Understanding neck pain: A non-surgical approach to diagnosis and management By: Mike Dougherty, DC

Pain that originates in the shoulder, arm, or upper back can arise from the neck. Differentiating between them can be tricky and should be managed by a licensed healthcare practitioner. In this article we will look at information to help understand the process of identifying the pain.

What your MRI says:

One study looked at the MRIs of individuals without pain. In this case, cervical intervertebral discs of 497 asymptomatic subjects by were assessed. In each subject, ?ve disc levels from C2-C3 to C6-C7 were evaluated. What they found was the frequency of all degenerative ?ndings increased linearly with age. Disc degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age. The take home message here is that MRIs are a tool to help us make a clinical decision. People without pain can have abnormalities in the spine as well. We should never use MRI to help us solely make our decision.

Pain generators in the cervical spine:

We typically think of four different pain generators; nerve root, disc, facet joint, or muscle. Let’s take a look at each one.

Nerve root lesions occur when there is compression of the nerves that exit the neural canal. Usually, there is a pain distribution that corresponds with the irritated nerve or nerves specifically. The irritation can be from a bone, disc, chemical irritation, or all of the above. When there is compression due to a multitude of factors, sometimes the word “stenosis” is used. This is a Latin word that simply means “narrowing.” It’s descriptive rather than diagnostic. It’s the same as saying the word “sciatica,” which is Latin for “leg pain.” We know you have leg pain or that there is spinal narrowing, but why or from what should be the real question.

Now, we know the disc is involved in nerve compression but what about just disc pain. A disc derangement is typically one sided, with or without radiation, usually to the shoulder blade, trapezius muscle, or deltoid muscle. There tends to be an absence of neural tension signs with limitations in specific ranges of motion. Patient’s will often say, “I felt like I slept wrong,” and have pain and stiffness first thing in the morning.

The facet joints are the joints that make up either side of the spine. These are typically where the clicking and popping sounds heard in the spine come from. They sometimes take a little more detective work to find but there usually is clinical history with imaging findings. The patient may have pain with extension (tilting the head back), and pain with provocative testing to the facets . There is typically restriction in range of motion with similar referral patterns as discogenic pain. Patients will often complain of cervicogenic headaches, or those arising from the back of the head into the top of the head face, and sometimes even the eye.

Muscular pain alone is rarely a clinical condition in and of itself. It tends to be contributory in nature and related to an underlying spinal problem. We do see some muscular spasms with postural faults or syndromes. For instance, Kapandji, Physiology of the Joints, Volume 3 wrote: “For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.”

Understanding where your pain is coming from can sometimes ease worrying. It’s also important to realize that what an old MRI says doesn’t have to define you.

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