Neck pain is the 4th leading cause of disability about 30% of the US population experiencing chronic or recurring neck pain at some point in their lives. It accounts for 25% of patients in outpatient Physical Therapy clinics!
Up to 54% of people will report experiencing neck pain in the past 6 months.
Non-traumatic Neck Pain
In terms of non-traumatic neck pain, such as the type you may get from sitting in place for too long looking at your phone or computer, there are a number of risk factors.
The biggest risk factors for new onset neck pain include the female sex and previous history of neck pain.
Older age, stressful jobs, smoking history, low social/work support, and history of low back pain are also risk factors for chronic pain.
Acute Neck Pain: WAD (Whiplash and Associated Disorders)
It is EXTREMELY important to get the proper care after a whiplash injury affecting your neck. Only about 50% of people will have complete resolution of symptoms that don’t persist. There are 3 general categorizations of people’s recovery following a WAD event:
The first trajectory details 50% of people with minor symptoms and quick + full recovery.
The second trajectory encompasses about 35% with moderate symptoms with some but incomplete recovery
The third possible trajectory involves 15% of people with severe problems that have little or no recovery
This is scary! Plus, it is a bit counter-intuitive how we can predict people’s recovery trajectories. It’s been found that the direction and speed of impact provide very weak prognosis, so it’s hard to predict how two people in the same car accident are going to recover!
There are 5 effective prognostic factors to determine risk after a WAD event (the more that are present, the worse the prognosis):
High pain intensity: Pain rating above 6/10 on a scale of 0-10
High self-reported disability with a neck disability index score above 30%: https://www.smcnd.org/assets/docs/pt/neck_disability_index.pdf
High pain catastrophizing with a score greater than 20:
High acute posttraumatic stress syndrome; score greater than 20 predicts chronicity:
Hyper-sensitivity to cold: easy alternative to questionnaire is testing cold endurance with ice cube or cold metal bars
If you or someone you know has a high likelihood of a poor prognosis, the important thing is to get good care early to get as much improvement as possible, because research has shown that most of the recovery after a WAD event occurs in the first 3 months following the event.
This doesn’t mean you give up at 3 months, it just means that we need to get the care we need as soon as we can for optimal recovery in these cases!
As we age, the spine undergoes a lot of changes and is subjected to a lot of different pressures that can cause degeneration of the structures. The neck (cervical spine) is much more mobile than other parts of the spine and is therefore going to be more susceptible to degeneration as we age.
Fun Fact: In the case of the cervical spine, full maturation of the bony structures doesn’t occur until around age 33!
Not so Fun Fact: Degeneration of the spine becomes pretty common after age 30, and up to 57% of people without neck pain above age 65 will have degenerative changes in the cervical spine with imaging.
Read that again! There is good news here though. Even though so many people have degeneration of the spine, most people will not be affected by those changes if they don’t have symptoms.
Because of this, it’s not always necessary to get imaging of the spine without trying non-surgical procedures first. Unless there are red flags present, unnecessary imaging can waste money and give people a false sense of fragility along with unnecessary anxiety.
Red flags include: spinal fractures, vascular issues (blood supply), ligamentous stability (instability of spine), and malignancy (cancer). Medical professionals are taught how to detect possible signs and symptoms of these red flags for referral to specialists.
The link below is a research-backed guideline to determine if imaging is required after an accident:
Diagnosing the source of neck pain is one of the most difficult things to do medically because there are so many complex structures in and around the neck that can contribute to neck pain. Vascular issues (blood supply), nerve issues, muscular issues, and spinal cord issues are just a few broad sources of neck pain.
Categories of Neck Pain that Can be Treated by PT
There are four categories of neck pain (with overlap): Neck pain with mobility deficits, Neck pain with movement coordination impairments (WAD), Neck pain with headache (cervicogenic), and Neck pain with radiating pain (radicular).
Central or one-sided pain
Limitations in neck motions that consistently reproduce symptoms
Referred shoulder or arm pain can be present
Neck pain with movement coordination impairments (WAD)
Caused by trauma or whiplash
Referred shoulder or arm pain
Headache, concentration issues, memory issues, confusion, distress
Other possible concussion signs and symptoms
Neck pain with Headache
Non-continuous one-sided neck pain with associated headache
Headache is caused by certain neck movements or held positions/postures
Neck pain with radiating pain
Neck pain with pain radiating down involved arm (narrow band)
Arm numbness and possible specific weakness of muscles
This will follow specific dermatomes and myotomes
Dermatomes are areas of the skin that correspond with a spinal segment that gives you your sense of sensation in that area
Myotomes are muscles that are activated by the corresponding nerve root
If you have numbness/tingling in an area that corresponds with the same nerve root you have arm weakness with, you likely have an issue at that level of the spine!
Take Home Message
The point of this post is not to diagnose and treat neck pain, but to provide you with a resource to spread awareness of the importance of getting neck pain treated by a medical professional.
The benefits of early intervention easily outweigh the time and effort to get a consultation, and the whole purpose of these screens is to give you the peace of mind that nothing is wrong.
In the case that something is wrong, obviously it’s good you figured that out as soon as you could! As you can see, it clearly helps with the prognosis with quicker and more complete recoveries following most cases of neck pain.
Please let me know if you have any questions or feedback for future posts! I’m also happy to provide some basic exercises to help manage these types of conditions!