Understanding Chronic and Recurrent Neck Pain: Causes, Treatment, and Management
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 6, 2024
Chronic and recurrent neck pain are common issues affecting many individuals. Chronic neck pain lasts for more than three months, while recurrent neck pain involves repeated episodes over time. About 30% of adults experience neck pain each year. This condition can disrupt daily life, work, and overall well-being.
This article will define chronic and recurrent neck pain, discuss their prevalence and impact, and provide an overview of their characteristics.
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Definition of chronic and recurrent neck pain
Chronic neck pain
Pain lasting longer than three months, often due to ongoing issues such as poor posture or degenerative changes.
Recurrent neck pain
Pain that occurs in repeated episodes, typically triggered by specific activities or stress.
Comparison with acute neck pain
Acute neck pain is short-term and usually resolves within a few weeks, whereas chronic and recurrent pain persists or recurs over a longer period, creating a cyclical pattern.
Causes of chronic neck pain
Chronic neck pain can result from various factors, including degenerative conditions, muscular issues, nerve-related problems, poor posture, and psychological factors.
Degenerative conditions
Osteoarthritis: This condition involves the wear and tear of the neck joints, leading to pain and stiffness.
Cervical spondylosis: Age-related changes in the neck vertebrae and discs cause this condition, resulting in chronic neck pain.
Muscular issues
Myofascial pain syndrome: This syndrome involves trigger points in the neck muscles, causing pain and discomfort.
Muscle imbalances and weakness: Imbalances or weaknesses in the neck muscles can contribute to chronic pain.
Nerve-related problems
Cervical radiculopathy: This condition is caused by pinched nerves in the neck, leading to pain radiating into the shoulders and arms.
Cervical myelopathy: Spinal cord compression in the neck can result in chronic pain and other neurological symptoms.
Poor posture and ergonomics
"Text neck" syndrome: This modern condition arises from prolonged use of mobile devices, causing strain on the neck.
Workplace ergonomic issues: Poor ergonomics at work, such as improper desk setup, can lead to chronic neck pain.
Psychological factors
Stress and its physical manifestations: Chronic stress can cause muscle tension and contribute to ongoing neck pain.
Anxiety and depression: These mental health conditions can play a significant role in the experience and persistence of chronic pain.
Signs and symptoms of chronic neck pain
Chronic neck pain can significantly affect daily life with various signs and symptoms:
Pain characteristics
Location: Typically affects the base of the skull, sides of the neck, or upper shoulders.
Intensity: Varies from mild to severe, often described as dull, sharp, or burning.
Duration and patterns: Pain may be constant or intermittent, with some experiencing ongoing discomfort and others having periodic flare-ups.
Associated symptoms
Headaches: Often tension-type headaches originating from the neck.
Arm pain, numbness, or tingling: May occur due to nerve compression.
Stiffness and reduced range of motion: Limits neck movement and flexibility.
Impact on daily activities
Sleep disturbances: Difficulty falling or staying asleep.
Work performance issues: Impaired ability to perform tasks, especially those requiring prolonged neck use.
Limitations in recreational activities: Reduced participation in physical activities and hobbies due to pain and stiffness.
Risk factors of chronic neck pain
Several risk factors contribute to the development of chronic neck pain:
Age-related changes
Cervical spine changes: As people age, degenerative changes such as osteoarthritis and cervical spondylosis can increase the risk of chronic neck pain.
Gender differences
Prevalence: Studies show that women are more likely to experience chronic neck pain compared to men, though the reasons for this disparity are not fully understood.
Occupational hazards
Desk jobs and computer use: Prolonged sitting and poor posture associated with desk jobs can strain the neck.
Manual labour and repetitive motions: Jobs involving heavy lifting or repetitive neck movements increase the risk of neck pain.
Previous neck injuries
Whiplash: Previous injuries such as whiplash can contribute to the development of chronic neck pain.
Lifestyle factors
Sedentary behaviour: Lack of physical activity can weaken neck muscles and contribute to poor neck health.
Smoking: Smoking negatively impacts disc health and healing, increasing the risk of chronic neck pain.
Diagnosis of chronic neck pain
Diagnosing chronic neck pain involves a thorough assessment to identify the underlying causes and guide treatment.
Comprehensive physical examination
Range of motion tests: Evaluates the extent of neck movement and identifies limitations.
Palpation for tender points: Detects areas of tenderness and muscle stiffness.
Neurological assessment: Checks for signs of nerve involvement, such as reflex changes or sensory deficits.
Imaging studies
X-ray: Used to assess bone alignment, detect arthritis, and identify other structural issues.
MRI: Provides detailed imaging of soft tissues, including discs, nerves, and the spinal cord, to detect herniations, bulges, or other abnormalities.
CT scan: May be used when more detailed imaging is needed or when MRI is not available.
Additional tests
EMG: Electromyography tests for nerve-related issues by measuring electrical activity in muscles.
Blood tests: Help rule out systemic conditions such as infections or inflammatory diseases that could contribute to neck pain.
Prevention strategies for chronic neck pain
Preventing chronic neck pain involves a combination of posture improvement, ergonomic adjustments, regular exercise, and stress management.
Posture improvement techniques
Proper sitting and standing postures: Maintain an upright posture with shoulders back and neck aligned with the spine.
Neck positioning during sleep: Use a supportive pillow that keeps the neck in a neutral position to avoid strain.
Ergonomic adjustments
Workstation setup tips: Ensure your desk, chair, and computer are arranged to support good posture. The monitor should be at eye level, and your chair should support your lower back.
Proper use of mobile devices: Hold devices at eye level to reduce strain on the neck. Avoid looking down for prolonged periods.
Regular exercise and stretching
Neck-specific exercises: Incorporate exercises that strengthen neck muscles and improve flexibility.
Overall fitness importance for neck health: Regular physical activity supports overall muscle strength and endurance, reducing the risk of neck pain.
Stress management
Relaxation techniques: Practice deep breathing, progressive muscle relaxation, or other methods to reduce muscle tension.
Mindfulness and meditation practices: Engage in mindfulness and meditation to manage stress and its impact on physical health.
Treatment options for chronic neck pain
Managing chronic neck pain often involves a combination of conservative approaches, alternative therapies, interventional procedures, and, in some cases, surgery.
Conservative approaches
Pain management techniques:
Ice/Heat Therapy: Applying ice can reduce inflammation, while heat therapy can alleviate muscle tension and improve blood flow.
TENS: Transcutaneous Electrical Nerve Stimulation (TENS) uses electrical impulses to help manage pain.
Medications:
NSAIDs: Nonsteroidal anti-inflammatory drugs reduce pain and inflammation.
Muscle Relaxants: Help relieve muscle spasms and tension.
Pain Modulators: Medications like antidepressants or anticonvulsants can be used to manage chronic pain.
Physical therapy:
Covered in Detail in Section 9: Physical therapy is a key component, focusing on exercises and techniques to improve strength, flexibility, and posture.
Alternative therapies
Acupuncture: Involves inserting fine needles into specific points on the body to alleviate pain. Its effectiveness varies, but many find it helpful for managing chronic pain.
Massage therapy:
Types Beneficial for Neck Pain: Techniques such as deep tissue massage or myofascial release can help reduce muscle tension and improve circulation.
Interventional procedures
Types of injections:
Epidural injections: Administered into the epidural space around the spinal cord to relieve pain.
Facet joint injections: Target the facet joints in the spine to reduce inflammation and pain.
Radiofrequency ablation: Uses radio waves to generate heat and disrupt nerve activity responsible for chronic pain, particularly effective for facet joint pain.
Surgical options
When surgery is considered: Surgery is typically a last resort when conservative treatments and interventional procedures fail to provide relief or when there is significant structural damage.
Types of surgeries for chronic neck pain:
Discectomy: Removal of a herniated disc causing nerve compression.
Spinal fusion: Joining two or more vertebrae to stabilize the spine.
Laminectomy: Removal of part of the vertebra to relieve pressure on the spinal cord or nerves.
Physiotherapy's effectiveness for chronic neck pain
Physiotherapy is a highly effective approach for managing chronic neck pain, offering multiple benefits and utilizing a range of techniques.
Benefits of physiotherapy
Pain reduction: Physiotherapy helps decrease pain through various methods, including manual therapy and pain modulation techniques.
Improved mobility and function: Physiotherapy aims to restore neck movement and function, enhancing daily activities and quality of life.
Long-Term management strategies: It provides strategies for ongoing management, helping prevent future pain and maintain neck health.
Specific techniques used
Manual therapy:
Joint mobilisation: Improves joint function and reduces pain by gently moving the joints.
Soft tissue work: Targets muscles and connective tissues to alleviate tension and improve flexibility.
Therapeutic exercises and stretches: Strengthening and stretching exercises improve muscle support and flexibility, reducing pain and enhancing mobility.
Postural retraining: Helps correct poor posture, which can contribute to chronic neck pain.
Pain modulation techniques:
TENS: Uses electrical impulses to manage pain.
Dry needling: Involves inserting thin needles into muscle trigger points to reduce pain and improve muscle function.
Expected outcomes and treatment duration
A typical course of physiotherapy: Treatment usually involves a series of sessions over several weeks to months, depending on the severity of the condition and individual progress.
Factors affecting treatment success: Success depends on factors like the specific cause of pain, patient adherence to exercises, and the physiotherapist’s expertise.
Research supporting physiotherapy
Overview of Key Studies: Research supports the effectiveness of physiotherapy for chronic neck pain. Studies have shown that physiotherapy can significantly reduce pain, improve function, and prevent future episodes. For example, systematic reviews and clinical trials have demonstrated the benefits of manual therapy and therapeutic exercises in managing chronic neck pain.
These findings underscore the value of incorporating physiotherapy into treatment plans for chronic neck pain, offering a structured approach to alleviate symptoms and improve quality of life.
Self-management strategies
Managing chronic neck pain effectively involves a combination of home exercises, pain coping techniques, and lifestyle modifications.
Home exercises and stretches
Specific exercises with clear instructions: Incorporate exercises that target neck muscles, such as neck tilts, rotations, and stretches. For example:
Neck tilt: Gently tilt your head toward one shoulder, hold for 15-30 seconds, then switch sides.
Neck rotation: Slowly turn your head to one side until you feel a stretch, hold for 15-30 seconds, then switch sides.
Frequency and progression: Aim to perform these exercises daily. Start with 2-3 sets of 10-15 repetitions, gradually increasing intensity as tolerated.
Pain coping techniques
Cognitive-behavioral strategies: Use techniques such as mindfulness and relaxation exercises to manage pain perception and reduce stress.
Pacing activities: Break tasks into manageable segments and take breaks to prevent overexertion and pain flare-ups.
Lifestyle modifications
Sleep hygiene tips: Ensure a supportive pillow and maintain a neutral neck position while sleeping. Aim for consistent sleep patterns and a comfortable sleep environment.
Nutritional considerations for pain management: Maintain a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, to support overall health and potentially reduce pain.
When to seek professional help
Red flags and warning signs
Severe or worsening pain: If pain becomes intense or increases despite self-management efforts.
Neurological symptoms: Such as weakness, numbness, or tingling in the arms or legs.
Signs of systemic illness: Unexplained weight loss, fever, or other symptoms indicating a more serious condition.
Importance of ongoing management
Regular check-ups with a healthcare provider can help monitor progress, adjust treatment plans, and prevent exacerbations.
Conclusion
Chronic and recurrent neck pain can significantly impact daily life, but effective management is possible with a multidisciplinary approach. Key points include:
The importance of combining self-management strategies with professional care.
The value of physiotherapy in providing personalized treatment and improving outcomes.
Proactive management and prevention strategies are crucial for maintaining neck health.
For personalized care and effective management of chronic neck pain, consult a physiotherapist who can provide a tailored treatment plan to meet your specific needs.
References:
Carroll, L. J., Hogg-Johnson, S., Côté, P., Van der Velde, G., Holm, L. W., Carragee, E. J., ... & Peloso, P. M. (2008). Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33(4S), S93-S100.
Cohen, S. P. (2015). Epidemiology, diagnosis, and treatment of neck pain. Mayo Clinic Proceedings, 90(2), 284-299.
Hoy, D. G., Protani, M., De, R., & Buchbinder, R. (2014). The epidemiology of neck pain. Best Practice & Research Clinical Rheumatology, 24(6), 783-792.
Related links:
Understanding Neck Pain and Conditions: Causes, Types, and Effective Treatments
Acute Neck Pain: Causes, Signs, and Effective Treatment Options
Understanding Neck-Related (Cervicogenic) Headaches: Causes, Symptoms, and Effective Treatments
Cervical Radiculopathy: Understanding Pinched Nerves in the Neck
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.