What causes neck pain?

Non-specific neck pain

Many people develop a stiff and painful neck for no obvious reason. It may happen after sitting in a draught or after a minor twisting injury, for example while gardening. The underlying cause for this type of neck pain is not fully understood, so it is called 'non-specific neck pain'. Having non-specific neck pain does not mean that your neck is damaged and often it happens in people whose necks would appear completely normal under an x-ray. It is the most common type of neck pain and often disappears after a few days.

Cervical spondylosis

With everyday use over many years the discs and the facet joints become worn. This wear varies from person to person. The discs become thinner and this causes the spaces between the vertebrae to become narrower. Also, 'spurs' of bone, known as osteophytes, form at the edges of the vertebrae and the facet joints. In a way this is a particular form of osteoarthritis but it is known as 'cervical spondylosis'. These changes may also occur at the bottom of the spine where they are known as 'lumbar spondylosis'. These conditions should not be confused with ankylosing spondylitis, where inflammation in the spine can cause the bones of the spine to fuse together. The abnormalities found in cervical and lumbar spondylosis can be seen on x-rays (see Figure 2) and are present in almost everyone by the age of 65. However, many people have no neck pain even though quite significant changes can be seen on their x-rays.

When these changes do cause pain it may come either from the linings of worn joints or from stretched ligaments. Occasionally bulging discs or osteophytes pinch the nerve roots and this causes pain or numbness that travels into the arm. If the vertebral artery is pinched, this reduces the blood supply to the area of the brain that controls balance and this may lead to dizziness. Rarely an extra rib (cervical rib) can cause partial blockage of the blood supply to the arms, resulting in pain and numbness in the hands. Very rarely, in severe spondylosis, the spinal cord can be squeezed, which causes weakness and numbness in the arms and legs.

'Whiplash'

This type of injury often follows a rear-end collision in a car. In this type of collision, first the body is carried forward and the head flips backwards. Then, as the body stops, the head is thrown forwards (see Figure 3). Following a whiplash injury there is often a delay before the pain and stiffness start.

Although whiplash can badly damage your neck, the majority of people who suffer these shunt accidents do not have major damage. In most cases injuries feel better within a few weeks or months. Seat belts and properly adjusted headrests in cars have significantly reduced the damage from whiplash injuries.

Tension

Most muscles of the body relax completely when they are not being used but some muscles (known as 'anti-gravity muscles') have to work all the time in order to keep your body upright. Muscles at the back of your neck must always be tensed, otherwise your head would fall forwards when you are sitting or standing. When these muscles work too hard it can cause neck pain and tension headaches. People who are worried or under stress often tighten their muscles more than is necessary to hold their head upright – in other words, they are literally 'tense'. Tension headaches are very common and are often wrongly called migraines.