Define Cervicalgia and its causes, symptoms, diagnosis, treatment with exercises

What is cervicalgia or neck pain?

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Neck pain can be developed due to many reasons. A headache or pain, tingling, numbness into the upper extremity, pain in the upper limbs can be related to neck pain. There are many other factors that can cause neck pain are sport related injuries, car accidents, or sudden fall can cause neck sprain which is also known as whiplash.

Cervicalgia: What is Causing Your Neck Pain?

There are many different reasons for developing neck pain. Not only can the pain be present in the neck itself, but symptoms such as headaches or pain, tingling, and/or numbness into the upper extremity, can be related to the neck.  Injuries: Sports-related injuries, car accidents, or falls can cause a neck sprain (often called “whiplash”). Cervicalgia can occur when the neck is:

  • When your neck is forced to move forth and back in repetitive motion more violently, and move beyond the normal range of motion, muscles, ligaments, and other soft tissues are stretched. It may cause excessive swelling and limited movements of the neck, which cause extreme pain even in little movements.
  • Improper posture can cause cervicalgia. Our spine needs to be in balance with a line of gravity. The weak musculature of the trunk and neck or poor postural alignment can create muscular fatigue, joint compression, or musculoskeletal imbalances.
  • Emotional stress is also an indirect cause of cervicalgia. Holding patterns in the neck by contracting the neck or shoulder muscles can lead to neck pain. This may aggravate or prolong healing of an existing neck injury
  • Spine undergoes changes with aging and can lead to wear and tear which can be contributed by poor posture long life.

What is the anatomy of the neck?

Our neck is comprised of three parts which are stated as below:

1)   Cervical vertebrae:  The cervical spine of the neck is made up of the seven small bones.

2)   Spinal canal: It is made up of cervical vertebrae, supporting ligaments and overlying neck muscles. The spinal cord flows through this canal.

3)   Cervical discs: They are also called as tiny shock absorbers cushions that exist between neck bones. A gelatin like material is filled in these discs. When excessive pressure is put on the disc, the material (gelatin like) protrudes and is responsible for a “herniated disc”

What is the pathophysiology of neck pain or cervicalgia?

Bones, nerves, discs, longitudinal ligaments, muscles, facet joints, and dura are the structures which are responsible for causing neck pain or cervicalgia. When these structures are injured or inflamed, they cause severe pain. The pain that occurs can be categorized as nociceptive, neuropathic, or idiopathic in origin. The most common type of pain is nociceptive.  Acute pain is often of nociceptive origin, but when it becomes a chronic pain than the influence of psychologic and social factors becomes more apparent. Noxious stimuli and transmit sensations are considered as pain when impulses are conducted by part of myelinated A delta fibers and unmyelinated-C. Damage to peripheral nerves or central nervous system causes neuropathic pain which appears as chronic pain. The most common causes of neuropathic pain are infections such as herpes zoster, metabolic diseases like diabetes, and traumatic injuries to the spinal cord and strokes that involve ischemic damage to the ascending nociceptive pathways. The pain is termed as idiopathic when no damage in tissues or neurons can be found.

What is the epidemiology of cervicalgia?

Neck pain is one of the most common musculoskeletal complaints. About two-thirds of the population will experience neck pain at some point in their lives. Women are affected almost twice as much as men. Prevalence rises with age for men and women and is the highest in the age group between 50-59 years. The percentage of people in whom neck pain becomes chronic is generally thought to be about 10%.

What are the types of neck pain or cervicalgia?

There are two types of neck pain or cervicalgia:

Acute Neck pain or acute cervicalgia

As the name indicates, it is the type of severe neck pain with sharp and shooting pain that reaches to shoulders and arms as well. If you suffer from the symptoms such as weakness in arms or loss of feeling and coordination in the arms or legs (also known as the progressive neurological deficit), you should see your doctor immediately because these can be signs of nerve damage. You should never ignore some symptoms such as persistent pain, lack of appetite, sudden weight loss, nausea and vomiting with fever or chills as these symptoms may indicate the presence of spine tumor or infection.

Chronic neck pain or chronic cervicalgia

It is the pain that lasts for the longer duration of time. Like acute pain, it also radiates down the arms, hands, and into fingers. There are cervical discs which act as tiny shock absorbers that lie between the neck bones. These discs contain a gelatin like substance which comes out from the discs when extra pressure is put on the disc and it may lead to a “herniated disc”. So, a cervical herniated disc or foraminal stenosis pinching nerve can be the main reason of chronic cervicalgia. Such symptoms can be treated with medications, physical therapy, manipulations etc, or does not need any surgical treatment. Surgery is recommended if the pain persists even after 6 to 12 weeks of proper treatments.  Its treatment also depends on the intensity of the pain, duration of the pain, and damage to the cervical or spinal cord.

What are the risk factors associated with cervicalgia?

There are various risk factors for cervicalgia such as:

  • Age: It is very common to get this problem with aging.
  • Occupation: Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on your neck.
  • Neck Injuries: Risk of cervicalgia can also be increased due to previous neck injuries.
  • Genetic factors: Some people may suffer from these changes more due to their family history while some are not.
  • Smoking: Increase in neck pain is somehow related to neck pain.

Can cervicalgia cause migraine headaches

Who is more prone to get cervicalgia?

A neck injury can be caused by several reasons, for example, an accident, a severe attack on the neck or by any other trauma. Almost all people are at the risk of injury. At some point of the life, nearly two third of people will experience neck pain by anyway. Whiplash is the condition when neck pain occurred due to trauma. The reason could be rear end car collision that may lead to excessive damage and severe pain in the neck. There are many risk factors for neck pain that include injury from involvement in contact sports, motor-vehicle accidents, poor postures, or sleeping positions.

What kind of pain results from neck pain?

Depending upon the cause and structures involved, neck pain can be caused by different ways. There is a kind of dull aching associated with the neck pain. Even the slightest movement of the neck causes the severe pain in the neck. Numbness, tingling, sharp or shooting pain is some other pains associated with neck pain. It can also come along with a headache, facial pain, or shoulder pain also. Sometimes a pinched nerve or irritated nerve is a reason behind severe neck pain. Cervicalgia is accompanied by upper and lower back conditions in many conditions.

How to diagnose cervicalgia?

A physical examination, neck examination, incorrect posture of your neck and shoulder, troublesome movement of your neck is needed by your healthcare provider in order to diagnose the exact cause of neck pain. X-Ray, MRI (magnetic resonance imagining), CT scan (computer tomography) can be recommended by your doctor. As it will help him to diagnose a right cause which may be a “herniated disc” etc. It all depends on the history and physical examination of the patient.

Radiographic studies such as x-ray can reveal narrowing of disc space, fracture, osteophyte formation and osteoarthritis.

MRI is done to detect bulging discs and herniations that are usually responsible for neurologic symptoms.

  • Nerve conduction studies and/or electromyography are done to find out if there has been any nerve damage.
  • Bone scan detects spinal problems like osteoarthritis, fractures or infections.
  • Discogram helps in confirming or ruling out the disc(s) as the source of pain.
  • Myelogram helps in finding out any spinal canal or spinal cord disorder.
  • Nerve Conduction Velocity Test (NCV).

What are the causes of neck pain?

Neck pain or stiffness can happen for a variety of reasons such as muscle tension and strain. In case of trauma, injury falls, car accidents, and sports, the neck is most prone to get affected. The spinal cord may be damaged if neck bones or cervical vertebrae are fractured. Neck injury due to sudden jerking of the head is commonly called whiplash

Some causes of neck pain are:

A heart attack can cause neck pain

A heart attack can also cause neck pain but it came along with other symptoms of heart attack such as:

  • Shortness of breath
  • Sweating
  • Nausea
  • Vomiting
  • Arm or jaw pain

If your neck hurts and you have other symptoms of heart attack, call an ambulance or go to the emergency room immediately.

Meningitis can cause neck pain

A stiff neck associated with fever and headache is one of the common symptoms of meningitis. Meningitis is the inflammation of the walls of the brain and spinal cord. Meningitis is considered as medical emergency and can be fatal. You should seek your doctor help immediately if you find any symptoms related to meningitis.

Other causes include the following:

Rheumatoid arthritis can cause neck pain

Rheumatoid causes pain, swelling of the joints, and bone spurs. When these occur in the neck area, neck pain can result.

Osteoporosis can cause neck pain

Osteoporosis weakens bones and can lead to small fractures. This condition often happens in hands or knees, but it can also occur in the neck.

can osteoporosis cause shoulder and neck pain

Fibromyalgia can cause neck pain

Fibromyalgia is a condition that causes muscle pain throughout the body, especially in the neck and shoulder region.

Degeneration of cervical discs can cause neck pain

The cervical discs start degenerating with aging. This condition is called as spondylosis or osteoarthritis of the neck. This can narrow the space between the vertebrae and add stress to your joints. Herniated discs are also responsible for cervicalgia. There are cervical discs which act as tiny shock absorbers that lie between the neck bones. These discs contain a gelatin like substance which comes out from the discs when extra pressure is put on the disc and it may lead to a “herniated disc”. When spinal column narrows and causes pressure on the spinal cord or nerve roots, it causes spinal stenosis. Arthritis and long term inflammation can be responsible for such condition.

Other causes of neck pain

In rare instances, neck stiffness or pain occurs due to:

  • Congenital abnormalities
  • Infections
  • Abscesses
  • Tumors
  • Cancer of the spine

What are the signs and symptoms of cervicalgia or neck pain?

As mentioned earlier, cervicalgia pain is usually local, which means it doesn’t radiate to other parts of the body. Some people with cervicalgia neck pain will be lucky to get away with minor symptoms, such as a stiff neck for a few days or difficulty moving the head from side-to-side. Some people call this a “crick in the neck.”

Not everyone has mild symptoms though. For some people, neck pain can be severe and debilitating. Severe pain, inflammation, and muscle tightness make it hard to move. One symptom of cervicalgia is a sharp pain in the neck whenever moving the head suddenly. In some cases, this can happen every time the person tries to move their neck. The following list covers some of the other cervicalgia symptoms that people may experience:

  • Neck and shoulder tenderness
  • Dizziness
  • Headaches (possibly migraines)
  • Burning sensation
  • Aching sensation
  • Nausea
  • Night sweats
  • Blurred vision
  • Facial pain

What is Whiplash?

Whiplash is the most common form of neck pain. It can cause by a trauma. It is somewhat different from cervicalgia. A soft tissue injury in the neck can lead to whiplash. The ligaments and supportive musculature become overextended when the neck is whipped or moved forth and back quickly, violently, and in repetitive motions.

When should I see a doctor if I have cervicalgia?

If symptoms persist for more than a week, consult with your doctor. You should also see a doctor if you have:

  • severe neck pain without apparent cause
  • a lump in your neck
  • a fever
  • a headache
  • swollen glands
  • nausea
  • vomiting
  • trouble swallowing or breathing
  • weakness
  • numbness
  • tingling
  • pain that radiates down your arms or legs
  • an inability to move your arms or hands
  • an inability to touch your chin to your chest
  • bladder or bowel dysfunction

What is the treatment of cervicalgia or neck pain?

The individual treatment is tailored to the patient to help treat the underlying cause of pain.  Some possible treatments may include:

Medications for cervicalgia

In order to relieve neck pain, your doctor may prescribe you some pain killers such as Ibuprofen, naproxen or Tylenol. In case of excruciating pain, muscle relaxants or narcotics can also be prescribed.

Heat therapy for cervicalgia

Muscle spasms can be relaxed with the help of heat therapy. Other forms of heat therapy such as moist heat from a shower, hot tub, or moist towel warmed with warm water are considered as best treatments for cervicalgia.

Ice therapy for cervicalgia

Direct application of ice on the affected and inflamed area is highly helpful in reducing pain and inflammation. Ice therapy can be given in many forms such as the bag of ice, frozen peas, or ice cubes in a plastic bag is preferred mostly. You should avoid the application of blue ice which is used for coolers and camping to the skin because it may lead to freezer burn.

Massage for cervicalgia

Relaxing strained muscles with the help of massage on both sides of the neck and upper back is usually another preferred technique for treating cervicalgia.

Stretching exercises for cervicalgia

Do not attempt exercises without being evaluated by a healthcare provider as they can actually make the problem worse if performed incorrectly.  Exercises can be performed to relieve stiffness and improve range of function.

Stress reduction for cervicalgia

Delay in the recovery process and emotional stress can also cause neck tension. One can opt for breathing exercises, meditation, progressive muscle relaxation, yoga, bio feedback as it will help in reducing stress.

Proper posture for cervicalgia

A proper posture is mandatory for prevention of an extreme range of motion or positions that may cause constant tension. As this is the time when your body needs maximum relaxation, therefore you should avoid sitting in one position for longer periods of time, carrying heavy backpacks, purses that are hanged over the shoulders, carrying kids on the shoulders. You can maintain your posture by keeping your head straight, shoulder back and down. Always use a small pillow below you r head while sleeping at your back. Avoid using your arms for carrying heavy objects.

Other treatments for cervicalgia

  • Physically manipulating the muscles, soft tissues, and joints are beneficial in treating neck pain. This therapy is also called as osteopathic manipulative therapy (OMT).
  • When the pain is extreme, or in case of muscle spasm, a local anesthetic injection such as lidocaine is given. In this, the injection is given at trigger point.
  • Acupuncture therapy is also beneficial in treating the neck pain. In this, a needle is placed into the body area by an experienced doctor who is trained in acupuncture therapy.
  • Another treatment which is helpful in treating the neck pain is electrical stimulation. It is also called as transcutaneous electrical nerve stimulation (TENS). In this, mild electric current is given to skin in order to decrease the pain sensation and increase the mobility of the muscles. It is also known to provide strength.
  • Surgery is the other option which has a role in relieving symptoms related to a pinched nerve in some cases. Surgery is opted in patients when all other treatments are failed to provide any benefits.

What are some neck exercises for cervicalgia?

Neck flexion exercise for neck pain or cervicalgia

Stand straight and move your head forward so that your chin touches the chest or comes as close as possible to the chest as shown in the video. Neck Flexion stretches the muscles of your neck at the back of the cervical spine and gives relief from the neck muscle tightness.

Neck extension for neck pain or cervicalgia

Stand straight and tilt your head back, not fast or forcefully, until your face looks directly at the ceiling. Neck extension movement stretches the front of your neck muscles. Don’t continue this movement if you feels dizzy.

Neck rotation for neck pain or cervicalgia

Stand straight and slowly turn your head to the right as much as you can, looking over the right shoulder. Hold the position at the end of the movement for 20-30 seconds. Repeat this exercise 5 times. Then do the same exercise on the left side.

Lateral flexion of the neck for neck pain or cervicalgia

Keep your head straight and tilt your head down your right ear towards right shoulder, until you feel a slight stretch. Hold the position for 20-30 seconds. Do the same movement on your left side.

How much recovery time is needed for neck pain?

First few days of following an accident there are flare ups of whiplash. The pain subsides and injury heals with the passage of time. It may take one to three weeks to subside the pain. Sometimes pain and stiffness can last for up to three months if you have severe whiplash, it can occur when you suffer the neck injury again. It is very important to rest your neck during the first 24 to 48 hours after an accident in order to avoid further damage to neck muscles.

What are exercise guidelines for cervicalgia

When you accidentally met with an injury in your neck, you should avoid exercising for the first 24 to 48 hours. There should be no neck movement for that period of time. You can start doing exercises only when the pain in your neck subsides and injury begins to heal. You can start with small daily activities that need twisting and turning your neck. With the passage of time when the pain lessens you can start with some exercises with more intensity. Sudden or abrupt start of exercises immediately after neck injury can tear the ligaments and muscles of the neck which can lead to lifelong disability. Low-impact exercise, such as walking, yoga, and dancing, is preferable until you’ve completely healed.

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