Neck pain (or cervicalgia) is a widespread disease, because a large part of the population is affected by it: about two-thirds suffer from pain in the neck area once in their lives.

In most cases, there is no serious illness behind it.
Often it is not clear what causes the pain in the cervical spine, in this case one speaks of “non-specific neck complaints”.
In the course of time, the pain usually subsides on its own, without any sequelae remaining.

The neck muscles can shorten and harden in the long run due to postural errors, especially if you work a lot on the PC or desk.
Many people keep their shoulders pulled up because there is a strong muscle tension of trapezius muscle and shoulder blade lifter.
Osteoarthritis is one of the most common causes of neck pain, which particularly affects people over the age of 50.

The treatment provides for the correction of posture and a program of postural exercises.
The vast majority of neck pain gets better over time and does not require surgery.


What are the causes of neck pain?

Muscle tension and muscle weakness
Muscle-related neck pain is most common.
The exact cause of the pain is usually not known, it can occur due to muscle contractures, tension or fatigue of the muscles.
Symptoms include pain in the neck and back of the shoulder, restricted movement and, in some cases, headaches and dizziness.

Poor posture is certainly a factor that affects the muscles and can cause pain and stiffness in the neck, even in children.
In fact, neck pain is more common in people who spend most of the workday bent forward at a desk.
Pillows and mattresses can also be the cause of neck pain due to poor posture, they should be chosen wisely.

The muscle pain on the neck can also be caused by fibromyalgia (literally fiber-muscle pain), this unpleasant disease affects the muscles of the human body, causes pain and diffuse muscle weakness, also in the neck and shoulder area.

Stress and neck pain

The main cause of neck pain is muscle tension.
During high stress, the muscles contract.
Psychologically induced muscle tension can cause shoulderback and neck pain.

Worry, anxiety and stress are therefore not rare triggers for neck pain.
Many people feel muscle tension in the neck during great stress.
Worried and anxious people feel the contracture immediately and focus on the discomfort, they have a very low pain threshold.
Stressed people have a tendency to fixate on negative sensations, so their neck pain seems to be worse than those who are emotionally balanced, although objectively it is the same pain intensity.
Stress doesn’t necessarily lead to neck pain, but it often does.
There may be mild or severe discomfort and also a restriction of movement.

Bruxism and jaw pain

The neck is connected to the muscles of the tongue and jaw.
The people who grind their teeth at night (bruxism) may feel tension in the neck muscles.
An incorrect jaw position is another cause of neck pain.
In these cases, a dentist or orthodontist and possibly an osteopath should be consulted to relieve muscle tension and correct chewing movements.

Cervical distortion for neck pain

A “whiplash” is usually caused by a car accident, whereby muscle tears or lesions, a strain of the vertebral joints and overstretching of the ligaments can occur.
The possible symptoms are: pain in the cervical spine, dizziness, confusion, restriction of movement and tingling in the arms.
In a rear-end collision, the spine of the driver and passengers is first thrown backwards against the seat and then immediately thrown forward, forcibly overstretching the neck muscles.
In the more severe cases, there may be a rupture of the cervical vertebrae.

Crooked neck for neck pain

The acute crooked neck (torticollis) usually hits children and has a sudden onset.
The head is turned to the side and remains in this position, it is practically impossible to turn it in the painful direction.
The muscles are significantly hardened, making the rotation and tilting of the head on one side impossible, while the movements on the other side can be done freely and painlessly.
The pain occurs on the right or left side, but not on both sides.
In the case of a crooked neck, the stretching of the cervical spine (placing the head in the neck) is limited and causes pain, while bending (chin to chest) does not cause any difficulties.
The cause of a crooked neck is usually the sleeping position, in some cases it can also be a prolonged stay in a cold environment, for example at night, or taking a malposition over a longer period of time.
Normally, people are fine when they go to sleep, but have an acute crooked neck when they get up in the morning.
The pain usually subsides on its own in a few days without treatment.

Osteoarthritis for neck pain

Cervical arthrosis or spondylosis is the wear-related degeneration of the vertebral joints and intervertebral discs; it is a common cause of sustained pain in the neck region.
Due to their age, older people are particularly affected.
This is called cervical spondylosis.
Most people over 50 have some degree of degenerative vertebral changes (spondylosis) but are not affected by neck pain.
The symptoms of cervical arthrosis are: pain and stiffness, which increase in the morning, after an exertion and when the weather changes, as well as restriction of movement and an audible crunch when turning the head.
In rare cases, patients pass under nausea, vomiting and dizziness.
Spondylosis can cause stenosis, i.e. narrowing of the spinal canal, which presses the spinal nerves. In this case, the discomfort radiates from the neck to the arm, sometimes even to the hand.
The patient with cervical stenosis complains of pain, tingling, loss of strength and sensitivity.

Inflammation of the cervical nerves

Normally, inflammation of the cervical nerves is a symptom that the nerve is pinched at the root or in the further course.
Possible causes:

  • Herniated disc or protrusion of the intervertebral disc in the cervical spine, which, due to its displacement, pinches the root of a nerve or damages the nerve.
  • Contracture and shortening of some muscles (e.g. the scalenus muscles), which thereby exert pressure on the nerves.
  • Canal stenosis of the cervical spine: narrowing of the space in which nerve roots and spinal cord run.
  • Spinal tumor or infection (for example, meningitis).

In addition to pulsating neck pain, cervicobrachialgia can develop with the following symptoms: loss of sensitivity (numbness) of the upper limb, tingling in the hand and muscle weakness in the arm.
The pain increases during and after running, but walks are possible.
In this case, it is necessary to visit a neurosurgeon who specializes in nervous diseases.

Some symptoms may indicate a serious illness, patients should consult a doctor immediately in this case.
Progressive, neurological deficits with muscle weakness in the arms, sensory disturbances, coordination problems of the upper or lower limbs may indicate nerve damage.

Neck pain in pregnancy

Pregnancy in itself does not cause neck pain, but the change in posture can negatively affect the muscles in this region.
The only diagnostic method that comes into question in this case is magnetic resonance, because it does not emit radiation, but one tries to avoid this before birth.
Medication is generally not recommended during pregnancy, apart from a few exceptional cases that are decided together with the doctor.

Cervical lymph nodes
The cervical lymph nodes can swell and hurt.
The cause of this is probably a virus (e.g. flu virus).
Lymph nodes that are enlarged due to a tumor — such as Hodgkin’s lymphoma — don’t cause pain, even when palpated, but they feel hard.

Serious causes
Serious and rare causes include: rheumatoid arthritis, bone fractures, infections, meningitis, tumors, and severe injuries that damage the vertebrae, spinal cord, or nerves of the neck region.


Most acute pain in the neck region is triggered by tired and tense muscles.

Acute neck pain can be localized as follows:

  • Back of the neck: often paired with stiffness and muscle pain.
  • Neck and head: in the upper cervical region, may radiate to the whole neck and be accompanied by dizziness, headache and mental confusion.
    The pain in the upper cervical region can radiate to the neck and forehead to behind the eyes.
    Contractures on the upper cervical column or blockage of the first two cervical vertebrae (C1 and C2) can cause dizziness, difficulty swallowing and headaches.
    The pain becomes stronger when the head is turned or stretched upwards.
    The cervical treatment mainly includes massages and exercises according to McKenzie.
  • Neck and arm: in the lower neck area due to pinched nerves; from here, the pain can radiate down the shoulder and arm to the fingers.
    In the case of neck pain that radiates into the upper limb, loss of strength and sensitivity in the arm, tingling in the hand and restriction of head movements can also be noticeable.
    It may feel like the hand is being hit by pinpricks.
    A herniated disc of the cervical spine occurs predominantly between the cervical vertebrae C5 and C6 or between C6 and C7.
    The pain can be very intense and accompanied by numbness or tingling in the arms and/or hands. Symptoms may come on suddenly or develop slowly.
    Pain radiating to the upper limb is not always caused by a herniated disc, it can also be caused by hardened and shortened muscles (contracture) or adhesions (adhesions) of the connective tissue, such as the bottleneck syndrome of the upper thoracic aperture.

Chronic pain

There are numerous diseases that can cause chronic neck discomfort.

Neck pain that intensifies
in the morning and evening Those who suffer from osteoarthritis have greater complaints when getting up in the morning and at the end of the day.
Improvement occurs when the neck is moved; often the pain subsides on warm, sunny days and intensifies in cold, rainy weather.

The cartilage degeneration of the facet joints can lead to neck pain, especially older people over 60 are affected.
The facet joints actually have a smooth joint surface, but cartilage degradation creates increased friction and movement is restricted.
Pain and stiffness are particularly intense when getting up in the morning and are sensitive to damp weather.

The best treatment measures to maintain the range of motion and limit the discomfort are movement exercises to restore mobility, physical therapies, traction and manipulation.

In addition to the diseases listed above, there are other complaints of the cervical spine, but they occur less frequently.

Depending on where they occur, tumors (neoplasms) on the spine or bone can cause pain, loss of sensitivity and strength, sexual and sphincter dysfunctions, as well as tingling and limping.
Tumors can be divided as follows:

  • malignant (malignant) neoplasms that can form dangerous metastases (glioblastomas, osteosarcomas, etc.);
  • benign neoplasms, which are tissue masses that can grow and cause symptoms, but do not pose a threat to life (lipomas, meningiomas, neurinomas, etc.).

Neck and arm pain

Neck pain, which develops slowly (sometimes over years) and tends to occur during or after performing certain activities or neck positions, may be caused by spinal canal stenosis of the cervical spine.

As a rule, the symptoms are caused by a pinched nerve root.
This type of spinal canal stenosis arises due to a change in the vertebral joints (facet joints) or intervertebral discs that show signs of age-related wear and tear.
These structural changes can be diagnosed with an MRI or CT with myelogram.
Like a herniated disc, spinal canal stenosis is also treated medically (medication, therapy, exercise therapyinjections, etc.). For severe or prolonged pain or important functional limitations, the neurosurgeon may recommend surgery to widen the vertebral hole and make room for the nerve root.

Pain in the arm with coordination disorder Neck pain radiating
into the arm, combined with symptoms such as coordination and functional disorders in the arms and legs, as well as irregular, stabbing pain, are probably caused by cervical spinal canal stenosis with myelopathy.
The symptoms may also be due to a herniated disc in the cervical spine or degenerative changes in the joints that press on the spinal cord. As a rule, development is slow.

Diagnosis and imaging

During the physical examination, the doctor will check for stiffness, numbness and muscle weakness.

The patient is asked to turn his head, tilt to the side, bend and stick in order to evaluate the ability to move.

Image diagnostics In some cases, the doctor may prescribe diagnostic imaging procedures to find out what is causing the symptoms in the throat.

X-ray An
X-ray can indicate in which area spinal nerves or spinal cord are pressed by bone protrusions, and where there is a flattening of articular cartilage and intervertebral discs.

Computed tomography (CT)
A CT scan provides detailed images of the inner neck structures using numerous transverse incisions (as if the neck were cut into many horizontal slices).

Magnetic resonance tomography (MRI)
With the help of radio waves and a strong magnetic field, magnetic resonance imaging produces particularly detailed images of bones and soft tissue, including the spinal cord and the nerves arising from it.
Nevertheless, X-rays or magnetic resonance in many people indicate structural problems of the cervical region without experiencing these symptoms.
Therefore, it is difficult to determine whether the symptoms are really caused by the problems that the images display.

Nerve examination
If there is a suspicion that the neck pain is caused by a pinched nerve, the doctor may apply electromyography (EMG).
In this test, fine needles are inserted through the skin into a muscle and electrical impulses are sent out to check that the nerves are functioning correctly.

Laboratory tests
blood test. The blood values can provide information about whether there is an inflammation or infection that could cause the neck pain.
Lumbar puncture. In a spinal puncture, a needle is inserted into the spine to take a sample of the fluid that surrounds the brain and spinal cord.
This test can be used to diagnose meningitis.

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