Dr. Thomas Neviaser
How many of you have neck pain? Over the next couple of months, I will address what I believe causes neck pain. Medically speaking, the neck is considered the cervical spine. Cervical [SIR-vick-al] is the medical term for the uppermost portion of the spine. It is derived from the Latin word cervix, which means “neck.” Many people have neck pain often intermittent, sometimes stiffness only, sand sometimes very painful.
There is a very simple way to identify true neck pain for yourself. Should your neck hurt whenever you move your head from side to side, up or down, or during rotation, the problem probably lies within your neck itself. On the other hand, if moving your head in those directions doesn’t make your neck hurt, it’s time to look elsewhere for the cause.
One of my dearest friends called me from New York, telling me his cardiologist (a heart specialist) had sent him to an orthopaedic surgeon for his neck pain. He described his visit and said this orthopaedist had recommended a treatment similar to what I described in chapter 2 for occipital headache. When I asked him to move his head in all directions, he told me none of these motions brought on his neck pain. He was soon coming down for a visit, so I waited until I saw him to give my opinion about his condition.
The day after he arrived, he accepted my invitation to go duck hunting. During our half-mile walk to the duck blind, I noticed that with every thirty or forty yards, he would stop and rub his neck. Once we were in the blind, I asked him to move his head again to see if it brought on the pain. It did not.
At that point, I knew he had referred pain—pain felt in one part of the body but caused by a problem in another part. In his case, the real problem was his heart. He had angina pectoris [AN-jine-a PEC-tor-is], pain from a clog in one or more of the coronary arteries that supply blood to the heart muscle. His angina was not typical since he only felt the pain in his neck, whereas most folks complain of chest pain.
Even though his cardiologist had sent him to an orthopaedic specialist, I urged him to see a second cardiologist when he returned home. He did so, and within five days, he had undergone a quadruple coronary bypass. His neck pain disappeared. From this story, you can see that not all neck pain originates in the neck.
True neck pain is not usually felt just in the neck, however. Often, it’s referred to the trapezius [tra-PEA-zee-us] muscles, the large muscles that spread from the base of the neck across the top of your shoulders. In fact, pains here without neck pain may be the only symptom emanating from the cervical spine.
Many folks think of these muscles as their shoulders, but they aren’t, and insisting their “shoulder” or “shoulders” are bothering them often convinces the examiner that they really mean their shoulder joints. I have seen this mistake made many times over. That is why the initial instruction should be, “Point to your area of pain with one finger.” When they point to the trapezius muscle, the examiner will not be misled by their misnomer. Referred pain from the cervical spine may be described as a bee sting or deep pinpoint ache directly in the center of these trapezius muscles, and certain motions of the neck will increase this pain. Rubbing the painful area can give temporary relief, but it soon returns because the pain is coming from the neck, usually as a result of a fragmenting or degenerative disc.
Everyone has heard of a slipped disc, but what exactly does this mean?
A disc does not really slip; it fragments within its space and loosens up. When this fragmented tissue pushes, bulges against, and stretches the ligaments that hold it in place, pain is almost always felt or “referred” to areas in the neck and the trapezius muscles. Many patients swear they can pinpoint the pain directly over the muscle because they can feel it “right there.” They just know their symptoms are muscular in origin.
There’s a simple explanation for this. When someone rubs and massages the area for relief many times a day, or even for weeks at a time, this spot becomes quite sensitive. Simply pressing or touching it then produces a pain, but it’s not really the same pain arising from the real culprit, a disc in the neck. This is a difficult premise to explain and have patients understand. The patient will usually complain of pain over either the right or the left trapezius muscle, rarely both. Why? I’ll look more closely at the makeup and anatomy of these discs next month.
Dr. Thomas Neviaser is a retired orthopaedic surgeon and the author of The Way I See It: A Head-to-Toe Guide to Common Orthopaedic Conditions. You may reach him at firstname.lastname@example.org