Studies estimate that worldwide, more than one in five people suffer from neck pain every year. Neck pain can also be accompanied by pain, weakness, numbness and tingling in your arms and back. If this describes your symptoms, you may wonder if your pain is caused by something serious, or if it will go away with time.
In this article, I’ll explain common causes of neck pain, including a pinched nerve or a sprain. I’ll also talk about how medication and physiotherapy can help you feel better, and give guidelines about when you should see a doctor.
Anatomy of the Neck
Neck pain is often referred to as cervical pain because the neck area consists of the cervical part of your spine. This includes the seven bones or vertebrae that connect your back to your head.
Other parts of your cervical spine include:
- Spinal cord and nerves: These are the electrical conduits that travel through the spinal canal, carrying messages between your brain and the rest of your body. Eight pairs of nerve roots, numbered C1 to C8, branch out from both sides of the cervical spinal cord through small bony openings between the adjacent vertebrae called foramen. The nerves then continue along so that you can feel sensations on the skin of your shoulders, arms and hands. They also supply electrical signals to certain muscles to move your arms and hands.
- Intervertebral discs: These are flat round half inch thick discs between your vertebrae. They are made from a flexible ligament-type material and act as shock absorbers when you move.
- Muscles: These support your spine and allow you to move your neck and head in different directions.
- Ligaments: These connect your vertebrae together.
Causes of Neck Pain
Neck pain is a common medical condition and can be caused by a myriad of reasons. These include various disorders and diseases, injury, or poor posture. Common causes are those that occur with age, such as osteoarthritis; degenerative disc disease, where one or more intervertebral discs deteriorate or break down; and cervical spondylosis, where age-related wear and tear can shrink the intervertebral discs. Neck pain can also be caused by infections, or from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica.
In this article, we will be focussing on two common causes of neck pain: cervical radiculopathy and cervical sprains.
What Is Cervical Radiculopathy (Pinched Nerve)?
Cervical radiculopathy occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. Cervical radiculopathy is also referred to as a ‘pinched nerve’.
Causes of Cervical Radiculopathy
Your spinal cord runs downward through the center of your vertebrae, linking your neck all the way down to your lower back and sacrum. Nerve roots branch off the spinal cord and go outwards between each of the vertebrae. Cervical radiculopathy occurs when these nerve roots are hurt or compressed. For this reason, this condition is commonly called a ‘pinched nerve’. In fact, a pinched nerve is one of the most common causes of neck pain, affecting every 83 people out of 100,000.
Cervical radiculopathy can occur at any age, but most often occurs in people aged 40-50 years. Younger people can get a pinched nerve from a sudden injury, whereas older people usually develop this condition through changes that occur naturally as we age.
The main causes of cervical radiculopathy include the following:
Cervical Herniated Disc Injuries
Your intervertebral discs are soft cushions that act as shock absorbers between your vertebrae when pressure is put on them from moving your neck in different directions. A disc can get injured when a certain motion in the neck puts too much pressure on the disc and causes the disc to bulge toward the spinal canal and nerve roots. This is a herniated disc injury, also called a ‘bulged disc’ or ‘slipped disc.’
Pressure against the nerve root from a herniated disc can cause pain, numbness, and weakness to areas supplied by the nerve. There is now evidence that the pain may not be caused by the mechanical pinching of the nerve, but rather by chemicals that are released from the ruptured disc and irritate the nerve roots.
Herniated discs can occur when too much force is put on an otherwise healthy intervertebral disc. This can happen following a car crash where your head is pushed forward suddenly and the force is too much for a healthy disc to absorb. Herniated discs can also result from discs that have weakened or degenerated with age or over-use. This means that with age, less force is needed to tear or rupture a disc.
Cervical Degenerative Disc Disease and Bone Spurs
Whether caused by age, overuse or an accident, a degenerated disc loses its healthy liquid content and can shrink or tear. As the discs get thinner, the vertebrae move closer together and the body responds by forming more bone around the discs to strengthen them. These osteophytes or bone spurs can form around the nerve roots inside the foramen. When a bone spur gets large enough to protrude and rub on a nerve root and irritate it, it causes neck pain, and the symptoms may appear similar to those from a herniated disc.
This occurs when your spinal canal narrows with age, which can result in pressure being put on the nerve roots. This may cause symptoms similar to those of a pinched nerve.
Cervical Radiculopathy Symptoms
What Does a Pinched Nerve Feel Like?
For most people with a pinched nerve, the main symptom is a burning or sharp pain that extends from the neck and into the arm. The pain may worsen with certain neck movements, such as when you turn your head, or extend or strain your neck. Conversely, some people say their pain can be relieved a little if they place their hands on top of their head. This movement may temporarily relieve the pressure on the compressed nerve root.
Other symptoms include:
- A tingling or a “pins and needles” sensation in your hand or fingers
- Muscle weakness in your arm, shoulder, or hand
- Loss of feeling in your arm, shoulder, or hand
Many people with a pinched nerve also experience headaches due to involvement of the upper nerve roots, called cervicogenic headaches. These headaches may feel like a steady pain on one side of the head or face, and can have migraine-like symptoms of nausea and sensitivity to light or noise.
Can a Pinched Nerve Affect Other Parts of Your Body?
The symptoms of a pinched nerve are the result of damage occurring to a nerve that is rooted in the cervical spine. These nerves serve the shoulders, arms and hands. A cervical herniated disc can also affect the head and eyes, causing some people to experience headaches and problems with vision along with cervical radiculopathy. However, a pinched nerve in your neck will not affect other areas in your body that are not served by the damaged nerve, such as your legs.
Can Cervical Neck Problems Cause Chest Pain?
Recent case studies show that a few people who feel tingling in the left arm following a pinched nerve may also have some pain on the left side of their chest. This type of chest pain is called cervical angina, and it resembles the chest pain of someone with coronary heart disease. If you are experiencing chest pain, it is important for it to be differentiated from other, potentially life-threatening causes.
Diagnosing Cervical Radiculopathy
When you see your doctor, they will first review medical history and ask you about your general health. After discussing your symptoms, your doctor will then examine your neck, shoulder, arms, and hands. This is to check for any muscle weakness, loss of sensation, or change in your reflexes. You may also be asked to move your neck in certain ways to see if your symptoms get worse or better with these movements. (This is called Spurling’s test.)
After your physical examination, your doctor may ask you to have one or more of the following tests done to more closely evaluate your cervical spine. These will verify whether your symptoms are indeed caused by cervical radiculopathy rather than by other conditions, such as diabetes, which can also cause nerve damage.
- X-rays: An x-ray will show the alignment of bones along your neck and show if there are any fractures or narrowing of the foramen.
- Computed Tomography (CT) scans: More detailed than an x-ray, CT scans can show whether you have developed bone spurs near the foramen.
- Magnetic Resonance Imaging (MRI) scans: An MRI of the neck will reveal any damage to your soft tissues, such as a herniated disc, or damage to your spinal cord or nerve roots.
- Electromyography (EMG): An EMG measures the electrical impulses of your muscles, both at rest and during contractions. It is used to test whether a nerve is functioning normally.
Once you have had one or more of these diagnostic tests, you and your doctor will know if your neck pain or neck injury is serious or not. Your symptoms can then be treated appropriately.
Cervical Radiculopathy Treatment
Most people with a pinched nerve don’t require significant treatment. The symptoms generally improve with time, and frequently subside in a matter of days or weeks. What’s more, if the symptoms come back, which is quite common, they usually improve again without treatment.
Some people with cervical radiculopathy have symptoms that do not go away with time. If this is the case, you may require more evaluation and treatment. Based on the severity of your symptoms and associated medical conditions, some doctors may recommend immediate treatment rather than waiting to see if you recover without any interventions. Non-surgical treatments include cervical collars, physical therapy and medications:
A cervical collar can help you heal from a pinched nerve by allowing the muscles in your neck to rest. By preventing you from moving your neck too much, a cervical collar can help reduce the pinching of your nerve roots. Cervical collars can be soft (made of foam) or hard (made from metal or plastic) and should not be too uncomfortable.
This is a great way to learn and carry out certain exercises that can relieve your pain, strengthen your neck muscles, and increase your range of motion. Your physiotherapist may also recommend traction to gently stretch the joints and muscles of your neck.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These include aspirin, ibuprofen, and naproxen and may help your pain if it is caused by nerve irritation or inflammation.
A short course of oral corticosteroids may help relieve pain by reducing swelling and inflammation around the nerve.
This is a procedure where steroids are injected near the affected nerve to reduce local inflammation, reduce swelling and relieve the pain long enough to allow the nerve to recover.
These medications can be prescribed as a last resort, if no other medication has relieved your pain. They should only be taken for a limited time.
If non-surgical treatments do not relieve your symptoms after about 6-12 weeks, your doctor may consider surgery. The kind of operation will depend on various factors, including your specific symptoms and the location of the pinched nerve root. One kind of surgical procedure is called a diskectomy, where bone spurs or part of a herniated disc is removed. The aim of surgery is to relieve the pressure on the affected nerve.
What Is a Cervical Sprain?
Cervical sprains are caused by a stretched or torn neck muscle or ligament. Your cervical vertebrae are connected to each other by ligaments and muscles that act like thick rubber bands. A cervical sprain or overstretching can occur in one or more of these soft tissues when a sudden movement causes the neck to bend more than normal. Such an extreme neck movement can follow a car accident or a hard fall.
Is Cervical Sprain the Same as Whiplash?
One type of cervical sprain is due to a forceful and rapid back-and-forth movement of the neck, usually due to a rear-end car accident, sports accident, or other physical trauma. Because this movement is like the cracking of a whip, it is colloquially termed ‘whiplash’. A whiplash injury is treated similarly to other kinds of neck sprain.
Cervical Sprain Symptoms
A person with a neck sprain may experience a wide range of possible symptoms, including:
- Pain, especially in the back of the neck
- Pain that increases with movement
- Pain that peaks 12-72 hours after the injury, instead of immediately
- Muscle spasms and pain in the upper shoulder
- Headache in the back of the head
- Increased irritability, fatigue, difficulty sleeping, and difficulty concentrating
- Numbness in the arm or hand
- Neck stiffness
- Reduced range of motion in the neck
- Tingling or weakness in the arms
Diagnosing Cervical Sprain
Your doctor will discuss your medical history and perform a comprehensive physical examination. He or she will ask how you were injured, evaluate your neck’s range of motion, and check for any pain or numbness.
Similarly to a pinched nerve, your doctor may want you to have an imaging test. Since a cervical sprain involves soft tissues and not bones, a CT or MRI scan can provide more information about your injury. Nevertheless, your doctor may request you to have an x-ray to rule out other possible causes of your neck pain related to your bones, such as a spinal fracture, dislocation, or arthritis.
Treatment for Cervical Sprain
The goals of treatment are to control your pain, restore normal range of motion, and get you back to your normal routine. The earlier you can achieve this, the better your chances of avoiding long-term disability. This is true for all neck sprain treatments, including whiplash treatment.
How Long Does It Take for a Cervical Sprain To Heal?
Neck sprains, like other sprains, will usually heal gradually with time and appropriate treatment. Most cervical sprain symptoms go away in 4-6 weeks. However, severe injuries may take longer to heal completely. This means that some people will only need over-the-counter medication and at-home care, while others may need prescription pain medication and specialized pain treatment.
Some of the treatments for cervical sprain are listed below:
- Cervical collar: Just as with a pinched nerve, you may have to wear a soft collar around your neck to help support the head. This is to relieve pressure on your neck ligaments and muscles so they have time to heal.
- NSAIDs: As with a pinched nerve, these drugs may relieve some of your pain and reduce any swelling.
- Ice: In the first couple of days following your injury, you can reduce inflammation and discomfort by applying an ice pack to your neck. This can be done several times a day for 15-30 minutes each time.
- Heat packs: Heat packs, especially moist heat, can help relieve pain and loosen cramped sore muscles. However, you should not do this until several days after the injury.
- Exercises: As you start to recover from your injury, you can begin to do some gentle physiotherapy and other exercises. Always make sure that your doctor has given you the go-ahead so that you do not cause yourself any further unnecessary strain. Exercises can include traction exercises for the neck, aerobic exercise, and isometric exercise. You may also find ultrasound therapy or massaging the painful area helpful.
What Is the Difference Between Cervical Radiculopathy and Cervical Sprains?
Cervical radiculopathy and cervical sprains can be the source of significant neck pain, but they are generally caused by problems in different parts of the neck. Both cervical radiculopathy and cervical sprains can be caused by an injury from a car accident, a bad fall, or sports. Cervical radiculopathy, however, is often the result of aging and general wear and tear on our body.
How to Prevent a Pinched Nerve or Cervical Sprain?
Since both conditions can be caused by an injury from sports or a car accident, it is well worth taking some preventative measures to reduce your risk of suffering such an injury. When playing sports, make sure you always wear protective gear as appropriate, including a helmet for biking and skiing or other sports that could cause a head injury, and a lifejacket for water sports. When driving, do not use a hand-held cell phone and always wear a seatbelt.
Preventing a pinched nerve, which may be caused by the degeneration of your spinal tissues through aging, can be somewhat prevented by maintaining a healthy lifestyle. This means not smoking, eating properly (see some tips here for healthy eating), staying physically active, and making sure that you maintain good posture. Finally, by losing weight, if needed, you will benefit your overall well-being and also relieve excess pressure on your joints.
When to See a Doctor
If you have suffered a car crash, a sports injury, or some other kind of traumatic physical injury, it’s important to see a doctor right away in order to get a prompt and accurate diagnosis and determine the need for any treatment. Depending on the severity of your symptoms, you may be able to heal on your own, or you may require physical therapy or other treatment.
Call your doctor or go to the emergency department immediately if you are experiencing any of the following:
- Numbness, weakness, or paralysis in your arm or leg that comes on suddenly and does not go away
- You lose bladder or bowel control
- You lose feeling in your genital or anal regions
These may be signs of a serious condition that requires immediate treatment.
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