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The cervical spine (bones in the neck) allows more motion than other parts of the spine, thus the neck is an extremely flexible part of the body. The problem with the neck's being so flexible is that because it moves so easily and is less protected than the rest of the spine, it is more prone to injury. For most people, neck pain is something that disappears with time, but for some it requires medical diagnosis and treatment.
Neck pain can come from a variety of abnormalities including the soft tissues, the muscles, the ligaments, and the nerves. Neck pain also can come from the bones and joints of the spine. Prolonged wear and tear causes damage to the soft tissues, and this is the most common reason for neck pain. In some people neck pain can come from problems in the back or shoulders. Rarely people will get pain from infections or tumors.
Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in the elderly as a result of wear and tear of the joints between the bones in the neck. Rheumatoid arthritis causes destruction to the neck joints. Both are known to cause stiffness and pain.
Cervical disc degeneration can also cause neck pain because the disc acts like a shock absorber between the bones in the neck. People usually develop this after the age of 40. The disc degenerates and the space between the vertebrae narrows. Also the cervical disc could protrude and cause pressure on the spinal cord or nerve roots when the disc weakens (herniated cervical disc.)
Because the neck is so flexible and it supports the head, it's very susceptible to injury. Injury occurs often in motor vehicle accidents, with contact sports, diving accidents, and falls. Sometimes in car accidents, the neck is hyperextended, which is when the neck moves backwards further then the normal limit. The opposite can also happen, which is known as hyperflexion, a forward motion beyond the normal limits. Fractures or dislocations of the neck can damage the spinal cord and cause paralysis.
One should seek medical care for neck pain if it occurs after an automobile accident or following any sort of trauma to the head or neck. Immediate medical care should be sought if the injury causes pain down the arms and legs. Immediate care should also be sought even if the pain is not too severe in the neck, but causes radiating pain down the arms and legs with numbness. Medical care should be obtained when neck pain is: continuous and persistent, severe, accompanied by pain down the arms and/or legs, and when pain is accompanied by headaches, numbness, and weakness.
In order to treat the pain, the first thing to do is to determine the source of the pain. This is sometimes tougher than it may seem. The doctor will first take a complete history of the problem concerning the neck pain, ask about other medical problems, and if there was any previous treatment for the neck. Second, the doctor will perform a physical examination, which will include evaluation of some neck movements, neck tenderness, and nerve and muscle functions. Also, a lot
of time x-rays are used to be sure there isn't anything happening with the bones. If after these test are performed the doctor needs more help, one or more of the following tests will be prescribed:
- MRI (Magnetic Resonance Imaging) which allows evaluation of the spinal cord and nerve roots; it is non x-ray.
- Myelogram (injection of a dye or contrast material into the spinal canal) this x-ray allows for very specific evaluation of the nerve roots and spinal canal.
- CT (computed tomography) this specialized x-ray allows evaluation of the bone and spinal canal.
- EMG (electromyogram) used to evaluation nerve and muscle function.
Treatment depends on the diagnosis made by the doctor, but most of the time patients are successfully treated with rest, medication, immobilization, physical therapy, exercise, and activity modifications.
Rest is very important so not to overuse muscles. Medication is often given in the form of anti-inflammatories to reduce swelling from overuse or irritation of the muscles. Immobilization is to allow for the body to calm back down and rest before getting back into stressful situations.
Physical therapy is important to teach various stretches as well as to help people strengthen their muscles, to alleviate pain from overuse.
Surgery is sometimes used to treat neck pain if the pain persists after all of the other treatments has been applied. Sometimes surgery is needed to reduce the pressure on the spinal cord or a nerve root when the pain is caused by a herniated disc or narrowing of the spinal canal. Surgery is also needed sometimes following an injury, to stabilize the neck and minimize the possibility of paralysis, for example when a fracture results in instability of the neck.