Neck Pain

Neck pain is a common complaint and can be due to a variety of causes.  The cause of neck pain is not always clear because it can be associated with many other symptoms ranging from arm and shoulder pain to headaches.  The best way to determine the cause of neck pain and formulate an effective treatment plan is to start with a careful and through physical assessment from a musculoskeletal trained physician

Neck muscles can be strained from poor posture — whether it’s leaning into your computer at work or hunching over your workbench at home. Wear-and-tear caused by arthritis also is a common cause of neck pain. Rarely, chronic neck pain can be a symptom of a more serious problem and is normally a result of a more serious disease. Seek medical care if your neck pain is accompanied by numbness or loss of strength in your arms or hands or if you’re experiencing shooting pain into your shoulder or down your arm.

Causes of Neck Pain

Causes of neck pain can be caused by many different factors.   Three factors that frequently are associated with neck pain are the muscles of the neck and shoulder, the skeletal system and the nervous system.

Muscular neck pain is the most common type of neck pain and often results when a person performs an activity that requires more strength or more endurance than the muscles of the neck can provide.  Everyday activities including using a computer, driving or reading in bed can cause strain on the neck and neck pain.  Sometimes more acute injuries are to blame for the pain like in the case of car accidents and whiplash injuries.

When muscles are forced to contract harder or longer than they are able, then muscle spasms and inflammation can result.  One should not underestimate how much pain muscles can cause. Treating neck pain that is due to muscle first involves a careful physical exam that includes the neck, shoulders, arms and upper back as all of these areas can be effected.  Initial treatment of many neck pain conditions includes pain control with non-narcotic medications and then treatment of the cause of the muscle pain.  This frequently involves a combination of massage therapy and physical therapy to improve postural muscles and movement patterns that create pain.  On occasion, small trigger point injections are used to reduce pain and spasm so that a person can sleep more effectively.  Trigger point injections actually have lower risks then giving narcotic pain medications.

Bone and joint problems are a common cause of chronic neck pain.  Unfortunately, disorders of the bones and joints can be difficult to diagnose.  The first step in determining bone or joint related back pain is a careful physical examination. The causes of pain can range from trauma or arthritis of the small joints called facets, tears in the discs of the spine or fractures of the bones of the spine.  Frequently, x-rays or MRIs are used to assist in diagnosing the exact cause of pain.  Occasionally, carefully performed injections using x-ray guidance may be used to clarify the cause of pain if a physical exam and imaging are not enough.  These injections are frequently helpful in decreasing pain and allow other treatments to be more effective.  The mainstay of long term treatment and prevention of reoccurrence is to restore proper posture and strength to the neck and shoulder.  Sometimes injections or medications are required to reduce that pain so person move and sleep so they can participate in physical therapy.

Pinched nerves of the neck are often the most painful source of neck pain and require the more urgent attention. Pinched nerves can cause pain into the arm, numbness, weakness or all the above.   Very rarely, pinched nerves can cause bowel or bladder incontinence and this requires immediate evaluation by a medical provider.  It is a common belief that all pinched nerves require surgery.  However, the majority of pinched nerves can be treated without surgery.  If a pinched nerve only involves pain and numbness, physical therapy to reduce compression on the nerves combined with either steroid pills or steroid injections can be used to effectively manage a pinched nerve and support the body while it heals.  If there is weakness then this needed to be closely evaluated with repeat physical exams and potentially a study to evaluate the heath of the nerves called an EMG.  One can follow a pinched nerve with mild weakness for 2 to 3 months before a discussion about surgery is needed. A pinched nerve that causes weakness that is functionally impairing that does not improve with steroid injections, physical therapy or medications often require surgical consultation. Generally nerves can be compressed mildly for 2 to 3 months without permanent damage. After this time,  increased risk of permanent damage results.  It is often valuable to see a rehabilitation physician such as those at ROI first, to help diagnose and provide supportive treatments for a pinched nerve prior to referral to a surgeon. Most surgeons require at least some conservative management, that is, massage therapy, medication management, injections and physical therapy before even considering surgery for pinched nerve in the neck.


Our Clinic provides comprehensive diagnostic and treatment options for neck pain.  These include physicians to evaluate the cause of pain with physical exams, imaging review, EMG’s and injections.  Additionally, ROI has skilled providers from physical therapy, massage, acupuncture, and athletic training that work as a team to address your specific needs to improve your pain and restore your health and function.

Our Clinic provides an integrated approach to resolve your neck pain. We first confer with our specialist and then create a unique program specific to each patient for their neck pain. Contact us or call us for an appointment at 425-394-1200 to start you on a path to a pain free and healthier life.



 Neck Pain

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