Neck pain: causes and treatment
Neck pain mostly originates from postural changes involving increased thoracic kyphosis with increased cervical lordosis, so treatment involves correcting these various postural patterns.
Neck conditions fall into two main groups: axial, with pain in the centre of the neck, or radicular, with pain radiating into the arms.
In axial pain, cervical facet joint arthropathy/osteoarthritis predominates, which usually worsens when the neck is extended. When it affects the upper joints, the pain can radiate to the head; when it affects the lower joints, it tends to radiate to the trapezius area. Cervical medial branch blocks are a useful tool in managing this condition. If it recurs, cervical medial branch radiofrequency is a long-lasting option.
Muscular pain is also an important part of neck pain, and can affect several muscles such as the trapezius, splenius or levator scapulae. Heat, massage, stretching and diathermy are the basis of treatment for this type of pain, with peripheral nerve blocks and botulinum toxin injections also having a role in resistant cases.
In radicular pain, where nerve roots are compressed by various structures, injecting anti-inflammatories next to the compressed roots may be an option to consider before surgery.
When to seek urgent help
Neck pain after a fall or a road traffic accident.
Progressive loss of strength or numbness in the arms or legs.
Difficulty walking or poor balance.
Fever, severe neck stiffness or a sudden, very severe headache.
How we diagnose it
At a pain medicine consultation, the clinical examination distinguishes axial pain (in the centre of the neck) from radicular pain (travelling down the arm). A postural assessment shows the patterns that overload the cervical spine, such as a forward head posture at the computer. Imaging is only requested when it could change treatment.
What you can do day to day
Set your screen at eye level and take short breaks every 30 to 45 minutes.
Keep your neck moving: prolonged rest doesn't help.
Strengthen the deep neck muscles and the shoulder-blade stabilisers, with guidance from a physiotherapist.
Sleep with a pillow that keeps your neck aligned with the rest of your spine.
Treatment at Clínica Myalgia
Physiotherapy: postural correction and targeted exercise, in one-to-one sessions.
Image-guided procedures: medial branch blocks, radiofrequency and botulinum toxin in the cases described above.
Movement analysis: for people with recurring pain when training or during sporting movements.
Frequently asked questions about neck pain
Can neck pain cause headaches?
Yes. When it affects the upper cervical joints, the pain can radiate to the back of the head and the head itself. This is called cervicogenic headache.
Does tingling in the arm come from the neck?
It can, when a nerve root is compressed. It can also come from a compressed nerve at the elbow or wrist. Find out more about neuropathic pain.
How long does neck pain take to go away?
Most episodes improve within a few weeks. If the pain lasts more than six weeks or keeps coming back, it is worth treating the cause.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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