Pain in the Neck

A Real Pain

We hear it from time-to-time:
– “John is a pain in the neck.”
– “Fixing that car is a real pain in the neck.”
– “Just thinking about what I’ll face today gives me a pain in the neck.” 

A pain in the neck is a rather common term in our language, used for persons, things or situations that cause or exacerbate problems. It does have roots in reality. Stressful situations cause tension. In response, our muscles tense up, including neck muscles. And neck tension is a cause of both neck aches and headaches. It doesn’t stop there. The pain in the neck not only can cause headaches; it may radiate down the shoulder and arms, and misalignment caused by neck tension can spread to the thoracic spine.

What Causes Neck Pain?

Tension is only one cause of neck pain. Several causes have been identified and described medically. Some of the others are degenerative arthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, infectious disease, congenital malformation and misalignment, trauma (injuries), and posture.

     Degenerative arthritis

Degenerative arthritis, otherwise known as osteoarthritis, is the deterioration of a joint, resulting in bone rubbing on bone when the joint is articulated. In the neck, this is often the result of cervical discs (the padding between the neck vertebrae) breaking down. Arthritis can also result in calcium deposits in unwanted places, such as spurs and spinal stenosis (narrowing of the opening of a vertebra).

     Rheumatoid arthritis

Rheumatoid arthritis, also known as rheumatism, is not simply one condition, but several similar ones. Sometimes is is an autoimmune response, in which the body fights itself. Besides causing just pain, it can actually break down bone, discs, cartilage, tendons, ligaments, and other tissues – whatever is being attacked by the immune system. Thus, it can cause osteoarthritis.

     Osteoporosis

Osteoporosis is the loss of bone calcium. This weakens bone, making it more prone to injury. There are a number of causes, such as genetics (women are more likely than men to have it), poor nutrition (for instance, imbalance of calcium and magnesium), diseases, chemicals, radiation, and some medications. For example, a mechanic was given a steroid to control an autoimmune disorder, which in turn caused osteoporosis, and he broke a bone turning a bolt with a wrench.

     Fibromyalgia

Fibromyalgia is generalized pain. It can be in any one part or several parts of the body at any time. It comes and goes. Dr. Swartzburg and Dr. Mrazeck say on the #1 Back Pain Site, “Fibromyalgia symptoms and resulting back pain will vary in severity.” The causes are not really known, though several possible causes are considered. Even though we cannot be certain of the cause, there are treatments and means of reducing pressure and pain.

     Infectious Diseases

Several infectious diseases cause pain in affected tissues. Influenza, a viral infection, can cause aching joints, including those in the neck. Spinal meningitis is another contributor, and it has the potential of resulting in long-lasting damage to tissues.

     Congenital Malformations and Misalignments

There are any number of congenital malformations and misalignments of the neck. Some persons are born with fusion of two or more of the cervical vertebrae. Individual vertebrae may be misshaped and have excessively large, extremely small or missing parts. These can compress the spinal cord or pinch nerves as they extend out from the spine.

     Trauma

Trauma is a common source of neck pain. A frequent neck injury is whiplash, often the result of a traffic accident. Soft tissue injury will be immediately painful. Damage to ligaments, tendons and bone is frequently long-lasting, especially if not properly treated during the healing process. This is especially true for fractures, which can fuse misaligned, becoming a permanent source of discomfort and pain.

     Posture

Posture is a very common source of neck misalignment and pain, more often than many of us want to admit. We want to think that our posture is good. An honest evaluation by a physical therapist, orthopedic doctor, or chiropractor could change that. Poor posture may result from how we stand and walk, but often the culprit is how we hold the phone or how we sit and sleep.

          Mobile Phones

Mobile phones are a frequent culprit in poor neck posture. Watch shoppers in a store, and you will see several holding their cell phones between the shoulder and the jaw. This is an unnatural position which puts a lot of strain on both the shoulder and the neck. If held for long times, it has the potential of contributing to long-term cervical misalignment. It is also a safety issue, interfering with one’s ability to see to that side, which may lead to collisions with objects or other people, causing more injury to the neck.

          Walking, Standing

Walking and standing for long periods slouched, stooped or bent over pulls the spine, including cervical vertebrae, out of proper alignment. This is why people who have worked years at jobs requiring bending over or stooping for hours at a time are permanently stooped. Work rules in many places with these kinds of jobs now require frequent breaks for stretching to relieve the spine of this strain. It may hurt to stretch, but it is necessary for the worker’s health. If possible, the height of work surfaces should be adjusted so the job does not require stooping.

Often, stooping is habitual. Those who do not work the jobs desribed above need to see how they are standing and consciously work to correct their posture.

          Sitting

Several occupational health experts have said that desk jobs are among the worst for neck and back pain. If you have to sit at a computer for hours at a time, your job could literally be a pain in the neck. Fortunately, tables and desks are available with adjustable heights. Most office chairs are also adjustable, as are many desktop computer monitors. Find the combination of chair position and desk height so you can work sitting straight. Other helps include foot rests. Changing the position of the legs frequently helps circulation, and with foot rests you can do this without ruining your spinal posture.

As to laptops, the screens are often too low for good neck posture. There are laptops on the market with screens that can be elevated when the device is open. There are also tablets which can be mounted at a beneficial height with an attached or wireless keyboard.

When a person is relaxed at home, it is easy to forget about maintaining good posture, especially when sitting. The temptation is to slouch in the couch or easy chair. That is hard on both the back and the neck. Maintaining good sitting posture is easier if it is a habit. Changing bad habits can be hard, so one has to constantly remind oneself to sit up straight until the habit is established.

Falling asleep while sitting is especially hazardous for the neck, especially if it falls to one side or the other or droops forward. This applies in the car as well as indoors or on the patio.

Health professionals offer two suggestions for preventing misalignment of the neck if sleeping while sitting. One is to lower the seat back to a reclining position, which puts gravity on your side with the headrest part of the seat back supporting the head when the neck relaxes. The other is to use neck pillows designed for sitting. These are usually shaped like a horseshoe or a dog bone. The curved ends hinder the head from falling or turning to the side.

          Sleeping in Bed

Sleeping in bed is another matter. Three key factors are the sleeping position, the mattress and the pillow. Neck pain is the result of the neck not being in a “neutral position” – laterally in line with the rest of the spine while maintaining normal front-to-back curvature. Since the body, including the neck, is relaxed, the sleeping position is the determining factor, influenced by the mattress and the pillow.

Sleeping on the back is naturally the best for the neck, as well as the rest of the spine. Generally, only a little lift for the head is needed to maintain the natural curve of the cervical vertebrae. How much is actually needed depends on the firmness of the mattress. For the back, the best is on the firm side of medium to medium firm (7-8 on a scale of 10). The rule is the heavier the sleeper, the firmer the mattress. As a little more firmness or extra height under the lumbar helps support the lower spine for many sleepers, so a little more support under the neck provides more comfort for many.

A memory foam mattress conforms to the body, cupping more under the larger/warmer parts and supporting areas between. This means that the shoulders and upper back will sink in more than the head, and the neck can still be supported. Even then, a not-too-thick pillow will provide more comfort. Pillows have been used for thousands of years to hold the head high enough while sleeping.

Some people sleep better on their sides. Sleep apnea is a major reason, since side sleeping helps the person to breathe better. In this case, the mattress needs to be a bit less firm so the hips and shoulders can sink in. The goal is for the spine and neck, as seen from the back, to be in a straight line (the “neutral position”). Even with the right mattress, more support is usually needed for the head. The pillow should be higher than the one for back sleeping. The less conforming the mattress is, the higher the pillow needs to be.

Some persons prefer sleeping on their stomachs. This is a special challenge for both the back and the neck. The lower back tends to sag, and the head is turned to the side for breathing. The best solution is usually a stomach pillow or a body pillow.

Treating Neck Pain

Treatment for neck pain is determined by the cause and the kind and extent of symptoms.

     For Tension

When neck pain is brought on by tension, the tension and its causes are addressed. This may consist of counseling or psychological therapy for dealing with stress. If this stress is self-afflicted through poor choices or bad habits, a life coach could be enlisted. A psychologist will try to counsel the sufferer on how to respond to external stress.

As to the symptoms, over-the-counter or prescription medications can relax the muscles to reduce the tension on the neck. Other medications can reduce the pain itself. Non-medicative treatments can include massaging neck muscles, chiropractic manipulation, and hot/cold therapy. Another option is nutritional therapy with vitamins, minerals and herbs (such as Melissa officinalis).

     For Arthritis, Osteoporosis and Rheumatism

There are medical programs for treating degenerative arthritis, osteoporosis, and rheumatism, and most persons with moderate-to-severe cases of these are getting professional treatment. Surgery can remove deposits in spinal stenosis, take out spurs, repair discs or fuse vertebrae. What can’t be done now may be possible in the future. Medications, nutrition, physical therapy and hot & cold compresses also play a role in treatment. Nutrition is especially important for restoring and maintaining mineral balance in the bone.

     For Infection

Anti-viral drugs and antibiotics are the first line of treatment for infectious diseases to stop the infection itself. Analgesic treatment, similar to what is outlined above, reduces neck discomfort during this time. After the infection is defeated, damage to neck tissues may need to be addressed.

     For Congenital Defects

Treatment of congenital defects in the neck depends on the specific nature of the defects. In some cases, surgery can re-shape some abnormalities. The deformities can change the shape of the “neutral position” for the person with a congenital malformation or misalignment, which in turn alters the specifications for the pillows or mattress.

     For Trauma

Many injuries to the spine, including the neck, are undiagnosed at first. These include soft tissue damage (especially to tendons and ligaments) and hidden fractures. This is why many doctors will prescribe splints, braces or collars to hold the joints in place just in case there are hidden injuries which may show later. For injuries which were not treated early, treatment of the resulting conditions may be needed later. Untreated trauma can lead to osteoarthritis, permanent misalignment, and spinal stenosis, all causes of chronic neck pain.

     For Posture

Exercise to build muscle tone and stretching to loosen joints can enable persons to maintain proper spinal posture. Braces for the back, shoulders and neck will hold the spine in place while the user is focused on activities. Nutrition plays a role here, keeping the user alert and maintaining electrolytes.

However, sleeping requires passive measures, since the person is relaxed and not in control of position or movement.  Whatever the sleeping position, the right mattress and pillow can help keep one’s neck in a “neutral position” while sleeping.

     How the Mattress and Pillow Can Help

As was explained in an earlier blog post Back Pain, Mattresses, and Cushions, mattresses play a role in treating back pain while sleeping. The same is true for neck pain. A good mattress will be both supportive and conforming, with the two most recommended types being (1) a pocket coil mattress with memory foam comfort layers or topper, and (2) a memory foam mattress, which is even better. There are also memory foam/latex hybrid mattresses (such as the Fibro-Pedic) especially designed for fibromyalgia, as well as mattresses for other conditions.

With neck pain, the pillow is more important, since it influences the position of the head and neck relative to the rest of the body. Three properties of the pillow are determinative: height, shape, and composition.

The wrong and right pillows for back and side sleepers
The wrong and right pillows for back and side sleepers
(from Pillow Sanctuary)

          Height

For back sleepers, the pillow should not be so high that it pushes the head into a forward position, and a neck pillow should not be high enough to let the head flop backwards. For side sleepers, the head pillow height ought to be about the distance from the ear to the end of the shoulder, and a neck roll equal to the distance from the neck to the end of the shoulder, minus the depth the shoulder sinks into the mattress. The goal in both cases is to keep the neck properly oriented to the rest of the spine.

For stomach sleepers, the head pillow can be thin and soft, just enough to cushion the head. The best recommendation is a body pillow high enough to let the head turn to the side without strain, and enough body under the abdomen to keep the back from sagging. One of the top-rated body pillows listed on Amazon is the Snuggle-Pedic Shredded Memory Foam Body Pillow.

          Shape

The shape of the pillow is an important consideration. As was mentioned in the blog article Snoring Solution: Look to the Pillow, a study reported in the Journal of Physical Therapy Science found that for side sleepers and back sleepers ,contoured pillows are better than those of a uniform height for treating snoring, sleep apnea, and neck pain. This means that the middle of the pillow is cupped for the head, and the front edge is raised slightly to support the neck. In getting a shaped solid foam pillow, the customer must pay attention to the relative heights of the head trough and the neck support.

As far as shape and height are concerned, shredded foam pillows are adjustable. Unlike some other loose fillings, such as feathers, down, cotton or polyester fibers, and wool, a shredded foam pillow will hold its shape once it has been adjusted to the needs of the user. It can also be re-shaped if needed. The best-rated pillows on Amazon are shredded foam, and the top one is the Snuggle-Pedic Bamboo Shredded Memory Foam Pillow, which is also the top pick by the authors of Pillow Sanctuary, who actually use it.

          Composition

There are several choices of filling for pillows. Many upholstery pillows are stuffed with polyester fiber or cut polyurethane foam. Older pillow fillings included cotton and hemp, even sawdust. Traditional bed pillows were filled with feathers and/or down, which are still used today, but down alternative has been gaining in popularity.

For the purpose of consistent neck support, foam in general is better than other pillow fillings. In the first place, it holds its shape. As mentioned above, even shredded foam holds its shape, though it is adjustable. The most popular foams are Talalay latex and memory foam. The advantage of latex is its resiliency, but memory foam has the advantage of conformity. This means that if solid memory foam is reasonably close to the desired shape and size, it will self-adjust to the user, a good choice for staying in one position most of the night. This reduces undue pressure on the head, which anyone who has tried to get to sleep with a headache can appreciate. The conformity will also cup the neck, holding it along two dimensions, front-to-back and side-to-side.

Conclusion

As with back pain, there are many causes for neck pain, and there are special treatments for chronic cervical pain, depending on the kind and cause. Whatever the cause, the mattress and the pillow play a key role in prevention and treatment. The constituent material with the greatest overall benefit is memory foam, followed by latex.


External References*

Healthline:  “Neck Pain” by Ann Pietrangelo, Medically Reviewed by Modern Weng, D.O. on June 28, 2016: http://www.healthline.com/health/neck-pain.

Web MD:  “What Causes Neck Pain?” – http://www.webmd.com/pain-management/guide/neck-shoulder#1.

______:  “Snuggle Up With the Perfect Pillow” By Colette Bouchez,: http://www.webmd.com/sleep-disorders/features/snuggle-up-with-the-perfect-pillow#1.

Medline Plus: “Neck pain” – https://medlineplus.gov/ency/article/003025.htm.

______:  “What causes neck pain?” – http://www.webmd.com/pain-management/guide/neck-shoulder#1.

______:  “Osteoarthritis” – https://medlineplus.gov/osteoarthritis.html.

______:  “Fibromyalgia” – https://medlineplus.gov/ency/article/000427.htm.

Arthritis Foundation:  “What is Rheumatoid Arthritis?” – http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php.

NCBI (NIH):  Abstract of “Neck injury and fibromyalgia– are they really associated?” by Tishler M, Levy O, Maslakov I, Bar-Chaim S, Amit-Vazina M. in Journal of Rheumatology: 2006 Jun; 33(6):1183-5. Epub 2006 May 1: https://www.ncbi.nlm.nih.gov/pubmed/16652434.

______:  “Severe Neck Pain with Fever: Is it Meningitis?” by Angela McCormick, MD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555598/.

______:  “Chronic neck pain and whiplash: A case-control study of the relationship between acute whiplash injuries and chronic neck pain” by Michael D Freeman, PhD DC MPH, Arthur C Croft, DC MPH MS, Annette M Rossignol, ScD, Christopher J Centeno, MD, and Whitney L Elkins, MPH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585479/.

Medscape:  “Congenital Malformations of the Neck” (Updated: Nov 05, 2015) by Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA, et al.: http://emedicine.medscape.com/article/837477-overview and https://www.jstage.jst.go.jp/article/jpts/26/3/26_jpts-2013-387/_pdf.

Pillow Sanctuary: “Best Pillow For Neck Pain – The 5 Top Choices That You Have” – http://pillowsanctuary.com/best-pillow-for-neck-pain-the-5-top-choices-that-you-have/.

*All references accessed Nov. 17-19, 2016.