As is the case with many of the bodies symptoms neck pain can have a significant number of possible underlying causes. As we shall see the overwhelming majority of these causes are related either to specific movement and lifestyle issues or to degenerative changes in the spinal column.
Persistent and troublesome cases of neck pain are rarely simple matters. If you have had neck pain for some time it is likely that a combination of the following factors both past and present have conspired to create the pain.
The good news is that most cases of neck pain do not require that we achieve a state of muscular, postural, dietary and ‘life stress’ related perfection in order to resolve. In most cases it is enough to find some effective treatments and back them up with some consistent action in resolving the main driving force behind your neck pain.
To develop a clear understanding of what is causing your neck pain it is usually necessary to seek professional help. The right clinical team will not only be able to identify which tissues are causing your neck pain, they should be able to tell you what the underlying cause of your neck pain is.
Neck Pain Caused By Postural Issues
Postural neck pain issues are (along with emotionally related neck pain and injury related neck pain) by far the most common causes of neck pain. We seem to increasingly live in a world that predisposes us to postural issues, and our necks are one of the most common casualties of poor postural habits.
When your posture is not within the ideal range your neck may suffer. If you habitually sit with rounded shoulders and a sunken chest it causes shortening and compression of the vertebrae and soft tissues of the neck. Over time, as the upper back muscles weaken and the soft tissues adapt, our necks can become chronically shortened and drop forward, this is called a ‘forward head carriage’.
A sub-category of postural neck pain is neck pain caused by sleeping in unnatural positions and postures. If you spend 8 hours per night in an awkward position your neck can take that just as hard a working 8 hours per day at a poor workstation.
The impact of poor posture and a chronically shortened neck can induce muscle tightness, muscle trigger points, disc compression, scar tissue formation and joint inflammation. These kind of changes are what turn a posturally compromised neck into a stiff, sore neck.
Neck Pain Caused By Emotional Issues
There is a reason why phrases like ‘he is such a pain in the neck’ are part of our language. When we are under emotional stress many of us clench our necks and jaws.
Jaw clenching, despite being slightly less common than neck clenching is far more well known, probably due to the fact that it makes a grinding noise and visibly wears out the poor teeth. Neck clenching is more the silent killer when it comes to neck pain, and it is an ultra ultra common cause of neck pain.
There is a wide spectrum of how intensely people clench their necks in relation to stress. It’s important to know it’s likely that if you do cause your own neck pain through clenching you won’t be fully conscious of doing it. These kind of patterns are deeply ingrained into the subconscious, and our way of relating to a busy and or stressful life.
The impact of neck (and jaw) clenching on the tissues of the neck can be quite severe over time. The habitual muscle tension exerts powerful crushing forces on the neck tissues. Clenching can induce muscle tightness, muscle trigger points, disc compression, scar tissue formation and joint inflammation. These kind of changes are what over time turn clenching into a stiff, sore neck.
Neck Pain Caused By Old Injuries
One of the most common causes of stubborn neck pain is old injuries to the neck that were not properly treated or rehabilitated at the time. These injuries can range from car crashes, sports injuries and falls right through to birth trauma.
The most classic history behind an old injury causing present day neck pain is a past injury of some kind that lead to a period of pain, but that later settled. Then some years later stubborn neck pain and/or headaches increasingly become an issue where they had not been before.
Many people find it surprising to learn that it is reasonably common for adult neck pain and headache sufferers to still carry injuries that they sustained during their birth or soon after.
The simple fact is that injuries only heal if they are given sufficient rest. The human neck has to bear the weight of an unusually large skull and brain relative to body size; it does this all day every day, year in and year out. In other words our old neck injuries often never get the rest they need to heal the same way a wrist or ankle might. Add to this the fact that we don’t generally do much by way of rehab for neck injuries in our culture and you have a recipe for unhealed trauma.
Necks with unhealed injuries generally suffer from a combination of scar tissue build-up, joint inflammation and chronic muscle tension. Some cases even develop osteoarthritis and degenerative disc disease.
Neck Pain Caused By Occupation
Most of us spend a very significant portion of our lives working, which means whatever those work conditions are our necks must come along for the ride whether they like it or not.
The classic occupational neck pain is of course these days the one that relates to desk work. It has been estimated that we are only around 20% as physically active as our great grandparents and office workers partly drive those stats. Necks don’t benefit from being sat still in one position all day every day, because it just isn’t what nature intended for them.
For an understanding of how desk related neck pain can impact your body you only need refer to the heading on postural neck pain (and possibly the one on stress related neck pain) above. Muscle tightness, muscle wasting, muscles trigger points, disc compression, scar tissue formation and joint inflammation are all potentially on the table.
Categories of occupationally related neck pain other than those related to desk work do of course exist, professional sports people, truck drivers and those who pain ceilings are all classic and self explanatory examples. The common theme is always repetitive or stubborn compression of the delicate tissues in the neck, either by persistently unnatural or excessive loading.
Neck Pain Caused By Degenerative Disc Disease
All humans develop wear and tear on the cervical spine over time. It’s natural for the discs to gradually lose hydration and reduce in height over a lifetime. In most cases this is a completely painless and normal finding associated solely with a slow, gradual loss of flexibility. There are times however when disc degeneration can cause pain.
If a disc degenerates badly enough in the wrong spot it can lead to direct pressure and irritation of a cervical nerve root. An example of this is a cervical disc herniation where the discs jelly-like inner layer (nucleus pulposus) leaks out through a tear in the disc’s protective outer layer. This can result from an injury and/or aging.
Neck pain caused by pressure on a nerve in this way will often involve severe radiating pain down the arm and will also often be somewhat resistant to treatment with normal physical therapies. It is important to understand that having disc degeneration on your scan or X Ray does not necessarily mean those discs are the cause of your pain, in fact they are often not.
Neck Pain Caused By Osteoarthritis
Facet joints are delicate little weight bearing joints in your neck that sit just behind the discs. When the cartilage in a cervical facet joint degenerates enough it can lead to neck pain associated with cervical osteoarthritis.
Facet joint arthritis is usually a painless condition. If however it gets mixed up with the emotional and postural types of neck pain or other issues with health and well-being (like a poor diet or nutritional deficiencies for eg.) it can make for a very stiff and sore neck indeed. The joints can become stubbornly swollen, stiff and inflamed. The pain associated with facet joint arthritis can often be managed surprisingly effectively given the right treatment approaches and a bit of persistence with exercises.
Neck Pain Caused By Spinal Stenosis
Spinal stenosis occurs when degeneration within the spinal column includes the spinal canal, such as from a herniated disc that pushes into the spinal canal or bone spurs that grow into the canal.
When the spinal canal narrows enough to put pressure on the spinal cord ‘myelopathy’ can result. Myelopathy is the name given to the process whereby compression of the spinal cord starts causing symptoms, such as general muscle weakness or problems with motor coordination in the arms, hands, legs, or feet.
Neck Pain Caused By Foraminal Stenosis
The spinal nerves, that poke out from your spinal column to carry their life sustaining messages to and from the brain and body escape through little holes (foramina). Foraminal stenosis is the closure of these little holes due to degenerative change within the spinal tissues.
Foraminal stenosis can reduce the amount of space the nerve root has to work with, this can be associated with radiating pains, numbness and weakness in a pattern specific to the nerve that is pinched by the narrowing. It can also cause aggravation within the neck itself.
Fortunately, as is the case with all the degenerative causes of neck pain we have looked at foraminal stenosis only accounts for very few cases of neck pain and neck related pain.
Neck Pain Caused By Infection
Infections can spread through the body via the blood stream and the tissues of the neck are not immune to this fact of life. If an infection spreads somehow to the deeper tissues of the cervical spine it can cause pain in the neck.
Meningitis is a viral or bacterial infection of the spinal cord that we have all heard of. Severe neck pain that comes on in combination with body wide symptoms like fever, chills, lethargy, vomiting, skin blotches and light sensitivity is a cause to get checked up real fast!!
Neck Pain Caused By Rheumatoid Arthritis
Rheumatoid arthritis is a form of inflammatory, auto-immune arthritis where the bodies immune cells attack the cartilage and cause degenerative changes.
Rheumatoid arthritis can affect the hips, knees, hands, feet and also the spine, including the neck. Degenerative inflammatory change to the joints and their associated connective tissues is what leads to back pain caused by rheumatoid arthritis.
Neck Pain Caused By Fibromyalgia
Fibromyalgia is not really a diagnosis, it is more of a ‘syndrome’ that we don’t fully understand fully yet. Typically fibromyalgia involves pain in the muscles, tendons, and ligaments in multiple areas of the body, often including the upper back and neck.
We believe the true underlying causes of ‘fibromyalgia’ are most commonly a complex mix of postural pain, present day life stresses, early childhood or birth trauma, and dietary intolerances. These are the areas of change in which we have seen bring the most meaningful changes for folks diagnosed with the loch ness monster of pain conditions… ‘fibromyalgia’.
Neck Pain Caused By Spinal Tumors
Cancer can set itself up anywhere in the body, it had been known to establish itself in the cervical spine and press against a nerve. There are specific bone tumors that can do this but by far the most likely cause of neck pain related to cancer is a spread (metastasis from another part of the body).
As you can seen, there is potentially far more to neck pain than meets the eye. Our necks are subjected to a great deal of mechanical strain during a lifetime. Perhaps inevitably, it is more commonly this mechanical strain that causes neck pain rather than any other factor. A good way to think of and understand this is the following. Your gut is primarily in the business of digesting food, therefore ‘wrong foods’ are the most common cause of problems in the gut. Your neck on the other hand are primarily in the business of moving and bearing weight, the most common cause of problems with the neck are with movement & weight bearing.