Neck pain can result from injuries of (or abnormalities within) soft tissues, which include the muscles, ligaments, intervertebral discs and nerves, or the bones and joints of the spine.

The neck is vulnerable to pain for several reasons. The neck is designed to allow a wide range of motion. However, this beneficial aspect of the neck’s design is also its greatest vulnerability as the interconnected structures of the neck are subject to damage from aging-related wear and tear, arthritis and overextension caused by whiplash.

Sources of neck pain include:

• Muscle strains. When neck muscles are overused, it may contribute to muscle strain. Muscles in the back of the neck are particularly vulnerable and can be strained by daily activities such as too many hours of driving or reading in bed. Over time, the repeated strain on these muscles can lead to chronic pain. Lying down in a bad posture for a long period of time is a common cause of neck muscle strains.
  
  
• Trauma. Because the neck is so flexible and supports the head’s weight, it is vulnerable to injury. Some injuries, particularly those sustained in automobile accidents, may result in whiplash, an injury that occurs when the head is jerked forward and backward. This stretches or tears the soft tissues (such as muscles and ligaments) of the neck, resulting in injury and pain. Severe injury can lead to fracture or dislocation of the neck, which may damage the spinal cord and cause paralysis. Also, injury can predispose facet joint arthropathy.

• Arthritis. Neck joints tend to deteriorate with age, leading to arthritis. Patients with a history of whiplash are much more likely to develop arthritis in the neck as they get older. Forms of arthritis in the neck that may cause pain in the neck or elsewhere include:
  
• • Osteoarthritis. Occurs in older people due to wearing of the joints between the bones of the neck. This causes pain to radiate to the shoulder or between the shoulder blades. Pain is generally present at the start of the day, subsides during the day and then returns again at the end of the day.
    
    
  • Rheumatoid arthritis. Chronic disease marked by stiffness and inflammation of the joints, weakness, loss of mobility and deformity. It can cause destruction of the joints of the neck.
    
    
  • Ankylosing spondylitis. Type of arthritis that primarily affects the spine. Typically it begins in the lower back but can progress to the upper back and neck.
    
    
• Disc disorders. Just as problems with the lumbar spine and thoracic spine can cause back pain, problems with the cervical spine can cause neck pain:
  
• • Pinched nerve. As a person ages, the intervertebral discs that serve as cushions between the vertebrae of the spine begin to dry out. This narrows the spaces in the spinal column where the nerves come out, and puts pressure on the spinal nerves.
    
    
  • Degenerative disc disease. The discs deteriorate and press upon nerves.
    
    
  • Herniated disc. Intervertebral discs sometimes rupture or herniate, meaning the gelatinous center protrudes through the disc’s tough covering.
    
    
• Cervical stenosis. A narrowing of the spinal canal that pinches the spinal cord. As a person ages, the intervertebral discs begin to dry out, reducing their role as protective “shock absorbers” for the spinal cord. Degenerative changes in the vertebrae can also foster the growth of bone spurs that compress the nerve roots. Finally, bones and ligaments in the spine gradually thicken and become less flexible. All of these changes narrow the spinal canal.
  
  Symptoms associated with cervical stenosis include neck pain, numbness and weakness of the hands, inability to walk quickly, deterioration of fine-motor skills and muscle spasms in the legs.
  
  
• Meningitis. Neck pain associated with headache and fever may be a sign of meningitis, an infection of the membranes surrounding the brain. Extreme stiffness in the neck – such that it is difficult or impossible to touch the chin to the chest – may be a sign of meningitis and demands prompt medical attention.
  
  
• Encephalitis. Inflammation of the brain. Symptoms can include stiffness or pain the back or neck.
  
  
• Fibromyalgia. A chronic disorder marked by musculoskeletal aches, pain and stiffness, tenderness of soft tissues, fatigue and sleep disturbances. Neck pain is among the symptoms commonly associated with fibromyalgia.
  
  
• Myofascial pain syndrome. A chronic musculoskeletal condition that is often associated with trauma, poor posture, sitting at a computer or performing repetitive tasks associated with one’s job. Patients frequently report feeling pain in various parts of the body – including the neck – and may have difficulty sleeping or feeling rested despite sleep.
  
  
• Polymyalgia rheumatica. An inflammatory condition typified by pain and stiffness in the neck, shoulders and hips.
  
  
• Myositis. A group of inflammatory muscle conditions. Myositis typically afflicts areas near the trunk, such as the neck, shoulders and hips.
  
  
• Osteoporosis. A bone-thinning disease most common in women during and after menopause. It lacks symptoms in early stages, but in later stages osteoporosis can cause spinal fractures that may cause back or neck pain. 
  
  
• Paget’s disease. A metabolic bone disorder that involves bone destruction and regrowth that causes deformity. The cause of this disease is unknown, but it often results in neck pain.
  
  
• Large, heavy breasts. Women with large breasts often experience pain in the upper neck, which usually is due to increased pressure on the muscles. Some choose to have surgery to reduce the size of the breasts and relieve neck, shoulder and back pain.
  
  
• Other conditions. In rare cases, neck pain is a result of other medical disorders such as cancer, infections or congential abnormalities (birth defects) of the vertebrae. Neck pain can also be a symptom of a heart attack.

Neck pain may also be due to conditions that cause widespread joint pain, such as Lyme disease, lupus, chronic fatigue syndrome, sickle cell anemia or sarcoidosis.