Neck Pain – Where Does it Come From?

Neck pain is a very common problem that can with a number of possible causes. It can come from laying crooked while watching TV, it can come from sleeping in a draft, it can come as a response to a cold or flu, it can hurt because of a sinus infection (“referred pain”), it can arise from an injury like car accidents, it can come from over lifting or carrying, it can come from pinching the phone between your ear and shoulder, or it can even come from stress. Rare, but dangerous, causes include bleeding inside the head during a stroke or neck pain due to a heart attack. Obviously, these must be emergently evaluated and treated. There is even a category of causation called “insidious” or “idiopathic” which means we DON’T KNOW where the neck pain is coming from! It’s important to understand that neck pain is a symptom, not a disease which means we have to identify the cause… if we can! This is why a detailed evaluation is required.

These are some common causes of neck pain (please refer to the pictures below):

1. Degenerative Disk Disease (DDD): Over time (years), repeated injuries to the neck can result in DDD. The small “shock absorbers” that lie between the vertebral bodies lose their water retaining capabilities, become narrow, and less flexible, which is a common source of neck pain (and stiffness).
2. Mechanical Neck Pain: Any condition that does not involve the pinching of nerves can be placed in this category. There are two small joints called “facets” that lie in the back of the vertebra that are a common source of neck pain. “Sprains” or injury to ligaments that hold bones together and “strains” or injury to muscles and/or tendons that move the bones are also grouped here.
3. Pinched nerves: Result in pain down the arm. There are two primary causes: A) Herniated disk (HD): Think of a disk like a jelly donut. When the jelly “leaks” out and pinches a nerve (resulting in arm pain), that’s a HD. B) Bone spurs off the front of the facets and/or back edge of the vertebra can also pinch a nerve, resulting in the classic arm pain.
4. Spinal stenosis: (2-types) A) Central: A narrow spinal canal pinches the spinal cord creating pain, numbness, and/or weakness in the arms and/or legs. B) Lateral: Narrowing of the hole where the nerve exits creating arm pain, numbness, or weakness if the nerve is pinched (like an HD).

Of course, there are many other causes of neck pain, but these are quite common and should be first considered when evaluating a patient with neck pain.

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