There are many sources that could potentially cause pain in the neck. Metaphorically yes, there is always that person; however, structurally there are several anatomical parts that can produce neck pain. Without addressing pathology (which we will discuss in the next monthly newsletter on the uncommon sources of neck pain), let us take a look at the anatomical structures that most commonly can lead to pain in the neck.
As I have discussed in other areas of the spine, the main pain generators are within the muscles, joints and disc. Within the joint category, I will include bone, cartilage and ligament, as a joint is a complex of multiple tissues.
Muscles can become the source of pain when:
1) An injury to the muscle causes damage to the muscle fibers, i.e a strain. Strains most commonly occur during the eccentric phase, or lengthening phase, of a contraction. As the muscle is lengthened under tension, the muscle fibers can tear. A strain will be graded depending on the severity, from minimal fiber tear to complete tear.
2) A muscular spasm occurs when 1 or a few muscles maintain a sustained contraction for a period of time. Muscles can spasm after a strong forceful contraction or after a quick movement of an already short, tight muscle.
3) A mechanical irritation to muscle or tendon results in chronic inflammation/repair which changes the cellular structure of the tissue. The rubbing of the tendon against a bony prominence or the excessive movement of a tendon repetitively out of its normal groove can injure the tendon leading to a chronic inflammation. Read more about tendon injuries.
Joint pain can be the result of an acute injury to the structures of the joint. A joint complex includes 2 bones, cartilage that lines the 2 bones and ligaments that wrap around the joint. A joint can be injured when the two surfaces of the joint are:
- Compressed close together – When joints are compressed, the two surfaces which are covered in cartilage can become damaged. In addition, if compressed with enough force, the endplates of the bone can fracture, i.e as in a compression fracture to a vertebrae.
- Pulled apart – As a joint is gapped, the two bones are separated. If this gapping goes beyond the joints’ anatomical limits, this may result in a sprain to the ligaments surrounding the joint or a dislocation (if the pressure on the bone is great enough to move it out of its normal position). Dislocations can tear ligaments partially or completely, depending on the force that is applied. With sprains or dislocations, there tends to be swelling and bruising as tissues are torn to some degree, which will cause pain.
With both cases here, joints are highly innervated (i.e., there are many nerves present) and have established blood supplies which means any damage here will initiate an inflammatory cascade of events resulting in some degree of a pain.
The intervertebral discs can be another source of pain in the neck. Discs can become injured initially with small tears in their fibrous structure. Depending on where in the disc it is injured, patients may feel a significant amount of pain with these small little tears. This is because the posterior part of the disc is highly innervated with nerves and has a good blood supply. The tears in the blood vessels result in a bit of inflammation or swelling at the disc level. If these tears are large enough, the central part of the disc, the nucleus pulposus, will push outwards creating a bulge. Both of these can put pressure on the exciting nerve roots resulting in shooting pain down the arms. However, in my experience, these small tears, wherever they occur in the spine, tend to resolve faster, and the patient feels better quicker than if there is a larger disc bulge or herniation. More severe cases, may involve compression of the spinal cord resulting in further symptoms into the lower part of the body. Any damage to the disc will start the process of degenerative disc disease.
Management of all these injuries, regardless of the severity, will first start with first aid to minimize bleeding and swelling. As swelling subsides, different modalities, joint mobilization and soft tissue therapy may be used to promote tissue healing, prevent joint stiffness, prevent further damage and strengthen muscle to provide dynamic joint stability. More severe cases may need to consider surgical repair/reconstruction or protective bracing. As healing continues all grades of injury need to build muscular strength, improve proprioceptive and functional training.
Within the cervical spine, there are 6 discs, 7 vertebrae, 16 joints, and more than 20 muscles. As you can see, there are several sources where pain can occur in the neck. Our next newsletter will discuss the pathological processes that can cause neck pain, which adds a tremendous amount of further pain sources.
If you are experiencing any neck pain, I encourage you to have it assessed and treated. Call our clinic at 905-529-2911, or Click here to book online.