Chronic neck pain comes from one of three structures: the discs, the facet joints or the nerve roots. Each one causes a different pattern and needs different treatment. So the exam starts by working out which one it is.
Neck pain that has lasted more than a few months is rarely just muscle. Treating it as if it were is why it has lasted months.
What it is
The cervical spine (the neck part of the spine) has three possible sources of pain: the discs, the facet joints, and the nerve roots. They cause different patterns and need different treatment.
Facet joint pain is usually on one side. It is worse when you tip your head back or turn it, and it spreads to the shoulder blade. Discogenic pain (pain from a disc) sits more in the middle and is worse when you bend your head forward. Nerve root pain travels into the arm.
How it usually presents
- Pain at the base of the neck, often with a band across the shoulders.
- Stiffness that is worst in the morning or after sitting.
- Pain that spreads to the shoulder blade. It is often mistaken for a shoulder problem.
- Headache from the upper neck.
- Arm symptoms, which point to cervical radiculopathy rather than simple neck pain.
How we treat it
- A proper exam first, because the pattern narrows the diagnosis a great deal before any imaging.
- Diagnostic blocks when the source is truly unclear.
- Facet injections or radiofrequency ablation for confirmed facet pain.
- Epidural steroid injection when a nerve root is inflamed.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
Referred pain (pain felt away from its source) is the most common reason neck pain is treated in the wrong place. The neck’s facet joints send pain into the shoulder blade and the top of the shoulder. The pattern looks exactly like a shoulder problem. Patients often arrive after having a shoulder scanned, injected, or now and then operated on.
The test that tells them apart is simple. A true shoulder problem hurts when the shoulder moves, and neck position does not change it. Facet pain does the opposite. Anyone with pain around the shoulder and a full, painless shoulder range has a neck problem until proven otherwise.
What to expect over time
Neck pain that has lasted past three months rarely clears up on its own. But it also rarely gets worse the way people fear. The usual course is up and down. It gets better and worse in cycles tied to posture, sleep and stress. It is not a steady decline.
Those ups and downs are why scattershot treatment seems to work. Almost anything tried during a bad stretch will be followed by improvement. That is the natural cycle, not the treatment. It is also why a targeted diagnostic block is worth more than another round of something generic.
When this becomes urgent
Neck pain with fever, unexplained weight loss, night pain that wakes you, or a history of cancer needs a prompt check, not a routine clinic visit. So does arm weakness that keeps getting worse, or clumsiness and unsteadiness suggesting the spinal cord is involved.
Common questions
Is my phone causing this?
Holding your head bent forward loads the neck, so posture plays a part. But it is rarely the whole story in someone with months of pain.
Do I need an MRI?
Only if the result would change what we do. Many people with severe neck pain have normal-looking scans. And many with dramatic scans have no pain at all. See understanding your MRI report.
Sources
- Blanpied PR et al. Neck Pain: Revision 2017. The Journal of orthopaedic and sports physical therapy, 2017. PubMed 28666405
- El-Allawy A et al. Clinical Practice Guideline: Nonspecific Neck Pain. Deutsches Arzteblatt international, 2025. PubMed 40665902
- Côté P et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2016. PubMed 26984876
- Gross AR et al. Massage for neck pain. The Cochrane database of systematic reviews, 2024. PubMed 38415786
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