Could Cervical Spine Misalignment Cause Neck Pain?

neck pain

Tiger Woods’ recent incident with “popping” his sacrum out stirred up the media’s attention as well as the physical therapy profession about neck pain. Dr. Peter O’Sullivan, Professor of Musculoskeletal Physiotherapy at Curtin University in Perth, Australia, debunked several misconceptions about Woods’ quotes and his condition on a blog published in British Medical Journal. This incident may bring out people’s concerns about other parts of the spine, particularly the cervical spine (neck). Could a misalignment or structural disorders of the cervical spine cause neck pain? Could a disc or a vertebrae in the neck “pop” out?

First, neck pain is just as prevalent and complex as low back pain. According to Physician’s Weekly, more than half of all adults will experience some sort of back or neck pain at one point in their lives, and each year, Americans spend about $90 billion in back and neck pain diagnosis and management. This causes a yearly loss of $10 to $20 billion in economic productivity. Even with an increase of expenditure in neck pain treatment, there is no significant improvement in pain relief. In Feb. of 2008, JAMA published a report that between 1997 and 2005, the total medical expenditure for back and neck pain treatment and management rose from almost $4,700 to almost $6,100 after 2005 inflation is adjusted. Yet patients reported that there was no improvement in their outcome during and after their treatment.

There is no single type of neck pain since it can stem from various problems, such as radiculopathy, fibromyalgia, arthritis, nerve impingement, whiplash and cancer. Thus, the prognosis, diagnosis, treatment, and management of neck pain can be as varied and complex as a calculus problem. While neck pain is a very complex issue, there is a common belief that structural misalignment in the cervical spine could cause neck pain. However there is increasing evidence that it is not likely so.

A Swiss study — conducted by Grob, Frauenfelder and Mannion — that was published in European Spine Journal in 2007 found no strong correlation between the lack of a lordotic curve and neck pain among 107 men and women with between the ages 45 and 90. Researchers took X-rays and measured the neck curvature. They found no significant differences of total neck curvature (global) and individual vertebrae curvature (segmented) between those with or without neck pain. Thus, the neck’s curvature is “not necessarily indicative of the cause of pain” since both “healthy curved” necks and “not-so healthy curved” necks exhibited pain or no pain.

However, two researchers — the late Donald D. Harrison, PhD, who is the founder of Chiropractic Biophysics, and Deed E. Harrison, who is the current CEO and President of the same organization — countered the Swiss study with a letter to the editor of the European Spine Journal by citing its inaccuracies and their own research that showed moderate correlation between neck curvature and pain. The Swiss study is also inconsistent with two previous studies which showed a lack of lordotic curve is associated with neck pain and complaints, they mentioned.

While both Harrisons may have some valid arguments against the Swiss study, more current evidence points out that neck “misalignment” has little or no association with neck pain. A Greek study from Thriasio Hospital’s Department of Orthopaedics that was published in the
European Journal of Orthopaedic Surgery and Traumatology in 2013 found “no significant difference” of the neck posture between 60 patients who had suffered a neck injury and 100 patients without a neck injury. The researchers questioned whether the loss of the neck’s lordotic curvature would cause muscle spasm. Apparently patients with neck injury had either a lordotic curve or not. Therefore, they stated that changes of the neck’s posture “should not be associated with muscles spasms caused by neck pain.”

Another study from Hirosaki University Graduate School of Medicine in Aomori, Japan, also found no association between neck curvature and neck pain among 762  adults (age range 20’s to 80’s). However the researchers found that although men had a significantly higher cervical degenerative index than women, the pain severity was higher among women than among men.

Current evidence indicates that cervical spine “misalignment” does not necessarily correlate to neck pain, and there should be little concern about the neck’s posture if little or no lordotic curve exists. Correlation does not necessarily imply causation, as the current studies show. And so, if Tiger happens to “pop” his neck out and has neck pain because he says his neck “lacks a normal curve,” then the news is taken with a grain of salt.

6 Responses to "Could Cervical Spine Misalignment Cause Neck Pain?"

  1. Matt Whitehead   October 1, 2014 at 1:05 pm

    Remember spending on diagnoses and management is exactly that – the medical model of trying to diagnose whats wrong and management of symptoms – not finding cause and correcting the cause of pain. Most of this spending is on tests, drugs, injections, surgeries, etc that do nothing about the cause of the pain, only trying to reduce the symptom. You stated neck pain can “stem from various problems, such as radiculopathy, fibromyalgia, arthritis, nerve impingement, whiplash and cancer.” Most of those are just symptoms themselves, not causes (except cancer, but then again, what causes cancer?). Finding the underlying cause of neck pain is usually not hard and doesn’t take expensive tests and improvement in symptoms can be fast and long-lasting. You just have to know what you are looking for and how you are going to address what you find.

    • Nick Ng   October 9, 2014 at 9:52 am

      Great insight, Matt. Thanks for sharing. Indeed, many of these problems are symptoms of another problem or a cluster of problems. Pain itself is quite complex, and current science is slowly gaining better understanding of it. We can hope that with better research and critical thinking that we would have better interventions to treat the root of the problem. However, sometimes patients need the symptoms to be resolved before treating the root of the problem. The pain could be so severe that it renders them incapable of performing daily activities.

      There are no single best way to treat all pain. A better way would to understand pain before focusing on which intervention that we should use to treat it. Here’s one article from my friend, Paul Ingraham, who is a registered massage therapist and science writer, who explains pain.

      • Nick Ng   October 9, 2014 at 9:54 am

        Another good friend of mine, physical therapist Rex Fujiwara, provides a review of pain science history and how it has evolved.

      • Matt Whitehead   October 9, 2014 at 12:33 pm

        Nick, something that is great about treating the cause of the pain is often clients are pain free from day one, which means there is no need to treat symptoms. (This is speaking to musculoskeletal pain not phantom limb pain or pain from cancer etc.) When you understand how to find the cause of the pain and how to correct it, you don’t have to “treat pain” as you said. Treatments for pain are all treating symptoms, not causes.

  2. Aquila   September 19, 2014 at 12:17 am

    Thank you for your good and helpful article. Thanks for sharing this to us.

    • Nick Ng   October 9, 2014 at 9:46 am

      You’re welcome, Aquila.

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