Cervical spine pain — what is really happening in the tissues?
Neck pain is one of the most common musculoskeletal complaints. In adults, it occurs periodically in a large proportion of the population and increases with age and sedentary, desk-based work.
More and more research suggests that, in many cases, soft tissues play a dominant role, rather than only bony or joint structures.
This primarily involves:
- the cervical and shoulder girdle muscles,
- fascia,
- muscle insertions,
- structures responsible for proprioception and postural control.
Taut band — a tense band within the muscle
Within overloaded muscles, a taut band may develop — a dense, linear bundle of fibers that feels like a cord under palpation.
It is characterized by:
increased tissue stiffness,
- reduced elasticity,
- hyperreactivity to mechanical stimuli.
- These regions are often associated with microcirculatory disturbances, local hypoxia and accumulation of inflammatory mediators — all of which contribute to local and referred pain.
Trigger points — the mechanism of referred pain
Within a taut band, myofascial trigger points may be found. They are characterized by:
marked tenderness on palpation,
- predictable patterns of referred pain,
- local twitch response,
- restriction of movement.
- Active trigger points may provoke:
neck and occipital pain,
- a sensation of stiffness,
- shoulder and scapular pain,
- tension-type headaches,
- dizziness or subjective imbalance,
- referred discomfort into the upper thoracic region.
- Fascia — a key, often overlooked structure
Fascia forms a three-dimensional network surrounding and connecting all tissues of the musculoskeletal system. Fascial dysfunction — restriction, thickening, adhesions — may lead to:
impaired tissue gliding,
- pathological distribution of tension,
- altered proprioception,
- chronic referred pain.
- Phenomena previously referred to as myogelosis are now more accurately described as myofascial dysfunction.
Why does the neck become overloaded so easily?
Cervical pain is typically multifactorial. Literature highlights several contributing elements:
prolonged static postures,
- forward-head posture (“tech neck”),
- chronic stress and increased muscle tone,
- insufficient physical activity,
- micro- and macro-trauma,
- age-related degenerative processes.
- Importantly, imaging findings (X-ray/MRI) often appear in asymptomatic individuals.
This indicates that the myofascial component may play a much larger role than previously assumed.
Clinical presentation — what patients may report
Depending on the predominant mechanism, symptoms may include:
localized or referred neck pain,
- morning stiffness,
- reduced range of motion,
- sensation of a “heavy head,”
- headaches,
- occasional dizziness or cognitive fog,
- tenderness on palpation of muscles and fascia.
- In some patients, increased neural sensitivity (sensitization) further amplifies pain perception.
Summary:
Cervical spine pain:
is frequently related to overload of muscles and fascia,
- may involve taut bands and myofascial trigger points,
- often produces referred and nonspecific symptoms,
- does not always correlate with radiologic findings.
- Understanding the role of soft tissues is essential for explaining the pathophysiology of neck pain and for conducting thorough clinical assessment.