Neck Pain / Cervicalgia
Neck pain is one of the most prevalent musculoskeletal complaints in adults, affecting approximately two-thirds of people at some point during their lives. The majority of neck pain is axial — meaning it arises from the soft tissues, discs, and joints of the cervical spine without significant nerve root or spinal cord involvement — and resolves with appropriate conservative care. At Maryland Orthopedic Specialists, we evaluate cervical pain thoroughly to identify its underlying source, distinguish it from more serious radiculopathy or myelopathy, and deliver effective non-operative treatment to restore comfort and function.
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What is neck pain / cervicalgia?
Axial neck pain (cervicalgia) refers to pain localized to the cervical spine, suboccipital region, or upper shoulder girdle that does not radiate into the arm in a dermatomal pattern. It is one of the most common conditions to see an orthopedic surgeon. This is generally treated conservatively.
Axial neck pain (cervicalgia) refers to pain localized to the cervical spine, suboccipital region, or upper shoulder girdle that does not radiate into the arm in a dermatomal pattern. It is distinguished from:
- Cervical radiculopathy: Nerve root compression producing arm pain, numbness, or weakness in a dermatomal distribution — requires additional evaluation and management
- Cervical myelopathy: Spinal cord compression producing bilateral hand clumsiness, gait disturbance, and hyperreflexia — a more serious condition requiring urgent evaluation
Common pain generators in axial neck pain:
- Muscular (myofascial) pain: The paraspinal muscles, upper trapezius, levator scapulae, and suboccipital muscles are frequent sources of neck pain. Prolonged sustained postures, stress, and deconditioning contribute to muscle tension and trigger point formation.
- Discogenic (cervical DDD) pain: Degeneration of cervical discs generates axial neck pain through annular nociceptors and associated inflammatory mediators, without necessarily producing radiculopathy.
- Facet joint (zygapophyseal joint) pain: Cervical facet joints — particularly C2–C3 through C5–C6 — are important pain generators, responsible for a significant proportion of axial cervical pain and virtually all chronic post-whiplash neck pain. Referral patterns from cervical facets extend to the occiput, posterior neck, and shoulder girdle.
Postural contributors: The modern epidemic of sustained cervical flexion — screen time, smartphone use ("text neck"), prolonged desk work — places repetitive biomechanical stress on cervical discs, ligaments, and muscles. For every inch of forward head posture, the effective weight on the cervical spine increases dramatically, accelerating degenerative changes and muscular overload.
Treatment options
Most neck pain improves within a few weeks with the right combination of activity modification, posture correction, and physical therapy.
Activity Modification and Posture
Reducing time in forward-head posture — desk work, phone use — and optimizing workstation ergonomics addresses the most common driver of chronic neck pain. A monitor positioned at eye level and hourly postural breaks make a meaningful difference over time. A rolled towel or cervical pillow supports the natural curve during sleep.
Physical Therapy
Cervical stabilization exercises strengthen the deep neck flexors and scapular muscles that support proper head position. Manual therapy and mobilization reduce stiffness and acute pain. Most patients see significant improvement within 6 to 8 weeks of structured PT.
Medications
NSAIDs reduce inflammation and are first-line for cervical disc or facet pain. Muscle relaxants help with acute cervical spasm.
Cervical Facet Injection
For patients with localized facet-mediated neck pain that hasn’t responded to therapy, a diagnostic medial branch block identifies the pain source. A positive response leads to radiofrequency ablation, which provides longer-lasting relief — typically 6 to 12 months.
Frequently Asked Questions
Is my neck pain serious?
What is cervicogenic headache?
Does "text neck" cause permanent damage?
Should I use a cervical pillow?
Can I exercise with neck pain?
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Related conditions
References
- Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. "The Global Spine Care Initiative: a summary of the evidence for prevention, assessment, and management of spinal disorders." European Spine Journal 2018;27(Suppl 6):861–868. https://doi.org/10.1007/s00586-018-5635-4
- Gross A, Kay TM, Paquin JP, et al. "Exercises for mechanical neck disorders." Cochrane Database of Systematic Reviews 2015;(1):CD004250. https://doi.org/10.1002/14651858.CD004250.pub5
- Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. "Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain." New England Journal of Medicine 1996;335(23):1721–1726. https://doi.org/10.1056/NEJM199612053352302
- Côté P, van der Velde G, Cassidy JD, et al. "The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders." Spine 2008;33(4 Suppl):S60–S74. https://doi.org/10.1097/BRS.0b013e3181643ee4
- Falla D, Jull G, Hodges PW. "Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test." Spine 2004;29(19):2108–2114. https://doi.org/10.1097/01.brs.0000141170.89317.0e
- OrthoInfo / AAOS. "Neck Pain." https://orthoinfo.aaos.org/en/diseases--conditions/neck-pain/