Care Planning

Neck Injuries

Learn all about neck injuries, common causes, symptoms and how to prevent them.

Neck Anatomy

The Bones

When you are born, your spine is made up of 33 individual bones called vertebrae. As you mature into adulthood, the lower portions of your spine fuse together, leaving you with 24 different vertebrae when you are fully done growing and developing.

The 24 vertebrae that make up your spine are separated into 5 different regions:

  • Cervical vertebrae: 7 bones of your neck labeled C1-C7
  • Thoracic vertebrae: 12 bones of your upper and middle back labeled T1-T12
  • Lumbar vertebrae: 5 bones of your lower back labeled L1-L5
  • Sacrum: a triangular bone made up of 5 fused vertebrae
  • Coccyx: your tailbone made up of 4 fused vertebrae

Each vertebra of the spine connects with the vertebra above and the vertebra below to form a facet joint. Facet joints allow individual movements between the vertebrae of the spine. The combined movements of multiple vertebrae at multiple facet joints allow the entire cervical spine of the neck to move as one unit.

Motions of the neck include:

  • Flexion: bending your head down to bring your chin to your chest
  • Extension: extending your head backward to look up
  • Sidebending: bending your head to the side to the right and to the left to bring your ear closer to your shoulder
  • Rotation: turning your head to the right and to the left

Each vertebra contains several distinct features, which include:

  • Body: a large, round surface that allows the vertebrae to stack neatly on top of each other with spinal discs located in between
  • Vertebral foramen: a large hole located between the body and the other features of the vertebrae that forms the spinal canal when vertebrae are stacked on top of each other. The spinal cord runs up and down the length of the spine though the spinal canal.
  • Spinous process: a pointy ridge that extends back from each vertebra, forming the bumps that you can feel along your spine. The tips of the spinous processes of C3-C6 are split into a Y shape (bifid). 
  • Transverse processes: two pointy projections that extend out from the sides of each vertebra. The transverse processes of the cervical spine only contain transverse foramina, small holes that act as a passageway for the vertebral arteries. 
  • Laminae: connection points between the spinous and transverse processes
  • Pedicles: connection points between the transverse processes and body
  • Intervertebral foramina: small openings out from the right and left sides of vertebrae formed by the stacking of vertebrae on top of each other. Spinal nerve roots exit from the spinal cord through the intervertebral foramina at each spinal level from C1-L2.
  • Facets (articular processes): projections of bone that extend upward and downward from the laminae and connect with the facets from the vertebrae above and below to form facet joints

The vertebrae of the cervical spine of the neck are smaller than the other vertebrae of the spine. The neck also contains three unique vertebrae that have distinguishing features and individual names that set them apart from the other vertebrae of the spine. These include the:

  • Atlas (C1): the first cervical vertebra, which lacks a body and spinous process, that connects with the base of the skull to allow the head to move up and down
  • Axis (C2): the second cervical vertebra, which lacks a body, that connects with the atlas (C1) to allow the head to rotate via the dens (odontoid process), a vertical projection of bone that inserts upward into the opening of the atlas.There is no spinal disc between the atlas and axis
  • Vertebra Prominens (C7): the last cervical vertebra with a significantly larger spinous process that forms a large bump that can be felt at the back of the neck, marking the junction of the cervical and thoracic spine  

The Spinal Cord and Nerves

Your spinal cord is the main communication system between your brain and the rest of your body. Your spinal cord exits from the base of your skull and travels down your spine through the spinal canal formed from the openings in the middle of your vertebrae.

At each level of your cervical, thoracic, and lumbar spine, a pair of nerve roots branches off from your spinal cord and exits your spine through intervertebral foramina, small openings at the sides of the vertebrae. Each pair of nerve roots is named according to their corresponding vertebrae. 

  • The C1 nerve roots, for example, branch off from the spinal cord at the level of the C1 vertebra of the cervical spine of your neck.
  • The only exception is the C8 nerve roots, which are associated with the C7 vertebra along with the C7 nerve roots, as there is no C8 vertebra.

The spinal cord typically ends around the L2 vertebra. From here, the spinal cord forms the cauda equina, meaning “horse’s tail,” a ponytail-like bundle of nerves made up of nerve roots from L2 or L3 and below.

Bulging or herniated discs cause part of your discs to move into the openings where the spinal cord and/or nerve roots sit. When this happens, the nerves become compressed and cause symptoms like nerve pain, numbness, tingling, and muscle weakness. Traumatic injuries like falls, high impacts, and motor vehicle accidents can also cause significant damage to your neck, which can potentially injure your spinal cord and/or nerve roots.

The Cartilage

There are two types of cartilage in the spine:

  1. Articular Cartilage: a slippery lining that covers the ends of the facets. Facets of one vertebra connect with the facets of the vertebrae above and below to form facet joints that allow the vertebrae to move. Articular cartilage helps decrease friction between the facets and allows the spine to move smoothly as one unit through the movement of multiple facet joints. Over time and with age, this cartilage can start to wear away and lead to arthritis
  2. Spinal Discs: thick, round portions of tougher cartilage called spinal discs lay between the bodies of the vertebrae of the spine. Spinal discs help cushion the vertebrae and strengthen the ability of your spine to support your body weight and absorb shock. Each spinal disc is like a jelly doughnut, with a tougher outer ring (annulus fibrosus) and inner jelly-like substance (nucleus propulsus). When you have a herniated disc, the inner jelly-like substance of the disc breaks through and oozes out of the tougher outer layer.

The Ligaments

Ligaments are tough bands of connective tissue that connect bones together. The spine has three long, thick ligaments that run up and down the spine and connect the vertebrae together. These ligaments also provide stability and prevent the vertebrae from moving too much to avoid damaging the underlying spinal cord and nearby nerve roots. The three main ligaments of the spinal column include the::

  • Anterior Longitudinal Ligament: prevents excessive backward bending of the spine
  • Posterior Longitudinal Ligament: prevents excessive forward bending of the spine
  • Ligamentum Flavum: prevents excessive forward bending of the spine

In addition to the three main ligaments of the spine, the vertebrae also contain multiple smaller ligaments that provide additional support. 

  • The interspinous and supraspinous ligaments connect the vertebrae together through the spinous processes, the pointy ridges of the vertebrae that extend out from your spine. An extension of the supraspinous ligaments, called the ligamentum nuchae, connects the base of the skull to the seven cervical vertebrae of the neck.
  • The intertransverse ligaments connect the vertebrae together through the transverse processes, two bony projections that extend out from the sides of each vertebra. 
  • The apical, alar, and cruciform ligaments all connect the axis (C2) to the base of the skull.

Over time with aging, ligaments of your spine can weaken and thicken, which can limit the movement of your spine and compress nearby nerves. Thickening of the ligamentum flavum, in particular, is associated with spinal stenosis and resulting nerve compression.

The Muscles & Tendons

Tendons are tough bands of connective tissue that connect muscles to bones. Because the spine remains relatively stable throughout the day and does not move as much as other joints like those of the arms and legs, tendonitis, or inflammation of a tendon from overuse, typically does not affect any of the tendons of the spinal muscles. 

The entire length of the spine is supported by three vertical columns of muscles collectively referred to as either the erector spinae, spinal erectors, or paraspinals, meaning “next to the spine.” These muscles support keeping your spine upright and control side bending and backward bending of your spine. 

The three paraspinal muscles consist of the:

  • Spinalis: the innermost muscle layer
  • Longissimus: the middle muscle layer
  • Iliocostalis: the outermost muscle layer

The movement of each vertebra of your spine is also controlled by tiny muscles that connect one vertebra to another. These include the multifidi and rotatores, which both function to rotate the vertebrae. 

In addition to these muscles that connect throughout all the vertebrae and control the overall motion of the spine, the neck also has a variety of different muscles that solely control movement of the neck. These include:

  • Scalenes (anterior, middle, and posterior): three muscles on the sides of the neck that side bend and rotate the head
  • Sternocleidomastoid (SCM): a thick, long band of muscle that runs diagonally from the breastbone (sternum) and collarbone (clavicle) up to the base of the skull on each side of the head to side bend, rotate, and forward bend the head and neck
  • Suboccipitals: a group of four tiny muscles (rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, and obliquus capitis inferior) that connect the base of the skull to the atlas (C1) and axis (C2), causing rotation and forward and backward movement of the head
  • Trapezius (Traps): the main muscle of the neck and shoulders that shrugs the shoulders up and helps side bend, rotate, and extend the head and neck
  • Levator Scapulae: a muscle that runs from the vertebrae of the neck to the tops of the shoulder blades that moves the shoulder blades upward
  • Anterior neck muscles: four muscles (rectus capitis lateralis, rectus capitis anterior, longus capitis, and longus colli) located at the front of the neck that help stabilize the neck and bend the head forward
  • Posterior neck muscles: four muscles (splenius capitis, splenius cervicis, semispinalis capitis, semispinalis cervicis) located at the back of the neck that extend the head backward

Common Causes of Neck Pain

Neck pain can result from an injury or chronic stress to any of the structures within or surrounding the cervical spine. This includes damage or irritation to:

  • Bones: Trauma to the spine can cause a vertebral fracture. With advanced stages of osteoarthritis, bone on bone friction causes damage to the facets, causing the joints of the spine to become stiff and painful. 
  • Spinal Cord and Nerves: The spinal cord and branching spinal nerve roots can become damaged or irritated from injury to your spine or become compressed from factors like tight muscles and bulging or herniated discs. 
  • Cartilage: Cartilage lines the ends of the facets of the vertebrae and can be worn down over time with cervical osteoarthritis (cervical spondylosis). The spinal discs are also forms of cartilage that can wear out over time and become damaged from poor posture and lack of proper support from surrounding neck muscles.
  • Ligaments: Ligaments that support and hold the vertebrae together can become stressed with injury or wear out over time, causing spinal instability and contributing to spinal stenosis.
  • Muscles: Muscles that support your neck can be stressed and strained from poor posture, sleeping in a bad position, and motor vehicle accidents resulting in whiplash.
  • Neck Pain Symptoms
    Depending on the underlying cause of your neck pain, your symptoms may affect just your neck or may cause symptoms that travel into your arms and hands.
     
    In addition to pain, you may also experience other symptoms, such as:
    Joint stiffness
    Cracking, popping, or grinding sensations with neck movement
    Muscle spasm
    Muscle weakness
    Numbness or tingling into your shoulders, arms, and hands
    Burning, shooting, or pulling sensations down your shoulders and arms
    Difficulty moving your head in certain positions
    Difficulty holding your head upright when sitting or standing
    Comparing Neck Injuries
    The type of symptoms you experience as well as how your injury or symptoms occurred can help differentiate between different types of injuries and conditions.
     
    Osteoarthritis/Degenerative Disc Disease (DDD)/Cervical Spondylosis
    Cause: Degradation of cartilage and underlying bone that occurs over time from wear-and-tear, with increased risk with age, increased weight, prior neck injuries, and poor spinal alignment
    Symptoms:
    -Diffuse neck pain that develops gradually and worsens over time
    -Neck stiffness and decreased range of motion
    -Swelling around the affected vertebrae
    -Cracking or grinding sensations within the neck with movement
    -The feeling of increased pressure within the vertebrae, especially with changes in temperature and pressure
     
    Muscle Strain
    Cause: Injury or irritation to the muscles of the neck from poor posture, sleeping in a bad position, or motor vehicle accidents resulting in whiplash
    Symptoms:
    -Muscle pain in the neck and/or between the shoulder blades
    -Tenderness to the touch over the affected muscle
    -Increased pain with stretching of the affected muscle
    -Decreased neck range of motion 
    -Inability to move your neck in certain motions due to pain
    -Muscle weakness
    -Difficulty holding your head up when sitting or standing
     
    Spinal Stenosis
    Cause: Narrowing of the openings of the vertebrae, either the large opening in the middle of the vertebrae (central stenosis) or the smaller openings in the sides of the vertebrae (foraminal stenosis)
    Symptoms:
    -Neck pain
    -Radiating pain into the arms
    -Numbness and tingling into the shoulders, arms, and hands
    -Weakness in the arms and hands
    -Increased pain with extension of the neck
    -Decreased pain with forward bending of the neck
     
    Bulging or Herniated Disc
    Cause: Movement of a disc out of its normal alignment between the vertebrae, resulting in part of a disc that sticks out of the back of the spine (disc bulge) or the breaking and oozing out of the inner disc material (disc herniation)
    Symptoms:
    -Neck pain
    -Increased pain with prolonged forward bending of the neck
    -Decreased pain with extension of the neck
    -Radiating pain into the arms
    -Numbness and tingling into the shoulders,  arms, and hands
    -Weakness in the arms and hands
    -Joint stiffness
    -Decreased grip strength
    -Difficulty completing fine motor tasks
     
    Cervical Myelopathy or Radiculopathy
    Cause: Compression of the spinal cord (myelopathy) or cervical nerve roots (radiculopathy) from a bulging or herniated disc or tight muscles
    Symptoms:
    -Neck pain
    -Radiating pain into the arms and hands that is burning, shooting, or pulling
    -Numbness and tingling into the arms and hands
    -Weakness in the arms and hands
    -Decreased neck range of motion
    -Decreased grip strength
    -Difficulty completing fine motor tasks
     
    Spinal Infection or Tumor
    Cause: An infection caused by a virus or bacteria or tumor resulting from abnormal extra growth of cells, either benign (non-harmful) or malignant (cancerous)
    Symptoms:
    -Deep, aching spine pain that does not improve with rest
    -Fever, chills, and fatigue
    -Weight loss and loss of appetite
    -Radiating pain and/or weakness in the arms
    -Loss of sensation
    How to Diagnose Neck Pain
    The first step in determining a diagnosis for the underlying cause of your neck pain is through a comprehensive medical history. Your healthcare provider will ask you several questions about your neck pain to help figure out how and why it began. Questions that can help aid in the diagnosis of your neck pain include:
    Did the pain start all of the sudden (acute neck pain) or did it gradually build over time (chronic neck pain)? If the pain started all of the sudden, what were you doing when the pain started?
    If the pain has been increasing over time, how long have you been experiencing the pain and has it been getting worse over time?
    Where is the pain located? Is the pain specifically located at one spot or do you feel the pain travel into your arms?
    Does the pain limit your ability to move your head in different positions?
    Does your pain and/or other symptoms limit your ability to keep your head up when sitting or standing for long periods of time?
    Is it painful to complete daily activities, such as bathing, getting dressed, preparing meals, and driving?
    Does your pain get worse with either forward bending or backward bending of your neck?
    Do you have any other symptoms (fever, swelling, pain in other areas, signs of infection, etc)?
    What type of routine activity or exercise do you do?
    Do you have any other medical conditions?
     
    The second step in determining a diagnosis for the underlying cause of your neck pain is a physical exam. A good physical exam combined with a thorough medical history can sometimes be enough to determine a diagnosis for your neck pain without requiring diagnostic imaging like x-rays or MRIs. Symptoms of many neck conditions overlap, however, so diagnostic imaging may be needed if your symptoms do not improve after several weeks of conservative treatments like rest, physical therapy, pain medications, and heat or ice.
     
    Your healthcare provider will look and feel around your neck and examine your posture. During your physical exam, your healthcare provider will:
    Look for: swelling, redness, bruises
    Feel for: abnormal positioning of your spine, tenderness, stiffness
    Listen for: popping, cracking, or grinding sounds with neck movement
     
    Labwork 
    For many causes of neck pain, bloodwork is typically not needed as many neck conditions are mechanical in nature and result from physical stress or injury to muscles, ligaments, nerves, discs, cartilage, or bone. Some inflammatory autoimmune conditions that attack the joints, however, can cause pain, stiffness, and inflammation within your neck without an obvious cause of injury.
     
    If your healthcare provider suspects that your spine pain might be caused by a systemic condition such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or an infection based on your medical history and physical examination, you may have bloodwork taken to test for certain inflammatory markers associated with these conditions.
    Comparing Imaging Modalities (XRay, CT, MRI, Ultrasound)
    While a comprehensive medical history and physical exam may be enough to determine a diagnosis, diagnostic imaging methods are often used for traumatic injuries or chronic conditions to determine the extent of damage to your neck. These include
    X-Ray: a 2-dimensional imaging technique used to examine the bones of your neck to check for arthritis, spinal stenosis (narrowing of the openings of the vertebrae), or broken bones
    MRI (Magnetic Resonance Imaging): a 3-dimensional imaging technique used to examine the nerves and soft tissues of your neck including the muscles, tendons, ligaments, discs, and cartilage, for signs of inflammation and damage
    Ultrasound: an imaging technique used to check for fluid accumulation or changes to the structure of tendons and ligaments
    CT (Computed Tomography): an image produced by a series of x-rays taken at different angles to provide a more detailed image to check for broken bones, infections, and tumors
     
    Neck Injury Prevention
    Preventing neck injuries is crucial for maintaining a healthy cervical spine that will support you through all of your physical demands and activities and decrease the risk of developing arthritis as you age. Several factors come into play when it comes to neck injury prevention. These include:
    Limiting sedentary behavior and staying active and exercising regularly 
    Getting enough rest in between exercising to allow your body to recover and avoiding strenuous exercise when your neck is hurting
    Warming up your muscles and joints before working out
    Correcting muscle imbalances, especially through strengthening the muscles that control your shoulder blades, to support good spinal alignment and prevent increased stress at your neck
    Stretching tight muscles, especially your pecs and upper traps, which can affect your spinal alignment, to allow your joints to move in an unrestricted range of motion 
    Gradually building up your exercise intensity, duration, and frequency to decrease the risk of overuse injuries
    Using supportive pillows to maintain good alignment of your neck when you sleep
    Being mindful of maintaining good posture, especially when driving and sitting at a desk for long periods of time
    Limiting use of technology that requires looking down for extended periods of time, such as phones and tablets, to decrease strain at your neck
    Attending physical therapy sessions for “pre-habilitation”
Take the next step on your road to recovery.
Book an Appointment