By Raj Hullon, MD
Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason. One of the most common causes of such pain is poor posture. Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain. Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low. The key is always to maintain the neck as close to a neutral position as possible.
The best medical care, however, begins with a crucial question: What is the most serious problem this could be? Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage. Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.
Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time. People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain. It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling. Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.
The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent. Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs. When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.
The natural healing processes result in improvement in almost all cases. In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months. There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.
Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments. Whiplash injuries can be serious in certain situations. Severe damage to the spinal cord can be fatal.
Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.
Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.