"The cervical spine is where the spinal cord lives," said Volker K.H. Sonntag, MD, a member of the American Association of Neurological Surgeons Board of Directors and a neurosurgeon practicing in Arizona. "The spinal cord is the most delicate tissue in the entire body. Even minor damage to the spinal cord cannot be repaired. Unlike low back pain, in which waiting to seek treatment may prolong the pain but usually doesn't cause any further damage, untreated spinal cord compression can lead to irreversible damage."

Two Types of Neck Pain

There are two distinct types of cervical neck pain. The first type often involves a dull pain in the neck that radiates down the shoulders and arms. Patients may also notice weakness in specific muscles in the arms.

A herniated (bulging) disc in the spine pinching a nerve root in the neck often causes this type of neck pain. Discs are found between each vertebra, or bone, in the spinal column. They serve as "shock absorbers" within the spine and have a gel-like center that makes them flexible, allowing the spine to bend and move. However, because the discs are soft they can also bulge and become misshapen. When this occurs, they can place pressure on the spinal cord or irritate one of the nerves leading from the spinal cord out to the arms and upper torso. If the bulge becomes severe, the disc may herniate and push into the spinal canal. The result can be weakness, tingling, clumsiness and numbness in the arm and hands. Bulging discs can be caused by injuries like whiplash, stress on the spine by overuse, or by arthritis/degeneration in the spine.

The second type of neck pain often isn't experienced as 'pain' by patients at all. It usually involves numbness or weakness in the arms or legs, difficulty walking, loss of pain or temperature sensation in the hands and arms, poor balance and stiffness in the neck. In this case, there is pressure directly on the spinal cord. Because this type of "pain" is not felt in the neck itself, it is easily misdiagnosed.

"We usually see patients with neck pain in one of three different scenarios," Dr. Sonntag said. "One, they've been in some sort of accident and have suffered a whiplash-type injury. Two, they have a chronic injury caused by overuse, most likely caused by working at a computer for endless hours. Or they've experienced one of the first two scenarios in the past and now have arthritis or a tissue degeneration problem."

Neck Injuries

Neck injuries, which commonly occur in automobile or sports accidents, are not to be taken lightly. "If a vertebra in the neck is broken and left untreated, injury to the spinal cord can happen hours or days after the injury," explained Edward C. Benzel, MD, a spine surgery professor and practicing neurosurgeon in Ohio. "Because of the severe consequences and irreversible nature of spinal cord injuries, extreme caution needs to be taken with anyone who has suffered a direct injury to the neck." If the spinal cord is injured or bruised the patient can be paralyzed below the site of the injury. If a vertebra in the neck is broken or cracked, neurosurgeons often will stabilize the spine by fusion and instrumentation to prevent further injury to the spinal cord.

A more common neck injury is whiplash. Symptoms include neck stiffness, shoulder or arm pain, headache, facial pain and dizziness. Aggressive physical therapy, time and medication are often the most effective treatment for whiplash injuries, unless there is a herniation of a disc in the cervical spine. If the symptoms still persist after four to six weeks, or if there is severe weakness in the arms, hands or legs, a neurosurgical consult should be considered. Over 90 percent of patients who undergo surgery for cervical disc herniation have significant pain relief.

Degenerative Conditions

The neck is also susceptible to osteoarthritis and degenerative disc disease, which can be caused by general wear and tear on the spine. The discs begin to lose their flexibility and ability to absorb stresses in the spine. Or, bone spurs develop on the vertebrae. In either case, the nerves in the cervical spine can become irritated or pinched, causing pain in the neck or the arms. If there is a great deal of degeneration in the cervical spine, the spinal cord and nerve roots may become compressed, causing irreversible damage.

Cervical stenosis is another condition that may result from degeneration in the spine. It occurs when the spinal canal narrows and compresses the spinal cord. If the pain from stenosis is restricted to the neck, conservative treatment is prescribed. However, if it extends into the arms or legs neurosurgeons can remove part of the vertebrae and ligaments to allow more room for the spinal cord and nerves. If there is significant degeneration in the cervical spine, the neurosurgeon can fuse the vertebrae by grafting bone or using metal plates to provide additional support and stability in the spine.

"The cervical spine is a delicate area and the surgeon must use an exact touch," said Dr. Benzel. "The brain and the cervical spine are the two areas of the body where there is little margin for inaccuracy and the neurosurgeon's hands and instruments must be precise and controlled. I like to compare it to a jump shot that hits 'nothing but net.'"

Developing a Program That's Right for You

Information is readily available on the way to stop neck pain. The challenge is to tailor it to the particular patient. For example, it's said that using certain kinds of pillows are best for the neck. But which kind? And does the information apply to every kind of neck pain?

Using the telephone improperly is also said to create problems in the neck. But what is the proper way to use a phone? And if a brace or special piece of equipment is necessary, which is the right one? The list goes on: cold or hot applications, rest or activity?

What Kinds of Problems Might Cause Neck Pain?

Treatment for any neck condition is recommended as soon as possible to minimize the danger of further aggravation. The following is a list of only some of the conditions that may cause neck pain and is not a substitute for a visit to your doctor:

• Radiculopathy - A pinched nerve, often from a herniated, or slipped, disk. This causes pain down the arm that's often described as an electrical feeling.

• Myofascial Pain - Generally an aching pain in muscles that tends to be associated with poor posture, sitting at a computer or other job-related tasks. Patients can become sore in different parts of the body like the neck and arms, and often patients report they have difficulty sleeping or feeling restored from sleep.

• Spinal Stenosis - A narrowing of the nerve openings either around the spinal cord or nerve roots that can cause symptoms similar to a pinched nerve. The pain is described either as an aching or an electrical feeling down the arm.

• Tendon, Ligament and Soft Tissue Pain - Localized pain when an area is stretched or its muscles are overused. This results in tenderness.

• Spinal Instability - Increased motion between vertebra, usually resulting from an injury. The pain typically feels like tingling in the neck or arms.

• Non-Spinal Causes of Neck Pain - Pain imitating a neck injury, but from another cause. Shoulder and elbow injuries and gall bladder disease are examples of problems that can refer pain to the neck area.

• Repetitive Strain Injury - An injury that occurs from a chronically used part of the body, either in a normal or abnormal way. These problems are often found in people who sit at desks or work at computers.

Treatment Options

The rehabilitation of neck injuries occurs in three phases. During the first phase, called the acute phase, physiatrists treat pain and inflammation. After they make a specific diagnosis and develop a treatment plan, physiatrists may offer treatment options like ultrasound, electrical stimulation, mobilization, medication, ice and even specialized injections.

In the second, or recovery, phase of treatment, flexibility and strength are developed to get the body parts into their proper positions. The goal of this phase is to get you back to your usual work, sports and leisure activities. This goal is achieved through specially designed exercises that rebuild the body.

The main goal of the third phase of treatment, the maintenance phase, is to minimize recurrence of the problem and to prevent further injury. This often consists of a total body fitness program, designed to maintain body mechanics and increase endurance after the original symptoms have resolved.

These are very broad and general approaches to the treatment of neck pain. The physiatrist that you choose will develop an individual treatment plan for you.

Physical therapy
Physical therapy is the science of blending physiology with exercises and applying these principles to the body when an injury is sustained. Physical therapy for back and neck conditions focuses on the structures that support the spine and its joints including muscles, tendons, and ligaments

• To educate patients on the principles of stretching and strengthening, which will in turn, help manage pain and accelerate tissue healing.
• To educate patients on proper posture and ergonomic principles to preserve the spine. 
• To accelerate the stages of healing, which focus on:
   --Reducing pain and the inflammatory cycle
      *Apply passive modalities only if severe: ice/heat/ultrasound/traction/electrical stimulation
      *Educate regarding posture and resting in neutral position
  
   --Restoring muscular flexibility, joint mobility, and spine motion
      *Introduce specific stretching exercises and progressions to abolish pain and stiffness to
        specific regions with high frequency and repetitions
  
  --Strengthening the involved muscles
      *Teach how to maintain the new postures
  
  --Returning to normal activities
      *Create new awareness of body mechanics and daily stretching for life
• To prevent future occurrences. As you are able to maneuver through episode of back or neck pain, learn what program is needed to deter relapses.
• To manage exacerbations. No matter how diligent you are, you are bound to have a forgetful moment and do an activity improperly and suffer flare up, but new knowledge will help eliminate symptoms in a couple days, instead of suffering for weeks or months.

• Studies show that 90 percent of the population experience spine symptoms at least once in lifetime.
• Many people have neck and back pain, but it is not always isolated to those regions. The pain can also travel into arms or head/eyes as well as radiate into the gluts, groin, hip and legs/feet.
• Each episode of back stiffness and pain can become progressively worse and last longer and travel farther from its origin.
• If you don't stop the cycle and figure out the cause of each episode, accumulation of damage to structures lead to eventual failure of the spinal structures. At this stag, physical therapy alone will not be effective. You will need more extensive intervention with spine doctors, pain management, or possibly a surgeon.
• If the patient addresses symptoms early, 95 percent of herniated disc patients would NOT require surgery!

Action plan: What you can do

• Overall, you need to maintain good posture throughout all of your daily activities. If you start to feel sore or stiff, change your posture and modify your body mechanics. Your body will warn you -- using pain as a signal -- when your body mechanics are improperly aligned. However, many times we choose to ignore these signals in order to complete the project, paper, book, etc. By not listening to your body, sometimes it is too late and the inflammatory process is initiated. The best way to avoid pain is to learn to listen to your body.
• Sit up straight! It feels better and puts the least amount of strain on your spine! If you sit or bend too often or for too long a period of time, bend in the opposite direction to balance the stresses out and relieve muscle tension.
• More on sitting. . . When sitting, arch your back 5 to 10 times if you feel stiff. Repeat two to three times a day (or more often if you are sore).

Other stretching exercise to do at your desk:

1. shoulder rolls backwards x 10
2. shoulder blade squeeze x 10
3. chin in x 10
4. chin in & slowly stretch head back x 10
5. head turn over shoulders x 10 each way
6. standing back bend stretch x 10

• If you are having headaches, do chin tucks or cervical retractions 10 to 15 times every couple hours or hold your head in a retracted position for up to 3 minutes to eliminate the headache symptoms. However, if inflammation has gone too far, you may need to reduce it by lying on your back with an ice pack placed at the base of your skull for 20 minutes.
• If your neck is sore or you experience pain down into your shoulder blades or have stiff/tight muscles, bend your head backwards 10-15 times. Repeat this exercise every couple hours if you continue to hurt. If you are really tight or feel pinching, go slowly, move a little at a time, and apply ice as well.
  
  NOTE: If stretching exercises affect the symptoms of headache or neck pain by either increasing or decreasing their occurrence, it’s likely that the problem is indeed mechanical and will respond positively to the proper amount of stretching exercises.
• If your back hurts, stand up and do 10 to 15 back bends or if it’s too sore, lie on your stomach and perform 10 press ups. Repeat them two to three times per day.
• Strengthen and reeducate your postural muscles so that you can endure your daily activities. Although it takes more muscular and mental effort, create this new awareness and develop this new habit.
• Regular stretching of upper and lower cervical spine 4 to 6 times a day over 6 to 8 weeks can increase spinal mobility, allowing good posture to be maintained with little effort.
• If your symptoms are improving after attempting the exercises for a few days, continue your stretching exercises. If, on the other hand, your symptoms are not changing or are getting worse, stop the stretching exercises and seek professional help. A physical therapist can make sure you are performing the exercises correctly and can modify the exercise as necessary. To be seen by a physical therapist in the state of Ohio, all patients require referral from a physician for evaluation and treatment with the appropriate diagnosis included on the prescription slip.

Ergonomic Tips: Tricks to them all:
Simply Put: Use your postural muscles! Don't just wear them. Think chest out, chin in, stomach tight with standing, walking, lifting & bending

• Standing: keep one foot in front of and more elevated than the other when working in a cupboard, ironing, washing dishes, or even standing at work.
• Sitting: use lumbar support in car/chair or adjust car seat to upright. Sitting up straight puts the least amount of stress on the spine. It may take more muscular and mental effort but it is wise to create this new awareness and habit!
• Sleeping: sidelying: bottom leg straight; top leg can be bent or rested on pillow
• Bending: use golfer's lift or ½ kneeling position when putting dishes in dishwasher, getting laundry out of washer, putting items into trunk/cart, etc.
• Lifting: keep the object being lifted close to you; get down under it

Remember: chronic poor posture causes a loss of flexibility in the major muscle in front of the shoulders (i.,e., the pectoralis major muscle), decreases the mobility of the cervical spine, and causes loss of strength of the scapular muscles, making it nearing impossible to maintain good posture, even if asked to do so.

Optimal body positioning to decrease neck and back pain

Sleeping: Get into a neutral position, either on your back (use 1 pillow) or side (use 1 pillow). Avoid lying on your stomach. When lying on your side, make sure your head is positioned such that you are looking ahead, not down at your feet. Contour pillows are good to use (though they take some time to get used to) or pillows that incorporate a cervical roll.

Driving: Stay upright with you head against the head rest and straighten arms out to keep shoulders back. Tilt rearview mirror a titch toward the roof so that an upright posture is necessary to maintain the total field of vision in the mirror.

Computer: Screen should be positioned at eye level, with head back and chin in. Sit back in chair and use a lumbar roll. Use attached arm on monitor or other device to hold documents at eye level.

Reading: DON’T READ IN BED!!! Often, too much head flexion is created if pillows are bunched up behind the head. Instead, sit with your back against the headboard or in a chair next to the bed.

Hobbies counter- or lap-based hobbies such as quilting, sewing, collecting items in albums, etc): Don’t continuously look down for long periods of time without taking a break. Change your physical position and stretch in the opposite direction about every 20 minutes.

Gardening: Don’t do marathon gardening sessions. Take frequent breaks. Half kneel or squat when working.

Cleaning: When possible, half kneel or squat to keep spine in a neutral position.

Watching television: Sit up straight in the chair or on your couch. Don’t slouch. Get up periodically and walk around. Do neck exercises to keep limber.

Posture: Why is it so important?

• The three natural curves of the spine plus the discs in the spine help absorb the “shock” or “forces” of everyday life. Jobs or tasks that require bending forward all day (in addition to the 3,000 and 5,000 times a day we ordinarily bend forward), decrease the natural curves of the spine, resulting in more stress being placed on the back side of ligament and joints of cervical and lumbar spine. 
• Overall, bad posture results in more wear and tear on the spinal structures. 
• After age 30, all the years of straining the normal tissue from slouching eventually decreases structural stability allowing for greater wear down of ligaments.
• Postural misalignment can cause radiating pain away from the back and spine due, for instance, to a pinched nerve; and muscle spasms can create headaches and neck/scapular pain.
• Pain often begins as a soreness or stiffness in the neck and shoulder blades and can progress to headache pressure and band-like symptoms around head and/or back tightness that can progress to the hip, leg, and toes.
• Many factors contribute to the onset of pain, including job duties, hobbies, household responsibilities, studying, genetics, etc.