Neck pain can be caused by a number of factors, including muscle strain, ligament sprains, arthritis, or a “pinched” nerve. Approximately 10 per cent of adults have neck pain at any one time. For the majority of patients with neck pain, however, regardless of the cause of pain, they heal naturally. There are several possible causes of neck pain, although it is often difficult to know with certainty what is causing the pain. This is because the examination and even imaging tests are often not able to easily differentiate among the various causes. Cervical muscle strain can occur when there is an injury to the muscles of the neck, causing spasm of the cervical and upper back muscles. Cervical strain may result from the physical stresses of everyday life, including poor posture, muscle tension from psychological stress, or poor sleeping habits. Typically, symptoms include pain, stiffness, and tightness in the upper back or shoulder, which may last for up to six weeks. Ligament damage can happen when the neck moves back and forth suddenly (called “whiplash”), such as in a car accident using neck pain. Ligaments are strong tissues that connect bones to other bones. A bundle of nerves (called the spinal cord) travels down the middle of the spine. Nerves branch off from the spinal cord to all parts of the body. People can have symptoms if their nerves are irritated or pushed on by nearby bones or discs. Neck pain can happen when the bones that make up the spine get worn down or develop abnormal growths. Up to 90 per cent of pinched nerves in the neck are caused by wearing of the bones. Some degree of wear and tear is normal with ageing, although severe changes are not normal and cause symptoms, such as neck pain or weakness, numbness or abnormal sensations of the arms or shoulders, headaches, or limited ability to move the neck. It is helpful to determine the cause of a person’s neck pain. An evaluation with a healthcare provider is recommended for anyone with severe head or neck pain, inability to control the bowels or bladder, severe pain, numbness or changes in sensation in the arms or legs, or if pain does not begin to improve after one week with treatment at home. The evaluation of neck pain usually begins by observing the person’s ability to move the head to the left and right, forward and backward, and side to side. The healthcare provider will observe the posture and movement of the neck and shoulders. They will feel the muscles in the neck, head, upper back, and shoulders to detect areas of pain, weakness, or tension. In some cases, further testing, such as an x-ray, computed tomography scan (CT), magnetic resonance imaging (MRI), and other imaging tests can be recommended. The need for these tests depends on the person’s age, symptoms, medical history, and examination findings. In most cases, neck pain can be treated conservatively with over-the-counter pain medications, ice, heat and massage, and strengthening and/or stretching exercises at home. If pain does not improve after a few weeks of conservative treatment, further evaluation is usually recommended. Emotional stress can increase neck tension and interfere with, or delay, the recovery process. Reducing stress may help to prevent a recurrence of neck pain. Relaxation techniques can relieve musculoskeletal tension. An example of a relaxation exercise is to take a deep breath, hold it for a few seconds, and then exhale completely. Breathe normally for a few seconds, and then repeat. To help prevent neck pain, one can; use good posture by always holding the head up and keeping the shoulders down, avoid sitting in the same position for too long, avoid doing work above your head for too long, or putting a lot of weight or pressure on your upper back, and keeping the neck in line with the rest of your body whenever you sleep. Dr. Ian Shyaka , Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
