Neck pain

Neck pain can be far more severe than even a very sore back.

Radiating patterns from the cervical spine causing neck pain.

How common is pain in the neck? "Epidemiology"

  • Most people can expect to experience some pain in the neck in their lifetimes, although for the majority, it will not seriously interfere with normal activities.
  • During any 12 month it was found in up to 70% of the general population, and up to 48% in workers. However, pain in the neck with associated disability was less common: 12 month prevalence ranged up to 11.5 percent in the general population.
  • Each year, between 11 and 14.1 percent of workers reported being limited in their activities because of pain in the neck. It was common in all occupational categories, and the results of the Ontario study suggest that worker's compensation data significantly underestimate the burden of pain in workers.
  • The number of persons seeking health care in emergency rooms for traffic related Whiplash Associated Disorders has been increasing over the past 3 decades. What are the symptoms of whiplash? See lower down.

Neck pain

Neck pain is experienced by about 50 percent of the population in any year; a new study reveals much about treatment and prevention.

This sketch by van Gogh shows why sewing may cause neck pain.

Risk factors 

  • There is NO EVIDENCE that common degenerative changes (arthritis) in the cervical spine are a risk factor for pain in the neck.
  • Smoking and exposure to environmental tobacco is a risk factor. The spine like every organ requires oxygen and any decreased oxygen in the blood impacts on joint healing negatively.
  • In the workplace high quantitative job demands, low social support at work, sedentary work position, repetitive work, and precision work increased the risk. 
  • Habitual self manipulation of joints without the proper distraction damages the hyaline cartilage lining the joints.
  • Devices aimed at limiting head extension during rear-end collisions were found to have a preventive effect. For more interesting facts about whiplash, click here: Whiplash research.

    Hobbies?! (Ps Know the artist? See if you see the "Vincent" in one of the seams.)

Aside: My own opinion too: those who sleep on their stomachs, and those who deliberately click their own necks have a higher incidence of neck pain.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Course and prognosis 

Most people do not experience a complete resolution of symptoms. Between 50% and 85% of those who experience pain at some initial point will report having it again 1 to 5 years later. These numbers appear to be similar in the general population, in workers and after motor vehicle crashes.

The prognosis also appears to be multifactorial. Younger age was associated with a better prognosis, whereas poor health and prior episodes of pain in the neck were associated with a poorer prognosis.

Poorer prognosis was also associated with poor psychological health, worrying, and becoming angry or frustrated in response to pain in the neck. Greater optimism, a coping style that involved self assurance, and having less need to socialize, were all associated with better prognosis.

Specific workplace or physical job demands were not linked with recovery from neck pain. Workers who engaged in general exercise and sporting activities were more likely to experience improvement in their symptoms.

Post injury psychological distress and passive types of coping were prognostic of poorer recovery in whiplash associated disorders.

There is evidence that compensation and legal factors are also prognostic for poorer recovery from whiplash.

What is the place of x-rays and scans, imaging and electrophysiology, blood tests and other medical procedures in the management of uncomplicated neck pain?

And does the presence of radiating pain to the arms and hands mandate extra views showing the uncovertebral joints or imaging?

The assessment for fracture in the emergency room and the diagnosis of cervical pain with radiculopathy are of value, but there is little evidence that diagnostic procedures for cervical pain without severe trauma or radicular symptoms have validity and utility.

Computerized tomography scan has better validity and utility in cervical trauma for high risk or multi injured patients.

The clinical physical examination is more predictive at excluding a structural lesion or neurologic compression than at diagnosing any specific etiologic condition in patients with cervical pain.

Conventional xrays, as with other forms of arthritis, are considered insensitive in patients with the early osteoarthritis that follows whiplash as surely as night follows day.

All other assessment tools such as electrophysiology, imaging, injections, discography, functional tests, and bloods test lack validity and utility.

Reliable and valid self assessment questionnaires given to neck pain patients can provide useful information for management and prognosis.

The finding of degenerative changes on imaging has not been shown to be associated with pain in the neck.

How bad is the pain?

Slipped disc Arm Pain

Probably the most difficult and painful condition treated in Chiropractic clinics is a slipped disc in the neck, with radiating pain down the arm.

Often the deep inescapable ache in the arm is even worse than the neck pain, and it's often bad at night.

A bulge of the disc, impinging on the nerve root is a great challenge to all clinicians, not only chiropractors. Pain from the neck that radiates down the arm needs to be assessed and treated immediately. Left to its own devices this can be a very nasty condition, and allowed to become chronic is to be avoided under all circumstances. Slipped disc Arm Pain

Tingling in arms and hands

Tingling in arms and hands is one of the most common questions asked at chiropractic help; it's really just the referral of neck pain to the limbs.

Many of the arm pain syndromes have their basis in the neck. So too those like carpal tunnel syndrome that cause tingling in arms and hands.

Remember, CTS never causes symptoms in the little finger.

Chiropractic help

Prior to treatment for any condition there should always be a diagnosis. And that means it always begins with a thorough History and Examination before the treatment of neck pain.

Treatment, should subluxations be found, is based on getting any fixated joints into motion again, to restore the normal movement of intracapsular fluids that bathe the joint cartilage, thus reducing the risk of inflammation of joints starved of nutrients and oxygen.

That adjustment should be highly specific. Crude manipulation of the spine causing multiple releases at many levels is dangerous and totally unnecessary.

Needless to say, cervical spine manipulation should only be done by a highly trained and skilled clinician. There are dangers associated with the procedure, as in any treatment. Iatrogenic illness is not specific to medication, surgery and hospital acquired infection; would you let a chiropractor take out your appendix?

Highlighting this is the fact that there are plans afoot in the Netherlands to completely ban all cervical adjustments after three strokes following manipulation by other professionals who have been to a few weekend courses on physical therapy.

The training of chiropractors in the art and science of manipulation is long, arduous and painstakingly thorough. Even so, one in six million manipulations causes a stroke; that's very rare.

The thorough examination also enables the clinician to decide which levels to adjust, and how.

Medical treatment of cervical pain is based on the use of anti inflammatory and muscle relaxing drugs.

Suppression of inflammation following whiplash is felt to be important in slowing the inevitable structural disease progression.

It is widely acknowledged that getting the patient back to work as soon as possible is very important.

Should this relatively conservative treatment fail; medical research admits that anti inflammatory drugs in fact cause many thousands of deaths in the United States, mostly from bleeding ulcers, and that in their opinion more radical nerve root injection, neurotomy and open surgery should be used.

New research 

  • 'Alternative' care for cervical pain, research concludes, appeared to be more beneficial than surgical or 'best' usual medical care.
  • Educational videos, mobilization, manipulation, exercises, low-level laser therapy, and perhaps acupuncture appeared to have treatment benefit for pain in the neck.
  • For both whiplash associated disorders and other cervical pain without radicular symptoms, interventions that focused on REGAINING FUNCTION and RETURNING TO WORK as soon as possible were relatively more effective than interventions that did not have such a focus.
  • There is NO EVIDENCE that epidural or selective root injections with corticosteroids decrease the rate of open surgery for neck pain.There is evidence for SHORT TERM symptomatic improvement of radicular symptoms with these treatments.
  • Evidence is lacking to support intra-articular steroid injections or radiofrequency neurotomy for cervical pain.
  • There is no clear evidence that LONG-TERM OUTCOMES are improved with the SURGICAL TREATMENT of cervical radiculopathy compared with non-operative measures.
  • However, relatively rapid and substantial relief of pain and impairment in the SHORT TERM (less than 3 months after surgery) after surgical treatment appears to have been reliably achieved.

Neck pain anatomy 

In Chiropractic we try to encourage patients to understand their pain and disability. Participating in your own disease means you will be far more able to get on top of it, and cope with it.

It is important that we do our utmost to make sure the pain does not continue passed the critical 6 months point. Thereafter, research indicates it is likely to remain a life-long problem.

Repeated self manipulation of the cervical spine injures the sensitive UncoVertebral joint Luschka that protects the nerve root. So does whiplash and in particular whiplash from the side. So, what are the symptoms of whiplash?

Shoulder pain often originates in the lower neck.

For more info about the anatomy of the neck, type NECK PAIN ANATOMY ... here:

Searching for something specific? Just type it in here: 


  • There is an association between chiropractic and medical services and subsequent vertebrobasilar artery stroke in persons under 45.
  • A similar association was also observed among patients receiving general practitioner services.
  • This is likely explained by that patients with a vertebrobasilar artery dissection-related in progress, with the associated neck pain or headache, seek care from either their doctor or chiropractor before having their stroke. Neither their doctor's or chiropractor's care is considered the cause of any ensuing stroke.
  • For more information about the risks of stroke, click here: Stroke chiropractic ...

For a stunning interview with a neurologist who herself had a stroke and, afterwards was able to describe in the most amazing way what was happening, follow this link. Scroll down to My STROKE of insight at Neck pain and Headache.

Classification and prevention of neck pain 

Grade one cervical pain; there are no signs or symptoms suggestive of major structural pathology and only minimal interference with daily life. The patinet will most likely respond to minimal intervention such as reassurance and pain control. In depth investigations and prolonged treatment are not indicated.

Grade two cervical pain; again, there are no signs or symptoms of major structural pathology, but significant interference with the activities of daily living now begin. The patient requires pain relief and early treatment aimed at preventing long term disability.

Grade three cervical pain; there are once more no signs or symptoms of major structural pathology, but the presence of neurologic signs such as decreased deep tendon reflexes, weakness, and sensory deficits is found on examination. The patient may require further investigation and, occasionally more invasive treatments.

Grade four neck pain; there are signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; it demands prompt investigation and treatment.

Prevention is best directed at reducing the occurrence of major injuries and dealing effectively with whiplash to avoid the development of disabling spinal pain. For example, wearing of seat belts has been proven to have major benefits in cases of motor vehicle accidents. Keeping to the speed limit and taking regular breaks on long trips are equally important.

Seeking treatment for so called minor neck pain, before the onset of radiating symptoms like tingling, numbness and weakness in the shoulder, elbow, wrist and hand is important; the ache in the arm can be very severe.

Managing headaches with minimal analgesics to prevent kidney failure makes sense. 

Think of good posture but even that is often not enough. This teacher required an axis adjustment yesterday, but this book stand has reduced her need for chiropractic treatment by more than fifty percent. An old neck injury has left its mark.

Think too about your bedside lights; do you have to crane your neck to get adequate light? There's a simple solution, costing little more than one chiropractic treatment. Prevention is the name of the game.

The Posturite desk helps to prevent neck pain.

Cervical facet syndrome

Cervical facet syndrome is probably the most common cause of neck pain.

There are five joints between the vertebrae in the neck. The most common spoke in the wheel is the facet joint, two on each side. Read more at lower cervical facet anatomy if you want more material on the subject. 

Whilst care of the cervical spine can never be described as simple, the cervical facet adjustment is a procedure done many times every day by all chiropractors.

Fixations in the facet joints cause local pain, sometimes radiation down to the shoulder and arm, and midback, and often headaches.

The sudden onset of an extremely painful neck, with very limited motion, often on awakening in the morning, is known as wry-neck or torticollis. Reducing the displaced meniscus requires great care since the patient is in such pain, but correctly done brings almost instant relief. Read more at torticollis physical therapy.

Pronator teres syndrome

Pronator teres syndrome is a repetitive strain injury in the forearm; there's lots of research that the many arm pain conditions can refer back to the cervical spine causing neck pain. There's plenty of the proverbial chicken and egg here.

The net result is severe pain radiating down lower arm to fingers, always excluding the pinkie; it follows the median nerve distribution, same as carpal tunnel syndrome.

The distribution of the median nerve that illustrates the tingling in the hand related to neck pain.

Horse riding

Unregulated, poorly managed horse riding often leads to a lifetime of misery. Expensive misery. Would you put your untrained child on a superbike? Chiropractors hate horse riding.

How reliable are x-rays? Should one take radiographs every time a child falls off a horse?

Injuries in childhood to the cervical spine are one of the causes of advanced degenerative changes in the neck in the elderly, leading to the diffuse and oft serious symptoms of cervical stenosis.

» Neck pain

Bone and joint decade 

The applied minds of many different disciplines, including chiropractic has made great strides in the management of neck pain; a more academic page. 

Important considerations  @ Neck Pain

Testing for Dizziness and Vertigo in the Chiropractic practice using the Hallpike Dix test.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.