Neck (Cervical) Pains

The neck is the most mobile part of the spine, which helps us to keep our head in a supported position and allows us to move in many directions. It has a complex joint structure, which is responsible for protecting various vessels and nerve structures from the skull to the body, and also includes the spinal cord. Therefore, it is in a position open to traumas.

Although it is less common in children, the frequency of neck pain increases with age, and it is more common in people who use desks and computers. Cervical pain can also be experienced as a result of a blunt trauma to the neck.

What Factors Cause Neck Pain?

Since the anatomical structure of the neck is quite mobile, it consists of 7 vertebrae and discs. Discs are structures that are located between the neck vertebrae and provide some kind of support. Its task is; to distribute the load falling on it in a balanced way and to keep the friction force between the vertebrae at a minimum level. Since the nerves to the trunk and shoulders pass between the neck vertebrae, numbness and tingling sensations may be experienced in the hands and legs during neck pain.

Neck pain may occur as a result of connective tissue deformation in the muscle structures that make up the neck. Sudden and wrong movements can cause pain as a result of injury to these muscle structures. Jumping from a high place or traumas, calcification in the joints in the neck region, bulging of the discs that serve as pillows, some rheumatic diseases, narrowing or hernia in the spinal canal, and psychosomatic factors can cause various neck pains.

Neck pain can be classified into two main groups;

1. Mechanical neck pain

2. Neck pain due to spinal diseases

Mechanical Neck Pain: It is the most common type of neck pain epidemiologically. It mostly occurs as a result of traumas to the neck region and injuries that occur as a result of misuse of the muscles in the neck region. The most common cause is anatomical poor posture. It is especially common in people who work at a desk or computer all day long. Mechanical neck pain may radiate to the back, shoulders, or arms as a type of referred pain. Often, no underlying pathological cause of pain is found.

Neck Pain Due to Spinal Diseases: It is less common than mechanical neck pain. Among the reasons;

• Neck hernia (cervical disc herniation)

• Degeneration / wear on neck vertebrae ( Cervical Spondylosis)

• Spinal cord involvement due to narrowing in the neck spinal canal (Cervical Spondylotic Myelopathy)

Neck Hernia (Cervical Disc Herniation): The discs located between the two vertebrae consist of hard tissue on the outside and gelatinous soft tissue on the inside to facilitate movement. As a result of the weakening of the hard tissue on the outside, the soft tissue forming a bulge outward is called neck hernia. Since this hernia will put pressure on the neural structures there, pain reflected to the shoulder and arm may occur. As a result, tingling or numbness may occur in the fingers or arms.

• Symptoms of Neck Hernia: Pain, tingling or numbness in the neck, shoulders and arms, and decreased reflexes are among the main symptoms.

• Diagnosis of Neck Hernia: One or more of the above symptoms can be seen. In addition to these findings experienced by the patients, various laboratory tests may request EMG, MRI or computed tomography.

• Neck Hernia Treatment: There is no single treatment for neck hernia, and the patient’s anatomical bad posture should be corrected first. Patients should avoid lifting and carrying heavy loads. It has been proven that physiotherapy applications during treatment have many benefits. If the exercises to be done in the neck area and the painkillers applied do not work, surgical treatment may be considered.

Degeneration/Wearing in the Cervical Vertebrae (Cervical Spondylosis): As a result of the deformation of the elastic disc structure between the vertebrae with advanced age, the amount of water decreases and its movements are restricted. As a result of this deformation, the amount of load falling on the neck vertebrae will increase and abnormal bone structures will form. These abnormal structures will press on the nerve roots and spinal cord, causing neck hernia-type pain and will give similar symptoms as experienced in neck hernia. The patient’s complaint can be diagnosed by the physician by evaluating various laboratory findings and imaging methods. Although the treatment varies for each patient, if there are no signs of pressure, physiotherapy and painkillers can be tried. If there are signs of compression, surgical treatment may be considered to relieve that area.

Spinal Cord Involvement Due to Narrowing in the Neck Spinal Canal (Cervical Spondylotic Myelopathy): Compression findings that occur due to narrowing in the spinal canal as a result of some changes in the neck region are called spondylotic myelopathy. Symptoms such as tingling, numbness and numbness occur in spinal cord compression. The effectiveness of conservative treatment in cervical spondylotic myelopathy has been proven. Physiotherapy treatment given to the patient with a good clinical approach is satisfactory. If the mechanical and spondylotic changes are severe, surgery is the reason for the indication.

General Approach to Types of Neck Pain: Among the musculoskeletal complaints voiced by patients in the spinal canal, neck pain comes after herniated discs. He or she will inquire about your professional status, your history of trauma, if any, your previous surgery, your genetic factors, and whether there are other symptoms accompanying the pain. In cases such as excessive weight loss, persistent vomiting, and worsening of neck pain in the last 1 month, which we call alert findings, the cause of neck pain should be investigated immediately. You may have mechanical neck pain without any underlying pathology, or you may be faced with pain caused by malignancy.

Mechanical causes of neck pain include; There may be conditions such as degeneration of the discs between the vertebrae, muscle-induced deformations, facet joint wounds, vertebral fractures, spondylosis, spondylolisthesis, and postlaminectomy syndrome. Approximately 80-90% of neck pains are of mechanical origin. Neurogenic neck pain can also be caused by disc herniation, spinal stenosis, osteophytic nerve root compression, failed neck surgery syndrome, infection (herpes zoster), and nerve root irritation. Non-mechanical pathologies include malignancies, spondylodiscitis, osteomyelitis, inflammatory spondyloarthropathies, ankylosing spondylitis, and Paget’s disease. Fibromyalgia, and gastrointestinal causes can also lead to neck pain.