At best, neck pain is awkward but brief -- a couple days of stiffness where you can't turn your head. At worst, severe neck pain can commandeer your life. Find out how to deal with mild neck pain at home, when to see a doctor and what to expect from physical therapy.
Blame the Boss?
Neck pain doesn't get nearly the attention that back pain receives, says Dr. Steven P. Cohen, director of the Johns Hopkins Blaustein Pain Treatment Center. "Neck pain is one of the top five causes of pain worldwide and in the United States," he says. "But people don't talk about it."
More than 30 percent of people suffer from neck pain each year. Feeling stressed can hunch your shoulders, clench your jaw and tense your neck muscles -- all of which contribute to neck pain. For most people, it fades away without treatment. But nearly half go on to have chronic or recurring pain, Cohen reports in the February Mayo Clinic Proceedings.
Women are more at risk. So are people who do manual labor, health care workers, computer workers and military pilots, among others.
But the No. 1 factor in neck pain is not the job you have -- it's how you feel about it. "The biggest predictors for neck pain are if you don't like your job or boss," Cohen says. A mixture of workplace woes, depression, poor sleep and injury lead to neck pain that won't go away.
When patients come in complaining of a crick in their neck, it's often due to their sleeping position, says Paul Anderson, a physical therapist and owner of the Advanced Physical Therapy Center in Denver, North Carolina. For instance, sleeping on your stomach is a no-no.
Other times the problem is how people sit at their desks and work with computers. That's why ergonomic specialists check employees' chair fit, computer keyboard level and monitor height. Workers who wear bifocals can develop neck pain at the computer, Anderson says, because they protrude their chin, which puts extra strain on the spinal joints.
Taking frequent breaks, stretching at your desk and being aware of good posture can help prevent work-related neck pain.
While Anderson hadn't heard of "text neck," he says it makes sense. "You're focused down and punching away at your keyboard -- it just leads to a postural situation."
For mild neck pain, sessions with ice or cold packs, followed by warm showers or a heating pad, can help. Anderson recommends using ice for about 48 hours, and then switching to heat. "After the second day, start doing some real gentle range of motion," he says. Then, gradually increase your range of motion.
Over-the-counter drugs to reduce inflammation and relieve pain can help for the short term.
Building Your Base
Major neck muscles include the trapezius (large flat muscle covering most of the upper back and rear neck), scalene muscles (along the side of the neck) and suboccipital muscles (four small muscles at the base of the head).
When you see a physical therapist for neck pain, treatment often focuses on improving the flexibility of the neck muscles and front of the chest, Anderson says, and strengthening the upper-back muscles and deep stabilizing muscles of the neck.
To build a better base, your physical therapist will teach you simple exercises to stretch the pectoral muscles and make your rhomboid and shoulder retractor muscles stronger.
Meanwhile, hands-on techniques to relax the muscles and loosen the spinal joints can ease pain symptoms right away, Anderson says: "Manual therapy is an excellent way to get people over the hump."
A patient whose reflexes have changed, who has serious weakness in certain muscles groups or extreme dizziness with neck movement should move on to medical evaluation, Anderson says.
Fever, headache and neck stiffness can be signs of meningitis, a rare but devastating infection that must be treated immediately. Doctors evaluate neck pain by taking a history, doing a physical exam and ordering imaging tests such as X-rays and MRIs, or blood tests to rule out infection. If meningitis is suspected, doctors may order a spinal tap.
How Whiplash Works
Stress, osteoarthritis and muscle strain from overuse can all bring on neck pain, as can trauma and injuries. Compressed spinal nerves in the neck, from herniated discs and bone spurs, can send pain from the neck shooting down to the arms. Cancer, meningitis and rheumatoid arthritis are also possible culprits.
Much more research has been done on treating back than neck pain, says Cohen, also a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. But, he says, findings on back pain don't always apply to the neck, as they have such different functions.
"The back bears the load of your weight-bearing; whereas your neck is much more mobile," he says. Because the neck moves in different directions, it's vulnerable to various stresses from falls or auto accidents. That's why being rear-ended may lead to whiplash. "You can imagine what happens in a car," Cohen says. "Your chest stops, and then your neck keeps going and your head keeps going."
Neck pain has plagued Baltimore resident Shirley Barger for nearly 25 years. A retired nursing aide, Barger, 67, worked with the elderly until 1995, when worsening arthritis pain forced her to go on disability.
"I couldn't lift my arms. I couldn't turn my neck. I couldn't drive a car," Barger says. At times she couldn't sit, while other times she couldn't stand. Sometimes she couldn't even lie down.
She's been through many treatments over the years, including surgery for herniated disks. After a grueling recovery, she felt better for a while, but then the pain returned as strong as ever.
Barger had been prescribed Percocet but stopped taking it because she doesn't approve of narcotic painkillers. But, she says, other pain medicines don't help.
Neck pain has sidelined Barger socially, too -- keeping her from outings with family or friends. "Sometimes I hurt so bad I don't even go to church."
Last year, Cohen ran a study in the journal Anesthesiology comparing treatments among 169 adults with neck pain that radiated to their arms. One group received epidural steroid injections -- injections into the space around their spinal nerves.
The second group received physical therapy along with prescription pain medicines, either gabapentin or nortriptyline -- conservative treatment. The third group had both spinal injections and conservative treatment.
One month later, there was no significant difference among groups. Three months later, though, 57 percent of patients receiving the combination "experienced meaningful relief in the arm pain," compared with 37 percent in the injection-only group and 27 percent on conservative treatment.
Radiofrequency ablation is a minimally invasive treatment that helps some people. The procedure targets tiny nerves that transmit pain from the neck joints. This week, Barger is trying her first radiofrequency treatment at Johns Hopkins and hoping for the best.