Neck Pain Differential Diagnosis

For whatever reason, my office has been filled with neck pain cases lately.  Most of these have been pretty severe, too.  Therefore, I thought a basic discussion of neck pain might be a good topic for this article.

Neck pain can arise from several different places within the neck and can bring with it a variety of other symptoms, including arm pain, headache, upper back pain and jaw pain.  It can also result in numbness in the arm, hand or head.  It can cause dizziness.  It can be difficult to sort it all out if you don't understand the reason why the pain can travel so many other places.

The neck is a very complex region.  Within its confines, you have the esophagus, trachea, larynx, a major chain of lymph nodes, many muscles and the spine, which houses the nervous system.  The nerve supply for everything below it and even some things above it exits at or travels through the neck.   In addition to housing so much "stuff", it is also the swivel for the eyes, which means that it has to be able to move a lot for us to see and balance well.  The neck also houses one of the 3 major balance regions in the body.  The variety of symptoms referred from the neck is more understandable when you look at all of the things housed within.

So, what are the major pain generators or syndromes that a chiropractor deals with on a regular basis?
1.  Facet Syndrome.
This is the pain that most commonly starts after sleeping.  You wake up and suddenly can't turn your head.  The pain is usually moderate to severe and seemingly comes "out of nowhere."  This syndrome often has arm or upper back pain associated with it.  Tingling and a feeling of numbness may also be present.  Weakness or TRUE numbness (where you cannot feel touch to the skin) are not generally present.  This pain originates from the posterior joints, or facet joints, in the neck.  It begins when something, usually spending too long in an awkward position, triggers inflammation.  This area has a lot of nerve supply and therefore can generate a lot of pain.  It most commonly occurs in the mid to lower cervical spine, which is also where the nerve supply for the upper back and arm arises.  This is why the pain will often follow that path.  The inflammation in the area inflames the sleeve of the nerve root, triggering pain along the route of the nerve.  This is one of the main conditions referred to as a "PINCHED NERVE."

2.  Disc Injury.
The disc is the cartilage between the bones, or vertebrae, in the spine.  When a disc becomes damaged, it can cause pain.  It can also bulge or herniate and cause direct pressure on nerves or the spinal cord.  This condition can look exactly like a facet syndrome or it can involve true numbness or weakness in the muscles or the arm or upper back.  A disc injury can be a mild event that heals with no residual pain or it can be a very serious condition that can require surgery in the most extreme cases.  It should be noted that VERY few cases require surgery and that most disc injuries can be managed with chiropractic or other forms of conservative care.  This is also often called a "PINCHED NERVE."

3.  Muscle Strain.
This is common and can result from even minor trauma, like slipping.  This pain is generated mostly from the muscles, although the joints can become involved if the muscles restrict the motion too much.

4. Cervicogenic Headache (Tension Headache)
This is a pain that is primarily felt in the head but extends into the upper neck.  This is most commonly caused by poor posture or prolonged computer or other sitting work.  The headache is most commonly in the back of the head but can spread to other regions.  This condition involves the upper neck and the muscles that connect the skull to the neck.  These muscles and joints and the nerves that exit in the area have connections in the head and send pain there, making it feel like the head is the pain generator when it truly is the neck that is causing the problem.

All of the above conditions are treatable with chiropractic care.  Please click on the word chiropractic in the last sentence for more information on treatment options.