Neck Pain

What is it?

Neck pain is a real pain in the neck…. Ba doom Tsh!

But seriously, although it seems obvious, anything that relates to the cervical spine and surrounding structures would fall under the classification of neck pain. However, people who experience neck pain can also have related symptoms in their arms and hands.

If you experience or have experienced neck pain, you’re not alone. In Australia, neck pain has been reported to be as high as 20% of the adult population (RACGP 2018). It is also in the top 5 chronic pain conditions in regards to prevalence (how many people have it)  and years lost to disability (Cohen & Hooten 2017). So neck pain is clearly a significant problem. This article will look at why someone might develop neck pain and what you can do about it. We will then go over the answers to some frequently asked questions.

Why does it occur?

We can learn a lot about neck pain from another area of the spine - the low back. Low back pain has received a lot of attention in the research literature, and more and more we are discovering that very rarely can back pain be attributed to a specific structural cause. In fact 90% of low back pain cases are deemed non-specific lower back pain (You can read more about back pain in this article). Like back pain, most cases of neck pain are the result of a culmination of factors, beyond the physical structure of the neck.

Risk Factors

Historically, musculoskeletal pain has been viewed through the biomedical lens. The biomedical lens views pain as solely the result of anatomical changes such as viruses, structural changes or tissue injury. In other words, the biomedical model only considers biological factors. Thankfully, the scientific community has adopted a broader approach in what is called the biopsychosocial model - a perspective that considers the intricate, variable interaction or biological, psychological and social factors to pain and disease. This can be hard to get your head around, so let me give you some straightforward examples relating to lower back pain:

• People with anxiety or depression are more likely to develop back pain

• People from lower socioeconomic backgrounds are more likely to develop back pain
• If you have an underlying chronic disease like diabetes, you are more likely to develop back pain. (Hartvigsen et al. 2018)

These are just a few examples of how factors unrelated to the structure of an area can cause back pain. If you are unfamiliar with this concept, I would highly encourage you to read our pain article.

Let’s take a closer look at some of the risk factors for neck pain.

Biological Factors

The biological risk factors of neck pain are commonly seen through the narrow lens of structural changes in the cervical spine. However, there is plenty of evidence to show that structural ‘abnormalities’ such as changes to the cervical spine alignment, or disc degeneration are not well correlated with pain. For example, in a study investigating intervertebral disc degeneration in asymptomatic people (people with ZERO symptoms), findings of disc degeneration increased linearly with age (Matsumoto 1998). The older you get, the more likely you are to have ‘degenerative changes’.  Thus, these findings are probably better described as ‘age related changes’ - a much less threatening description of a normal anatomical finding.

There doesn’t appear to be any specific biological factors that are strongly associated with neck pain, however, but jobs that requires long periods spent in subjectively reported ‘awkward’ or sustained postures may contribute to neck pain (for a discussion on posture, read here). In fact, risk factors for neck pain appear to be more related to psychological and social factors.

Psychological and Social Factors

Psychological risk factors for neck pain are:

• Depression
• High perception of muscular tension
• Previous episodes of neck pain

Whilst social factors that contribute to neck pain include:

• Low income and financial stress
• Work related demands such as:
• Low support from co-workers
• High perceived job demand

So as you can see, the risk of developing neck pain is far more related to psychosocial factors as opposed to biological or structural changes.

This is good news! It means that you can improve your neck pain, without altering the actual structure of your cervical spine!

What can I do about it?

Of course, if you look at the risk factors above, it would appear that completely altering your workplace and financial situation would be a big step to reducing neck pain. That may be impractical and likely beyond the scope of this article. Suffice to say that if you are experiencing physically demanding positions and sustained postures, it may be worth experimenting with altering your position through the day and taking regular breaks for movement snacks or physical activity. It’s reasonable to expect that these changes could be applied to both work and non-work activities.

Let’s focus on changes that are perhaps more viable.

This first recommendation will come as no surprise to anyone that has come across Be Mobile Physiotherapy - Exercise.

There is evidence to show that increases in physical activity reduce the risk of developing neck pain (de Campos 2018). This could be anything from walking to cycling to resistance training. The important thing is to simply get moving. If reducing your risk of neck pain is not motivation enough, consider the dramatic impact exercise has on your overall health - be it physical or psychological.

Neck Specific Exercises

In addition to general exercise, neck specific exercises can be a useful addition for many people. Join Ollie as he runs through a quick explanation of neck pain, and then outlines where to get started with neck exercises.

Frequently Asked Questions

• Does bad posture cause neck pain?
  
  Contrary to popular belief, there isn’t ‘good’ or ‘bad’ postures. There are simply different positions to accomplish different tasks. The belief that the human body cannot cope with certain postures fails to acknowledge that the human body is incredibly adaptable. This perspective is supported by the literature. Take the so-called ‘text neck’ issues - this idea that the neck posture adopted to send a text is bad for the cervical spine. In one study, the authors were unable to find a link between neck flexion (looking down) and the occurrence or magnitude of neck pain (Correia 2021). This is not to say that certain people will not find different positions painful. But the issue here is generally the sustained nature of a given posture. If you stand up all day, you may end up with a sore back, but no one would say that standing is bad. So if you are looking down at a smart phone all day and you get some pain, we can presume that it’s the sustained nature of your posture, rather than the posture itself which was problematic. A good slogan to remember here is - the best posture is you next posture! For more information on posture check out our posture article.
  
  
• I had an MRI showing degenerative changes, does that mean my pain is going to get worse?
  
  No, remember that degenerative changes are common in people who have no symptoms whatsoever. So an imaging finding of ‘degeneration’ is most likely coincidental. You probably had those findings before you got your pain, and you will more than likely have those findings when your pain goes away. It’s also good to remind yourself that ‘degenerative’ is a scary sounding word that might elicit images of something crumbling away - this thought in itself might be enough to increase your symptoms. This is why we prefer to call such findings normal age related changes. When someone develops wrinkles in their skin, we don’t say they have ‘degenerative skin changes’, so why would imaging findings of the spin be any different.
  
• I get very tight in my neck and shoulders which causes me pain. What can I do about that?
  
  The perception of tightness is a risk factor for the development of neck pain. The first step to address this is for you to understand that tightness is often just a perception. Your muscles may not actually be measurably ‘tight’. This works in a similar way to pain, where you can have pain in the absence of any injury or physical abnormality. This however, does not mean that your feeling of tightness is not real, and there are things you can do about it. In the short term, relaxation techniques can be helpful. Mindfulness, massage or finding time for things you enjoy can help. In the longer term, building your confidence in that area of your body and increasing it’s capacity to tolerate the movement and loading of daily life is useful. The best way to do this is by consistent exercise, hopefully incorporating aerobic and resistance training.
  
  If you would need help getting started with some structured exercise, you can access some free workouts when you sign up for a free account for the Be Mobile Exercise platform!

References:

Christensen, J., & Knardahl, S. (2014). Time-course of occupational psychological and social factors as predictors of new-onset and persistent neck pain: A three-wave prospective study over 4 years. Pain, 155(7), 1262-1271. doi: 10.1016/j.pain.2014.03.021

Cohen, S., & Hooten, W. (2017). Advances in the diagnosis and management of neck pain. BMJ, j3221. doi: 10.1136/bmj.j3221

Correia, I., Ferreira, A., Fernandez, J., Reis, F., Nogueira, L., & Meziat-Filho, N. (2020). Association Between Text Neck and Neck Pain in Adults. Spine, 46(9), 571-578. doi: 10.1097/brs.0000000000003854

de Campos, T., Maher, C., Steffens, D., Fuller, J., & Hancock, M. (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. Journal Of Physiotherapy, 64(3), 159-165. doi: 10.1016/j.jphys.2018.05.003

Kim, R., Wiest, C., Clark, K., Cook, C., & Horn, M. (2018). Identifying risk factors for first-episode neck pain: A systematic review. Musculoskeletal Science And Practice, 33, 77-83. doi: 10.1016/j.msksp.2017.11.007

Matsumoto, M., Fujimura, Y., Suzuki, N., Nishi, Y., Nakamura, M., Yabe, Y., & Shiga, H. (1998). MRI of cervical intervertebral discs in asymptomatic subjects. The Journal Of Bone And Joint Surgery. British Volume, 80-B(1), 19-24. doi: 10.1302/0301-620x.80b1.0800019

Neck pain. (2021). Retrieved 13 July 2021, from https://www1.racgp.org.au/ajgp/2018/may/neck-pain

Ray, M. (2021). Barbell Medicine Guide to Neck Pain Part I: Definitions & Risk Factors | Barbell Medicine. Retrieved 13 July 2021, from https://www.barbellmedicine.com/blog/barbell-medicine-guide-to-neck-pain-part-i-definitions-risk-factors/

Ray, M. (2021). Barbell Medicine Guide to Neck Pain Part II: Posture | Barbell Medicine. Retrieved 13 July 2021, from https://www.barbellmedicine.com/blog/barbell-medicine-guide-to-neck-pain-part-ii-posture/

Ray, M. (2021). Barbell Medicine Guide to Neck Pain Part III: Framing the discussion | Barbell Medicine. Retrieved 13 July 2021, from https://www.barbellmedicine.com/blog/barbell-medicine-guide-to-neck-pain-part-3-framing-the-discussion/