Neck pain is often very confusing because the pain is frequently referred to distant areas. In addition to causing pain in the neck, a neck injury can cause pain in the upper back, chest, upper arm, forearm or hand. Even headaches and pain that is felt as far away as the inner side of the shoulder blade can also be caused by a problem in the neck.

When you have a pain in the neck, shoulder or upper arm area, first you have to establish if it is a neck or a shoulder injury. The way to know if it is a neck injury is to see if the pain comes on or gets worse when you move your head in certain directions, e.g. looking back over your shoulder, looking up at the ceiling, and so on. (pg 215) A person may also have a neck injury if the neck hurts after holding the head in certain positions for a long time; for example, typing, or holding a telephone between the shoulder and the ear. If, however, the pain is felt when moving the arm, for example, to throw something or lift something, the injury is most likely in the shoulder.

If you think this could get confusing, you're right. Neck and shoulder injuries are often confused with one another. Unfortunately, it's common to have both a neck and a shoulder injury at the same time, both creating a very similar pain in your body. To get rid of the pain it is important to discover if the injury is coming from the neck or the shoulder or both. Treatment will be more likely to succeed if it is precisely identified first. To clear away some of the confusion let's take a close look at the relevant anatomy.

The Anatomy of the Neck

There are seven neck (cervical) vertebrae. If you put your fingers on one of those bony bumps on the lower part of your neck, you are touching the end of a longish protruding bone, called a spinous process (A). Transverse processes are similar extensions of bone going out on each side (B). You cannot feel the transverse processes as readily with your fingers because they are more deeply imbedded in your neck. There are thousands of ligament fibers that run between these extensions of bone to give the spine its strength and stability. The supraspinous (C), interspinous(D), and intertransverse (E), ligaments span these bony prominences. In my experience injuries to these three ligaments are the source of most neck pain which is recurrent and/or long standing.

Between the main bodies (F), of the vertebrae lie the shock-absorbing spongy discs (G). The discs in the neck are thicker than those in the midback. This extra cushioning is needed because the neck is capable of more varied movement and is therefore more vulnerable to injury. A disc is made of fibro-cartilage and has no feeling; when it is injured it does not cause pain directly. Only when the disc presses on a nerve or some other structure is there pain, numbness, weakness or tingling sensations. The nerves exit through small holes between each of the vertebrae and keep branching out through the body.

The muscles in the back of the neck allow you to look up at the ceiling or kiss somebody taller than you. The ones on the sides of the neck help you to tilt and turn your head, and ones in the front help you bend the head forward. The primary function of the neck muscles are to help you to balance the head on top of your spine. The neck muscles aren't usually very strong because they don't have to be, except, of course, if you are a wrestler, boxer or football player.

Although people often think neck pain comes from strained or sore muscles in the neck, more often neck pain is caused by problems with ligaments, joints, discs and nerves. If you have pain when turning your neck into any of these positions (pg 215) you have a problem in your neck.

© copyright Ben Benjamin 2001