Pain from the neck may be local or referred. It may be felt in the head, yoke area, upper back, in the shoulder or shoulder blade area, upper arm, elbow, forearm, wrist, or hand.

This diffuse area of potential symptoms, is because, neck problems may send pain along any nerve that comes from the damaged area of the neck. They may also result in an error of perception in the brain, which interprets the pain to be in an area supplied by the nerve coming from that level of the neck, instead of allowing the pain to be felt in the place from which it comes.

For this reason, tennis elbow and carpal tunnel syndrome, among other symptoms may easily be misdiagnosed. So do not always expect neck problems to produce neck pain, and always be sure that you are seen by someone who is an expert in diagnosing, so that the cause and not the result of your symptoms is treated.

• Sharp catching pain with movement
• Sharp, or dull aching in the shoulder blade area
• Yoke, or upper trapezius area tightness, and spasm
• Pain early in the morning
• Pain at the end of the day
• Pain at night
• Pain which radiates down the arm, either one or both
• Pins and needles and or numbness in any part of the arm
• Weakness in any part of the arm

Sharp catching pain with movement: This is usually due to a sprained ligament, or to a piece of capsule (the "sock" around the joint) that has become stuck between the joint surfaces. It may also be due to a damaged annulus fibrosis (the outer casing of the disc, which lies between the vertebrae).

It is best treated with physiotherapy, which aims to open that joint and stimulate the circulation to that area, and promote healing of those tissues. You can help, by finding the position of comfort and keeping your head in that position, preferably resting, and applying heat, and anti-inflammatories. You may need a protective soft neck collar (on sale at the practice), but this must be carefully fitted for you. Do not keep doing the painful movement. If properly treated it should be better within a few days.

Sharp, or dull aching in the shoulder blade area: Usually due to a disc injury, in the front of the neck. Best treated with physiotherapy, and ergonomic adjustment, or position change at work. Strengthening of the muscles that improve the posture will be part of the long-term solution. Consult us for the ergonomic advice required to change your work place, as well as for the physio' and the exercises.

Yoke, or upper trapezius area tightness, and spasm: People often attribute this to stress, especially since it is often worse at stressful times. Stress does not, however cause it, but it does aggravate it. This may be due to a problem with the fourth vertebrae, or may be due to general neck joint problems which have led to the muscles needing to guard the joints, by going into spasm. This pain will not respond to massage, although it may produce temporary relief, the joint problem must be addressed if the symptom is to go. Therefore, physiotherapy, alteration of posture, and work space, avoiding carrying heavy handbags and things on the shoulders, and correct sleeping positions need to be used. Relieving stress is unlikely to either be possible, or to relieve the symptom.Heat will provide temporary relief.

Pain early in the morning: As with the lower back, this is often arthritis (wear and tear), especially if it is associated with morning stiffness. No one can cure arthritis, but we can alleviate the symptoms and teach you to do the same for yourself. With special movements, joint fluid production is stimulated, which feeds the cartilage and is excellent for arthritic joints.

This type of pain may also be due to a disc injury, because the disc is most full of water in the morning and is therefore under pressure at this time of the day. It may also be due to a facet joint structure (see earlier) which does not like being still for extended periods.

Treatment, may involve careful positioning; finding the most comfortable position, (e.g. lying on your side with a pillow under your hip). It is advisable to take short periods of rest only. Physio with a lot of mobilization, and possibly traction, will be the most effective treatment. Anti-inflammatories may help.

Pain at the end of the day: This is due to a structure that swells when it is overused. The swelling eases with rest at night, but with activity during the day it becomes increasingly inflamed and therefore sore. It is probably due to a soft tissue structure, which has been strained or sprained.

To self treat, find and do what is comfortable and feels good and then try to avoid what you know will hurt. When your body is damaged it tells you what it needs or does not want. Rest in a good position is helpful (e.g. with your legs bent up on a low table with your body on the floor). Heat in the form of a hot pack placed on the painful area of your neck or a hot shower, are also helpful. Physio and strengthening of the muscles, which protect the spine, will always be the best answer, and will provide a lasting cure.

Pain at night: This type of pain is divided into two types, that which wakes you as you turn, and that which wakes you because you need to turn. Any night pain (especially pain without movement) is a sign of serious pathology and must be investigated, by ourselves or some other back specialist. If it is pain with turning over, it is probably not too serious, it may be a swollen soft tissue structure, which pinches with movement. Pain without movement could however be bad inflammation, or something more serious like a fracture, a tumor, TB, or something equally sinister. So if you are experiencing pain which wakes you, do not panic, but get it checked out.

Pain which radiates down the arm, either one or both: This type of pain comes from something, which is either irritating the nerve, or squashing it. It is serious and should be investigated immediately to avoid it worsening, or resulting in permanent damage to the nerve. Something, which is seen early, will usually respond to physiotherapy, but something, which has been around for some time, will often not respond and may require surgery in order to heal. It may be a disc, or a swollen facet joint structure that causes this irritation to the nerve. The pain is measured by the distance it travels down the arm; something that causes shoulder pain is less severe than something that results in hand or entire arm pain. Remember, you may have pain in your arm, that you may not be aware is related to your neck, only an expert could assess that for you. Remember that treatment directed at the arm, elbow, or shoulder, will have no effect, if the pain is actually coming from the neck.

To treat this type of pain yourself is usually not possible, however any position that relieves the pain, or brings it back up the arm, is a good position. Rest always helps, as do anti-inflammatories, and heat. They will usually not cure, only relieve the symptoms, so do not waste time, trying to heal yourself. Avoid anything which cause the pain to move down the arm, or worsen, and rest in comfortable positions.

Pins and needles and or numbness in any part of the arm: This results from pressure on the sensory part of the nerve. It is a serious sign if it is causing these referred symptoms, as this means there is intense pressure on the nerve. The area of the symptom, determines which nerve is being squashed. To treat this symptom, consult us or some other back expert, immediately. Anti-inflammatories will also help, as will rest, but self-treatment is not an option.

Weakness in any part of the arm: This results from pressure on the motor component of the nerve (the part of the nerve, which supplies the muscles). It is a serious sign and may require surgery to free the nerve. It is essential that it is not ignored, as damage may quickly become permanent. Weakness that is not severe may also result from inhibition of muscles due to pain, or when the brain 'wants to avoid creating pain'. To treat the sign of weakness, consult us immediately.