MONTHS AFTER EVERYONE STOPPED ASKING

They said it would settle in six weeks. It has been eight months.

Six weeks is what the research says about most acute neck pain, and it is true. It is also the sentence that gets handed to the people it is not true for, who then spend eight months assuming they are the problem.

Which of these is you?

• It is worse on Thursday and fine by Sunday — a pattern that tracks your week rather than your tissue.
• Your hands are doing something — numbness, dropping things, waking up with a dead arm.
• The headache starts in your neck and ends behind your eye.
• The pain runs down one arm in a line you could draw.
• It started with a collision and never finished.
• Your scan was normal and nobody has examined you since.

Why six weeks became the wrong number for you

The six-week figure comes from the natural history of acute mechanical neck pain, and for most people it holds. What it does not describe is the minority in whom a specific structure — a facet joint, a nerve root, a disc, the muscles that have been compensating for all of them — keeps generating pain after the acute episode has passed.

Those people get the same advice on a loop. Rest it. Take an anti-inflammatory. Give it time. Each instruction is reasonable for the average case and none of them is a diagnosis. Eight months in, the file records a patient who did not improve, rather than a workup that was never done.

What actually gets examined here

A neck is not one structure and the treatment depends entirely on which one is generating the pain. That is a question answered by examination and, where it matters, by a diagnostic block — not by the adjective a radiologist used.

• The facet joints — the small paired joints at the back of each level, and the most common source of persistent axial neck pain. How they are identified.
• The nerve roots — where the pain leaves the neck and travels. Radiculopathy.
• The discs — and the important distinction between a disc that looks bad and a disc that hurts. The difference.
• The muscles and the load on them — frequently the consequence rather than the cause, and treated as such.

Why your scan did not settle it

Degenerative change in the cervical spine is close to universal past forty and is found in enormous numbers of people with no pain at all. A report describing disc desiccation, osteophytes and foraminal narrowing at three levels is describing a neck that belongs to somebody your age. It is not a diagnosis, and the gap between what it shows and what hurts is where most of these cases get stuck.

That is not an argument against imaging. It is an argument for reading it against an examination instead of instead of one. More on why a normal scan is not reassurance.

When it stops being a pain problem

Some neck symptoms are not a matter of timing. Progressive weakness in a hand, a change in balance or handwriting, clumsiness doing buttons, or bowel and bladder change are cord signs, and they need a surgical opinion rather than an injection. Those are set out on when a neck problem is urgent, and we would rather you over-read that page than under-read it.

Where this sits against pain medication

The neck is one of the more common routes onto long-term opioid therapy, because the pain is constant, the diagnosis is often uncertain, and the procedures on offer frequently disappoint. Nobody here will require a taper as a condition of being assessed, and nobody will imply the dose is a character question.

What we will do is refuse to inject a level that nothing has identified, because that sequence — a procedure, partial relief, a rising dose, another procedure — is how somebody arrives with two problems instead of one.

Why a neck-only practice

Because the neck gets ten minutes inside a general spine appointment, and the structure most likely to be causing your pain cannot be found in ten minutes or on any scan you have had.

Narrowing the practice is what makes room for the parts that get skipped: a proper myotomal examination, a diagnostic block rather than an assumption, gait measured rather than eyeballed, and the metabolic bloodwork that explains why your tissue failed under a load thousands of people tolerate.

The engine underneath most of this

Chronic pain, obesity and type 2 diabetes are usually treated as three problems by three specialties. They share an engine. Insulin resistance and chronic metabolic inflammation glycate collagen, stiffen it, and hold tissue in a degradative rather than a rebuilding state.

For a neck that means a lower failure threshold and a slower repair between one working week and the next. It is why the same desk produces a problem in one person and not another, and it is why bloodwork belongs in a neck consultation even though nobody expects to be asked for it.

Where we are

12174 Natural Bridge Rd, Suite 302, next to DePaul Hospital, just off the junction of 270 and 70 and west of the airport. Roughly fifteen minutes from St. Charles, eleven from Maryland Heights, sixteen from Creve Coeur. Parking is free and at the door, which matters when reversing is the thing you cannot do.

What people ask eight months in

Is it too late to work this out?

No, and the length of time is diagnostic information rather than a verdict. Pain that has persisted past the expected natural history is telling you the acute model did not apply, which changes what should be examined rather than closing the question. What the first visit covers.

My X-ray and MRI were both normal. What is left to find?

A great deal. Facet-mediated pain is not visible on imaging and is identified with a diagnostic block. Muscular and myofascial pain generators are found by examination. Normal imaging rules some things out and identifies almost nothing about the structures that most often cause persistent neck pain. What a normal scan does and does not rule out.

Do I need surgery?

Most people with persistent neck pain do not, and the honest answer depends on whether there is nerve compression producing progressive deficit. Where there is, we will establish it precisely first, so that the surgical conversation starts from a refined diagnosis rather than a scan. Where there is not, an operation is being asked to solve a problem it does not address. How candidacy is assessed.

Will you just give me another injection?

Not into a level nothing has identified. The first job is establishing which structure is generating the pain. If the answer is that no procedure is indicated, that is what you will be told. Cervical facet syndrome, in full.

Related reading

• Work-pattern neck pain
• When your hands are the problem
• Cervical radiculopathy
• Why your MRI is normal
• When a neck problem is urgent
• What happens at the first visit