A Pain in the Neck”: Understanding and Treating Neck Pain

Neck pain is such a common problem that it even has its own saying: calling a thorny issue “a pain in the neck.” Fortunately, we have solutions for it.

The first step is making an accurate diagnosis. While that may sound routine, it actually requires specialized skills that most physicians don’t possess. Neck pain generally falls into two main categories: pain caused by nerve compression and irritation, or mechanical pain. Mechanical pain is like a hinge that is rusty, stuck, or crooked. Determining which type you have requires a careful and specific interview by the doctor, along with a thorough physical exam to look for signs of nerve irritation, painful joints, or both.

Frequently, patients with mechanical joint pain also have mild scoliosis and poor posture, often with an excessive curve in the upper back. MRI and X-rays can help us further refine the diagnosis, but it’s important to understand that imaging alone rarely provides the full answer. The results must be interpreted within the context of your medical history and physical exam. This level of assessment isn’t possible during a video appointment.

The foundation of treatment is physical therapy tailored to the specific diagnosis. The goal of physical therapy is to balance the forces on the neck by optimizing posture through exercises, awareness training, and hands-on treatment to get all the moving parts working in harmony.

By the time patients reach us, they often require a procedure performed with a needle under X-ray guidance to relieve the pain. Physical therapy and exercises then aim to keep the pain away for the long term. Even in cases with seemingly severe findings on MRI, the majority of patients do very well with our nonoperative approach. Surgery is reserved for a small minority of patients who have nerve compression and don’t improve with our comprehensive program.

Here’s a tip for all those computer users out there: set your monitor close enough to your eyes so that leaning in any closer makes the screen blurry. Most people tend to slouch forward, so this simple adjustment can help you maintain better posture and avoid arching your head forward.