Neck pain

What it is

The cervical spine is mobile and densely innervated. Pain can arise from the facet joints, the discs, the nerve roots as they exit, or the muscles that stabilise the head — and each of these has a recognisable referral pattern.

After a whiplash-type injury the facet joints are the most commonly implicated structure, which is useful, because that is a structure we can test directly.

What it feels like

• ·Stiffness turning the head, worse in the morning or after screen work
• ·An ache between the shoulder blades that will not release
• ·Headache starting at the base of the skull and moving forward
• ·Pins and needles or weakness in the arm — always worth reporting

How we assess it

Examination covers range of movement, segmental tenderness, and a full neurological check of the arms. Where the picture suggests a specific level, a diagnostic medial branch block can confirm it before anything longer-lasting is offered.

Treatment options

• ·Cervical facet joint or medial branch injection
• ·Radiofrequency neurotomy for confirmed facet pain
• ·Nerve root injection where an arm-radiating pattern is present
• ·Postural and deep-neck-flexor rehabilitation with a physiotherapist
• ·Medication simplification, particularly where sleep is disturbed

What recovery looks like

Neck rehabilitation is slower and less dramatic than people expect, and the gains are held through consistency rather than intensity. Review points are scheduled at four to six weeks.

Risks and honest limits

Cervical procedures are done under image guidance for a reason — the anatomy is tight. Risks are discussed individually and in writing. Progressive arm weakness, unsteadiness or swallowing change is assessed urgently rather than managed conservatively.