The neck is a very sensitive part of the body that joins the head and the torso and is made out of bones, muscles, nerves, and other components. Neck is where all the nerves are located and by any sort of injury the whole system may be affected. It is important to take care of your neck so that you don’t end up having pain or any injury. Luckily, we got the means to relieve neck pain with the help of an experienced orthopaedic surgeon.
Neck pain can result from either an accident or non-injury conditions, including poor working ergonomics. Inadequate adjustability of computer monitors and chairs, along with inappropriate monitor positioning, frequently compels people to work with their necks at unpleasant angles. This problem becomes more severe when an underlying neck ailment is present, which frequently results in neck strains. Over time, muscular fatigue develops, resulting in neck pain and other symptoms.
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Neck pain can have three major causes:
A neck pain can manifest with a lot of symptoms, and people may perceive them very differently. Compression of nerves in the neck region will lead to the pain shooting down the arms with the electric current like sensation, typically induced by neck movements, and is a common condition referred to as radicular pain. The numbness and weakness of the arm or hand are a result of the nerve compression, which reduces the sensation of the hand and the arm mobility. The spinal cord compression can produce tingling, burning, or crawling sensation (syndrome known as paraesthesia) as well. Severe narrowing of the subcortical cervical spinal cord can squeeze it and distort normal activity, which may cause difficulties with hand coordination. In the worst case scenario, patients can experience clumsiness while walking, or myelopathy, especially when they are not steady on their feet, thus the risk of falling and injuries is increased.
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Regarding neck pain management, the treatment of the underlying disease is critical, and orthopaedic surgeons apply a variety of surgical and non-surgical methods to help alleviate the neck pain. The pharmaceutical approach is mainly achieved through the use of medications that reduce the pain in the neck, shoulder, and arm, together with lifestyle changes, and ergonomic guidance that is specific to the treatment of work-related neck pain. One of the ways the neck muscle physiotherapy can be used is to increase neck strength, enhance function, and relieve symptoms. Furthermore, options for medicinal treatment are provided to cure the root causes of neck pain and in some cases, surgery is carried out to ease the constriction of nerves and stabilize a cervical spine that is deteriorating.
To keep away from neck strains and injuries, use good posture while walking, sitting, and performing daily activities. You may be prone to neck strain if you slump, since it may create discomfort and pain in your neck. You can also do it right by keeping your shoulders, head, and back in the right position all the time and by giving yourself a rest and a change of position, especially if you have to sit or stand for long periods. Make sure you choose the right sleeping position, too; pick a pillow that maintains the natural curve of your neck and upper back so that you won’t have any pain due to misalignment when sleeping. Besides, as a sportsman, upper back and neck stretches on a regular basis can be really helpful to release the tension and reduce the probability of injuries. As the case may be, you should include some exercises that will help you in this process.
If you are experiencing severe neck pain as a result of an injury such as a vehicle accident, diving event, or fall, you should seek medical assistance immediately. This type of injury does not resolve with mere bedrest or home treatments. In other circumstances, if your neck pain is not caused by an accident, you should see an orthopaedic surgeon if it persists despite treatment with pain medications.
Furthermore, if the pain spreads to your arms or legs, or if it is accompanied by symptoms such as headaches, numbness, weakness, or tingling, you should seek medical attention and treatment. You will undergo a medical evaluation or interview, diagnostic testing (X-rays or MRIs) so that your orthopaedic surgeon can create a treatment plan for you.
The first step in the treatment process for neck pain or discomfort is the assessment. The diagnosis can best be made through a thorough patient history and physical examination. During a physical examination, a healthcare provider will probably perform range of motion assessments, muscle strength testing, and palpation to assess for tenderness or regions of increased pain, as well as sensory examination to assess for numbness or tingling. Most patients can be diagnosed through a standard patient interview of their previous medical history, symptoms, and current conditions.
Assessing the patient’s previous medical history is crucial, as it may help healthcare providers to sort through a myriad of diagnoses quickly. The following are some of the more important subjects to be covered in the assessment: medical history, including the patient’s current and previous medical conditions such as asthma, multiple sclerosis, and scleroderma. Anxiety or other mental illnesses may also exist. A precise timeframe of when the patient’s neck discomfort began is important. The affected person may also experience pain when asked. Imaging studies such as X-rays or MRIs should be performed to assess if details such as degenerated discs, herniated discs, or other structural issues are present. As medical professionals, we take into account societal guidelines as well as extensive diagnostic research when assessing patients. A definitive diagnosis is not always necessary when dealing with a new client, particularly when creating rapport and relieving their anxiety. However, diagnosing their disorder can be helpful in reducing uncertainty, changing their anticipation towards condition integration, improving understanding as providers, and making it simpler to figure out treatment. Identification can thus contribute to successfully treating the patient.
A comprehensive physical examination is pivotal in diagnosing the source of neck pain. By observing the patients’ responses, practitioners assess a patient’s ability to independently evaluate neck function and mobility. To examine a neck patient, it is essential to have knowledge of the biological and psychological environment surrounding the neck. History-taking should cover the biological and social aspects. A comprehensive physical examination of the neck includes range of motion tests and palpation to see which joints are moving and which joints or muscles are tender. Tests need formal descriptions. Pain and paresthesia can indicate which structures are involved. Physical findings and symptoms may not be specifically coherent.
A physical examination should be used to confirm the working diagnosis and exclude possible alternative diagnoses. Rather than confirming the initial image description, the examination frequently changes the working diagnosis. If the history and examination are in serious doubt, a possibility should be measurable. During spine consultation, the physical examination follows the history, clinical setting, and clinical condition of the patient. Conservative practitioners should not examine every patient because they are concerned about disease. It is hemodynamically stable. But identifying the few patients that are ‘at risk’ of an explosive disc is critical. The situation is classified into a number of potential diagnoses.
Imaging Tests
Your healthcare provider will recommend getting imaging tests if they suspect that the cause of your neck pain is an underlying condition, such as a herniated disc, that cannot be visualized through a physical examination. Three well-known imaging tests of the cervical spine are X-rays, magnetic resonance imaging, and computed tomography scans. Each of these imaging tests reveals a different aspect of the cervical spine and can provide more extensive information about the neck. X-rays provide a detailed, two-dimensional view of the neck. Using X-rays, a healthcare provider can confirm whether you have a fracture or a dislocation. MRIs offer a three-dimensional look at the neck to check for disc problems, spinal cord changes, or nerve compression. CT scans create a more detailed and comprehensive image of the cervical spine to check whether you have problems with the alignment of the bones in your spine, spinal fractures, and infections. Even though X-rays, MRIs, and CT scans can identify small and often overlooked changes in the cervical spine that might be causing your neck pain, they are not always recommended for everyone because of prolonged waiting periods, radiation exposure, safety concerns, additional costs, or no change in the treatment course even after knowing the problem. Most healthcare providers recommend getting the imaging test when the physical examination further reveals that you have nerve-related problems, such as leg pain that travels down one or both legs with numbness, tingling, or weakness, or other symptoms. The imaging test is usually performed to confirm the structural changes in our body and to compare the timing and extent of the recommended treatment. The result of an imaging test should always be confirmed along with a physical examination finding, after which a comprehensive treatment plan should be designed by the healthcare professional.
The treatment options for managing neck pain can be categorized as conservative treatments, i.e., rest, use of hot and cold therapies, and lifestyle modifications, and administration of such medications as oral and topical NSAIDs and muscle relaxants that work as an adjuvant to physical therapy to help decrease the pain and improve the tolerance for exercise. Physical therapy (PT) is a crucial aspect of managing all patients with neck pain, especially those with whiplash-associated disorders but also in patients with chronic neck pain. The treatment of neck pain should be approached from the onset using a multimodal, integrated plan of care. Using an interdisciplinary team ensures that all facets of an individual’s pain are adequately addressed, including physical and psychological aspects of a patient’s care. The patient’s values, functional goals, and attitudes about their pain should be continuously assessed and referred throughout treatment to appropriate providers who have the skills to help support these aspects of care.
The management of neck pain should be geared towards improved function and activities of daily living. An obvious impairment can be identified as a specific target and will be the focus of this discussion. A healthy lifestyle consists of regular exercise, maintaining a low body weight, a healthy diet, social network support, as well as effective coping strategies. It is important to emphasize the importance of addressing not just the physical aspects of neck pain, but the psychological, social, behavioral, and functional aspects as well. The expectations of each provider, the patient, and any family or support system that is involved should be clearly delineated. A point of emphasis should be to ensure the patient has realistic expectations about their treatment program. The expectations should also be reviewed regularly. The therapeutic approaches mentioned above should be utilized in conjunction in order to obtain the greatest outcome. It is important to note that seeking interdisciplinary care is not uniform across different sampled populations in the community. A visit to the rural primary care clinic may have different access points and expectations than an individual who receives care at a dedicated acute or chronic pain clinic. As previously noted, the visit to the care site should be as non-stigmatizing as possible. The practice of pain medicine often includes therapeutic pharmaceutical prescriptions that may involve a variety of interventions. No single medication or combination has been shown to be the most effective. Current guidelines and practice are to keep the patient on the lowest effective dose and to have clear goals for the medication. Ultimately, the formation of a comprehensive treatment or intervention plan in neck pain rehabilitation should follow a thorough evaluation and be uniquely structured on the basis of the individual needs and resources of the patient. All of the preceding therapeutic categories can be beneficial but should always be augmented with rehabilitative intervention to support pain management, restore musculoskeletal function, and resolve dysfunction as activity is fostered. Care should also be tailored to ensure that the interventions provided to the patient are culturally accepted, and they must have access to the services to which they are referred. The following details describe a host of multimodal therapies and procedures that can be used in combination in neck pain rehabilitation, but not all-inclusive.
Conservative treatment is often considered the initial approach to managing neck pain. If the pain is acute or has only been present for a short time, and there are no significant neurological symptoms, we often recommend one or a combination of:
– Short-term rest to allow the irritation to calm down
– Application of heat or ice to reduce inflammation and pain
– A light cervical spine stretching exercise to relieve muscle pain
– Addressing postural and ergonomic factors that exacerbate neck pain
– Options such as massage therapy and acupuncture that may relieve tense muscles or nerve pain.
Passive treatment methods may help reduce pain and make you feel more comfortable, but they don’t address the cause of the problem and therefore will not provide lasting relief. If you feel you can control your neck pain without medication, apply a gel ice pack to your neck for 15 minutes every 2 hours. Pain relief gels can also help. If you find you need some pain relief, taking an average dose of medication every 8 hours for a period of 3 to 5 days is a reasonable amount of time to make you feel better. In combination with taking pain-reducing medication, continue to practice gentle stretching exercises and perform your normal activities as best as possible. Do not completely stop using your arms or movements, as this can also worsen your symptoms. It is recommended to apply a gel ice pack only in the neck area for 15 minutes every 2 hours.
While medications will not cure the underlying issue, they may help manage symptoms and provide relief during flare-ups, especially in the short term. There are various over-the-counter and prescription medications that one might try. Some of the more commonly used types of medications include nonsteroidal anti-inflammatory drugs, muscle relaxants, analgesics, and topical analgesics and anesthetic medications.
For medications, there are two main classifications that a practitioner can prioritize. The first is to help reduce swelling and inflammation around the body of the issue; in this case, it would be the neck. The goal of using these types of medications is to help maintain mobility and quality of life. In effect, nonsteroidal anti-inflammatory drugs are the main group in this class. The second is to manage the pain. The doctor will not enter too detailed medical advice for legal and medical reasons, but the main point is that it is very likely that someone with neck pain may find some relief in pain when using this. Nonsteroidal anti-inflammatory drugs are available in many forms, from over-the-counter options to prescription-only medications. Although these are all fairly effective in reducing pain and some degree of swelling and inflammation, it is of the utmost importance to consult a doctor before starting any of these medications, as some are relatively contraindicated with some pre-existing health issues and reactions or interactions with other medications a person may be currently taking. This also applies to the other medications in the two classes. Also, it is not recommended to just be using one of these medications in avoidance of other treatments because the long-term complications and chronic use of these nonsteroidal anti-inflammatory drugs are still largely unknown.
In physiotherapy, patients receive treatment in the form of targeted exercises, manual therapy, and other modalities, which are determined on a case-by-case basis. Treatment is individualized, meaning physical therapists consider a patient’s neck pain symptoms, medical history, causes, aggravators, and previous interventions as they put together their treatment plan. Physiotherapy is active care, and as such, is done in a supervised setting with the expectation that patients are willing to engage. Most importantly, patients learn strategies to manage and eliminate their own pain and progress to prevent future occurrences of their symptoms, giving them a greater range of healthy motion, strength, and a better understanding of their own conditions for the best short- and long-term outcomes. Physiotherapy does not replace or negate conservative care, such as medication management, and the all-encompassing approach is often considered superior to the sole use of medication for chronic pain management. No two patients have the same condition, and it is often a mistake to pursue the same approach as a friend or acquaintance with similar symptoms. As always, a good first step for finding a therapeutic approach is to work with a doctor or physical therapist in one’s state, as all exercise and health professionals require state licensure.
Physical therapists favor non-invasive and long-term solutions to neck pain. Neck pain treatment aims not only to lessen or eliminate pain but also to provide continued care as part of a rehabilitation process. Physical therapists are trained to provide a thorough examination, develop a diagnosis, and create a patient-centered strategy for health improvement. If a patient has been diagnosed with a severe injury or systemic diseases, the immediate plan of care can be different. It is important to note that patient-centered care allows for each individual’s therapy plan to constantly adapt to their personal health profile and their body’s response to therapy techniques. Physical therapy is intended to help control, decrease, or eliminate neck pain, and it may also help address the underlying causes of the pain in the long term.
Lifestyle changes can help prevent neck pain. As a general rule, it’s important to maintain good posture during all activities. While sitting, it’s important to keep the back straight, the shoulders back, and the knees at the same level as the hips. The feet should also be flat on the floor. It’s important to take regular breaks to stand up and walk around and to keep a good posture even while walking. The exercise is a good option for strengthening the neck. To do this exercise, the person lies on their stomach, then raises and lowers their head and chest from the floor. It’s also helpful to stretch the neck. To stretch the muscles on the right side of the neck, the person should place the right hand on the left side of the head and gently pull the head toward the right shoulder.
To release overall muscle tension in the body, it can be helpful to engage in relaxation and stress management techniques. This could include training, in which the person learns how to turn their attention toward body sensations, which may help reduce tension.
Other preventive measures focus on making lifestyle changes or on adjusting the ergonomics of the workspace. Practical advice for proper sitting, standing, and sleeping posture, as well as advice on heavy lifting, are available to avoid neck pain in the first place. The following could also help prevent neck pain: adopting the correct workspace ergonomics, taking regular breaks, and prioritizing musculoskeletal fitness at an early age. Practicing relaxation, mindfulness, and stress management techniques can also help. Taking regular breaks while sitting or standing for a long time may help prevent neck pain. For instance, office workers could stand or stretch every 30 minutes.
Everyone should care about ergonomics and posture in order to prevent neck pain. An ergonomist is a professional who can evaluate your posture and ergonomics at work or in any environment and create a safe, comfortable, and efficient environment designed around your specific needs. In other words, a professional will tell you what heights, lengths, and angles will keep you safe when doing your tasks. But why wait? Right now, you can make a few simple changes, too. First, pay attention to your posture. Your ears should be approximately over your shoulders. When typing, let your fingers and wrists be part of a straight line and do not overextend. Your elbows should be close to your body and opened greater than 90 degrees. Your computer screen should be just below eye level. Your desk should allow your feet and knees to be at 90 degrees. Your legs should dangle without your knees pushing against the edge of the chair. When using a tablet or phone, keep your shoulders relaxed and bring the device to you. Do not allow your neck to jut out to see the screen or keyboard. Beyond proper ergonomics, be mindful about sitting or standing in one position for too long. Ensure you listen to your body and adjust. Be consciously aware of your posture and seek good postural habits throughout your day. Most of us develop a forward head position or jutting chin. Aim to keep your chin even with the ground and just tucked in slightly. Gain awareness and posture can become a proactive practice rather than something you address only when problems begin to surface.
In addition to strength and flexibility training, neck exercises can help maintain overall neck health. Strengthening neck muscles is also crucial, as training neck musculature can substantially reduce neck pain. It is advisable to perform exercises that strengthen the muscles in the neck. Improving flexibility in the neck is also important for neck pain prevention. To improve flexibility in the neck, the following exercises could be performed. Perform flexibility exercises at least 2 days a week, for a minimum of 30 seconds, at least 4 times a day. Make sure to listen to your body and not force it, as this could lead to injury. It might be useful to consult a fitness professional or physical therapist if you’re not sure how to start. 1. Chin Tuck: With the neck in a relaxed position, gently bend your head down. Next, let your chin drop down to your chest but don’t press your head toward your chest. With the shoulders down slightly, try to look down at your chest. With hands on hips, hold the position before returning your head to its natural position. 2. Bend Backward: While sitting or standing, tip your head back. The chin should drop to the chest. Hold the position for a few minutes before returning to a natural position. Many people include low-impact activities in their exercise programs to decrease pain and minimize the risk of new neck injury. These activities include swimming and using elliptical machines or stationary bicycles. Getting your body ready for exercise is also important. Before starting any activity, it is important to remember to warm up. Make sure to consult with your healthcare provider about the activities that are suitable and safe for you. It is also important to remember to warm up before starting any back or neck exercise. When training and trying to avoid injury, it may help to consult a fitness professional or physical therapist.
Chronic or uncontrolled stress can cause muscles in the body to contract and tighten. Neck pain is a common and often unavoidable side effect of this physical state. Stress also encourages bad habits like poor posture, discomfort, and sensitivity. Poor habits that lead to tension and discomfort can begin to reduce the day’s productivity and happiness, as can finding the body’s muscles increasingly seizing up. As such, an individual needs to tap into relaxation to break the cycle of irritability, short temper, tension, and pain. An excellent way to alleviate mental stress and its physical effects is to begin practicing mindfulness, meditation, diaphragmatic breathing, or some other relaxation exercise. The goal is to replace negative systems with supportive and positive ones. When stress and pain have been persistent or unmanageable, the healthcare provider can work hand in hand with the professional counselor who can offer life tools. Lastly, finding local social and recreational clubs or any area groups that harmonize with personal interests can prove beneficial. This will not only expand the social network but aid in stress release when pursuing enjoyable hobbies. Overall, easing stress helps relieve neck pain. Controlling stress by addressing its root causes and learning how to cope with and support difficult situations will draw the results of these procedures. Relaxation and individual satisfaction can be achieved by cultivating life habits that give inspiration, laughter, and calm. Creating smart stretches when encountering discomfort and stress would enable the individual to persevere and concentrate on head-to-neck discomfort while also going back to utmost excitement, social engagement, and efficiency.
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When conservative or standard therapy fails to relieve neck pain, surgery is considered. This treatment may be explored if the patient’s functionality and mobility deteriorate owing to chronic pain. Furthermore, surgery is required when the patient develops severe neurological symptoms affecting their limbs and loses the capacity to walk and maintain their balance. In such circumstances, surgery is regarded as a viable option for treating the underlying causes of neck discomfort and enhancing the patient’s quality of life.
When neck pain is successfully managed with non-surgical, conservative treatments, the follow-up is often on an as-needed basis, with patients encouraged to contact us if their symptoms recur or worsen. However, for people who have surgery to treat neck pain, the follow-up process is frequent. Each surgical technique requires unique post-operative care and monitoring. This individualized approach guarantees that patients receive the necessary attention and support to help them recover and optimize the outcomes of their surgical intervention.
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When dealing with neck pain, talking with an orthopaedic surgeon is a critical step toward appropriate treatment and alleviation. To get the most out of your appointment and ensure you have a thorough understanding of your issue and potential treatments, ask the proper questions.
What is causing my neck pain?
What are my neck pain treatment choices, and which strategy would you recommend depending on my specific condition? Am I an appropriate candidate for this treatment?
Are there any non-surgical options that might be considered before undergoing surgery?
What is the likely outcome of the proposed treatment, and what are the potential risks or complications?
Can you explain the post-operative care plan if surgery is recommended, including the expected recovery time?
Neck pain can be caused by various factors, including muscular strain from overwork, tears in the intervertebral discs (discal pain), and wear and tear of facet joints in the spine (facet joint pain).
There is no best treatment but there are options like epidural steroid injections, facet joint injections, and cervical radiofrequency ablation for more severe cases.
Treatments for neck pain encompass a range of options, including medications to alleviate pain, lifestyle modifications, ergonomic adjustments for workplace-related neck pain, neck muscle physiotherapy, pain procedures targeting the root causes, and in some cases, surgical interventions to release pinched nerves and stabilize a degenerated cervical spine.
Treatment for neck pain that causes headaches may involve a combination of physical therapy to address muscle tension, medication to relieve pain and inflammation, and possibly trigger point injections to target specific areas of discomfort.
Seek immediate medical attention for neck pain if it results from a severe injury like a car accident, diving incident, or fall, as these injuries often require urgent medical evaluation. In other cases where neck pain is not due to an injury, it’s essential to contact an orthopaedic surgeon if you have chronic neck pain that persists despite trying pain relief medications or if it is accompanied by symptoms like headaches, numbness, weakness, or tingling, as these signs warrant a thorough medical evaluation and appropriate care.
Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.
He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.
Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.
Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.
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