Chronic Neck Pain

Acute vs. Chronic Neck Pain

Neck pain is something that many people experience. At any given time, approximately 10-20% of people have neck pain, and anywhere from 22-70% of people will experience it at some point during their lifetime. Regardless of how long you have been experiencing neck pain, you are not alone. There are various causes and classifications of neck pain and thus, different ways to treat it. Understanding pain can help us positively change our relationship with it. Here are some different kinds of neck pain and what you can do to alleviate them.

Pain can be split into “acute” or “chronic” categories. Acute pain has a specific and identifiable cause and usually lasts a few days to several weeks. Acute pain goes away once the cause of the pain goes away.  For example, if you are working at home sitting on the couch in an uncomfortable position all day, you may develop neck pain — this is initially acute pain. Acute pain is our nervous system trying to warn us that some type of tissue damage or strain is occurring. Usually this pain will go away after a few days if you stop sitting in the same posture all day. 

Chronic pain is different. It lasts longer than 6 months and does not serve a purpose like acute pain does. In chronic pain, the nerves are still sending pain and warning signals to the brain, even after there is no more damage being caused to the body. One common example is neck pain that was initially caused by a whiplash injury after a car accident (acute), but does not go away even after months of healing and becomes chronic.

Causes of Neck Pain

Neck pain can have many causes including frequent poor postures, muscle strain, arthritis, cervical stenosis, trauma (such as whiplash from a car accident) or nerve compression. Rarely, neck pain can have serious causes such as cancer, meningitis, other infections, or issues with arterial blood flow.

It is difficult to be certain exactly how common chronic neck pain is, but one study estimated that the world prevalence is somewhere between the range of 16.7-75.1%. There are many physiological causes for neck pain. However, neck pain (and most pain) is complex and thus has a complex cause. 

Neck pain — particularly chronic (long-lasting) neck pain, can be influenced by a variety of factors. Ergonomic factors such as posture, repetitive movements, and poor workstation set-up can certainly play a role. Other contributing factors include age, weight, and medical history. Behavioral factors (such as smoking and level of physical activity) and psychosocial factors (overall mental wellbeing, levels of stress, anxiety, and depression) all contribute to the likelihood of experiencing chronic pain as well.  Evidently, there are a lot of factors that can influence why and how you experience chronic neck pain! Injuries and tension in other parts of your body can pull on the muscles and vertebrae in the neck and cause pain in that area. Therefore, if you go to physical therapy, your therapist will not only be examining your neck but likely your shoulders, spine, and upper body as well. 

Physical Therapy for Neck Pain

A conservative treatment option for neck pain is physical therapy. When you go to your physical therapist for chronic neck pain, they will perform an evaluation which will include a subjective portion, an objective portion, and an assessment.

The subjective portion is the “interview” portion where your physical therapist should ask you all about your pain. They will likely ask when you first noticed it, how long it has been lasting, if you feel any tingling or numbness, and what improves or worsens your pain (among other questions). Your therapist may also give you a questionnaire in order to help better understand and track your pain. Your therapist should ask questions about your symptoms that will help them decide if the cause of your pain is musculoskeletal or if it may be caused by something else. After the evaluation, if your therapist believes that the cause of your pain is likely of musculoskeletal origin, they will be equipped to help you in a variety of ways. However, if your PT believes that there may be a more serious medical cause, they will refer you to your doctor who may order mor advanced tests like  CT scan or MRI. 

The next portion of the evaluation is the objective portion. This is where your therapist will perform various tests and measures to assess your strength, range of motion, coordination, and joint mobility.

After performing the evaluation, your physical therapist will assess the information they have gathered and interpret how these factors might be contributing to your pain. This will allow them to categorize your pain and best determine how to treat it. Treatment will be individualized and will depend on the type of neck pain you have, but will likely include education, exercise, and manual therapy. 

Depending on the cause of your neck pain, your therapist may also suggest some changes you can make at home. They may suggest a small pillow for sleeping to assist with optimal neck alignment or suggest ways to improve the ergonomics of your workstation. Your therapist will likely educate you to take frequent breaks and change your posture throughout the day.

However, your treatment plan should be tailored to your unique situation and symptoms, which is why going to a knowledgeable and caring physical therapist can have such a beneficial impact on improving your pain and returning to the activities you enjoy.

Medical Intervention for Neck Pain

If conservative interventions do not work or are not preferred, there are options for medical intervention including surgery or injections. Steroid injections given to the neck are used to reduce inflammation if the cause of neck pain is an inflamed nerve or joint. However, injections should not be a standalone intervention and have been shown to be more effective when they are combined with physical therapy.  Neck surgery is considered a “last resort” when all other forms of treatment have failed and is usually only done if the cause of the neck pain is compression of a nerve root. In this surgery, the surgeon can remove bone spurs, portions of bone, or herniated discs. They can also fuse discs together to remove pressure on the nerves. 

Although chronic neck pain is something that many people will experience in their lifetime, those afflicted by it are not helpless or doomed to experience chronic pain forever. There are a variety of ways to intervene. Educating yourself and knowing where to get help is the first step. Once you understand what is going on for you and your options for treatment, you can begin to take action. Working with a skilled and knowledgeable physical therapist is a great way to empower yourself to become stronger, reduce your pain, and return to the activities you once enjoyed.

For an individualized treatment plan to help you with your neck pain, consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them.  Remember to also check out our Facebook, Instagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!

Submitted by Camille Jamshidi PT, DPT
Edited by Alexander Franz
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES