Axial neck pain—also called uncomplicated neck pain, whiplash, neck strain, or cervical strain—refers to pain along the posterior (back of the) neck. By definition, axial neck pain is pain that remains localized to the neck and immediate surrounding structures and does not involve dysfunction of the arms, hands, fingers, or other body regions.
How Common Is Axial Neck Pain?
Axial neck pain is very common, affecting approximately 10% of the population at any given time. Fortunately, the majority of these people do not have symptoms severe enough to limit their daily activity.
What Are the Symptoms of Axial Neck Pain?
Pain in the posterior neck is the primary symptom of axial neck pain. The pain can sometimes travel to the base of the skull, shoulder, or shoulder blade. Other symptoms include neck stiffness, headaches, and localized areas of muscle pain, warmth, or tingling.
What Are the Risk Factors for Developing Axial Neck Pain?
Poor posture, ergonomics, and neck muscle weakness can increase the risk of developing axial neck pain. Risk factors for developing chronic pain include: older age, pain that began as a result of trauma, having low back pain in addition to neck pain, headache, depression, severe neck pain, and pain interfering with sleep.
What Are the Causes of Axial Neck Pain?
There are a variety of anatomical structures that can cause axial neck pain. Injury to the muscles and ligaments supporting the skull and cervical spine is a common cause of pain and can be precipitated by poor posture, ergonomics, or trauma. As we age, degeneration and arthritis can affect the vertebral bodies, vertebral discs, or facet joints and cause neck pain. Shoulder arthritis or rotator cuff tears can mimic axial neck pain. Rarely, axial neck pain can be caused by dysfunction of the temporomandibular joint (joint that allows jaw movement) or blood vessels of the neck.
How Is Axial Neck Pain Diagnosed?
The physician may order an X-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) of the cervical spine to rule out infection, cancer, or fracture. These symptoms include prior trauma (e.g., fall, car accident), fever, weight loss, night sweats, and persistent night pain. Rheumatic causes of neck pain include morning stiffness that improves over the course of the day. If symptoms persist for more than six weeks, spine imaging may be warranted, particularly in patients that have had previous neck or spine surgery or if there is concern for cervical radiculopathy or myelopathy.
Differential Diagnosis:
- Muscular strains
- Arthritis
- Fractures
- Spinal cord
- Nerve injuries
- Neoplastic disorders
- Infections
- Inflammatory conditions
How Can Axial Neck Pain Be Prevented?
Keeping your neck muscles strong can help prevent the development of axial neck pain. Proper posture while sleeping includes sleeping on your back or side with a pillow that supports the natural contour of your neck. When using a computer, ensure that your eyes align with the top third of your screen. When reading, avoid extended periods of neck flexion (looking down) by keeping your arms supported in the arm rests and ensuring your glasses, if you use them, are pushed up on the bridge of your nose.
Non-invasive methods of treatment:
- Transcutaneous electrical nerve stimulation (TENS)
- Electromagnetic therapy
- Chiropractic manipulation
- Qigong
- Acupuncture
- Low-level laser therapy
- Cognitive-behavioral therapy
Physical Therapy Treatment:
Instrument-assisted soft tissue therapy uses special instruments to diagnose and treat muscle tension. Manual joint stretching and resistance techniques can help reduce neck pain and other symptoms. Therapeutic massage can help relax tense muscles. Trigger point therapy is used to relieve tight, painful points on a muscle. Inferential electrical stimulation uses a low frequency electrical current to stimulate neck muscles. Ultrasound sends sound waves into your muscle tissues to help stiffness and pain in your neck. Therapeutic exercises may also be recommended—these can help improve overall range of motion in your neck and prevent neck pain from progressing.
Acute Stage (less than 6 weeks):
Acute NP with mobility deficits can be managed in a variety of different ways. Recommended interventions include: thoracic manipulations, neck ROM exercises (such as movement through restricted range with increases in range to progress), scapulothoracic and UL and upper extremity strengthening, and cervical manipulation and/or mobilisation (such as AP glide of cervical spine).
Subacute Stage (6-12 weeks):
For subacute management of NP with mobility deficits the following has been advised: neck and shoulder girdle endurance exercises (e.g. chin tuck endurance exercises. With gravity, against gravity, etc.), thoracic manipulation, and cervical manipulation and/or cervical mobilisation.
Chronic Stage (more than 12 weeks):
Chronic NP with mobility deficits benefit more from a multimodal management technique, to include: thoracic manipulation and cervical manipulation or mobilisation; mixed exercises for cervical/scapulothoracic regions: neuromuscular exercise (e.g. coordination, proprioception, and postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements; or intermittent mechanical/manual traction.
Dry needling can also be used as an intervention. It has been shown to be effective in short-term and long-term follow-ups when measuring its effect on: pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability. Low-effect laser therapy can provide relief from chronic NP for 2-6 months, with no serious side effects or complications being reported.
Furthermore, patient education should be provided in order to recommend an active lifestyle and address cognitive and affective factors – e.g. help to arrange a suitable weekly activity schedule. Lastly, neck, shoulder girdle and trunk endurance exercises should be used – e.g. plank, side plank, shoulder shrugs, etc.
About Authors
Dr. Muhammad Mahmood Ahmad is a Spinal as well as an Orthopedic Surgeon with over 14 years of experience currently practicing at Razia Saeed Hospital, Multan.
