Uncomplicated mechanical neck pain
Uncomplicated mechanical neck pain is extremely common, affecting 10% to 20% of the population at any one time. It is the second most common condition (after low back pain) that we treat at the Sussex Back Pain Clinic.
In a very similar way to back pain, often there is no apparent reason why neck pain starts, sometimes you can just wake up with a bit of neck ache that then gets progressively worse over the next day or two and you don’t really know why. This is because most neck pain is a complex condition, meaning that it is not usually due to one event, but rather many different risk factors all interacting to result in neck pain.
The usual risk factors are:
- previous injury, such as a fall or whiplash-type strain
- poor posture, especially if the head is pushed forward and the neck bent backwards
- poor upper neck or thoracic (mid-back) mobility, especially if this curve has increased
- psychological stress
- wear and tear in the joints (spondylitis and arthritis)
Acute neck pain often occurs in the morning with patients thinking they must have slept awkwardly but this is not usually the case; it’s just that the accumulation of these factors over a period of time has disrupted normal spinal mechanics in the neck and often the upper back, that in turn has led to changes in motor control and altered movement, creating abnormal loading of the joints. During the night they have reached the limit of their ability to cope with the tissues becoming fatigued and sensitive and pain following soon afterwards, as pain-sensitive structures in the neck become irritated and inflamed. This normally manifests as pain in the base of the neck, which may radiate into the shoulders and the upper arms if particularly bad.
More commonly, neck pain increases gradually over a period of weeks or months, but may become chronic if left untreated.
Neck pain is often associated with:
- severe stiffness, especially if degenerative facet syndrome is present
- cervicogenic headache – usually travelling from the back of the skull to the front in a tension-type pattern
- migraine
- pain into the shoulder or along the border of the shoulder blade
- trapped nerves – giving radiating pain and pins and needles into the arms or hands (common if a slipped disc has occurred)
Because the neck is so mobile it is actually very good at adapting to small injuries and increasing stresses and strains. But the accumulation of these adaptations over a period of time can eventually lead to changes in motor control and altered movement creating abnormal loading of the joints, and they reach the limit of their ability to cope. Tissues become fatigued and sensitive and pain follows soon afterwards, as pain-sensitive structures in the neck become irritated and inflamed. This normally manifests as pain in the base of the neck, which may radiate into the shoulders, the upper arms or even up into the skull.
- Factors involved usually include:
- previous injury, such as a fall or whiplash-type strain
- poor posture, especially if the head is pushed forward and the neck bent backwards
- poor thoracic (mid-back) mobility, especially if this curve has increased
- psychological stress