Author: Dr. Simranjeet Singh
Consultant Neurosurgeon 
ARHI Hospital

Neck pain is a very common symptom with which patients present to Neurosurgery OPD and what is alarming is probably the increasing number of young adults who are presenting with this symptom.

The cause of neck pain can range from simple ones like poor work or sleep posture to a muscular sprain/strain, to age related degenerative changes, to more complex problems like an underlying pathology like a significant injury or a spinal tumour / infection. 

The type of pain may also vary from neck pain or neck stiffness with painful restriction of neck movement to neck pain associated with pain radiating / shooting down the upper limbs, to neck pain accompanied with headache or less commonly with more serious symptoms like weakness in the upper or lower limbs. 

In young adults and in students, the most common cause of neck pain is usually related to poor posture, prolonged sitting, poor work ergonomics, lack of regular exercise, and maybe unhealthy diets. Travelling on bad roads can also put significant strain on the neck, which can be further worsened by carrying weight on the shoulders( eg a backpack). Simple measures like ensuring proper support for the back when seated, with a minus type desk, with provision for supporting the palms and the elbow and ensuring frequent breaks, avoiding prolonged sitting; coupled with regular stretching exercises can prevent / cure most of these types of neck pain. Avoiding bad roads when possible, and especially avoiding carrying weight on the shoulders when travelling will also help.

However, if the pain is not improving, lasting weeks rather than a few days or is severe/worsening, then expert advise is warranted. Medical review is also warranted if the pain is associated with any of the danger symptoms like radiation down the arms or a weakness in the limbs or an area of sensory loss.  If there is a past history of trauma, then too medical evaluation is warranted. 

In the elderly, neck pain is more likely to be associated with underlying degenerative changes in the spine. If simple procedures like improvement of work and sleep posture, avoiding activities which may be putting too much strain on the neck fail to bring relief; or if the pain is too severe or associated with any of the red flag signs as mentioned above, then seeking expert medical opinion is warranted. 

Pain in neck which appears after an injury, eg if a car or bike has been rear ended / hit from behind, should definitely be taken seriously, as it may be associated with a significant underlying injury/spinal instability and expert medical assistance/treatment should be urgently sought.

In the elderly, trivial trauma, like a ground level fall can also lead to significant injury. Cervical spine fractures may be seen in elderly patients who come with complaint of neck pain after a seemingly trivial fall. 

Remote trauma, in adults, may be a cause of accelerated degeneration of the cervical spine, causing them to present later with prolapsed cervical disc leading to signs of nerve impingement ( patient presents with pain shooting down the upper limbs or an electric shock like sensation on moving the head). 

Spinal tumours are relatively rare and may present with symptoms which range from only neck pain to neck pain associated with pain shooting down the upper limbs; though the more characteristic finding would be weakness in the hands and legs, and sometimes even loss of bowel and bladder control.

So though most of the common causes of neck pain may be simple and easy to treat, the red flag signs should not be missed and these should alert us to seek expert medical advise. 

Good posture, regular exercise, and a healthy diet can prevent a large majority of cases of chronic neck pain.