Neck Pain

Why your neck hurts

Your cervical spine has a tough job. It balances a head that weighs 10 to 12 pounds atop seven small vertebrae, lets you look in every direction, and protects the spinal cord and the nerve roots that supply your arms and hands. It is the most mobile section of your spine, and mobility is always purchased with vulnerability.

Most neck pain isn't caused by one bad event. It accumulates — from sustained postures, work habits, stress carried in the shoulders, poor sleep, and how the rest of the spine is moving. The neck is a chronic over-worker: when the thoracic spine stiffens (and desk life stiffens it reliably), the neck supplies the rotation and extension the upper back stopped providing. It compensates beautifully, for years, until it doesn't.

The reassuring baseline: neck pain is extremely common — most adults will have a meaningful episode — and the overwhelming majority of it is mechanical, benign, and treatable. The job is sorting that majority from the exceptions quickly.

Common causes

Somatic dysfunction. The most frequent finding in the clinic: cervical segments that have lost their normal motion, with neighboring segments moving too much to make up the difference, and muscles tightening protectively around the whole arrangement. That guarding tension often becomes the loudest part of the pain. This pattern doesn't show on any scan, which is why "your MRI looks fine" and "my neck doesn't work" so often coexist.

Facet joint irritation. The small paired joints on the back of each vertebra handle rotation and extension. Irritated, they cause localized pain worse with looking up or turning, and they refer in recognizable patterns — to the base of the skull, the top of the shoulder, the shoulder blade. A great deal of "shoulder blade knot" is actually a cervical facet talking.

Myofascial pain. Trigger points in the upper trapezius, levator scapulae, and suboccipital muscles — the deskworker's trio. Real pain, referred over surprising distances, and usually a result of the joint and postural pattern underneath rather than a standalone problem, which is why massage alone helps and doesn't hold.

Cervical radiculopathy. A disc herniation or a narrowed exit foramen irritating a nerve root. The signature is arm symptoms that outrank the neck symptoms: pain, numbness, or tingling radiating below the elbow into specific fingers, sometimes weakness. Which fingers, which motions — that pattern usually names the level before any imaging does. Like its lumbar cousin, most cervical radiculopathy improves substantially without surgery over weeks to a few months.

Cervicogenic headache. Dysfunction in the upper cervical segments — C1 through C3 — refers pain up over the skull and behind the eye. If your headaches start at the base of the skull and travel forward, the neck deserves the first look. More in our headaches article.

Whiplash after a collision follows its own rules and timeline — covered in its own article.

What we're ruling out

A short list changes the urgency entirely. Cervical myelopathy — spinal cord compression, usually from age-related narrowing — announces itself not mainly with pain but with clumsy hands (buttons, handwriting), a changed unsteady gait, or electric sensations down the spine when bending the neck. It's progressive and it's surgical; it should never be waited out. Fever with severe neck stiffness, pain after significant trauma, a history of cancer, or arm weakness that's worsening likewise move the visit from "soon" to "now."

None of these are common. All of them are why persistent neck pain deserves an actual examination rather than an ergonomic pillow and hope.

How we approach it

The structural exam covers the cervical spine, the thoracic spine, the first ribs, the thoracic inlet, and the cranial base — because neck pain is rarely just the neck. If your first rib is stuck and your upper back is rigid, treating the cervical segments alone gives you a good afternoon and a bad next week; the pattern that produced the restriction reproduces it.

OMM is usually the first move: restoring motion where it's lost, unloading the segments working overtime, and calming the protective guarding that's amplifying everything. The neck responds to skilled manual treatment as well as any region we treat — and to be clear about method, this is precise, graded work; nothing about it requires forceful cracking, and patients who dislike cavitation techniques simply don't get them.

The neck's support system gets trained. Evidence for exercise in neck pain is strong and specific: deep cervical flexor work, scapular strengthening, and thoracic mobility, progressed over weeks. We build that program and we check it's actually happening.

Electrodiagnostics (EMG/NCS) when arm symptoms raise the nerve question — distinguishing a cervical root problem from carpal tunnel, ulnar entrapment, or thoracic outlet syndrome, which imitate each other constantly. Testing shows which nerve, where, how severely, and whether it's active or old news.

Imaging when it earns its place. Red flags, real trauma, progressive neurologic findings, or planning for an injection — those justify imaging. Routine neck pain does not, and cervical MRIs in adults over 40 nearly always show degenerative changes that would be there with or without pain. We read scans next to the exam, not instead of it.

Ultrasound-guided injections for the persistent minority — targeted to specific facets, nerve roots, or stubborn myofascial generators — as a bridge that lets treatment and training proceed, not as a subscription.

When to seek care

Come in if neck pain has lasted more than a couple of weeks, if it radiates into the arm or hand, if grip strength seems off, or if headaches keep starting at the base of your skull. Come in urgently for the myelopathy pattern — clumsy hands, unsteady walking — or for neck pain with fever, after real trauma, or with progressive weakness.

What you can do right now

Raise your screen to eye level and bring the keyboard close; hours of looking down is a load your neck counts even if you don't. Then interrupt the stillness — the best posture is the next posture, and a neck that moves every half hour ages better than one held perfectly still in textbook alignment.

Move your thoracic spine daily: seated rotations, extension over a foam roller, shoulder blade squeezes. Every degree the upper back contributes is a degree the neck doesn't have to.

Sleep on your side or back with a pillow that keeps the neck neutral — stomach sleeping holds the neck in end-range rotation for hours. And notice stress: jaw clenching and shoulder hiking are neck loads too, ones no workstation adjustment reaches.