Neck Pain Causes & Treatment Options

January 13, 2014June 24, 2014 / Thomas Cohn, MD

The cervical spine and neck can often cause pain, especially as the body ages. There are seven cervical vertebras with multiple joints contributing to the core structure. The spine and multiple nerves traverse the region. Multiple muscles and ligaments contribute to motion and stability.

On top of the neck is the head with all its structures and below are the torso, shoulders and arms. Pain perceived as from the neck may come from any of the structures in the region. All pain fibers from the mid shoulder blade and chest level on up travel through the same area of the brain. As a result, the brain can have difficulties in determining the exact location that is generating the pain signals.

Acute Neck Pain

Neck pain may be described as headaches that originate in the neck or it may be specific pain in the neck. Acute pain may be as simple as a muscle strain if there was no significant trauma. More chronic pain often comes from a deeper structure in the neck, such as:

Cervical facet joints
Cervical discs
Cervical nerve irritation
Degenerative changes irritating the nerves

Shoulder problems can also be misinterpreted as neck pain.

Chronic Neck Pain Causes

The most common causes of chronic neck pain are cervical facets joints, cervical degenerative changes, discs irritating nerves in the neck, and secondary muscle spasms in the neck. Trauma over time often contributes to the changes that have caused pain. The result is felt as neck pain, muscle tightness, and decreased range of motion of the neck. Determining the cause starts with a good history and physical exam. If simple solutions such as exercise, massage, heat and ice, and over the counter medications have not worked, then a physical medicine pain physician would be extremely helpful in coordinating future care.

Chronic neck pain that is limiting function warrants help from an expert. Muscle spasms and pain are the symptoms most commonly reported by patients. The cause is often a combination of problems such as:

Degeneration of discs, bones, and joints
Nerve irritation
Muscles tightening to prevent further pain and movement of the head

After age 30, almost everyone will show a degree of degeneration of the cervical spine and these normal changes can also contribute to pain.

Treatment Options for Chronic Neck Pain

Treatment of neck pain starts with determining the causes, and often requires a complex plan that addresses each of the contributing factors that are maintaining the symptoms. Chronic pain often involves multiple causes and a simple treatment is often not available. Patient frustration is common since we all want a simple treatment. If there are multiple structures involved and pain is chronic, expect that more than one thing will be necessary to manage the symptoms.

Spinal Stenosis: Causes & Pain Management Options

October 14, 2013June 24, 2014 / Thomas Cohn, MD

Spinal stenosis is a narrowing in the spinal canal where the spinal cord and nerves of the spine travel and exit the bony spine structure. It most commonly occurs in the neck and low back regions. It can be caused by normal changes relating to aging, such as:

Bony overgrowth
Trauma
Congenital changes

The body is highly adaptive, and if changes that lead to stenosis are slow, often no symptoms are present until the body can no longer compensate.

Causes & Symptoms

The symptoms of stenosis are signs of nerve damage at the spinal level that include:

Pain
Numbness
Muscle weakness
Bowel or bladder problems

Symptoms are dependent on the cause and location of the spinal narrowing. Trauma, like car accidents, can cause sudden fracture of the spinal vertebrae. The bone pieces can damage the spinal cord causing immediate paralysis. Congenital abnormalities may cause curvatures of the spine (scoliosis) and pinching of the nerves as they exit the spine.

Stenosis most commonly develops as one ages. The bone can become overgrown where the vertebral discs and joints are causing central and lateral spine narrowing. In the neck, symptoms of pain, numbness, and weakness occur in the arms and head, but can also occur in the legs. Low back stenosis causes symptoms in the low back and legs, and sometimes bowel and bladder control. Symptoms in the low back may be very positional. Bending forward and sitting may significantly relieve the pain. The most common symptoms that send a person to a doctor are pain or muscle weakness.

Diagnosis

Diagnosis of spinal stenosis is made based on symptoms, history, and physical examination. Pain is often in the distribution of a particular spinal nerve level and muscle weakness corresponds to that level. An exam shows sensation changes, weakness of muscles, and reflex changes. If stenosis is suspected, CT or MRI scans of the spinal region can confirm the diagnosis. Electrodiagnostic studies may also be useful to determine the extent of nerve damage, and are performed by Physical Medicine doctors or Neurologists.

Pain Management Options

Treatment for spinal stenosis needs to be individualized for every patient. Conservative care centers on physical therapy to strengthen spinal muscles and maintain proper posture, to medications for pain and spinal injections. Many people can control symptoms for years with a variety of conservative care techniques. If the conservative path is not controlling symptoms, then surgical care may be necessary to relieve spinal narrowing.

Spinal stenosis is a complex condition. A good Physical Medicine pain specialist can lead one through the maze of diagnosis and treatment. Most people do respond to conservative care. Narrowing of the spine does occur in many people and often can be treated with PT, medications and other types of care. Find a physician who can lead you through conservative care before you consider surgery.

4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.

5 DIY Neck Pain Treatments

June 10, 2013November 17, 2015 / Thomas Cohn, MD

The neck is an incredibly complex part of the body that is in almost constant use. As a result, it’s easy to incur overuse injuries and chronic pain in the neck. Neck pain is, quite simply a “pain in the neck.” It can hinder your daily activities and put you in a bad mood. Below are 5 treatments for neck pain that you can do at home:

Good posture. Your neck is directly connected to your spine, and thus directly affected by your posture. When you slouch, your lower back bends forward, causing your neck to strain forward in order to compensate.
Over the counter pain relievers. Common pain relievers like aspirin and ibuprofen can decrease inflammation and pain in the neck. As with all medication, be careful not to overdo it with these pain relievers. Only take them as needed.
Heat & Ice. A combination of hot and cold can help relieve neck pain. Wrapping a handful of ice in a towel and resting it on your neck for 5-10 minutes can reduce inflammation, while applying heat (by taking a hot shower for example) can increase circulation.
Massage. Having someone rub your neck and shoulders is a great way to loosen up the muscles and help you relax.
Workplace habits. It’s important to stay at eye level with your computer at work. If your monitor is higher or lower than your eye level, you will strain your neck by constantly looking up or down. This can have a terrible toll on your neck muscles, especially if you’re on your computer for 8 hours a day.

If you still have persistent neck pain after trying these treatment methods, there may be a more serious underlying issue. If this is the case, it’s a good idea to consult a doctor who specializes in pain management.