- The neck (cervical spine comprising 7 vertebra – naturally forming a gentle lordotic curve)
- Mid back (thoracic spine comprising 12 vertebra – naturally forming a gentle kyphotic curve)
- Lower back (lumbar spine comprising 5 vertebrae – naturally forming a gentle lordotic curve)
- The sacrum (comprising 5 vertebra)
- The coccyx (tail bone comprising between 3-5 vertebra).
The vertebrae within the neck, mid back and lumbar spine are separated by shock absorbing structures called intervertebral discs. The sacral and coccyx vertebra are fused and do not have discs.
The spine is an amazing structure affording excellent mobility/flexibility. It also provides protection to important neurological structures such as the spinal cord which is contained within a natural tunnel of bone within the spine called the spinal canal. Due to the amount of nervous tissue around the spine it can be a pain sensitive area.
Neck pain, discomfort or stiffness felt anywhere from the base of the head, the back and sides of the neck and across the tops of the shoulders and shoulder blade area.
What are the common causes of neck pain?
There are different anatomical structures thought to cause spinal pain including the intervertebral discs, facet joints, nerves, surrounding soft tissues including muscles, tendons, ligaments and other connecting joints. Sometimes neck pain, however, can start for no obvious reason, this can be very frustrating.
The truth is that despite advances in imaging techniques it is often very difficult, if not impossible, for us to be able to find the exact cause or structure for most spinal pain. This is why an x-ray or an MRI scans are not needed in the management of spinal pain.
Simple advice is keep active and keep moving, it will often settle with time. Please click on the information below to find out how to manage your pain.
Common conditions of the Neck
See below for the common signs and symptoms with a link to the MSK Matters page on how best to manage it.
- Can be a sudden onset or develop over time
- Pain can be sharp, shooting, dull ache, stiff, hot or burning
- It can be felt anywhere from the base of the head, the back and sides of the neck and across the tops of the shoulders and shoulder blade area.
- Occasionally there may be some pins and needles or numbness felt
- Can disturb sleep
Neck related arm pain
- Pain and symptoms maybe in your shoulder, arm and hand
- You may have some neck pain
- Pain maybe stabbing, burning or shooting
- You may feel tingling (pins and needles) traveling down the arm
- You may have some numbness
- You may have some weakness in the arm
- It may disturb your sleep
Is your pain coming from somewhere else?
At every level of the neck, mid back and lumbar spine and sacrum there are a pair of nerve roots which branch off from the spinal cord and exit the spine to serve certain areas of the limbs or trunk with skin sensation and muscle power as well as other functions. As a rough guide, nerves which exit the neck will serve the arm / hand, nerves exiting the mid back will serve the trunk and nerves exiting the lumbar spine will serve the legs / feet. These nerves follow a pattern so when a nerve becomes irritated we can usually identifying which spinal level may be causing problems during clinical assessment. The classic example of an irritated nerve in the lower back is sciatica which refers pain into the leg – sometimes as far as the foot.
When to seek medical advice
If your radicular arm pain is associated with weakness and loss of muscle bulk in the arm then make your GP aware.
On some rare occasions the nerves in the spinal canal may become compromised. This may lead to a variety of symptoms.
- Unexplained (and possibly pain free) arm weakness in one or both arms.
- Finding it difficult for you to use your hands for tasks such as undoing and doing up buttons or unscrewing jars
- Experiencing a loss of balance or co-ordination when walking.
- Weakness, tingling or numbness into the legs.
- Changes to the control of your bladder and bowels. Including difficulty initiating flow of urine or fully emptying the bladder
- Erectile dysfunction
- Dizziness, vomiting or blackout associated with neck movements
Thankfully these are rare but if you feel you are experiencing a combination of these, you should contact to your GP (or spinal clinician if you have already been seen in the spinal service).
If the symptoms are severe or progressing rapidly you should seek urgent medical advice and attend the emergency department.
The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer but this doesn’t mean there is something seriously wrong.
However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek advice. We would advise if you experience any of the following you should seek the advice of you GP.
- the pain you are experiencing is getting worse rather than better despite following the self-management guidance above for the condition in the time frame expected
- symptoms have not been significantly helped by a trial of medication as expected
- you feel unwell and suffer symptom such as fever, night sweats or weight loss
- you experience pain at night, possibly worse than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.
- you experience a change in your ability to walk including balance problems or weakness/heaviness in your legs
- you develop a hot and swollen joint for no apparent reason
- early morning stiffness, lasting for longer than 30 minutes
Understanding the complexity of pain and other influencing factors
What we have learnt through research is that pain, especially persistent pain is more complex than just what is going on locally to where you feel the pain. It can be affected by many things including poor sleep, poor general health, reduced fitness, stress, past experience of pain and our beliefs about pain and our physical structure. These factors have a very real physical effect on pain and how your body functions. The links below provide some insight into understanding pain, understanding your own beliefs around your pain and then looking at positive changes you can make that can in turn have a positive effect on your pain and levels of function.
Understanding pain in less than 5 minutes – Online video looking at the complexity of pain and the brain.
Why things hurt – Online explain pain video from Lorimer Mosley
Tame the Beast – Website with information on persistent pain
Pain Tool Kit – Website created by a patient to help manage persistent pain providing education and knowledge on how to improve self-management.
Pain-ed – Website providing patient and clinician information regarding pain and specifically back pain and Cognitive Functional Therapy
Abdominal breathing, relaxation and sleep
Stress and tension are common with persistent pain. For some it may be part of the underlying cause for many it’s a consequence as pain itself causes more stress and anxiety. What we know is that if we can use tools to help reduce our muscle tension and stress this can help with pain, sleep and function. Below are links you may find useful
Abdominal breathing – a written description from the NHS website.
Headspace – This is a website and APP that uses meditation and breathing.
Breathe2relax. This is an APP specifically for abdominal/diaphragmatic breathing – go onto your smart phones APP store for more details
Sleep well with pain – Leaflet to help try and improve sleep
Below are links to local services that can help with aspects of physical and mental health that you feel may be impacting your pain and general health.
Live well Dorset – Weight management, stop smoking, exercise advice, lifestyle change 0800 8401628/ 01305 233105
Steps to wellbeing – for help with feelings of anxiety, depression, bereavement and trauma/PTSD
Welcome to the moodzone – for help with self-management of stress, anxiety and depression
Dorset Pain Management Service website – This website contains a lot of further information and links about pain and also gives you the opportunity to see if you feel a referral to the Pain Service may be beneficial for you.
Understanding persistent pain – this booklet is commonly used by the Dorset Pain Management Service.
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