Underlying Causes of Neck Pain

by Ryan Gocke, MD

Underlying Causes of Neck Pain

Neck pain can be an extremely frustrating and debilitating issue that affects what are usually the simplest of daily tasks. And unfortunately, no one is immune from developing neck problems at some point in their life’s journey. As a spine surgeon who focuses mainly on the cervical spine and neck, I’ve seen patients of all demographics deal with some degree of neck discomfort during their adult years.

The vocation or career of a person can play a significant role in the development of neck pain. The patients I see most frequently perform manual labor for a living, but I certainly see numerous patients who also suffer from chronic neck problems, pain, and dysfunction simply from working in front of a computer for extended periods of their day.

Another large component towards the onset of neck pain symptoms is a factor beyond any of our control: genetics. As we all progress along in life, or more bluntly put, start to age, the muscles, tendons, ligaments, and bones in our neck begin to wear out. This aging alone puts us at a predisposition to suffer from neck pain, and if your family has a history of neck problems, there is a much higher risk for the development of cervical spine/neck issues.

What are the symptoms neck pain caused by an underlying issue?

The most common complaint I see in my office is neck pain and stiffness that radiates into the top of the shoulders, and if it is severe enough, shoots all way down to the arms. Patients will describe a tightness in their cervical spine or neck that prevents them from being to turn their head one way or another. It is not uncommon for an individual to experience numbness, tingling, or weakness that causes them to drop their morning cup of coffee or have difficulty buttoning their shirt.

Another symptom is headaches that can disrupt your sleep patterns and interfere with your ability to concentrate during the workday, leading to less productivity. Pain will start in the neck and travel to the back of the head. Again, if severe enough, the pain can extend even further into the front of the head.

Other patients will describe pain in their shoulders that travels down the arm and ventures down their spine towards their tail bone. Patients suffering from this symptom set often have issues with balance when they walk and have difficulties with bowel and bladder function.

Yet, while the symptoms appear to originate from the neck, the underlying issue is actually a neurologic one where the nerves within the neck are being compressed.

What are the underlying conditions?

Disc degeneration

As mentioned before, as we age, our body does not always function as well as it once did. Disc degeneration is usually seen in patients in their 30’s and 40’s and is a condition where the intervertebral discs or “shock absorbers” of the spine start to wear out, and the spinal column literally starts to collapse down. This condition is enough to cause localized pain and discomfort.

Sometimes, I will see patients who have only had neck pain for a couple of weeks and will report a history of being involved in a car accident or perhaps were moving heavy furniture the previous weekend, and they pull a muscle in their neck. While yes, these patients are suffering from neck pain, they are suffering from a muscular problem, not an underlying condition I am referring to. They will start to see improvement soon after the onset of their muscle injury.

Patients who have disc degeneration have a more chronic problem and will have symptoms that last for not weeks but months at a time.

Stenosis

As disc degeneration continues over time and patients get into their 50’s and 60’s, the space available for the nerves as they exit out of the spinal column can become compromised, leading to a mechanical compression or squeezing of the nerves.

This condition is related to the wearing out of our spinal discs and collapsing of our spinal column. The mechanical downward pressure causes nerve discomfort such as pain, numbness, tingling, and weakness that radiates to the arm and sometimes the tailbone.

Disc herniation

Disc herniation occurs when the jelly-like substance within our spinal discs leaks out and starts to push on a nerve such as the nerves within our neck. These neck nerves travel all the way into our shoulder and down our arms. If they become compressed by the jelly-like fluid, we will feel nerve symptoms along our shoulders and arms.

Symptoms will include

  • Burning sensation
  • Charlie horse
  • Dull ache usually in the shoulder blade

Disc herniation is most commonly seen in patients 50 and younger and is it not unique to the cervical spine. This condition can happen in the middle of the spinal column and also in the lower back.

Central cervical stenosis or cervical myelopathy

This condition is particularly concerning for older patients and develops when bone spurs become so large in the spinal column and around the neck that the spinal cord itself becomes compressed. These patients will start having issues with clumsiness in their hands and will struggle with fine motor tasks.

Activities such as buttoning a shirt, picking coins off a table, or anything that involves fine dexterity or use of the fingertips becomes extremely difficult. Balance and walking steadily will also start to be affected when the spinal cord is compressed.

How do you treat underlying issues causing neck pain?

It is hard to place all of the previously described conditions into one treatment pool, but generally speaking, patients who have had symptoms for a shorter period of time will respond well to non-surgical options such as over-the-counter anti-inflammatories.

Activity modification is certainly beneficial for allowing your body to rest and heal. If you’re a manual labor worker, taking some time off work might be in your best interest. If that is not possible, talk to your employer to see if there is a different job set or different task that you can complete at work. If you work a desk job, look into acquiring a standing desk. Simply changing a seated position to a standing position can significantly help reduce symptoms.

There are also old-fashioned remedies such as ice and heat being applied to the spinal column and neck. It won’t solve any problems, but it certainly can make you feel better. I recommend using heat in the morning when you’re waking up and ice on your neck at night when you’re finishing up your day.

If symptoms still persist after more conservative treatments, patients can pursue the following treatment options.

Physical therapy

  • Physical therapists can work with to strength the muscles around your neck and improve your total neck flexibility.   
  • Massage therapy can be helpful in loosening tight muscles, but usually doesn’t last long term.
  • Acupuncture therapy can also lessen the significance of symptoms by alleviating muscle pain, but again, it won’t solve the underlying nerve problem.

Medications

Many patients say they don’t want to start down the road of medications, but I always suggest they at least be willing to take medication when they really need it. If you’re having a really bad day or you know you will be at work for an extended period of time, take a medication that can potentially give you relief.

  • Muscle relaxants, which target the muscles to relieve spasms and cramping.
  • Nerve pain medication, which relieve nerve discomfort such as tingling down the arm.
  • Light narcotics, which help patients with significant pain sleep, but these are not given out frequently.

Epidural or steroid injections

Epidural or steroid injections are treatments that are designed to specifically target the nerves with steroid medication, which is an extremely potent anti-inflammatory. The injections won’t remove any of the mechanical pressure being placed on the nerve, but it certainly can calm down inflammation. This treatment option is reserved only for patients who do not have spinal cord compression.

Frequently asked questions

If the numbness and tingling in my arm goes away periodically, is that sign that the spinal or neck disorder is healing, or am I just dealing with the pain?

Usually, there are two reasons why the mechanical pressure causing your neck pain and discomfort will periodically go away.

The first reason is positional. How you sleep at night or how you hold you neck and head during the day can affect how the nerves in your spinal column are being compressed.

However, there are a lot of patients whose nerves can actually adapt to the mechanical compression. Nerves are a living tissue with living cells inside of them, and these cells can adapt to function better in certain environments.

Should I see a chiropractor for neck pain?

Seeing a chiropractor is a great option for many patients, and if the issue causing your neck pain symptoms is muscular, then a chiropractor will definitely help resolve that issue. But, if the underlying cause of your neck pain is neurological, seeing a spine surgeon would be in your best interest.

Is there a certain type of pillow or mattress I should be using?

I wish there was a straightforward answer for everyone, but unfortunately, there is no pillow that is correct for all people. Everyone’s body is different, and we all have a different physique.

So if you can afford to try a new mattress, it is worth a shot. If you cannot afford a new mattress, I recommend trying out different styles of pillows. Try soft pillows, firm pillows, and anything in between, or even try changing the number of pillows that you use at night.

I’ve seen many patients who come back to my office and say that they adjusted their pillow arrangement, and it helped relieve some symptoms.