If you have chronic neck pain, you’ve likely heard many different reasons about why your neck hurts—from tight muscles, to bulging discs, to neck bones that aren’t aligned. What’s causing the pain is only half the battle. The other half is figuring out why it hurts. Unfortunately, 90 percent of the alternative or traditional medical care used to treat neck pain is solely based on getting rid of symptoms and can provide only short-term relief.

To understand what hurts in your neck, you need to understand its different parts. You have neck bones that stack on top of one another with discs between that act as spacers. Your spinal cord travels through a hole in these bones carrying electrical impulses from your brain. When all of the bones are stacked together, these holes create the spinal canal. There also are holes between each two stacked neck bones called foramina, and this is where the individual spinal nerves exit. There are small joints (about the size of those in your fingers) called facet joints that articulate in the back of the neck between each pair of stacked neck bones. Finally, there are ligaments that act as duct tape to hold the whole structure together. Muscles and fascia stabilize the neck and allow you to move your head.

The following parts of the neck can be injured or degenerate due to wear and tear, which in turn causes pain:

• disc spacers (intervertebral disc)
• spinal cord and nerves
• small joints (facet joints)
• muscles

The following protective systems in the neck also can fail, causing more damage to parts that can cause pain:

• ligaments and muscles that stabilize the neck bones
• natural curve and overall alignment of your neck
• fascial connections to the rest of the body

To summarize, there are structures in your neck that as they degenerate of if they become injured can cause pain (pain generators), and there are protective networks of muscles, ligaments, and fascia that can fail and lead to more damage to the structural parts. This duality between the simple structural pain generators and the more complex issue of how those parts got injured creates two different medical approaches to treating neck pain. The “pain generator” approach usually is favored by interventional spine physicians and spine surgeons. The focus is to identify the painful area with diagnostic numbing injections or an MRI. The second more complex approach is related to understanding the biomechanics of the neck and involves detecting the failure of the natural protective mechanisms. Regrettably, this second approach to treating neck pain is less commonly used by doctors.

The main reason a good number of patients with neck pain never get any long-term relief is that too much emphasis is placed on the first part of the equation, while there is a lack of understanding of the second part. Most doctors tend to overemphasize finding a magic pain generator and spend little or no time or resources figuring out the biomechanics of why the neck degenerated or become injured in the first place.

Doctors use injection or imaging techniques to try to locate pain generators. This means injecting parts of the neck that may hurt with numbing agents under sophisticated fluoroscopic guidance to find the one spot that’s causing most of the pain. Surgeons rely on MRI images to locate some structural problem on the image that will directly correlate with where the patient hurts. While the pain-generator approach can be helpful in some patients, relying too heavily on a neck MRI is a sure-fire way to misdiagnose patients. Study after study has shown that MRI findings in the spine often are meaningless. Many patients experiencing pain show nothing on their MRI, while other patients who have horrible MRIs experience no pain.

Both the injection-based way to find pain (called a diagnostic block) and relying solely on MRI have two problems. The concept is simple: If the “pain generator” is numbed and most of the patient’s pain disappears, you have a diagnosis. This is what happens when a doctor does facet injections in the neck to find the one or two joints causing pain. If the patient reports that most of his or her normal pain has become numb, then the doctor assumes that those joints are causing pain. Diagnosing with an MRI, anything that appears to look abnormal on the image is assumed to be causing the pain. While in theory these approaches make lots of sense, in reality they have two main problems.

Unfortunately, the pain-generator approach it doesn’t help to identify why the painful area failed, and this approach produces poor results when multiple parts break and are painful. Whatever the doctor does to “fix” the painful part doesn’t address the cause, so whatever originally caused the pain also will cause it to return. Think about your car for a second.If the tires are wearing too much because of a misaligned wheel, then replacing the tire is only a temporary fix. The tire will continue to wear. The same holds true for the body. Whatever can be done to help the pain in the broken and painful part will be a temporary fix if the cause of the pain isn’t addressed.

Another serious problem with the pain-generator approach is that it produces poor results in patients who have multiple causes for their pain. Doctors trained in this approach are taught to find one thing that’s causing most of the pain. While this works for some patients, in others, numbing one painful part of many doesn’t ever produce much relief. If the facet joints are causing pain and there’s also a pinched nerve in the neck, numbing just the joints still leaves the nerve causing pain. Or if the MRI shows a bulging disc pressing on a nerve, but the nerve and the facet joints hurt (an issue that’s invisible on MRI), then surgically removing the offending bulge only helps part of the pain.

While most specialists who treat neck pain today use the pain-generator approach, this treatment ignores the cause of why certain parts of the neck hurt. Following the pain-generator approach frequently leads a doctor to miss problems.

Understanding the biomechanics at work in the protective mechanisms of the neck and how their failure causes the component parts to degenerate or become injured can identify the cause of neck pain and point doctors in the right direction to fix it.

“What Causes Neck Pain?” first appeared as a post on the Regenexx blog.