sedentary lifestyle, it’s important to get a few hours of exercise into your week. If you currently aren’t exercising at all and are scared to get into it, I suggest starting with 2-3 days a week of light to moderate cardio (walking, biking, swimming). Just doing this can help shift you into a more active lifestyle, slowly, but surely!

2. Fix your posture! 
If you want tips on improving your posture and reducing headaches (especially those related to neck pain), check out the Headache blog.

Acute or Chronic Injury

1. Imaging!
If you haven’t already, it is very important to get imaging done (X-ray/MRI) to rule out serious pathology. 

2. Physical therapy!
If you aren’t in need of immediate medical intervention, see a physical therapist to start rehabilitating sooner than later. You may need to wear a cervical collar to prevent extreme end range motions or receive cervical traction to relax and open your joints. Your PT will provide manual approaches like mobilizations and muscle release as well as a comprehensive and customized home exercise program.  

3. Injections and meds
If you have acute pain and inflammation, your MD might prescribe oral/topical NSAIDs or muscle relaxants. You may also need a dose of local injections for pain relief (local anesthetic, corticosteroid, botulinum toxin, nerve root block, etc). 
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*Please be careful of overusing these two options. On a personal note, I find that those who rely on injections and medications on the long term don’t solve the underlying problem behind their neck pain. 
*In severe cases with failed conservative treatment, your doctor may discuss surgical intervention

Psychosocially driven

1. See a Therapist
Seek help from someone specialized in cognitive behavioral therapy, if possible, to help reshape your thoughts and behaviors into ones that serve you better. 

2. Yoga and Meditation
There is growing evidence that the ancient practices of yoga and meditation can have a tremendously positive effect on stress management. Meditation and mindfulness are not easy concepts. Try Youtube or a meditation app to get you started. 
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3. Breathe
I’ve said this many times but I’ll say it again - if there is one thing I swear by, it’s breathing more efficiently. Learn how to take a proper deep belly breath from a yoga teacher, physical therapist, or health coach. Repeat this many times a day!

Other Medical Conditions:
Please receive immediate medical attention if you experience neck pain along with any of the following:

1. Recent trauma (Ex. car accident)
2. History of cancer
3. Down Syndrome
4. Age > 65
5. Numbness or tingling anywhere
6. Abnormal walking
7. Dizziness
8. Double vision
9. Fainting Spells
10. Balance Issues
11. Difficulty speaking
12. Difficulty swallowing
13. Inability to turn head

*Note that this list is NOT inclusive of all red flags, but just gives a sense of a some. 

Last Thoughts.

As you can see, there are many reasons for neck pain and many ways to tackle it. The most important thing to know is that you shouldn’t be living with debilitating neck pain. Taking actionable steps to reducing and managing your pain can be daunting at first, especially if you’ve been experiencing it for a while. However, just trying one of the suggestions above gets you closer to a better quality of life. 

References:

1. Binder A. Neck Pain. BMJ Clin Evid. 2008; 1103:1-34.
2. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2):284-299.​