Many people suffer from muscular tension in their necks. There are certain activities that may contribute to developing a sore neck. These include repetitive activities at work such as using a computer, a poorly set up desk, pillows that are too high or too low, sitting or standing for long periods of time, driving, lifting objects or operating machine tools.
If you are not aware of your daily movement and the amounts of time you spend doing repetitive activities, tension can gradually build up in the neck, upper back and shoulder area. Neck tension can be very debilitating, especially if you lose any of your normal range of motion (movement).
Knowing how your neck normally works and why you feel pain are important in helping you care for your neck. Clients are often less anxious and more satisfied with the outcomes of bodywork when they have information so that they feel empowered to make good decisions about caring for their neck. This article will give you a general overview of neck pain. It should help you understand:
- what parts make up the spine and neck
- what causes neck pain
- how to decrease your pain and increase your mobility
Symptoms from neck problems vary. They depend on your condition and which neck structures are affected. Some of the more common symptoms of neck problems are:
- Neck pain
- Pain spreading into the upper back or down the arm
- Neck stiffness and reduced range of motion
- Muscle weakness in the shoulder, arm, or hand
- Sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column is the body’s main upright support.
The cervical spine (your neck) is formed by the first seven vertebrae. Physiotherapists, osteopaths, chiropractors, doctors and massage therapists often refer to these vertebrae as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom edge of the skull. The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine. This is where the chest begins.
Each vertebra is formed by a round block of bone, called a vertebrae body. A bony ring attaches to the back of the vertebral body. When the vertebrae are stacked on top of each other, the rings form a hollow tube. This bony tube surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.
As the spinal cord travels from the brain down through the spine, it sends out nerve branches between each vertebrae called nerve roots. These nerve roots together form the nerves that travel throughout the body and form the body’s electrical system. The nerve roots that come out of the cervical spine form the nerves that go to the arms and hands. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the lumbar (lower) spine go to the organs of the pelvis, the legs, and the feet.
One way to understand the anatomy of the cervical spine is to look at a spinal segment. Each spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints that link each level of the spinal column.
An intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. The disc is a specialised connective tissue structure that separates the two vertebral bodies of the spinal segment. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting.
An intervertebral disc is made up of two parts. The centre, called the nucleus, is spongy. It provides most of the ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.
There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made up of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the cervical spine allows freedom of movement as you bend and turn your neck.
The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a super smooth, incredibly hard material that covers the ends of most joints. It allows the bone ends to move against each other smoothly, without pain. Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen.
Why do I have neck pain?
There are many causes of neck pain. It is not always able to pinpoint the source of pain because pain is a complex thing. Below is a brief overview of some of the most common causes of neck pain.
People with minor neck pain or stiffness are often told they have a muscle strain. However, unless there was a severe injury to the neck, the muscles probably haven’t been pulled or injured. Instead, the problem may be coming from irritation or injury in other spine tissues, such as the disc or ligaments. When this happens, the neck muscles may go into spasm to help support and protect the sore area.
Mechanical neck pain is caused by damage or wear and tear on the parts of the neck. It is similar in nature to a machine that develops a fault or begins to wear out. The pain is typically felt in the neck, but it may spread from the neck into the upper back or to the outside of the shoulder and can even spread into the arm and hand.
Radiculopathy (Pinched Nerve often called Referred Pain)
Pressure or irritation in the nerves of the cervical spine can affect the nerves’ electrical signals. The pressure or irritation is normally felt as pain along the path of the nerve (where the nerve goes to) but can be felt as numbness on the skin, or even weakness in the muscles. Most people think of these symptoms as indications of a pinched nerve. Health care providers call this condition cervical radiculopathy or referred pain.
Several conditions can cause radiculopathy. The most common are disc herniation, facet joint irritation, disk degeneration and spinal instability.
Herniated Disc: Heavy, repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc. If great enough, this increased pressure can injure the annulus (the tough, outer ring of the disc). If the annulus ruptures or tears, the material in the nucleus can squeese out of the disc. This is called a herniation. Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand these pressures. However, the annulus can crack and tear. It is repaired with scar tissue. Over time, the annulus becomes weakened, and the disc can more easily herniate through the damaged annulus.
If the herniated disc material presses against a nerve root it can cause pain, numbness, and weakness in the area the nerve supplies. This condition is called cervical radiculopathy (mentioned earlier). And any time the herniated nucleus contacts tissues outside the damaged annulus, it releases chemicals that cause inflammation and pain. If the nucleus herniates completely through the annulus, it may squeese against the spinal cord. This causes a condition that is even more serious because it affects all the nerves of the spinal cord. This condition is called cervical myelopathy.
Facet Joint irritation: Just like any other joint in the body the facet joints can be over stretched or compressed beyond their normal range. When this happens the joint becomes inflamed and swells. The swelling can cause local pain or if sever enough will press onto the nerves just as disk did in the example above. The joints will stiffen when swollen causing loss of motion and pain on motion.
Spinal Instability: Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissue may also have spinal instability. Spinal instability also includes conditions in which a vertebral body slips over the one just below it. When the vertebral body slips too far forward, the condition is called spondylolisthesis. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms.
Degeneration: As the spine ages, several changes occur in the bones and soft tissues. The disc loses its water content and begins to loose height, causing the space between the vertebrae to narrow. The added pressure may irritate and inflame the facet joints, causing them to become enlarged. When this happens, the enlarged joints can press against the nerves going to the arm as they squeese through the neural foramina. Degeneration can also cause bone spurs to develop. Bone spurs may put pressure on nerves and produce symptoms of cervical radiculopathy seen below.
Spinal Stenosis (Cervical Myelopathy)
Stenosis means closed in. Spinal stenosis refers to a condition in which the spinal cord is closed in, or compressed, inside the tube of the spinal canal. Spinal stenosis may be caused by degenerative changes, such as bone spurs pushing against the spinal cord within the spinal canal. However, stenosis can also develop when a person of any age has a disc herniation that pushes against the spinal canal. When the spinal cord is squeesed in the neck, doctors call the condition cervical myelopathy. This is an alarming condition that demands medical attention. Cervical myelopathy can cause problems with the bowels and bladder, change the way you walk, and affect your ability to use your fingers and hands.