Neck Pain

What is neck pain?

Neck pain is a very common symptom, which up to 30% of people in the Western World experience each year. Most neck pain is short-lived and non-specific, but some people develop chronic, intrusive pain which leads on to having an MRI to look for potentially dangerous causes of neck pain.

Unfortunately, most pain-free people have less than normal necks on MRI, meaning that it can be difficult to point to a specific finding on MRI and confidently describe it as the cause of the neck pain.
This is an interesting overview published in 2013, looking at how common is neck pain, how the different causes of neck pain can be diagnosed and what treatments are available. It’s a free download too, which is helpful!

What causes neck pain?

Most neck pain is caused by muscular pain, which could be due to inadequate posture. Spinal surgeons very commonly concentrate on posture as a key contributor to neck pain symptoms. The surgical term for this is “sagittal imbalance” or “sagittal malalignment”, but in plain English, this means poor posture. Rather than seeking structural changes to your neck in the form of re-balancing surgery, however, it is far less risky and more prudent to seek help with optimising the posture of your neck by means of targeted exercise therapy. A DIY approach to this could include reference to Robin McKenzie’s famous and popular book Treat Your Own Neck, which is available to buy for less than a fiver.

Other causes of neck pain can be categorised into the usual groups including trauma, cancer, infection, inflammatory processes such as Rheumatoid arthritis, congenital (being born with unusual anatomy which then prematurely wears and causes pain eg Klippel Feil), vascular, ligament loosening/disruption and referred pain from other organs, such as the heart. So, while an MRI may by used to try and establish a cause for unremitting and intrusive neck pain, this is not a “catch-all” investigation and other tests such as blood tests for inflammatory markers, flexion-extension X Rays to look for dynamic neck instability, cardiac tests or angiography may be indicated.

Treatment options for neck pain

The proposed treatments will depend on either a working diagnosis of, say, musculoskeletal pain, or an evidence-supported diagnosis such as a fracture requiring stabilisation, for example.

Let’s assume that the neck pain is due to the commonest explanation: musculoskeletal, wear and tear, spondylosis, degenerative changes, the list goes on, but basically describes the same thing- there are non-specific changes occuring in the neck which are causing neck pain. Contrary to what most people think when given this “diagnosis”, they are not falling apart and they are not destined to feel older than their true age for the longterm.

It may feel slightly dissmissive when neck pain sufferers are told to go and exercise or to engage with physiotherapy, but this advice is evidence-based, as the following papers will show:

Cochrane evidence for exercise in treating neck pain

National Institute of Clinical Excellence evidence for non-specific neck pain treatment recommendations

Massage for neck pain

Having a massage has to be the commonest intervention that neck pain sufferers pursue, when taking over the counter painkillers are not effective. Most people experience significant improvement immediately following a massage and many chronic pain sufferers tend to find their favourite masseur and book in for another massage when the neck pain is particularly bothersome. There are people who treat their neck pain for years in this manner, at a significant cost.

This artlcle, published in 2014, and available online as a full text article, appears to provide evidence that it is better to invest in high intensity and long duration massages in order to achieve prolonged neck pain relief, instead of shorter massage sessions conducted more sporadically. Unfortunately, the paper does not provide information in relation to duration of neck pain relief following this high concentration of massage intervention, but it implies that 30 minute massage sessions performed infrequently do not appear to be any better than having no massage at all.

Pilates for neck pain

A study in 2013 demonstrated that pilates reduced disability associated with neck pain by 6 weeks, by focussing on 10 different exercises for one hour once a week. Only fourteen patients with neck pain of a minimum of six weeks’ duration were recruited, but the outcomes convincingly showed that by 12 weeks, there was improvement of neck pain.

This study implies that pilates offers improvement in pain and function, but it can take at least three months before the benefits can be experienced.

Osteopathy for neck pain

There is evidence to show that people visiting their GP suffering with spinal pain have more improvement if they see an osteopath compared with if they don’t. There is also evidence that osteopathic intervention for chronic neck pain is more effective at improving pain than sham procedures (placebo).

Finally, a study in Quebec showed that not only is osteopathy a popular treatment choice for a broad range of issues in both children and adults, but spinal problems are the commonest reason for seeking help from an osteopath. For women, the commonest problem was neck pain and for men, the commonest problem was lower back pain.

Mc Kenzie Exercises for neck pain

New Zealand physiotherapist Robin McKenzie first published his work in relation to targetted exercises for spinal pain in the early 1980s and has sinced published several editions of his spinal work in two publications called “Treat Your Own Neck” and “Treat Your Own Back”. The essence of his advice is to counteract the repetitive flexion that we perform with both our necks and lower backs every day. The simple exercises which extend the neck and lower back can provide significant pain relief, but the exercises should be continued even when the pain has subsided, in order to stop the pain from returning in the future.

The McKenzie Institute website is here and his book is available through public libraries for free, or can be bought online for roughly five pounds.

Yoga for neck pain

The essence of yoga is to promote a healthy spinal posture and encourage spinal flexibility, which can reduce stiffness and pain. Yoga includes extension-based exercises which counteract the predominant bending that we perform in our daily lives.

Surgery for neck pain

Surgery is not recommended for mechanical neck pain alone, as there is no evidence to show predictable benefit, however, there is the risk of harm from having a surgical procedure. Simply put, the gamble does not pay off.

Severe, unremitting neck pain should be investigated to rule out unusual causes of isolated neck pain and this can be done by asking advice of your physician. The vast majority of neck pain, however, is not dangerous and responds to targetted neck exercises.