Neck pain: causes and treatment of cervicalgia

By Cristiano Antonino On Apr 20, 2023

When one speaks of neck pain, one refers to a nagging pain at the cervical vertebrae, i.e. the seven short bones that make up the section of the spinal column closest to the head

The consequence of this is that even simple movement may be impeded.

Technically, this is referred to as ‘cervicalgia’, a condition characterised by the appearance of pain in the back of the neck that often reaches the shoulders and sometimes also affects the arms.

The mainstay of drug therapy involves the use of non-steroidal anti-inflammatory drugs (‘NSAIDs’), but above all it is essential to adopt a healthier lifestyle to prevent relapses.

Symptoms

Neck pain is felt in the neck and causes stiffness and limitation of head movements.

The muscles appear contracted and sore, and it is difficult to make twisting, extending and bending movements of the head.

It is not uncommon for the pain to also affect the head, shoulders and arms.

Tingling in the areas affected by the pain also occurs not infrequently.

Those who suffer from cervical pain often experience headaches that develop by radiation: they start in the neck and go up to the nape of the neck, until they reach the forehead and the area around the eyes.

Finally, nausea, dizziness, vision problems (blurred vision) and hearing problems (tinnitus) may occur in severe cases.

These symptoms are indicative of an advanced stage of the disease and are more frequent in those who ignore the symptoms and make it worse.

Depending on the location of the pain, three categories of neck pain can be distinguished:

cervicalgia proper: the pain mainly affects the neck and is accompanied by muscle rigidity and limited mobility of the affected area;
cervico-brachial syndrome: pain tends to radiate to the shoulders, arms and sometimes the hand with tingling or altered sensitivity in the affected limbs;
cervico-cephalic syndrome: results in the onset of tension-type headache or dizziness, impaired vision or hearing, nausea and vomiting.

It is important to distinguish the exact origin of the pain because it may depend on muscular trauma, on problems with the joints or even on altered injuries to the nerves, which may be inflamed or improperly stressed and compressed.

Neck pain, the causes

In most cases, especially at a young age, cervicalgia is caused by contracture of the neck and/or shoulder muscles due to an incorrect posture adopted at night or during the day.

The most common cause of neck pain, in fact, is a sedentary lifestyle, a dangerous habit not only for the neck muscles.

In fact, those who exercise have stronger and more toned muscles, while untrained and untoned muscles do not adequately support the spinal column and thus also the cervical vertebrae.

The sporting activity in question can also be postural gymnastics: exercises that focus on strengthening the muscular apparatus of the head and neck region can help improve muscle tone and prevent neck pain.

In general, the causes of neck pain can be various:

previous traumas (whiplash, cold blows, joint traumas and carrying heavy objects can cause problems in the neck area)
osteoarthritis of the cervical vertebrae (spondylosis);
degeneration of one or more intervertebral discs;
incorrect postures during the day (e.g. people who work with their torso bent forward or spend many hours in front of the computer or in the car are more prone to these types of problems than people who move more);
excessive and repeated overloading of the neck muscles;
stress;
lack of physical activity or, on the contrary, excessive exertion;
poor sleep at night (use of unsuitable mattresses and/or pillows).

If neck pain, on the other hand, appears after lunch, it probably has to do with a dental malocclusion, gingivitis or a missing molar.

In all these cases it occurs because during chewing the teeth are not properly aligned, inducing a contraction of the mandibular muscles which, in turn, is transmitted to the neighbouring cervical region.

Finally, we must not forget cervical arthrosis, a degenerative disorder that worsens with age, because over time the cartilage of the intervertebral discs wears away, bringing the vertebrae closer together and resulting in compression and crushing of the spine.

In severe cases, a cervical herniation can occur, with the intervertebral disc protruding from its seat.

Diagnosis

If the pain does not respond to common therapies based on painkillers and exercises, it may mean that the subject may be suffering from another concomitant pathology and its origin must be identified.

Making a correct diagnosis is also important in order to understand whether surgery is needed, which may be necessary in the presence of pathologies that cause compression at the level of the spinal cord or nerves, as is the case with herniated discs.

For a correct diagnosis, it is important for the physician to assess the characteristics of the patient’s pain by studying the position that induces it, the intensity of the pain, its duration, and whether it improves or worsens with head rotation.

A careful objective test of the neck is then performed.

Tests such as an X-ray of the cervical spine or a CT scan can reveal the underlying problems of neck pain if it is not resolved by postural adjustments and pain medication.

Risks and complications

If not treated properly, the symptoms of neck pain tend to recur relatively easily.

This is the case if the inflammation has not been adequately treated or if an incorrectly diagnosed pathology is present.

If cervicalgia continues for more than three months, it can be called chronic.

This condition can occur if risk factors continue to be present in the patient’s life, such as stress, poor posture, but also if congenital malformations of the spine or degenerative diseases, such as cervical arthrosis, are present.

There are risk factors that increase the likelihood of neck pain, among them:

cigarette smoking,
genetic predisposition,
suffering from back pain and/or headaches,
previous neck trauma or injury,
poor general health,
sedentary lifestyle,
low job satisfaction (predisposes to stress and depression, in turn possible causes of neck pain)
work environment with unsuitable physical workstations (non-ergonomic chairs).

Interventions and therapies

If neck pain can only be attributed to incorrect posture during the day, a targeted exercise programme, followed consistently, can improve and eventually solve the problem.

In most cases, neck pain does not last more than a few days and rarely exceeds a week, especially when it is of traumatic origin: in the latter case, it regresses spontaneously or after taking over-the-counter anti-inflammatory drugs.

To relieve the pain, one can resort to non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or Naproxen, which decrease inflammation and reduce pain.

Another type of drug used in this case belongs to the cortisone class, which is prescribed by the doctor in the most severe cases due to numerous side effects.

The drugs can be taken orally or through the application of ointments that have a local action.

Therapy is usually prescribed for a period of 7 to 10 days and should neither be interrupted (the pain may go away, but the underlying inflammation does not) nor prolonged beyond this period unless under medical supervision.

Physiotherapy can help both to correct any postural problems and to restore function to the affected area once the acute symptoms have resolved.

Thanks to stretching and muscle-strengthening exercises and massage or manipulation performed by professionals, a relapse of symptoms can be prevented.

If the pain is of inflammatory origin or is caused by arthritis or hernias, physiotherapeutic manipulations may be counterproductive, so it is essential to make a correct diagnosis at the outset.

Finally, if the cervicalgia is due to trauma, such as ‘whiplash’, the doctor may suggest using an orthopaedic collar, which, by helping to support the neck and reducing its movement, helps relieve the pain.

It should not be used for more than 2 weeks, unless otherwise medically indicated.

Prevention

Obviously, not all risk factors are within our control (advancing age, for example, exposes us more easily to cervicalgia) but it is possible to act on those risk factors that are modifiable.

Prevention starts with leading a healthy lifestyle: doing sports, for example, helps to strengthen and keep the muscles and joints in the neck toned.

Likewise, trying to reduce stress and anxiety triggers, which are sources of excessive muscle tension, can also help.

Neck pain can be prevented by physical activity that strengthens the neck and shoulder muscles, reducing the risk of contractures.

It is very useful, especially for frequent sufferers, but also for those who have to stay in one position all day for work.

For example, one exercise consists of performing a slow rotational movement of the entire head, first to the right and then to the left.

To help the muscles that support the neck, it can be useful to perform counter-force movements.

The subject should tilt the head to one side, bringing the cheek closer to the shoulder, and at the same time, with the hand resting on the same side of the head, he or she should resist, pushing in the opposite direction.

The movement should be repeated a few times, preferably while seated, without straining too much, first on one side and then on the other.

The beneficial effects of these exercises will not fail to be felt in the cervical region, but time and perseverance are required.

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