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DEFINITION
Neck pain is a common complaint. Neck muscles can be strained from poor posture — whether it's leaning into your computer at work or hunching over your workbench at home. Wear-and-tear arthritis also is a common cause of neck pain.
Rarely, neck pain can be a symptom of a more serious problem. Seek medical care if your neck pain is accompanied by numbness or loss of strength in your arms or hands or if you're experiencing shooting pain into your shoulder or down your arm.
SYMPTOMS
Give your doctor as many specifics as you can about the location and severity of your pain. Be sure to mention any head or neck movements that make your neck pain better or worse.
CAUSES
Neck pain can result from a variety of causes, including:
- Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
- Worn joints. Just like all the other joints in your body, your neck joints tend to undergo wear and tear with age, which can cause osteoarthritis in your neck.
- Nerve compression. Herniated disks or bone spurs in the vertebrae of your neck can take up too much space and press on the nerves branching out from the spinal cord.
- Injuries. Rear-end auto collisions often result in whiplash injuries, which occur when the head is jerked backward and then forward, stretching the soft tissues of the neck beyond their limits.
- Diseases. Neck pain can sometimes be caused by diseases, such as rheumatoid arthritis, meningitis or cancer.
PREPARING FOR YOUR APPOINTMENT
While you may initially consult your family doctor about your neck pain, he or she may refer you to:
- A rheumatologist, a doctor who specializes in arthritis and other diseases that affect the joints
- A neurologist, a doctor who specializes in treating nerve-related disorders
- An orthopedic surgeon, a doctor who operates on bones and joints
What you can do
Before your appointment, you may want to write a list that answers the following questions:
- When did your symptoms begin?
- Have you ever injured your neck? If so, when did the injury occur?
- Do any particular neck movements make the pain improve or worsen?
- What medications and supplements do you take regularly?
What to expect from your doctor
Your doctor may ask some of the following questions:
- Where exactly does your pain occur?
- Is the pain dull, sharp or shooting?
- Do you have any numbness or weakness?
- Does the pain radiate into your arm?
TESTS AND DIAGNOSIS
During the physical exam, your doctor will check for tenderness, numbness and muscle weakness. He or she will also ask you to move your head as far as it can go forward, backward and side to side.
Imaging tests
In some cases, your doctor may order imaging tests to get a better picture of what might be causing your neck pain. Examples include:
- X-rays. X-rays can reveal areas in your neck where your nerves or spinal cord may be pinched by bone spurs or a bulging disk.
- Computerized tomography (CT) scan. CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.
- Magnetic resonance imaging (MRI). MRIs utilize radio waves and a strong magnetic field to create especially detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.
However, many people have X-ray or MRI evidence of structural problems in their neck without experiencing any symptoms. So it can be difficult to determine if your symptoms are actually being caused by what shows up on imaging studies.
Nerve tests
If your doctor suspects that your neck pain may be related to a pinched nerve, he or she may suggest electromyography (EMG). This test involves inserting very fine needles through your skin into a muscle to determine whether specific nerves are functioning properly.
Lab tests
- Blood tests. Blood tests can sometimes provide evidence of inflammatory or infectious conditions that may be causing your neck pain.
- Spinal tap (lumbar puncture). During a spinal tap, a needle is carefully inserted into your spine to obtain a sample of the fluid that surrounds your brain and spinal cord. This test can reveal evidence of meningitis.
TREATMENTS AND DRUGS
The most common types of neck pain usually respond well to home care. If neck pain persists, your doctor may recommend other treatments.
Medications
Your doctor may prescribe stronger pain medicine than what you can get over-the-counter. Muscle relaxants or tricyclic antidepressant medications used for pain also may be prescribed.
Therapy
- Neck exercises and stretching. Your doctor may recommend that you work with a physical therapist to learn neck exercises and stretches. A physical therapist can guide you through these exercises and stretches so that you can do them on your own at home. Exercises may improve pain by restoring muscle function, optimizing posture to prevent overload of muscle, and increasing the strength and endurance of your neck muscles.
- Traction. Traction uses weights and pulleys to gently stretch your neck and keep it immobilized. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation.
- Short-term immobilization. A soft collar that supports your neck may help relieve pain by taking pressure off the structures in your neck. If used for more than two weeks, however, a collar may do more harm than good.
Surgical and other procedures
- Steroid injections. Your doctor may inject corticosteroid medications near the nerve roots, into the small facet joints in the bones of the cervical spine or into the muscles in your neck to help with pain. Numbing medications, such as lidocaine, also can be injected to relieve your neck pain.
- Surgery. Surgery is rarely needed for neck pain. However, it may be an option for relieving nerve root or spinal cord compression.
LIFESTYLE AND HOME REMEDIES
Most neck pain is associated with poor posture on top of age-related wear and tear. To help prevent neck pain, keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help. Consider trying to:
- Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
- Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
- Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
- Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
- Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
- Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.
ALTERNATIVE MEDICINE
Talk to your doctor if you're interested in trying alternative treatments for your neck pain. Your doctor can discuss the benefits and risks. Alternative treatments include:
- Acupuncture. Acupuncture involves the insertion of thin needles into various points on your body. Studies have found that acupuncture may be helpful for many types of pain. But studies in neck pain have been mixed. For best results, you may need to undergo several acupuncture sessions. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
- Chiropractic. Given mainly to the spine, a chiropractic adjustment applies a controlled, sudden force to a joint — moving it beyond its normal range of motion. Chiropractic treatments to the neck may slightly increase your risk of stroke.
- Massage. During a massage, a trained practitioner manipulates the muscles in your neck with his or her hands. Little scientific evidence exists to support massage in people with neck pain, though it may provide relief when combined with your doctor's recommended treatments.
- Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.
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