Joey Wahler (Host): It's a common condition that can hurt our quality of life, so we're discussing when to be concerned about neck pain. Our guest, Dr. Gary Alegre. He's a board-certified orthopedic surgeon, a fellowship-trained spine surgeon, and he's Assistant Clinical Professor for the UC Davis Department of Orthopedic Surgery.

This is Hello Healthy, a Dignity Health podcast. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Alegre. Thanks for being with us.

Gary Alegre, MD: Hey, Joey. Thank you.

Host: Great to have you aboard. So first, what neck pain symptoms should people watch out for and how do they know when it's time to see a doctor?

Gary Alegre, MD: Typically, neck pain that comes on very abruptly and may be associated with like shooting pain into the arm or particularly any numbness or any weakness would be of concern. If it's essentially pain that is just centralized in the neck, feels like maybe a kink neck or a sore muscle or pain that's been chronic for a long time that doesn't travel to any particular area outside the neck area. Those kinds of conditions are pretty, pretty standard that essentially somebody that would have any referred pain or pain that travels beyond the neck into the arm or particularly with any associated numbness or weakness into the arms and/or legs.

Host: Gotcha. So, what are the most common causes of neck pain?

Gary Alegre, MD: Typically, the most common causes of neck pain are just as we age. The discs in the neck, which are the cushions that sit in between the bones, tend to dry out. The little articulations or little joints that we have in our neck tend to get a little bit rusty. So, the disc and the rusty joints can cause a little bit of trouble with movement. They can be associated with some pain and inflammation. So typically degenerative type conditions, such as wear and tear, aging process can cause typical neck pain.

Host: And what are the main neck conditions that you treat?

Gary Alegre, MD: The most common neck conditions I treat are degenerative. I mean, certainly, there's traumatic where if somebody were in an accident and broke a bone or had a slipped vertebra or a pinched spinal cord, that would be a different category of problems. The most common thing I see is degenerative, which means as we age, we may have like a slipped disc that occurs or arthritis sets in.

And the most common thing most people present with is just essentially some ache and pain in the neck region. What I get concerned as an orthopedic spine surgeon is any pain that radiates down into the arms, which means there's a pinched nerve, or any numbness into the arms, which means it could be a pinched nerve and/or spinal cord or particularly any weakness. And if a neck condition becomes more severe, you can have loss of control of your legs or difficulty ambulating, because the main nervous system or the spinal cord travels through the neck.

Host: Okay. So, what are some things people can do on our own to try preventing neck pain?

Gary Alegre, MD: Typically keeping healthy lifestyle, avoiding nicotine products. And the reason nicotine products are problematic is as we age our discs, which are the cushions sitting between our bones, get it nutrition through the bones themselves. And if you take nicotine products, what happens is it tends to dry out the blood supply and the discs become degenerative early.

Also keeping good posture, trying to avoid positions where your neck is in an awkward position, such as frequent bending, looking down at a desk or if you can keep your neck in a more ergonomic type position when you're doing prolonged activities would be helpful. Regular exercise such as non-impact aerobic exercises would be helpful and just keeping essentially a healthy lifestyle.

Host: And speaking of exercise, I know that back pain is often related to other body parts, like for instance, if you have tight hamstrings because it's all connected, that can cause back pain, particularly lower back. Is that also true in certain cases of neck pain where it's related to something going on elsewhere?

Gary Alegre, MD: Essentially, if you have, say, a deformity, which means like a curvature in your upper back, or you have some lower back condition, which puts your whole spine alignment out, then that can cause some increased problems. Occasionally, some shoulder pain can be referred to the neck or the neck can be referred to the shoulder, but it's not as common for degenerative type conditions to cause neck pain as it does in the lower back region.

Host: Okay. You mentioned this is something that most often comes about from age. So, should you be more concerned if you have neck pain that lingers and you're in your, let's say, 30s and 40s as opposed to being in your 60s or 70s?

Gary Alegre, MD: Typically, if you're having neck pain in say your 30s and 40s, it's most likely a disc issue, because that's typically when the discs start to rupture and start becoming more problematic where they may start pushing into the spinal cord or where the nerves are. As we age, the discs have already started to degenerate, start having some arthritis in the little articulations or joints that we call facet joints, in the back of the neck, and those can be essentially more of a chronic degenerative arthritic type condition. But, as we're younger, in your 30s and 40s, if you're having neck pain that persists, most likely a disc type issue if it persists for more than a couple of weeks.

Host: Okay. I want to ask you about treatment options in a moment. But first, I know I have found that I'm more susceptible to turning my head sometimes and suddenly getting a stiff neck for several days, especially upon getting up in the morning if I go off my daily multivitamin for any length of time. Whereas if I take the vitamin on a regular basis, I never seem to get that. What's the benefit or the connection there?

Gary Alegre, MD: I'm not sure there's any real established connection between vitamins. I mean, there's some anecdotal things that vitamins, anti-inflammatories or natural anti-inflammatories can be helpful. But it could be that the vitamins are just providing a natural antioxidant type effect. It's most likely what it is.

Host: All right. Well, it seems to work one way or the other. So, I mentioned treatment. For some of the things you've talked about, what are the most common treatments?

Gary Alegre, MD: A patient will require, if it's an acute neck pain, which means recent neck pain, we're talking less than maybe a couple weeks, typically an anti-inflammatory prescribed by a doctor over-the-counter such as Advil, Motrin, Aleve You can take some over-the-counter non-anti-inflammatory medications such as Tylenol typically if they get to see me. Hopefully, they've had some physical therapy or supervised exercises done by professionals, such as a physical therapist. Occasionally, people can try some chiropractic treatment for an acute neck pain, such as a sprain and strain type of injury. So, those are the most common things, would be a start of some medication management, whether over-the-counter or prescribed, and then physical therapy. If the pain becomes more severe, if it's not causing any severe neurologic deficits, such as severe numbness or weakness in the arms or in the legs, then we can generally talk about trying some interventional procedures such as injections.

Host: And when would surgery be recommended?

Gary Alegre, MD: Typically, surgery is required if a patient has neurologic deficits, which means if there is pressure on a nerve or a spinal cord that's causing significant loss of function into the extremity, being at the arm, or if it starts causing more troubles with the legs, such as walking. There's different type of neurologic conditions, such as what we call radiculopathy, which means there's a pinched nerve or maybe one or more nerves that's causing a certain distribution of pain, numbness, and weakness.

The other condition would be what we call myelopathy, which means spinal cord dysfunction. And that's where the spinal cord starts getting compressed. And it's like having the main trunk of your tree being squeezed. And then it affects all the branches and the leaves. So, those would be the more urgent, or not necessarily urgent, but more critical type of conditions.

Other condition would be say some type of intractable pain that has not responded to conservative care, that there may be a particular lesion or lesions that we could treat surgically that there's a good enough success rate that a patient would benefit from undergoing a surgery.

Host: Just a couple of other things, one being you touched on it earlier, doc, that there are some other complications, other conditions that can arise as a result of certain kinds of neck pain if left untreated. So, maybe just tell people about the importance of nipping this in the bud if it does occur.

Gary Alegre, MD: The more concerning thing is that people as they age, they may just have some arthritic type pain in the neck, but yet there's some underlying pressure on the spinal cord. they may not make too much of it. We typically see it in the elderly patients that are having difficulty walking, they start falling, they trip and then they hit their head. They've already had some spinal cord pressure compression, which is causing the difficulty walking, and they didn't really know that he had pressure on the spinal cord. They hit their head and then they have what we call an acute spinal cord injury. It's not uncommon. In fact, there's somebody I'm operating on today, this afternoon, that has the same type of presentation, was having difficulty walking, started stumbling over time, eventually hit their head. And then, they present with significant neurologic deficits and unable to walk.

So if you're starting to have some symptoms of difficulty walking, tripping, loss of movement of your arms, you started fumbling things, that would be something that you'd want to get treatment for right away. And sometimes, the hard part is it may not necessarily be associated with neck pain, but the condition comes from the neck.

Host: Gotcha. And so in summary here, what would you tell our listeners about, generally speaking, the chances of effectively addressing most neck pain?

Gary Alegre, MD: Most neck pain resolves, if you just take care of yourself, if you take an anti-inflammatory, take maybe a non-anti-inflammatory medication, you rest a sore neck, as long as it doesn't get intractable or associated with any referred symptoms or findings into the arms and/or legs. But the most common neck problem is just a sore neck from either a muscle, maybe a disc, drying out, or maybe some arthritis in the neck. Those typically resolve over a course of a few days, if not a couple weeks. The things that would be more concerning is if it becomes prolonged, severe, incapacitating, and/or if it's associated with any neurologic symptoms, such as numbness, weakness into the arms, or any difficulty walking, because you're tripping or falling.

Host: All right. Great to know. Well, folks, we trust you're now more familiar with when to be concerned about neck pain. Dr. Gary Alegre, thanks so much again.

Gary Alegre, MD: Thank you very much.

Host: And for more information, please visit dignityhealth.org/stockton/ortho, O-R-T-H-O. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Hello Healthy, a Dignity Health podcast.