Axial neck pain is also known as uncomplicated neck pain, whiplash, and cervical/neck strain. They refer to pain and discomfort running along the back or posterior of the neck. Axial is defined as forming or around an axis. This type of pain stays around the neck and immediate surrounding structures. It does not spread/radiate to the arms, hands, fingers, and other body areas. Axial neck pain differs from two other neck conditions. They are:

• Cervical radiculopathy
• Myelopathy

Cervical radiculopathy describes the nerve’s irritation or compression/pinching as it exits the spinal cord. The nerves of the cervical spine are known as the peripheral nerves. They are responsible for relaying signals to and from the brain to specific areas of the arms and hands. The signals that are sent from the brain are for muscle movement, while signals going to the brain are for sensation.

When one of these nerve/s gets irritated, inflamed, or injured, it can result in:

• Muscle pain
• Weakness
• Numbness
• Tingling sensation
• Burning pain
• Other types of abnormal sensations in the arms, hands, or fingers.

Cervical myelopathy describes compression of the spinal cord itself. The spinal cord is the information highway/pipeline to all body parts. There is a range of symptoms that can include:

• Same symptoms as cervical radiculopathy
• Balance problems
• Coordination problems
• Loss of fine motor skills
• Bowel and bladder incontinence

Axial neck pain

Axial neck pain is a quite common type of neck pain. It affects around 10% of the population. However, most of these cases do not involve severe symptoms that limit daily activity.

Symptoms

Pain in the back of the neck is the primary and most common symptom. Sometimes the pain travels to the base of the skull, shoulder, or shoulder blade. Other symptoms include:

• Neck stiffness
• Headaches
• Localized muscle pain
• Warmth
• Tingling

Developmental Risk factors

Poor posture, lack of ergonomics, and muscle weakness increase the chances of developing axial neck pain. Risk factors for development include:

• Age
• Trauma – Auto accident, sports, personal, work injury
• Headaches
• Depression
• Chronic neck pain
• Sleep problems

Diagnosis

A diagnosis is usually achieved based on symptoms and physical exam findings. A doctor typically orders an x-ray, CT, or MRI of the cervical spine. There could be severe symptoms indicating something more dangerous, causing pain like infection, cancer, or fracture. This calls for an immediate visit to a hospital/clinic for evaluation. These symptoms include:

• Prior trauma/injury from a fall, automobile accident, sports, or work injury
• Fever
• Weight loss
• Night sweats
• Constant night pain

Rheumatic conditions/diseases that cause neck pain include morning stiffness and immobility, which get better as the day progresses. Spine imaging could be recommended if symptoms continue for more than six weeks. Especially for individuals with previous neck or spine surgery or if it could be cervical radiculopathy or myelopathy.

Treatment

There is a wide range of treatment options. Surgery is rarely required except for severe cases. Returning to normal activities almost right away is one of the most important things to do to prevent the pain from becoming chronic. First-line treatments typically begin with:

• Physical therapy
• Chiropractic
• Stretching routine
• Strengthening exercises
• Acetaminophen
• Anti-inflammatory medication/s
• Muscle relaxants are sometimes prescribed

A neck brace could be recommended for short-term use if a cervical spine fracture has been diagnosed. A soft collar could be utilized if the pain is severe, but a doctor will usually discontinue use after three days. Other non-invasive treatment options include:

• TENS – transcutaneous electrical nerve stimulation
• Electromagnetic therapy
• Qigong
• Acupuncture
• Low-level laser therapy
• Cognitive-behavioral therapy

Invasive treatments like injections, nerve ablation, and surgery are rarely required. But if necessary, it can be beneficial for those cases.

Causes

A variety of the neck’s anatomical structures can contribute to the pain. Common causes include:

• Poor posture
• Age
• Degeneration
• Ergonomics
• Injury to muscles or ligaments
• Arthritis

All of these can affect vertebral bodies, discs, and facet joints. Shoulder arthritis or a rotator cuff tear can imitate axial neck pain. Dysfunction of the temporomandibular jaw joint or the neck blood vessels can cause axial pain, but it is rare.

Prognosis

Symptoms are usually alleviated within 4-6 weeks from when the pain started. Pain that continues beyond this should encourage a visit to a chiropractic physician.

Prevention

• Keep neck muscles strong with exercise.
• Stretch the neck regularly.
• A healthy diet specifically for bone support.
• Proper sleep posture, for example, on the back or side with a pillow that supports the neck’s natural curve.
• If on a computer for work or a long period, align the eyes with the top third of the screen.
• Avoid looking down when on the phone, reading, etc., for a long time by keeping the arms supported on an armrest.
• Glasses should be pushed up on the bridge of the nose; if they slide down, there is a tendency for the head to follow.
• Don’t forget to look up frequently.

Optimizing posture, ergonomics, and muscle strengthening can help prevent the onset of pain and help alleviate the symptoms.

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Treatment for Whiplash Injuries