Neck Pain Intro
Here are some neck pain facts just to drive the point home…
- Neckpain is far more likely to become chronic in people who’s work involves sitting and lower income earners.
- Neck pain ranked 4th highest impactful health condition in terms of disability as measured by YLDs, and 21st in terms of overall. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.
- Neck pain occurs commonly throughout the world and causes substantial disability and suffering.https://www.physio-pedia.com/Epidemiology_of_Neck_Pain
- Rates of recurrence and chronicity of neck pain are high. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association
- The economic burden due to disorders of the neck is high. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association
The true story of neck pain is however not told in the numbers. The story of neck pain is told in loss of happiness, the loss of relaxation, the loss of enjoyment, the lack of sleep, the inability to concentrate, the frustration, suffering and the uncertainty that people go through when they live with neck pain. All chronic pain sucks to live with but neck pain in many ways is worse than having pain lower in your body as it’s harder to ignore.
If you have stubborn neck pain you most likely have more than one reason why it has manifested. Let’s take a look at some of the more common causes of neck pain, then finally we will take a look at the Big Kahuna of neck pain causes.
*If you couldn’t care less about what causes you neck pain and you just want to know what to do to fix it please read this blog instead it will suit you better.
Whiplash & Neck Pain
Whiplash is most often associated with motor vehicle accidents. Whiplash injuries happen primarily when the head is shoved back at speed which causes the neck to bend backwards. Bending the spine backwards at speed is bad because it causes the small delicate joints that run down the back of the spine to compress. Sudden compression of small joints can cause injury to them.
Injury, strain and inflammation in the small joints in the neck is a major source of neck pain. These small joints can cause neck pain even when they haven’t been subjected to whiplash, so they can most definitely do so when the type of force a motor vehicle accident inflicts upon them.
Although whiplash type injuries that lead to neck pain happen most often in road traffic accidents, but they can occur in many other ways. Any movement that throws the head back can in theory cause neck pain via a whiplash mechanism.
The suffering caused by whiplash injuries often goes unacknowledged, undiagnosed and untreated, this is because much of it occurs months and years after the initial injury.
In the most typical scenario the patient has a small to medium size road traffic incident after which their neck and shoulders are sore or tight for a week or two. After a short time tthey appear to settle and everything seems fine, only then to develop neck pain and even headaches and migraines months or even years later.
There are numerous reasons why so many whiplash injuries ‘fester’ in this way and cause chronic pain complaints down the track. The primary reason is the pure and simple fact of constant weight bearing. The constant downward pressure of the large human skull on the small joints of the neck alone can be enough to prevent whiplash injuries from healing and result in neck pain.
Sports Injuries & Neck Pain
Sports are supposed to be good for you right? Well, cardiovascular exercises and activities that stimulate the brain and body together in movement are definitely good for you. Like so many things in life however, sport can be good for you, and also not so good for you.
Ankle Sprains, osteoarthritis, cruciate ligament tears, broken bones, rotator cuff tears, concussive brain injuries, spinal injuries are all commonplace outcomes of playing sport. Neck pain and neck injuries are well and truly on the list as they are extremely common in people who play contact sports especially.
Any sport that involved heavy human on human contact presents a significant risk of neck injuries both big and small. Sports that involve deceleration also place the delicate tissues of the neck at risk of injury.
Many sports people have neck pain that stems from a single large neck injury. Other sports people suffer from neck pain that builds up over many smaller events. Mini-trauma’s can cause a gradual build up of pain and scar tissue in the neck, in much the same way that repeat exposure to sugar leads to a build up of plaque on your teeth.
What makes all this worse is how seldom we give attention to the wellbeing of our necks and spines, and how poorly we rehabilitate such injuries. Much of this work is offloaded onto the physiotherapist profession who’s basic training involves very little spinal rehabilitation.
Posture & Neck Pain
We live in a world that is HIGHLY conducive to poor posture. Desk work, driving, smart phones, modern furniture, low activity levels, lack of education on posture and a lack of understanding of the issue within the health and fitness community all contribute. If we had intentionally devised an evil plan to develop widespread crappy posture in our population we couldn’t have done much better.
Poor posture is a major contributor in to majority of stubborn neck pain cases. Many neck pain sufferers have not sustained any sports injuries or been in any motor vehicle accidents, on the other hand very few stubborn neck pain sufferers have good posture.
When we slump forward with classic round shoulders poor posture we compress our vertebrae and the connective tissues of the spine. Put simply, when you slump your spine becomes shorter. A shorter spine is a compressed spine, and a compressed spine is a spine that is far more likely to become inflamed. An inflamed spine can mean neck pain, headaches, back pain and sciatic pain.
Birth Trauma & Neck Pain
When it comes to being born in human form we are victims of our own evolutionary biology. Back in the day child birth was a major cause of death, such is the extreme nature of the human birth process. These days thankfully we are right on top of that historical death toll, there is however still a fairly massive amount of physical and emotional trauma involved in many cases.
If you went to full term when you were born your head circumference was larger than the space in your mums pelvis that she pushed you through. You also had relatively broad shoulders that had to contort their way into the world. The act of squeezing through this small space can easily cause sprain like injuries to the neck. Adding to that problem is the fact that newborns have virtually no protective muscle tone in their necks.
If you start life with an undiagnosed sprain injury to your neck (a huge number of us do) you have a very good chance of developing neck pain later in life if some other things also don’t go your necks way. If our necks didn’t take such a beating while we learn to hold up our huge skulls under gravity (year 1) – learn to walk without falling over (years 2-3)- learn to run without falling over (years 4-6) – learn to play sport etc. these birth injuries would probably heal up. The simple fact is though that life is hard on our necks and injuries often aren’t given a chance to heal, this is a major part of that reason so many of us have neck pain without knowing why.
Tummy Sleeping & Neck Pain
Starting the day with stiffness and pain is not great mentally of physically. A huge number of neck pain sufferers have increased pain when they first rise in the morning. The obvious questions that neck pain sufferers in this situation pose are around the topics of sleeping position, pillow choice and mattress renewal.
The important thing to understand about waking up with more neck pain than you went to bed with, is that the actual harm may not have been done during your sleep. When you lie in bed all night your muscle shorten slightly and become ‘cold’, your joint fluids become more sticky and viscous and your circulation reduces.
All these changes to the tissues in the neck during the night can have the effect of increasing stiffness and pain. The kicker is that this also applies to neck pain that was caused by daytime activities, many of which may not have hurt at the time. This fact can create the illusion that the problems for the neck are nocturnal when they were just daytime ‘injuries’ that stiffened up over night.
Having said all this there are ways in which we can hurt our necks during the night. By far the most common way is though tummy sleeping. When we sleep on our tummy we need to turn our heads to the side in order to breath and not smoosh our noses. When it is a strong habit this kind of forceful rotation held for 8 hours per night can cause irritation and damage to the delicate joints of the neck.
Food Intolerances & Neck Pain
People like me tend to think of most cases of back pain and back pain in ‘biomechanical’ terms, in other words relating to movement issues within the body. And while it is certainly the case that most of them respond to biomechanical solutions, some cases are more multi-factorial than others.
One potential ‘cause’, or possibly ‘aggravating factor’ in neck pain is diet. Some of us most definitely get a lot more neck pain and headaches when we eat certain foods regularly. This may be due to some kind of inflammatory or auto-immune response triggered by those foods.
Dairy intolerances can be a factor in some stubborn cases of neck pain, a percentage of people who give up dairy will see a sharp decrease in the amount of pain they get. Others may have a Salicylate intolerance. Salicylates are found in a wide array of fruits, vegetables and even household products, if are really struggling to solve a case of neck pain it may be worth investigating this matter further.
And By FAR The Most Major Neck Pain Cause Of All……Stress
Back up and take a look at how great we have made our life. We live in warm dry houses, we have excellent healthcare, we are not breathing smog (in NZ at least), noone is dropping bombs on us, we are vaccinated, we have access to abundant food, coffee has improved out of sight. What is the 1 thing that virtually all of us still struggle with from time to time… stress. Admittedly the substance addiction that springs out of emotional stress is also a major factor still for many of us.
Stress most lilkely has the ability to negatively impact every health condition on the planet, and neck pain was an unlikely exception to this rule. Stress can have quite a profound effect on the function of the body. The effects of stress on the nervous system have been studied for 50 years. Some studies have shown that stress has a profound impact on the nervous system and can cause structural changes and even physical shrinkage of the brain.
We now know for sure that stress can affect the function of the immune system, it does so by modulating processes in the central nervous system and neuroendocrine system. . Sustained emotional stress also has a profound impact on the function of the cardiovascular system, endocrine system . Not to say I told you so, but this is what I keep telling my patients until I am blue in the face and my hair has fallen out .. stress is a HUGE factor when it comes to pain and being unwell.
So, in a nutshell stress has been shown beyond any doubt to negatively effect all of our major organ systems. The human spine and the human neck are of course not going to get a free pass. There are essentially 2 mechanisms by which we understand that stress can cause neck pain. Stress can cause compression to the tissues of the neck itself and result in neck pain. Stress can also trigger changes in the central nervous system that predispose neck pain.
Your neck is an incredibly sophisticated and delicate piece of equipment. Muscles, fascia, joints and nerves are all susceptible to sustained forms of pressure. Prolonged emotional stress has a tendency to cause muscle tension in the neck and shoulders. Muscle tension in the neck exerts downward force on the delicate tissues of the neck. With sustained stress and sustained muscle tension eventually the neck tissues can become stiff and inflamed. Stiff and inflamed tissues are a recipe for neck pain.
As we mentioned earlier, stress can have a profound effect on the central nervous system, including even causing the poor brain to shrink. When we are under stress for extended periods of time, and also after trumatic events we can develop changes in the brain. Some of these chnages predispose us to chronic pains like neck pain. When this gets really bad we call it ‘central sensitization’, which essentially means that the central nervous system has become more sensitive to pain. The principle of ‘central sensitisation’ exists on some level in most cases of chronic stress related pain.
The good news is that the changes in the neck and central nervous system i have describedare never set in stone. The best way to think of them is how you would think about being ‘unfit’, you know that it is something that can be worked on effectively. The most important thing is to understand and accept that stress is a major factor in your neck pain (if it is in your instance). Without understanding and acknowledgement of the truth it is very hard to start out on the path to managing stress related neck pain more effectively.
Closing Thoughts On Neck Pain
So we have covered some of the main causes of neck pain and taken a closer look at the king of all neck pain causes… our old friend stress. If you have already lived a bit you probably won’t be surprised to hear that reality is nearly always more complex than the content of a 2000 word blog thrown at you by Dr Google. If you have neck pain that is stubborn or reoccuring you most likely have some combination of the above factors, and quite possibly some other micro-factors that are all playing a part. Realistically the key to unravelling your own combination of issues (if that’s what you are up for) you’ll miost likely need some coaching and guidance from someone like yours truly.
Regardless of what causes you neck pain the bottom line is always how fed up it can make you, stubborn pain can really drain the colour out of life. If you have truly had enough of your neck pain to the point where you are willing to get whatever treatment is required, and make whatever lifestyle changes are required I am confident you will have success. There is a broad spread of difficulty levels but those of us who are willing to trust the process, persist with the process and make changes where necessary have every reason to be optimistic.