Neck pain

Neck pain is quite literally, pain in muscles and joints in the area of the neck. The condition is also referred to as a ‘stiff neck’ because movements of the neck and upper spine become limited. Sometimes, one shoulder (and very rarely both shoulders) can be involved, which is why some people may refer to the condition as ‘neck and shoulder pain’.

Pain and stiffness in the neck and shoulders can range from a mild discomfort to severe pain. It can be acute (sudden) or chronic (long-lasting) and the root of the problem can range from a strained muscle, a trapped nerve, rheumatism, to various forms of arthritis.

As you will have seen, the term neck pain covers quite a wide range of ailments with different causes. Unfortunately, this short article can’t go into the detail of all of these. However, the main causes of neck pain may be summarised as:

• Muscular problems
• Injuries or trauma
• Arthritis
• Other spinal problems

This is perhaps the most common cause of a stiff neck in modern society. Most of us will have experienced episodes of muscle strain in our neck or shoulders, sometimes referred to as a ‘crick in the neck’.

A stiff neck is almost always an ‘acute’ problem. The pain comes suddenly (typically, we wake up with it) and tends to resolve within one week.

Causes of a stiff neck include:

• Sleeping in an awkward position, or uncomfortable bed
• Stress, worries or anxiety
• An unusual amount of time driving
• Working for long hours in front of a computer

In many cases however, no obvious cause can be found. Spasms in the muscles of the neck and shoulders make the pain worse and this limits movement in the neck and upper part of the spine.

A stiff neck can make normal everyday tasks more difficult – for instance, take special care when driving to make sure you can turn your head sufficiently to see the traffic around (and behind you), especially as you pull out of junctions.

A stiff neck often resolves with little or no treatment. However, the use of muscle rubs such as an anti-inflammatory gel can provide pain relief and help relieve symptoms.

Injuries to the upper part of the spine can come about with a car accident and is typically known as a whiplash injury. Other similar injuries can lead to neck pain, such as falling off a bike, ladder or whilst skiing.

If these injuries are mild, the cause of the neck pain can be almost entirely attributed to muscular causes and in this way, it is similar to the ‘crick’ in the neck described above. However, if severe, injuries and trauma to the neck can cause structural damage to the upper spine and may lead to disc prolapse (a slipped disc) or other serious conditions.

It is clear that neck pain arising from injuries or trauma should be firstly attended to by a doctor. In most cases, investigations such as x-rays or scans will be called for.

Arthritis is a problem which arises because of inflammation in the joints, and can affect any part of the body. Arthritis affecting the upper spine can lead to pain in the neck and shoulders.

There are two types of arthritis:

• Osteoarthritis. Also known as ‘wear and tear’ arthritis, osteoarthritis is caused by overuse or overworking of the joints and tends to be more frequent as one becomes older. Often, there is no obvious cause for this ‘overwork’ and the condition occurs because of metabolic, dietary or lifestyle reasons, as bones and joints start to decay and wear away before their time. Osteoarthritis typically affects the large weight-bearing joints of the body (hips or knees) but can also affect the upper spine and neck, where it is known as cervical spondylosis.
• Rheumatoid arthritis. This is an autoimmune condition which affects the smaller joints of the body, including the small joints of the neck bones. Rheumatoid arthritis may affect people of any age and all parts of the body can be involved. When the bones of the neck become inflamed, the result is a stiff and painful neck.

Both forms of arthritis should be managed by a doctor. Apart from the use of prescribed medication, anti-inflammatory gel can be useful to help relieve pain and stiffness in the muscles in these conditions.

Neck pain can arise from problems in the spine. In general, these are all major health concerns which should be managed by a healthcare professional. Types of spinal problems giving rise to neck pain include:

• A pinched nerve
• A prolapsed disc
• Deformation of the spine
• Tumours
• Infection

A pinched nerve can arise because of a prolapsed disc or other spinal problem such as a congenitally deformed spine. Pain originating from the neck can radiate (move) down one shoulder and into the arm. Very, very rarely, pain in the neck can arise as a result of a tumour or infection in the spine.

As we have now learnt, most causes of neck pain are due to muscular causes and resolve quickly. If trauma is involved, severe and sudden neck pain can be a symptom of head injury or a prolapse of a disc in the neck.

Neck pain can also be a sign of a condition known as bacterial meningitis. This is most often seen in children (rather than adults) and is especially dangerous.

The signs and symptoms of meningitis are described below. Neck pain (a stiff neck) is included in the symptoms, and if you recognise the other signs of meningitis from the list, you should seek medical help very urgently.

• A flu-like feeling or general feeling of being unwell
• Fever
• Neck pain or difficulty bending the neck forward
• Severe headache and / or vomiting
• A skin rash which does not fade when you press it with a glass or a finger
• Needing to lie in a dark room as light bothers the eyes