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The Guide to Neck Pain

Have you ever suffered from neck pain?

Perhaps you woke one morning with a “crick” in your neck, or you’ve been diagnosed with “whiplash” after an accident. Maybe you’ve experienced numbness and tingling in your arms or hands and been told that this is coming from your neck. If these situations sound familiar, then this guide is for you. We will aim to provide clarity about neck pain as well as a practical path forward.

Neck pain is defined as having pain symptoms for at least 24 hours in the cervical spine region, which includes the first 7 bones in the neck known as the C1-C7 vertebrae. Neck pain may also include symptoms that radiate into the arms. Millions of individuals worldwide experience neck pain each year. A recent review found 288 million cases of neck pain worldwide, ranking it in the top 25 leading causes of global disability. Kim 2018 GBD 2019 Safiri 2020 Men between the ages of 45-49 and women between 45-54 experience the highest burden from neck pain (see figure 1). Safiri 2020

While many people assume that neck pain implies that something is wrong with the structure of their neck, it turns out that there are lots of other factors that can influence the experience of neck pain. This is actually good news, since it means that we have lots of things we can work on when experiencing neck pain. In the following sections we will discuss some of these factors that increase or decrease the risk of developing neck pain.

What factors relate to the onset and recurrence of neck pain?

“Risk factors” are variables that can influence the development of a condition like neck pain. There are two main categories of risk factors:

  1. modifiable – variables that we can influence, such as obesity, physical activity, nutrition, and smoking. These often represent targets we can work to improve.

  2. non-modifiable – variables that we cannot influence, such as age or a prior history of neck pain. These are things that we can’t do anything about

Risk factors that influence the development or recurrence of neck pain can be divided into three general categories: physical, individual, and psycho-social factors. Kim 2017 A discussion of these risk factors can direct our efforts when managing neck pain.

In the following sections we will use numbers to describe the strength of relationship between a given variable and neck pain. A value of 1.0 indicates no relationship between a variable and neck pain, a value less than 1.0 indicates that the variable is associated with a LOWER risk of neck pain (i.e., “protective factor”), and a value greater than 1.0 indicates that the variable is associated with a HIGHER risk of neck pain (i.e., “risk factor”). See table 1 for a summary of these concepts. We will focus on the most influential factors here, although many other variables have been studied as well.

Individual Risk Factors

Individual factors describe things specific to a person that relate to the risk of neck pain. A major contributor to the risk of neck pain in this category is Body Mass Index (BMI). Body mass index is a measure of body size that can be a useful screening tool for overweight and obesity. You can calculate your BMI HERE.

High BMI (> 30 kg/m2) is associated with 2.21 times higher odds of experiencing neck pain, indicating that obesity has a strong relationship with neck pain. Since BMI is a modifiable risk factor, we can focus some attention on this area for aiding the management of neck pain.

Other individual risk factors with moderate-strength relationships include variables that are likely not as tangible for influence such as marital status, family size, and socioeconomic level (see table 2).

Physical Risk Factors

Physical risk factors describe variables specific to the person's body and the demands placed upon it. Factors with moderate influence on the risk of neck pain include workspace setup and demands. For example, not having the ability to adjust sitting positions at work (1.80 times higher odds) and working in sustained or “awkward” positions (1.6 times higher odds) are associated with neck pain. In the research, "awkward" was defined using a questionnaire with questions relating to:

  1. Working with hands above shoulder level

  2. Lifting greater than 25 kg

  3. Using force with arms or hands

  4. Bending or turning the torso frequently per hour

  5. Working in uncomfortable positions

  6. Prolonged work in the same position of the body

  7. Repetitive movements with arms or hands frequently per hour Luime 2004

Researchers combined bending or turning the torso frequently per hour and working in uncomfortable postures to define "awkward postures”. The use of “awkward” to describe a posture is subjective and may be based on an individual’s past or current experience of discomfort or fatigue with particular body postures. However, not everyone may share this experience, which makes it difficult to define “awkward” postures that are generalizable to all people. This label further drives expectations and ideas about “correct” or “perfect” postures – which don’t actually exist. Korakakis 2019 Korakakis 2020

Psychosocial Risk Factors

Psychosocial factors include individual psychological characteristics, as well as social and inter-personal variables. Of the variables studied, psychological and social factors seem to hold stronger relationships with the risk of neck pain compared to individual or physical factors. Kim 2018

Many of these factors relate to workplace stressors, such as high perceived job demands (2.14 times higher risk), imbalances between the effort required by the job and the rewards received (1.66 times greater risk), and a perception of low support from co-workers (2.43 times higher risk). Other psychosocial risk factors include:

  • “Poor” self-rating of health (2.4 times higher risk)

  • High perception of muscular tension (4.0 times higher odds)

  • Personal history of neck pain (2.24 times higher odds)

  • Depression (3.36 times higher odds)

Another important risk factor is the perception of high “quantitative demand” at work (2.32 times higher odds). “Quantitative demand” describes the amount of work and time pressure a person deals with (e.g., ‘‘do you have too much to do?’’ and ‘‘do you have to work overtime?’’) Christensen 2014 Another major risk factor is high role conflict (2.61 times higher odds of neck pain), assessed by questions like ‘‘do you receive conflicting requests from 2 or more persons?’’ Christensen 2014

Protective Factors

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