Do you suffer from Nasty Nagging Neck Pain?
Neck pain afflicts almost all of us sooner or later.
This article might not help if you just woke up with neck pain today and you're searching for something to help right away.
For this situation, I'd say slap some heat on it, maybe do a little stretching, and you’ll probably be fine in a few days.
But what if your pain is a 10 out of 10 and you can't move your neck at all?
Or maybe it’s the seventh crick in your neck this year.
Or maybe you’ve had low-grade constant, chronic neck stiffness ever since that car accident in 2018.
If this is you, then maybe you do need to read this article and learn a little more about what the problem could actually be.
Plus… knowing more about what could be causing your pain, can actually help to lower your pain levels [1, 2], compared to physical therapy, drugs and surgeries which often don't help to resolve our pain. [3]
Neck Pain, Neck Cricks and Pinched Nerves
Let's get right into it and discuss the differences between neck pain, cricks and pinched nerves.
“Crick” is an informal term and really falls into a sub-type of neck pain.
A “crick in the neck” usually feels like something in a joint is catching or sticking or locking when you try to move.
Most people would say that the “crick” in their neck is not necessarily painful, but annoyingly uncomfortable.
That said, we shouldn't ever underestimate the amount of discomfort that can come from a neck crick.
In other words, not all pain is painful and it's entirely possible to suffer deeply without hurting.
A feeling of stuckness can be just as bad as severe pain.
Just like a pebble in your shoe would eventually make you go crazy, a crick in your neck will nag and irritate you to the point of serious mental health hazard.
I have seen people showing every sign of severe chronic psychological distress, unable to function well mentally because their neck will not stop harassing them.
In fact, I would argue that long standing irritating pain causes more emotional distress and dysfunction than pure pain.
This is where it's important to differentiate the type of pain you're experiencing such as:
- Jarred/Mechanical discomfort but not painful
- Dull or Achy pain
- Sharp, Shooting, Stabbing pain
- Burning, Itching pain or Tearing pain
Jarred funky movement discomfort is what we would consider a true “crick in the neck”. Whereas Dull, achy pain is what you feel when you work out or when you have tightness in the muscles and ligaments. And then sharp, shooting, stabbing pain is definitely a sign of tissue damage and inflammation.
So identifying the quality and type of pain you're experiencing is something we need to consider.
What about nerves?
Could it be a pinched nerve? Probably not.
This is one of the most common and understandable concerns that people have about pain near any part of their spine.
The pain of pinched neck nerves is much less common than other kinds of neck pain.
Nerves make people nervous. And they should because they're super important, but it's just not likely that the pain you're experiencing is coming from a pinched nerve.
Could it be a nerve? people often ask me. Is this a nerve problem? It's probably a pinched nerve right? Is something pinching my nerves? Something must be pinching a nerve!
The idea of a pinched nerve root is deeply embedded in the public consciousness and it's just wrong.
It's surprisingly difficult to actually pinch a nerve and if you do – you most likely would not be able to use your limbs or function very much.
So if you can move your arms and neck, it's probably not a pinched nerve.
Why Neck Pain Persists
“Sensitization” is the tendency of the nervous system to start firing alarms and then over-react to stimuli. [4]
As a general rule, the longer any kind of pain lasts, the more likely sensitization is to become a factor, and even to take over and become the main problem.
This means that the actual problem or cause of the initial pain could be long gone, but now the alarm system is continuously activated.
Sensitization can complicate any chronic pain problem, and as my career lengthens I find myself dealing with it more and more.
It's also unfortunate that most of my patients come to be after they've tried all the things. And at this point, their problem is chronic.
There is great variety in acute pain, but chronic pain is often defined by sensitization, regardless of how it all started.
How do we know that neck pain can be the beginning of sensitization?
Could the neck pain just be ordinary neck pain at first, and then sensitization sets in over time as a complication … and then spreads, like an infection?
Yes, it’s possible.
But most people who end up with sensitization can recall subtle, early symptoms of sensitization dating all the way back to the beginning of their troubles.
Neck pain was the main problem and other clues were overlooked or filed under “odd,” too vague and minor to interpret.
But surely the chicken does come first!
In this other worst case scenario, sensitization didn’t start it, but it is the main reason that your neck keeps hurting — even if it never progresses to causing widespread symptoms.
Probably most chronic pain gets complicated by sensitization eventually, if not all of it, and some chronic cases are chronic not because there’s still something wrong with your neck tissues after all these years, but simply because your brain has set up a permanent ban on full neck movement (and pain is the main way the brain does that).
This is why every chronic pain patient needs to know about sensitization.
To sum up, central sensitization is involved in two kinds of worst case scenarios for neck pain:
- Neck pain may simply be the first, worst symptom of sensitization (along with, perhaps, back and/or abdominal pain).
- Neck pain may become chronic due to sensitization that develops as a reaction to some original problem, a permanent case of “false alarm” that stays confined to the neck.
What's Causing My Neck Pain?
So how do you really know if something is really wrong with your neck and causing all that pain?
Although it’s rare, once in a while neck pain may be a warning sign of cancer, infection, autoimmune disease, or some kind of structural problem like abnormal spine alignment, a spinal cord injury or a threat to an important blood vessel.
Fortunately, most of these situations cause hard-to-miss signs and symptoms other than pain and are likely to be diagnosed correctly and promptly by someone who understands spine bio-mechanics and physiology.
If you are aware of the “red flags,” you can get checked out when the time is right — but avoid excessive worry before that.
The rule of thumb is that you should start a more thorough medical investigation only when three conditions are met:
- Neck pain that's been bothering you for more than 6 weeks
- Neck pain that is severe and/or not improving, or actually getting worse
- There is at least one other “red flag” (see below)
Red Flags of Neck Pain
- Light tapping on the spine causes pain
- Weight loss without dieting
- Mystery fevers and chills
- You have a fierce headache
- Severe throbbing pain that doesn't go away
- Loss of muscle function, weakness and numbness
- Unexplained dizziness/nausea and vomiting
Common Causes of Neck Pain
Out of all the possibilities, factors and causes of neck pain, here is a short list of the most common.
Neck Curvature and Spine Alignment Matter
In two separate cervical spine investigations, McAviney and colleagues [5] and Harrison et al. [6], compared the cervical lordosis (curvature of the neck) in chronic neck pain populations to that in healthy participants without a history of neck pain or cervical spine trauma.
Here's what they found:
- Statistically, persons whose cervical spine curves were below 20° were twice as likely to be in the chronic neck pain group. This finding was not age or gender dependent strengthening these findings.
- Participants with a straightened or reversed cervical curvatures were 18 TIMES more likely to be in the chronic neck pain group as compared to the non-pain group.
- Thus, a cervical lordosis less than 20° can be considered a type of cervical spine subluxation that causes neck pain.
Spine Arthritis or Degenerative Joint Disease
It's important to understand that there is no clear pattern associated with spine arthritis and neck pain. However, if the joints are wearing down, it's certainly possible for the pain we experience day to day to be coming from these worn out joints.
Degeneration isn’t completely irrelevant to pain!
Degenerative features visible on MRI are more prevalent in older adults with pain compared to those without. [7] It’s just not nearly as strong a link as everyone assumes, and that is very important to know.
Herniated or Bulging Discs
What most people think they know about discs in their spine is that they painfully herniate or “slip” out of their normal position.
Discs don't really “slip”, but they can swell (disc bulge) and or tear (disc herniation).
But herniations do not normally cause the symptoms of chronic neck pain.
Instead, they mostly cause “nerve root pain” in the shoulders and arms, or a distinctive combo of pain plus other neurological symptoms like weakness and tingling.
So the main herniation myth is that disc herniations are a major cause of chronic neck pain. They are not.
Although a real problem, they don’t have much to do with most neck pain cases, even chronic neck pain.
A 2015 study found disc bulges in most (90%) of the 1200 people they examined, without any pain! [8]
Even young people had bulges with an incredible 75% of people in their 20s!
And yet many neck pain patients will be over confidently told that these disc bulges are the source of their pain. It's just not true.
Finally, both disc bulges and herniations often heal when given enough time. [9] They may not heal perfectly (for instance, the disc might remain vulnerable to reinjury, like a ligament sprain) — but they do heal, and fairly quickly.
Muscle Injuries Cause More Neck Pain than Disc Injuries
Muscle tissue is the elephant in this room.
We know that muscle fatigue and tension are both among the only clearly identified risk factors for neck pain. [10, 11]
By weight, there’s more muscle tissue than anything else in the neck, and it’s complex, active, sensitive tissue.
It’s a suspect even when it’s not actually injured (strained) or misbehaving (spasm).
Muscle pain probably accounts for the majority of stubborn moderate neck pain, especially the kind of neck pain associated with cricks.
