Neck pain is a common complaint. The one-year prevalence, that is how many people will experience it during a 1-year period is about 35-40% for the general population. This number can increase or decrease based on contextual factors, with wrestlers having among the highest one-year prevalence of 73% (2).
What is Neck Pain?
Neck pain is the experience of pain in the neck area, from the base of the skull to the shoulders. It is often associated with the spine or movement thereof. It can sometimes be associated with radiating pain or sensory loss to the arms. It is typically assumed that neck pain is caused by something wrong with the structure in their neck, which thankfully is untrue. This means there are lots of things we can target to help people with neck pain.
Posture
Posture is commonly blamed for pain involving the neck or back, often dividing postures in to “good” or “bad”. This dichotomous view stems from an outdated reductionist view about pain. Peoples perception of “optimal” posture is more-so the result of social contamination and stereotypes (3). High quality evidence has failed to find a relationship between neck posture and prevalence, frequency, or intensity of neck pain (4). In fact we’re much better off blaming neck pain on the amount of time spent in a singular, static posture rather than what the posture actually is (5). Overall, the spine is a fairly robust structure that is designed to operate in a variety of joint positions, and is highly adaptable to meet demands when not overworked.
Risk Factors & Protective Factors
Psychological and social factors have a stronger relationship with neck pain compared to physical factors (5). People with depression are at 3.36x higher odds, “poor” self-rated health 2.4x, high job demands 2.14x, low social support 2.43x. Some physical risk factors do exist such as working in uncomfortable positions, working with hands above shoulder level, repetitive movements and prolonged work in static positions. Physical activity via leisure however, rather than work is associated with a 30-40% reduction in odds of developing neck pain (6). As is increasing step count and neck muscle endurance (7, 8).
Natural history
The good news is that most people don’t need intervention for their neck pain most of the time. Around 50% of people will have complete resolution of pain by 12-months following incremental improvements if left untreated (9). However for the remaining 50% it will recur or persist. Put simply, this occurs due to the balance between the brief non-exhaustive list of protective and risk factors discussed above.
Degeneration on scans
Degeneration of the cervical spine is a broad term including disc herniations, decreased disc space height, bony outgrowths, changes in alignment and canal narrowing. These are sometimes interpreted as definitive slam-dunk causes of neck pain. One study of pain-free individuals found that around 15% of people in their 20’s and almost 90% of people above 60 years of age had disc degeneration (10). Another study of pain-free participants, 87.6% were found to have disc bulging which was proportionate in frequency and size depending on their age (11). Overall, degeneration is more-so a product of genetics and the ageing process rather than pathology. A great way to frame it is to see them as akin to grey hairs or wrinkles.
How Do I Know I Need To See Someone?
You should see a doctor if you experience any of the following:
Neck pain after a severe trauma or injury
Worsening neurological symptoms (Weakness, numbness, tingling)
Unexplained weight loss
Fever or chills
History of cancer
Night sweats or night pain that wakes you from sleep
Severe, unrelenting pain
Your Doctor will rule in or out the possibility of any serious conditions such as tumour, infection etc.
You should book a Physiotherapy consultation if:
You have goals of returning to sport or function
The pain has been chronic, recurring, or slower to recover than you’d like
You’re unsure how to modify your activities
You otherwise would like to optimise your recovery or are unsure of what to do
Your Physiotherapist after thorough assessment will provide you with a multifaceted rehabilitation plan including exercises to 1. Alleviate pain 2. Restore function 3. Reduce chance of recurrence.