5 Common Causes of Neck Pain

Your neck (called your cervical spine) is a complex structure composed of muscles, tendons, ligaments, joints, nerves, and bones called vertebrae that are stacked one upon the other. Between each vertebra is a soft, rubbery cushion called a disc that helps you bend your neck and also acts as a shock absorber.

Neck pain may occur as a result of injury or inflammation to any one of these structures in the spine—for example, a strained muscle or ligament, "pinched" nerve, or swollen joint, to name a few.

By learning about five common causes of neck pain, you can hopefully appreciate the complexity of the neck, and how difficult it can be to narrow down a diagnosis.

With that, it's important to not self-diagnose your neck pain. Instead, see your doctor for a proper evaluation; this way you can move forward with a treatment plan that most safely and effectively eases your pain.

Common Neck Injuries
Verywell / Hugo Lin

Sprain or Strain

A neck sprain is a tear of the ligaments that connect the vertebra in your neck. A neck strain is a pulled or torn muscle or tendon in your neck. These two types of neck injuries share symptoms and are generally treated similarly.

Ligaments are bands of tissue that connect bone to bone whereas a tendon is a band of tissue that connects muscle to bone.

A sudden neck movement, like from a car accident or fall, is usually the culprit behind a neck strain or sprain; although, everyday habits, such as poor posture or awkward sleeping positions, can also cause these two types of neck injuries

Symptoms

Symptoms of a neck strain or sprain may include:

  • Pain with neck movement
  • Neck stiffness (sometimes described as a "crick in the neck")
  • Muscle spasms and pain in the upper shoulder
  • Reduced neck flexibility

Be sure to seek medical attention right away if your neck pain is severe, or is associated with a headache or neurological symptoms like numbness, tingling, or weakness in the arms or hands.

Diagnosis

A neck strain or sprain can usually be diagnosed with a medical history and physical examination alone. Imaging tests are really only used to rule out alternative diagnoses.

Treatment

The pain and inflammation of a neck strain or sprain can generally be eased with ice and taking a nonsteroidal anti-inflammatory drug (NSAID). In some cases, your doctor may recommend wearing a soft collar for a short period of time and/or physical therapy.

Degenerative Disc Disease

Cervical degenerative disc disease refers to degenerative or "wear and tear" changes that occur in the discs in the cervical spine as a normal part of aging.

Symptoms

Often times, cervical degenerative disc disease causes no symptoms. However, if symptoms are present, they usually include pain and stiffness in the neck that may worsen with movement.

In addition, as spinal degenerative changes progress with aging (specifically, narrowing of the space between the discs and bone spur formation), compression of spinal nerve roots may occur.

This compression (called cervical radiculopathy) may cause symptoms of numbness, tingling, and weakness in the arms and hands.

If the spinal cord becomes compressed (as a result of degenerative changes), a person may develop trouble walking, balance problems, or bladder/bowel dysfunction. This condition is called cervical myelopathy.

Diagnosis

In addition to a medical history and physical examination, imaging tests are sometimes performed to confirm a diagnosis of cervical degenerative disc disease. Some of these tests may include:

  • X-ray
  • Magnetic resonance imaging (MRI)
  • Myelogram
  • Electromyography (EMG)

Treatment

Treatment of cervical degenerative disc disease depends on the severity of the symptoms, as well as whether any neurologic symptoms are present.

Typically though, conservative therapies, such as NSAIDs, ice and heat therapy, and physical therapy are recommended initially. Steroid injections can also offer short-term relief.

With severe and/or persistent cases of degenerative disc disease, especially for nerve root or spinal cord involvement, surgery to alleviate the pressure is performed.

Osteoarthritis

Cervical osteoarthritis, sometimes called cervical facet joint syndrome, occurs when the protective cartilage that lines each facet joint in the neck, begin to break down. This condition occurs as the normal part of aging but can be accelerated by a neck injury or being overweight or obese.

Cervical osteoarthritis often accompanies cervical degenerative disc disease.

Symptoms

Symptoms of cervical osteoarthritis include neck stiffness and achy pain that is often localized to one spot; although, less commonly, the pain may spread to the shoulder or back of the head. The pain of cervical osteoarthritis tends to improve with rest.

Similar to cervical degenerative disc disease, if the "wear and tear" changes within the facet joint cause nerve root or spinal cord compression, symptoms of radiculopathy and myelopathy, respectively, may develop.

Diagnosis

Besides a medical history and physical examination, a computed tomography (CT) scan or MRI test can reveal the classic findings of cervical osteoarthritis such as narrowing of the facet joint space, bone erosions, and bone spur formation. 

Keep in mind—facet joint changes seen on an imaging test do not necessarily correlate with the presence or severity of a person's neck pain.

Sometimes, a cervical facet injection is performed. This is a procedure where a doctor injects a steroid and/or a numbing agent into the facet joint. Relief of pain can then establish the diagnosis.

Treatment

The treatment of cervical osteoarthritis entails the following therapies:

  • Rest and activity modification
  • Ice and/or heat therapy
  • Engaging in moderate exercise
  • Over-the-counter pain medications, such as an NSAID or acetaminophen (Tylenol)
  • Physical therapy

Surgery may be an option for patients who have severe pain despite the above-mentioned conservative therapies, or if symptoms of radiculopathy or myelopathy are present.

Herniated Disc

A herniated disc occurs when the soft, rubbery substance that is normally contained to the inside of the disc (called the nucleus pulposus) escapes and pinches or compresses on a nerve root.

Tears in the tough outer fibers of the disc (called annular tears) may lead to a herniation. Annular tears may be brought on by either repeated or sudden, forceful stress to the spinal joint.

Symptoms

People with a herniated disc report symptoms of nerve root compression (radiculopathy) such as a burning or electric shock sensation that moves down one arm, along with numbness and/or weakness.

Diagnosis

A herniated disc can often be diagnosed by a medical history and physical examination. To confirm a diagnosis, your doctor may recommend a magnetic resonance imaging (MRI) test.

Treatment

Treatment of a herniated disc generally includes:

  • Slowing down certain physical activities (e.g., lifting)
  • Taking an anti-inflammatory medication like an NSAID
  • Applying ice to the neck several times a day for 15 to 20 minutes
  • Physical therapy
  • Cervical traction

Much less commonly, surgery to remove the herniated disc (called a cervical diskectomy) is performed.

Whiplash Injury

Whiplash injury is a neck injury that results from a movement event in which the head is suddenly thrown first into hyperextension and then quickly forward into flexion. It's most often due to car accidents (often as a result of being rear-ended), but less commonly may be caused by sports injuries or falls.

Whiplash injury is not technically a medical diagnosis, but rather an episode that can lead to any number of diagnoses, usually a neck strain or sprain. Sometimes, a whiplash injury damage joints or discs, which in turn may irritate spinal nerve roots or, very rarely, the spinal cord.

Symptoms

Depending on the exact nature of the injury, symptoms may include:

  • Neck pain and stiffness
  • Headache
  • Shoulder or back pain
  • Numbness and tingling that radiates down the shoulder, arm, hand, and/or fingers
  • Dizziness
  • Fatigue
  • Sleeping problems
  • Vision problems (e.g., blurry vision or sensitivity to light)

The symptoms of a whiplash injury may be felt right after the injury or be delayed for up to several days.

Diagnosis

The diagnosis of whiplash injury requires a comprehensive approach including a medical history, physical exam, and imaging tests (e.g., X-ray or magnetic resonance imaging of the neck).

Whiplash injuries are graded, based on the symptoms and signs they cause:

  • Grade 1: Causes neck pain or stiffness with no abnormalities noticed on physical exam.
  • Grade 2: Causes neck pain or stiffness with abnormal physical exam signs (e.g., tenderness over the neck or a reduced range of motion).
  • Grade 3: Causes neck pain or stiffness with signs of nerve damage (e.g., weakness or reduced reflexes).
  • Grade 4: Causes neck pain or stiffness with a neck fracture or dislocation.

Grade 4 strains are the most serious of all and require immediate medical attention.

Treatment

The treatment of whiplash depends on the grade of the injury and associated neck damage. That said, in most cases, a multi-modal treatment approach is utilized.

Common therapies used to treat a mild whiplash injury include:

  • Rest
  • Ice therapy followed by heat therapy a few days later
  • Taking over-the-counter pain medication, like Tylenol (acetaminophen) or an NSAID, like Motrin (ibuprofen)

For more severe or persistent cases, your doctor may prescribe pain medications, such as a muscle relaxant or opioid. Your doctor may also recommend physical therapy or an epidural injection if there is nerve inflammation from a herniated disc (that occurred as a result of the whiplash injury).

A Word From Verywell

Your neck is a flexible, yet susceptible-to-injury structure that is also vulnerable to the normal effects of aging. With that, if you are suffering from neck pain, please get it checked out and let your doctor sort through the potential diagnoses. Once diagnosed, you can hopefully move forward with a treatment plan that gives you back your comfort and well-deserved quality of life.

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Article Sources
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Additional Reading
  • Binder AI. Neck pain. BMJ Clin Evid. 2008;2008.