By Dr Victoria Chambers (Osteopath)
It’s happened again! You’ve woken up and can’t move your neck. Maybe it came on slowly. You noticed your neck getting tighter over the last couple of weeks. You asked your partner for a shoulder rub and it felt better for an hour or so. Or maybe you were fine, but in the middle of the night you felt something sharp and then the pain gradually got worse. You took some medication and maybe it helped a little, maybe it got you back to sleep or maybe you lay awake, wondering what was going on.
Either way, now it’s morning, you’ve woken up and you cannot look left or right without turning your whole body and you have intense pain in your neck and shoulders.
Maybe you’ve had this before. Maybe it happens a couple of times a year, maybe more. Maybe this is the first time. Regardless, it can be scary and incredibly intense to experience.
In this blog, I’m going to cover some of the reasons this can occur, what could potentially be going on, some strategies to manage it in the moment and also some long term preventative measures. So take a seat, grab a heat pack and let’s talk about acute neck pain.
What’s causing the pain?
It’s important to say up top, that every person is different and while many people present with the symptoms and diagnoses discussed in this blog, it’s always important to seek help from a medical professional for any acute pain. This is particularly important if you have any accompanying symptoms, such as pins & needles, numbness or an intense and specifically located headache.
That being said, in many cases, there are two or three culprits which usually cause this kind of intense pain; facet joints, ribs & muscular spasm. The first two are the more likely suspects, but occasionally an intense muscular spasm can cause a similar sensation. I will discuss the first two in more detail.
Facet joints are the joints which are responsible for all of the movement in your spine. Each vertebrae in your spine has a top and a bottom bony process called a facet which articulates with the facet of the vertebrae above and below. They slide and glide over one another to create spinal motion.
These joints can be irritated, over-stretched, or even sprained, just like you can sprain an ankle, a finger or your wrist. The trouble is that your brain tends to react a little more to a sprain in your neck or elsewhere in your spinal column. A sprain in your neck is a sign of danger for your brain and so it often sends the muscles around the affected joint into spasm and sends down intense pain signals into the area. The muscle spasm in conjunction with the pain from the facet joint usually means a dull ache through the whole area at rest, and a sharp pain with most neck and sometimes shoulder movements.
The worst movements for sore facet joints tend to be rotating or side-bending to one side more than the other and extension or looking up towards the ceiling. That being said, when your brain is in protection mode, most movements cause quite a lot of pain.
“Ribs! That high!” This is what I most commonly hear from my patients when we’re talking about neck pain, but yes, it’s true – your first rib sits right at the base of your neck and rib dysfunction can affect movements in your neck.
Each rib is attached to its corresponding vertebrae via two joints; the costotransverse and costovertebral joints. In the same way that facet joints can irritated, overstretched or sprained, so too can these spinal-rib articulations.
When a rib is the culprit in your neck pain, you’ll usually feel quite a lot of pain at the deepest point of your inspiratory breath and pain may radiate down the inside of your shoulder blade. You may also have trouble lifting your arms up above your head because of referred pain in your neck and shoulder.
Why is this happening!
There are many varied reasons why these sprains & strains occur. It can be a gradual build up over time; long periods at a desk coupled with a stressful period or sleeping on an unsuitable pillow for an extended period of time could be some of the many reasons for this type of pain. On the opposite end of the spectrum, facet & rib joint pain also can tend to follow a quick jerking movements such as a quick head turn or a restless night with tossing & turning. This type of pain can also be associated with a history of whiplash or cervical spine trauma. For ribs specifically, in my clinical practice I have found that a period of lifting outside of someone’s normal habits (i.e. moving house), can be a precursor for rib pain.
If you are someone who experiences this pain repeatedly, talk to your healthcare professional about some of your habits, your work ergonomics, sleeping habits etc, because there may be some easy changes that you can make to help to prevent this pain from occurring again in the future.
What do I do now?
If you have never had this pain before and are unsure, you should of course, seek help from a medical professional. However, as a general rule, this type of pain responds well to gentle, controlled, small, (relatively) pain free movement and heat – meaning heat packs or a warm shower.
You may find that there are some movements that you cannot do i.e. looking over your left shoulder, but if you can turn your head a little to the right, then gently and slowly move in and out of that range and see if you can gain a little more movement as you continue to do the movement for 4-5 rotations. You can also test gently dropping your ear to you shoulder and dropping your chin to your chest to see how much movement you have. You may experience some discomfort, but as long as it is easily manageable, it is okay. You should stop if you experience any intense pain. Any quick movements will generally elicit pain, so try to avoid these as much as you can.
Try to avoid lifting anything heavy that may place strain on your neck. You should also resist the urge to hold yourself and your neck rigid. Despite it feeling like the best strategy, if you can try to work on relaxing your shoulders and neck, you will find that it will be better in the long run.
Another great strategy is using a spikey ball through your shoulders and back as per the two below videos. Work through each spot for 1-2 minutes with enough pressure to feel a release, but not so much as to cause major discomfort.
Upper trap release
You can also speak to your pharmacist about appropriate pain management.
Finally, seek treatment from your healthcare professional who may be able to help settle down some of the muscle spasm and provide pain relief. If in doubt, you can always call and ask to chat to someone about what you’re feeling. We’re always here to help!
Long-term preventative measures
As I mentioned earlier, one of the best ways to help to prevent this kind of episode is to look at some potential causative factors, such as your desk set up, your pillow/mattress, sleeping and postural habits.
Something else to consider is movement. Bodies love movement and we often do not do enough of it. Often we find that those who experience neck pain have other musculoskeletal imbalances in their body which could be contributing to their pain and discomfort. You may be stiff through your mid-back, or maybe you are someone who habitually elevates your shoulders when you’re stressed. We find that some of the best preventative measures for neck pain is exercise targeting specific strength and mobility work. For many of my patients, pilates or exercise physiology has proved to be extremely helpful in aiding in preventing their acute neck pain.
- Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration; Siobhan A. O’Leary, Nikolaos K. Paschos, Jarrett M. Link, Eric O. Klineberg, Jerry C. Hu, Kyriacos A. Athanasiou., Annual Review of Biomedical Engineering 2018 20:1, 145-170
- Gellhorn, A. C., Katz, J. N., & Suri, P. (2013, November 13). Osteoarthritis of the spine: The facet joints. Nature Reviews. Rheumatology, 9(4), 216–224. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012322/
- Kahn, S., Xu, R., Musculoskeletal Sports & Spine Disorders: A Comprehensive Guide., Springer, Feb 2018
- Christensen et al., 2017a, S.W. Christensen, R.P. Hirata, T. Graven?Nielsen, Altered pain sensitivity and axioscapular muscle activity in neck pain patients compared with healthy controls, Eur. J. Pain, 21 (2017), pp. 1763-1771
- Origin of neck pain and direction of movement influence dynamic cervical joint motion and pressure pain sensitivity., Qu, Ning et al.., Clinical Biomechanics, Volume 61, 120 – 128