Hey Team,

There are different ways we experience neck pain: a dull ache, stiffness, numbness, tingling, burning, and radiating symptoms. For some of us, you are experiencing this pain right now. Neck pain can be present in various ways, so deciding when to receive help can be confusing. For example, I have experienced a few different neck pain types in the clinic, and each has its unique presentation.

MEET BILL AND DONNA

Bill is a 53-year-old mechanic who presents with pain in the elbow and has some mild numbness to the outside of the last three fingers on the right hand over the previous four months. He is continuing to work and perform most duties because his pain is not overwhelming, and he needs to keep working to pay his bills. Bill has been frustrated recently due to a progressing weakness in his hand, making his work as a mechanic more difficult. He is continuing to attempt to work and perform his usual daily tasks. He finds if he massages the hand, he has some relief.

Donna is a pleasant 62-year-old working as a checker at a local grocery store. She woke this morning to stiffness in her neck and pain when looking to the right. She mostly has difficulty turning her head fully when looking behind her while driving. Donna notices less stiffness with activity, and as the day progresses, she detects more motion returning to the neck.

These two examples show two types of neck pain and a common presentation. In the first description of Bill, we see he is developing some radiating symptoms. These symptoms are becoming noticeable in the elbow and the hand. One symptom is creating pain in the elbow, and the other is numbness or tingling in the hand. The third symptom is weakness in the hand. Donna is not experiencing any radiating symptoms and is experiencing pain at the neck's side with movement.

So, how do these two people know what to do? Who should seek medical attention? How do you decide?

3 WAYS TO DECIDE YOU NEED HELP WITH YOUR NECK PAIN

1. Duration: The length of symptoms indicates the urgency of seeking medical treatment for your neck pain. Any new symptoms presenting within the first few weeks are considered acute pain. Acute pain essentially means new pain. For example, Donna woke with neck pain and had not experienced this pain before sleep. This symptom would be considered a new pain. A recent pain presentation usually does not require medical intervention as a stand-alone criterion. Pain becoming more chronic in duration will require medical evaluation. Why? Pain lasting over three weeks decreases the probability of returning to the initial state without intervention. The longer the duration of neck pain, the more chronic the symptoms become and the more difficulty experienced with medical interventions. Current Tip: Pain longer than three consecutive weeks needs an evaluation.

2. Intensity: Another variable to consider with neck pain is intensity. For anyone who has experienced debilitating neck pain, this is no surprise. High intensity of symptoms will completely disrupt one's life, requiring an immediate shift in priorities. Increased intensity of pain will challenge all tasks. Therefore, more pronounced symptoms will require more urgency when seeking medical treatment. The intensity of the new symptoms does not always infer more damage. Still, quick access to medical care will allow a person to experience relief sooner, thus returning to life without disruption or modification.

3. Radicular Pain: OK… so here is the million-dollar bullet point. Radicular or radiating symptoms are to receive immediate attention. What are radiating symptoms? Any pain, numbness, tingling, or muscle weakness created closer to the body and traveling into the arms or legs are examples of radicular symptoms. Radiating pain can be easily determined, as seen with pain shooting from the neck to the hand, or can be challenging to determine, as seen with a generalized weakness in a muscle group. What causes radiating symptoms? Usually, entrapment or pinching to a nerve. Anytime a nerve in the neck is pinched… pain, weakness, or numbness/tingling will result in the body part away from the neck.

Radicular symptoms are the most concerning of these three variables due to the injury's nature. Radicular signs are created from the nerve's entrapment in the neck, making the "radiating" symptoms into the arms. The risk of not seeking urgent medical treatment is prolonged or permanent damage to the nerve. For example, the longer a nerve is "pinched," the more significant damage occurs, thus decreasing the likelihood of the nerve returning to its original status. Prolonged pinching to the nerve, as seen with a disc herniation at the neck, will create numbness/tingling and eventually muscle weakness to the body part the area of the neck supplies. Without proper medical interventions to relieve pressure on this nerve, permanent disability is a likelihood.

WHO NEEDS TO BE EVALUATED?

Let's return to Bill and Donna. What are Bill's symptoms, and does he need a medical evaluation? Bill has multiple factors requiring a need for medical evaluation: Radiating numbness/tingling and pain lasting longer than three weeks with variable intensity of symptoms. He has pain in the elbow, numbness and tingling in the hand, and progressive weakness in the hand muscles. Bill has also continued to have these symptoms for four months. Bill will need to seek medical evaluation and start a path to treatment. Radicular symptoms presenting from the neck will need confirmation during the clinical exam, and intervention will need to begin to reduce or relieve the suspected nerve pinching.

Donna appears to be in a different category. She has new symptoms (began this morning); therefore, she is in the acute, not chronic, healing phase. She does not report radiating symptoms into the arms and has an increasing range of motion with less pain. Symptoms overall are reducing as the day progresses. Based on our checklist listed above, Donna does not need to seek medical intervention at this time.

Overall, neck pain and when to seek medical evaluation can be confusing and misunderstood regarding the urgency for medical help. Many individuals will manage their pain and continue with their work or home duties despite the pain. When pain interferes with their ability to perform their job or basic tasks… this is when patients seek medical treatment. If this is you… STOP. Being evaluated with your injury sooner allows you to improve your symptoms before chronic pain begins, increasing your opportunity for success and shortening your overall treatment duration.

OK Team. Please contact me directly if you're unsure if your neck pain needs medical evaluation or if these modifications will give you a return to life. Thank you again for reading and reaching out with your questions. Keep Moving!

• The author, Rob Sumner, is a Doctor of Physical Therapy and owner of Sumner Specialized Physical Therapy. He's happy to answer any questions about this article, wellness, fitness, or physical therapy overall by phone at (509) 684-5621 or by email at Rob@SumnerPT.com