When it comes to the most common causes of neck pain, most people think of postural issues, "text neck" (pain caused by looking at a phone for extended periods of time), desk work, etc. While all of these things can certainly make a neck issue worse, it is something else that is typically the culprit, something you probably wouldn't initially think of.
Neck pain is typically caused by either muscle tension or imbalance in the head and/or neck, restricted motion within the joints of the neck, a loss of the cervical curvature of the neck (the cervical lordosis), or a combination of all of these. Most chiropractors, PT's, massage therapists, etc. will leave it at that and start digging into whatever area they are most suited at addressing. However, you have to look further upstream to find out why these issues are occurring.
The vast majority of neck pain is caused by one of the following issues, and truly addressing the cause of the neck pain typically requires a multi-disciplinary approach:
1. TMJ dysfunction- The TMJ, or jaw joint, is extremely important in terms of our body's proprioceptive capacity (how we react to gravity and contributes to balance), but can be a huge influence on posture (both being the cause, or potentially bearing the brunt of poor posture). Very few healthcare practitioners are trained to address the TMJ, and no discipline in healthcare gets any more than simple anatomy in school (this includes chiropractors, dentists, PT's, etc.). You'll see a lot of healthcare practitioners list this as a condition on their websites but very few can actually provide a real diagnosis and treatment, but rather they rely on one trick treatments with no diagnosis, and simply cross their fingers. For chiropractors this is a neck or jaw adjustment, for dentists it's a night guard, for massage therapists its massage. Finding someone to correctly identify and manage this condition is difficult but can be quite rewarding when it comes to finding a true solution to the joint and muscle issues that cause neck pain.
2. Malocclusion- Occlusion refers to the way in which your teeth articulate together, and malocclusion means there is a problem with the way they are coming together. Bite problems can cause forward head posture, TMJ problems, and are one of the main causes of neck pain, among other things. Often times the root cause of bite problems has to do with the tongue, which is another blogpost topic altogether, but the resulting tooth problems are obviously best suited to being treated by a dentist that understands how the teeth affect the neck and jaw (most dentists and orthodontists do not understand this).
3. Airway- How can airway cause neck pain? For a number of reasons the airway in the throat can become narrow. The airway sits behind the bones of the face, and in front of the neck bones that make up your cervical spine. If there is a kink in the airway (diagnosed with a combination of cone-beam CT and Pharyngometry) the neck bones will naturally pull forward (losing your cervical curve) to create more space in the airway. In this situation things like neck stretches, chiropractic adjustments, postural tools, and exercises for neck posture can actually be harmful, as the neck will then have to work that much harder to come forward to create adequate airway space. That's always going to be a losing battle until the airway space is opened up. Determining what is causing the airway compromise is another topic for another day!
In most cases of neck pain, the best combination is structurally oriented cranial work (not craniosacral therapy), light force and holistic physical medicine (we utilize SOT chiropractic), and working with a properly trained dental professional (treatment would vary quite a bit depending on needs/wants). The most common causes of neck pain are often NOT successfully treated with traditional chiropractic, PT exercises, massage therapy, etc. as they do not address the issues underlying the neck pain, and only attached the end result of the dysfunction.
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