There are 7 vertebrae in the neck region. Between the vertebrae is the cartilage tissue called the disc, which starts between the second and third vertebrae. The neck has the ability to move our head in all directions and has a structure that carries the weight of the head. It provides these movements through the discs and joints between the vertebrae. The spinal cord passes through the neck vertebrae. From the holes between the vertebrae, the nerves that provide the movement of the arm muscles and the sensation of the arms come out. Neck pain is a common complaint because the neck vertebrae have a very mobile structure. Half of the adults in the adult age group experience an attack of neck pain at least once in their lives.
Types and Causes of Neck Pain
There are two main types of neck pain: Mechanical neck pain and pain due to spinal pathologies
1. Mechanical Neck Pain
It is the most common type of neck pain. It is mostly caused by minor traumas affecting the neck or minor injuries affecting the neck muscles and connective tissue. Poor posture is the most important cause of this type of pain. It is a common complaint especially in people who work at a desk all day in a forward leaning position. Mechanical neck pain may radiate to the head, shoulders, and arms. Often the true cause and location of the pain cannot be found.
2. Neck Pain Due to Spinal Diseases
Neck pain in this group is proportionally less common than mechanical neck pain. The most common causes are:
a) Neck hernia (Cervical disc herniation)
b) Degeneration / wear on the neck vertebrae (Cervical spondylosis)
c) Spinal cord involvement due to narrowing in the neck spinal canal (Cervical spondylotic myelopathy)
a) Neck hernia (Cervical disc herniation)
The disc material consists of a relatively hard sheath between the two vertebrae on the outside and gel-like soft tissue parts inside. With the weakening or tearing of the outer sheath, the inner part slides outward and begins to press on the nerves. While weakening or tearing in the outer layer causes neck pain, neck hernia, which can be defined as the outward displacement of the inner layer, causes pain especially on the shoulder and arm, as it puts pressure on the nerve root. Arm pain is often more severe than neck pain, as it compresses the nerve roots. Depending on the level of pressure on the nerve roots, there may be weakness and numbness in the arm and hand muscles.
b) Degeneration / wear on the neck vertebrae (Cervical spondylosis)
Especially with aging, the water ratio of the disc between the vertebrae in the neck decreases and there is a decrease in the ability of the disc to contribute to movement. With the deterioration of the disc, its height decreases and more load begins to be placed on the joints located at the back of the neck vertebrae. Imbalance in load distribution and mobility leads to deterioration of the vertebrae and abnormal bone extensions occur. These bone extensions can cause pain in the neck. In addition, it causes arm pain similar to neck hernia, weakness and numbness in the arm and hand by pressing on the nerve roots and spinal cord.
c) Spinal cord involvement due to narrowing in the spinal canal of the neck (Cervical spondylotic myelopathy)
If signs of compression on the spinal cord occur due to spondylotic changes in the neck spine and narrowing in the spinal canal, it is called “spondylotic myelopathy”. When there is constant pressure on the spinal cord, symptoms such as a feeling of tension in the legs, stiffness, difficulty in walking, weakness in the arms and numbness are observed.
Evaluation and Treatment of a Patient with Neck Pain
Treatment for Mechanical Neck Pain: The most common cause of neck pain is “mechanical neck pain”. This pain gradually decreases within 2-3 days and disappears within 1-2 weeks. Sometimes the pain can become chronic and intensify in occasional acute attacks. Pain or numbness in the arm and hand may be a sign of nerve root compression. In this case, it is useful to consult a doctor to be evaluated in terms of neck hernia.
In what situations can the cause of the pain be serious?
– If the patient has a serious systemic disease such as cancer, rheumatoid arthritis
– If the pain worsens day by day
– If there is loss of strength in the arm
– Pain accompanied by fever, weight loss
– If there is tenderness in the neck bones
The aim in the treatment of mechanical neck pain is to bring the neck movements back to normal as soon as possible. Since neck movements are painful in the beginning, the person wants to keep his neck still. However, in order to prevent stiffening of the neck, it is necessary to make natural movements by increasing the degree of pain as much as the pain allows. Using a neck collar is not recommended as it will restrict neck movements. Recovering the normal movements of the neck as soon as possible prevents the pain from becoming chronic. Pain relievers are helpful to reduce pain. Tablets containing paracetamol or anti-inflammatory drugs help to make neck movements easier by reducing pain. If muscle spasm is evident, muscle relaxants can be used for 2-3 days. Due to the side effects of drugs, it is necessary to start appropriate drug therapy according to the doctor’s recommendation.
Treatment of Neck Hernia (Cervical Disc Herniation): Severe pain in the arm due to the pressure on the nerve root is the most important symptom of cervical disc herniation. The pain usually goes away on its own. The pain, which is severe in the first week, disappears within 4-6 weeks. During this period, pain relievers are recommended to reduce the severity of the pain. The neck collar can be used with the recommendation of the doctor. In a small group of patients, pain may persist after 6 weeks. Surgery may be considered for chronic pain or severe pain that is unbearable despite painkillers. In some patients, loss of strength develops due to pressure on the nerve root. The development of loss of strength requires surgery to remove the pressure on the nerve. Spontaneous relief of pain does not mean that the disease has disappeared. It is recommended that the patient protect his neck in order not to have the same pain attack again and he should do neck exercises to strengthen the muscles around the neck.
Degeneration / wear on the neck vertebrae (Cervical spondylosis) Treatment: Cervical spondylosis is a common radiological finding especially in the elderly. It does not always cause pain. If it only causes neck pain, strengthening the neck muscles with recommended neck exercises helps to reduce the pain. Physical therapy methods are also helpful.
Treatment in spinal cord involvement (cervical spondylotic myelopathy) due to narrowing in the neck spinal canal: If cervical spndilosis presses on the spinal cord and nerve roots, the pressure should be removed with surgery. Chronic compression, especially on the spinal cord, can lead to irreversible changes in the spinal cord. Therefore, the appearance of symptoms such as a feeling of stiffness in the legs, loss of strength and the gradual increase of these problems require immediate medical attention. Such a condition can be progressive and surgery is recommended to remove the pressure on the spinal cord to stop the progression. The aim of the surgical intervention is to prevent the progression of the disease by removing the pressure on the spinal cord. The surgery site may change depending on the place where the pressure is highest and the position of the neck. The important thing in cervical spondylotic myelopathy is to remove the pressure before permanent changes occur in the spinal cord.
Ways to Prevent Neck Pain
Avoiding movements that force the neck, especially avoiding working in a tilted position for a long time, can prevent neck pain attacks. Since it will be difficult to protect our neck in daily life, it is the best method to strengthen the muscles around the neck spine. Regular neck exercises strengthen the neck muscles and prevent minor trauma to the neck spine.
