Pain That Spreads

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Q: I have experienced headaches in my upper neck for about four years. Over time this pain has spread down into my arm and all the way to my fingers. This is accompanied by stiffness. When I experienced the pain in my neck and arm it seems to spread all the way down to my leg and foot. I was experiencing this pain on only one side of my body, but now it is on both sides. I suspect a cervical disc is pinching a nerve, but my doctor thinks it’s in my ligaments and muscles and that physical therapy would help. Unfortunately I tried this with little or no relief. Do you have any suggestions?

A: Please get a second opinion. Given that the pain and stiffness has progressed from your upper body to your lower legs, it is very important to see a physician skilled and experienced in the diagnosis and treatment of neuromuscular disorders (neurologist, physiatrist, others). In addition to a thorough physical examination, it is time to have a full diagnostic evaluation. This may include tests such as an X-ray, a magnetic resonance imaging or computerized tomography scan. Additionally, electromyography may help to determine if you have suffered any nerve damage.

A possibility exists that you are experiencing the “sensory march” that sometimes occurs in those with inflammation of their spinal nerve in areas of stenosis (narrowing) of the cervical spine. Essentially, this means that symptoms such as pain, stiffness, weakness and numbness can travel from your upper body towards your buttocks and legs. However, this is just a suggestion as it is very important to have a thorough examination. Other potential causes of your symptoms include but aren’t limited to:

Injury (whiplash, where the head is forced to move rapidly forward or back beyond its normal range of motion)
Degenerative disc disease, causing the disc to bulge or herniated onto a nerve and triggering symptoms such as pain, numbness and tingling
Osteoarthritis leading to formation of bone spurs (osteophytes) that affect motion of the neck
Poor posture, weak abdominal muscles and obesity can affect balance and cause the neck to bend forward, possibly leading to pressure on the spinal nerves
Tumor, infection of the spine or even a fracture

In tracking down the cause of your symptoms, your doctor will need the answers to the following questions:

When did the pain begin (days, weeks, month, or years ago)?
Have you had any previous treatment?
Does weakness, tingling or numbness accompany the pain?
Do you remember an injury that triggered the pain?
Does your occupation or hobby require you to continually lift, bend or turn your head?
Have you been diagnosed with arthritis?
Is your ability to move your head or neck limited?
What makes your pain better (certain positions, medications, etc.) or worse (lifting, turning in one or more directions, others)?
How long does the pain last (minutes, hours, days), and does it ever go completely away?
Do you experience shock-like pain down your arms, in your groin or down your legs?
Do you have difficulties controlling your bladder or bowels (may indicate a spinal cord problem)?

Next, a physical examination will be performed. This will focus on:

The curvature of your spine
Any limitation of movement
Problems with balance
Signs of pain
Loss of strength or sensation
Any abnormal reflexes (may suggest spinal cord involvement)

Depending upon the results of your examination, as well as the previously mentioned diagnostic tests, your physician might advise a treatment plan (physical therapy, corticosteroid injections, others), a surgical consultation (neurosurgeon, orthopedist), or require additional tests. These may include a bone scan (helps to detect fractures, tumors, infections, etc.) or even a myelogram (can show pressure on the spinal cord or nerve roots from tumors, bone spurs or from herniated discs).

Whatever you decide, it is important to get to the cause of your pain and stiffness. If left unchecked, further symptoms—as well as the potential for irreversible damage—may occur.

For additional information, please visit the U.S. National Library of Medicine and the National Institutes of Health.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)