Anatomy and Sources of Neck Pain
The spine contains the following components, each of which can be a source of pain.
Discs (Intervertebral Discs)
Discs are made up of the nucleus (the load-bearing cushion) and the annulus (a network of circularly arranged fibers that provide structural support). The nerve and blood supply of the discs comes from adjacent edges of vertebral bone (end-plates) and the outer layers of the annulus.
Disc pain can occur when small, inner tears of the annulus reach these nerve fibers, or with “microfractures” of the end-plates. These painful findings can occur with trauma and/or be associated with degenerative changes. However, it is important to know that visible imaging (MRI) findings are not always painful and that your pain can resolve through treatment.
Disc herniations associated with annular tears can cause both neck pain and the pain of pinched or inflamed nerves. Terms used to describe disc herniations include:
- Sequestration (free disc fragment)
These disc protrusions cause nerve root pain through mechanical compression and/or inflammation associated with the disc material. Fortunately, disc protrusions resorb in many cases. Treatment can provide pain relief and the ability to function by reducing inflammation of the nerves as the problem resolves. When the pain of a pinched nerve remains severe, there is significant weakness, or the situation is growing worse, surgery may be indicated.
Facet Joints (Zygapophysial Joints)
There are two facet joints at each spinal level, forming a weight bearing “tripod” with the disc. The facet joints allow spinal motion and have cartilage and a covering (capsule). They can be injured while twisting or with trauma, or can become painful gradually. Normally, the disc bears most of our weight, but as the discs degenerate and become thin, more of the load is shifted to the facet joints.
Chronic posture and ergonomic problems can also stress the facet joints. This leads to joint degeneration which can sometimes be associated with pain and can even cause pain in joints that do not show any signs of degeneration.
The vertebrae can become fractured, house tumors, or degenerate and lead to bone spurs that can pinch nerves. Fractures can arise from trauma such as a fall, blow to the head, or whiplash.
Ligaments run along the edges of bones and discs of the spine to keep the spine stable, while also allowing normal motion. When the ligaments are torn by trauma or loosened through degeneration, a condition called spinal instability develops. This can be painful and cause “catching,” shifting and muscle spasms in the neck.
Muscles (Movers and Stabilizers)
Muscles can become torn, bruised or overstressed, all of which can be painful. More commonly, pain from other structures in the spine cause a reaction in the muscles such as tightness, pain in muscles “on-guard,” or a lack of supportive activity and protection from other muscles. You can then have both spastic muscles and inactive muscles at the same time, requiring physical therapy to retrain them.
This muscle dysfunction can happen even after a brief episode of neck pain and usually requires formal physical therapy, as they do not often return to becoming functional on their own. Correction of muscle length and activity helps protect you from future neck pain episodes and gets you get back to life.
Inflammatory Rheumatological Conditions
Rheumatoid arthritis is a set of conditions that can cause neck pain. The physicians and physician assistants at The Denver Spine and Pain Institute keep a look out for symptoms suggestive of these conditions. Our team can order labs and refer you to a rheumatologist when needed.
Infections of the spine are rare but can occur, especially when someone is immunocompromised for any reason (disease, chemotherapy). Infection can also spread from other areas of the body. Severe, focused, spine pain while being sick or feverish would possibly indicate an infection, which would need immediate attention.
Neoplasm (Benign Tumors, Cancer)
Tumors of the spine are found in less than 1/1000 spine images. They are more commonly from metastatic disease, with breast, lung, prostate, kidney, gastrointestinal, and thyroid being the most common of those. Lymphoma and myeloma can be found, and primary tumors arising from the structures of the spine are least likely.
Non-Spine (Referred Pain) Causes of Neck Pain
Medical problems in the front of the neck, chest or head can refer pain to the spine. Please let your doctor know about any symptoms that you are experiencing so that they can determine if there is any link to the neck pain that you are experiencing.