Neck pain is a common clinical problem experienced by nearly two-thirds of people. Neck pain can be quite disabling, in some countries accounting for nearly as much disability as low back pain. Neck pain is also similar to low back pain in that the etiology is poorly understood and the clinical diagnoses can be vague. Compared to low back pain, however, neck pain has received limited study. The few available randomized controlled studies lack consistency in study design. This chapter reviews the epidemiology and anatomy of neck pain and provides an evidence-based guide for the evaluation, diagnosis, and management of this challenging disorder.
Neck pain is most prevalent in middle-aged adults; however, prevalence tends to vary with differing definitions and differing survey methodologies of neck pain. Worldwide prevalence of neck pain has been reported at 4.9% and ranked fourth in terms of disability. One study found that the 1-year prevalence in adults ranged from 16.7% (youngest) to 75.1% (oldest). Almost 85% of neck pain may be attributed to chronic stress and strains or acute or repetitive injuries associated with poor posture, anxiety, depression, and occupational or sporting risks. The acceleration-deceleration of a whiplash injury may result in cervical sprains or strains, which, in turn, are common causes of neck pain. Radicular neck pain occurs later in life, with an estimated incidence of 10% among 25- to 29-year-olds, rising to 25–40% in those age >45 years.
Occupational neck pain is ubiquitous and not limited to any particular work setting. Predictors for occupational neck pain include prolonged static positioning, other work-related psychosocial factors, and perceived general tension. Predictors of occupational neck pain include prolonged sitting at work (>95% of the workday), especially with the neck forward-flexed ≥20° for >70% of the work time. A neck angle of 30° forward flexion increases the weight of the head on the cervical spine to 40 pounds, and an angle of 60° increases the weight of the head to 60 pounds. Over time, the increased weight of the head on the cervical spine can cause disruption in the neck muscles and functionality.
More recently, the adolescent population has seen an increasing number of primary physician visits for neck pain. Neck pain was reported in up to 20% of adolescents, and screen time was found to be a major contributing factor. In one study, exercise and physical activity were found to be protective among adolescents in this group.
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