Neck Pain Causes

Neck pain has a wide variety of causes, and it’s important to understand the specific cause of your pain and symptoms to empower effective treatments.

Read on to understand neck pain causes and risk factors, and how the causes of acute (short-term) pain and chronic (long-term) pain tend to be different.

Common Causes of Neck Pain and Stiffness

The most common causes of neck pain—muscle/tendon strains and ligament sprains—heal within a few days or weeks. Many cases of strains and sprains result from overuse or overextension, such as from:

• Poor posture. Long periods of time spent slouching or hunched over a computer screen can lead to forward head posture, which places extra stress on the neck. Repeatedly looking straight down at a phone or tablet may also cause pain, sometimes called text neck.
• Sleeping in an awkward position. If the head is held at a bad angle or twists wrong during the night, a stiff neck might be present in the morning.
• Repetitive motions. Turning the head in a repetitive manner, such as side to side while dancing or swimming, may lead to overuse of the neck’s muscles, tendons, and ligaments.
• Trauma. Examples include any type of fall or impact, such as a sports collision or whiplash from an auto accident.

Sometimes muscle strain or spasm is not just a soft tissue injury. In some cases, a problem in the cervical spine is the underlying trigger for the neck muscle spasm in response.

When neck pain lasts or keeps coming back over a period of several months, it is typically due to spinal degeneration from wear-and-tear over time (also called cervical spondylosis).

• Cervical degenerative disc disease. All discs gradually lose hydration and the ability to cushion the spine’s vertebrae over time. Disc degeneration sometimes leads to additional problems, such as a herniated disc, pinched nerve, or facet joint osteoarthritis.
• Cervical osteoarthritis. When the cartilage in a cervical facet joint wears down enough, it can lead to cervical osteoarthritis. Cervical osteoarthritis is one of the most common causes of chronic neck pain.
• Cervical herniated disc. When the protective outer layer of the cervical disc partially or completely tears, some of the soft inner gel (nucleus pulposus) may leak out, or herniate, leading to inflammation and pain.
• Cervical spinal stenosis.  As spinal degeneration progresses, there is an increased risk for a narrowing of the foramen (cervical foraminal stenosis) and/or the spinal canal (cervical central stenosis). If the nerve root and/or spinal cord becomes impinged, pain, tingling, numbness, and/or weakness may radiate into the arms or legs.

There are many additional causes of neck pain, including:

• Emotional stress. Stress, anxiety, and low social support are potential causes or contributors to neck pain.  These stresses can also lead to a tension headache or cervicogenic headache.
• Infection. If part of the cervical spine becomes infected, inflammation could cause neck pain. Examples of infections include meningitis and vertebral osteomyelitis.
• Myofascial pain syndrome. Characterized by identifiable trigger points, which result from achy muscles and surrounding connective tissues, myofascial pain is commonly localized in the neck or upper back, and/or may spread to/from another area in the body.
• Fibromyalgia. This condition typically involves pain in the muscles, tendons, and ligaments in the neck, back and/or additional areas of the body.
• Spinal tumor. A spinal tumor can develop in the cervical spine and damage tissues or press against a nerve.
• Spondylolisthesis.  A condition called spondylolisthesis (or a “spondy”) can develop in the cervical spine, in which one vertebra slips forward over the one below it.

Your neck is intricately connected to your jaw and teeth, so it is also possible for problems in these areas to cause neck pain, such as dental or other oral infections, or TMJ which is joint dysfunction in the jaw.

Getting an accurate medical diagnosis for the cause of neck pain can help set up a more effective treatment plan.

Clinical Diagnosis to Identify the Cause of Neck Pain

A thorough medical history is the first step in diagnosing the underlying cause of neck stiffness and pain, and this includes questions such as:

• Current symptoms. When did the pain start? Does it come and go? Is the pain in one spot, or does it radiate into the shoulders, arms, or fingers? Are there any other symptoms in addition to neck pain?
• Medical history.  Any relevant medical events, such as injuries, participation in high impact sports, prior medical treatments.
• Lifestyle.  A review of your daily activities and time, such as your work, hobbies, household chores, sports, exercise, nutrition and diet, sleep position, and more.

As more information is collected, the doctor can narrow the list of likely diagnoses and point to the next course of treatments.

Physical Exam

The spine specialist performs a physical examination that typically includes:

• Observation. Examine the posture, particularly the neck and shoulders, and inspect the neck for any lesions or abnormalities.
• Palpation. Feel along the neck’s soft tissue for signs of muscle spasms, tightness, or tenderness.
• Range of motion test. Check to see how the neck moves side to side, up and down, and rotates compared to what would be considered normal.
• Reflexes. Perform simple tests with a rubber hammer to examine reflexes in the biceps, triceps, and forearm, which can show whether nerves in the neck are sending signals as intended.
• Muscle power. Test muscles in the shoulder, arms, or hands for any signs of weakness.
• Sensation. Check for unusual sensations, such as tingling that goes into the shoulders, arms, or fingers.

Many cases of neck pain are diagnosed based on the patient’s medical history and physical exam.

When more information is needed, advanced diagnostics may be needed to reach an accurate diagnosis.

Imaging Studies

The most common imaging technologies for the cervical spine are:

• X-ray. An x-ray shows a picture of the bones in the neck.  X-ray images can be used to identify spinal degeneration of joints and bones, vertebral fractures, and some tumors.
• CT scan. A CT scan uses x-rays and a computer to provide a series of cross-section images, which enables better viewing of the bones than a regular x-ray. CT scans are particularly useful for identifying subtle bone changes. Sometimes CT scans are performed with myelogram, which involves injecting dye into the spinal column to get a better view of the size of the nerve passages (foramina), the central canal, and whether the problem is caused by bone or soft tissue (disc).
• MRI scan. An MRI creates a series of detailed cross-sections of the soft tissues and bones. MRI is typically the primary diagnostic test for viewing soft tissues (e.g. cervical disc) because it does not have the risks associated with the additional radiation dose and myelography.

Other imaging options are available, such as a bone scan or ultrasound.

It is not uncommon for an imaging study to show damage or degeneration at a spinal level that does not correspond to the reported symptoms, as most people have some cervical degeneration that is a natural part of aging.

Diagnostic Injections

An injection might be done to isolate a specific structure, such as a facet joint (cervical facet block injection) or a nerve (selective nerve root injection).

If the pain medication that is injected temporarily relieves pain, it confirms that the joint or nerve root in question is likely the pain source.

While diagnostic injections tend to be safe and effective, they have the potential for serious side effects and are typically one of the last diagnostic tests performed.

Spinal injections can also be therapeutic and may provide enough pain relief to allow nonsurgical conservative care to progress.

Electrodiagnostic and Other Testing

Electrodiagnostic tests are sometimes done to provide information about where a nerve might be affected.

• A nerve conduction study (NCS) examines electrical activity of nerves in the arms and legs. For example, an SSEP is used to help identify problems affecting the spinal nerves or the spinal cord, such as damage to the outer covering of the nerves.
• An electromyogram (EMG) tests electrical activity in the actual muscles.

Other tests could include laboratory blood tests for diseases, or somatosensory evoked potentials for possible spinal cord issues.