What Causes Neck Pain?

Serious causes are rare and include tumors or infections involving the spine or the spinal canal. The most common causes of pain in the neck are related to osteoarthritis. The bones which surround the facet joints develop bone spurs from osteoarthritis. These can narrow the space through which nerves travel from the spinal cord to the rest of the body. A cause of osteoarthritis as well as neck pain is looseness of the ligaments and tendons which stabilize the many joints in the neck.
This looseness can be the result of injuries such as whiplash injury where ligaments and tendons get overstretched so much they cannot regain their original elasticity, poor posture, or age: Ligaments and tendons are made up of collagen, the same substance that holds up your skin, and, just as your skin loses its tone as you get older, so do your ligaments and tendons. When the joints are unstable, there can be slippage of the vertebrae one on the other causing severe pain. This is even more likely because the head is a heavy weight for your neck to carry, particularly if you allow it to sag forward.

Whiplash injury can also cause damage to the nerves that supply the skin of the neck, chest, shoulders and the back. These nerves have to cross the fascia, the fibrous sheath covering the muscles at the base of the neck through tiny holes . Whiplash stretches the fascia and distorts these holes which become slits. These squeeze the nerves and cause them to swell. Once swollen, the nerves are trapped in these holes and this prevents the nerves from regaining their normal size as they keep re-injuring themselves on the walls of these holes. As long as they remain swollen, these nerves will send pain messages to the brain. This pain can last for many years. Pain due to loose ligaments or tendons or arthritis only comes when you move the affected joints. Nerve pain, on the other hand, can be severe and happen at any time even when you are not moving at all. If you press lightly on an area with nerve pain, the pain gets worse.

What Can Be Done for Pain in the Neck?

Prolotherapy, a series of injections of growth promoting substances has been shown to be effective in stimulating the growth and repair of ligaments and tendons. Injections to the head and neck ligament and tendon insertions strengthen and thicken them. These stronger ligaments and tendons will help restore the stability of your head on your neck and help correct the cause of neck pain. Prolotherapy has been shown to reduce the overgrowth of bone which occurs in osteoarthritis of the fingers and of the knee. It probably does so because it stabilizes the joints by strengthening the ligaments that surround them. This reduces the wear and tear on the joints which is the main reason bones around the joints proliferate. If this occurs in the neck it may help free up the nerves that are squeezed because of osteoarthritis of the facet joints.

Perineural injection therapy (Nerve blocks) is likely to help if your neck pain is coming from the nerves that supply your skin. Many people suffering from pain in the neck have been successfully treated with perineural injection therapy (nerve blocks). Because this treatment is very safe, it is worth trying at least once, particularly if your pain has not been helped by other treatments.

As the nerves which supply the skin of the neck , also supply the ligaments, tendons and joints of the neck, if your neck pain does not disappear completely with perineural injection therapy, or if it comes back in less than one hour after your treatment, it is likely these structures are injured. If this happens, then you will probably need prolotherapy to help them repair themselves.
Physiotherapy may help neck pain by improving your posture and strengthening the muscles which stabilize your head and neck. Unfortunately, it is impossible to strengthen ligaments and tendons with exercise. Since your muscles are pulling on these weakened ligaments and tendons, your symptoms are likely to recur.

Chiropractors may realign your neck, but if your head and vertebrae are not solidly stacked and held together one on top of the other by strong ligaments and tendons, it is likely your headache will recur as they once again slip out of place.

Surgery may be needed in serious cases, such as when tumors are found or when bone overgrowth or a “slipped disc” compress a nerve or the spinal cord. The surgery is done under possibly hazardous general anesthesia and severs muscles and ligaments which are then replaced by scar tissue. If the spine is too unstable, some cervical vertebrae can be fused together. This will temporarily relieve the pain but this usually results in arthritis above and below the fusion area.

Acetaminophen, Tylenol and anti-inflammatory medications such as aspirin, ibuprofen, Advil, Motrin all relieve the symptoms that occur with overstretched ligaments and tendons. They relieve inflammation which is a cause of pain. Unfortunately, inflammation is the mechanism the body uses to repair itself, and using these medications interferes with the process which would help regrow the affected ligaments and tendons.
Narcotics can be used to deaden the pain and do not interfere with inflammation, but they can be addictive and should be used very sparingly.

If you have tried other treatments and still experience pain, you may want to try prolotherapy or perineural injection therapy. There is a good chance that prolotherapy can bring you relief from your pain in the neck. In one report, six people with whiplash neck pain had much greater cervical spine stability and much less pain six months after prolotherapy. A research project on perineural injection therapy is about to start in Vancouver.

Centeno et al • Prolotherapy for Cervical Instability 67 Pain Physician Vol. 8, No. 1, 2005 Pain Physician. 2005;8:67-72, ISSN 1533-3159

Prolotherapy References