9 Year old son with chronic neck pain

[bunkywoo]

My son has been experiencing neck pain for approximately 4 months now. Not real severe, but nagging pain off and on. I have taken him to his Pediatrician 3 times (3 different dr's). Each time the dr's did physical exam of him in office and everything was fine - full mobility, no spasms, no masses, no numbness or radiating pain. He is very healthy otherwise. Gaining weight, growing, plays on basketball team, no trouble in school etc. The pain is always on the right rear of his neck in one particular spot (muscle) and when I massage it for him it feels better. On occasion I give him tylenol. The 3rd visit to dr this week a spinal x-ray was done and came back normal.
My son has never been in a major accident with a car or such, but has taken some hard tumbles just from his boy-hood activities. A couple of years ago he fell on an ice hill face first and put his front tooth through his lip. He also fell off of a bar top in our basesment (shortly before this pain began)and landed butt first on the concrete floor. He's also been in the car on 2 occasions when we were rear-ended, but the speeds were very slow. He plays very rough as nine year olds do.
Would any of the above injuries cause this chronic pain and what types of things could be causing this. Can pain from injuries pop up months after an incident? Any recommendations to take him to a specialist of some kind.
Thank you for your response.
Laurie

[PT-works]

Bunkywoo-My 13 year old son had a very minor football injury to his neck last Oct. He developed  symtoms that were not appropriate for his injuries.  I insisted on a MRI and to my surprise he was diagnosed with Chiari I Malformation. 3 months later after much reseach and numerous consultaions, he underwent surgery to correct his problems. After reseaching Chiari, I realized he suffered from many of the symptoms: increased gag reflex; intolerance to loud noises and bright lights; developing subtle balance problems; neck pain. Chiari is sometimes caught with CT-scans, but best tool to Dx is with MRI. I agree with Neuro-MD to get evaluated by a Pediatric Neurologist.  The internet has great info on Chiari(Chips Chiari Page,Pediatric Neurosurgery,etc.) Review the Symtoms and go armed! John started to develope these sxs at puberty. PS. HE is pain free and playing travel soccer and lacross. Pediatricians are sometimes reluctant to order MRI's so be insistant if you feel something is being missed.  Good luck. PT-works.

[CCF-Neuro-M.D.-JT]

Remote injuries to the head/neck can cause chronic neck pain.  The bar stool incident probably doesn't count as you say he landed on his bottom.  One thing to consider though is cervical dystonia or torticollis.  This is a relatively common movement disorder in which the patient feels tightening/pain of neck muscles on one side and has almost a tilt or turn to his neck so that he's a bit skewed. Sometimes it can come on without any known cause while some physicians believe that it can be a result of remote trauma. These can usually be treated with muscle relaxants and botox injections.  

Start with a pediatric neurologist so he can get a formal examination to make sure everything is ok neurologically. There are certainly other causes of neck pain in a young patient such as neuromuscular disorders, tears in the artery of the neck, mass lesions in the neck, etc... But a good neuro exam and possibly more imaging such as an MRI of the Cervical spine and brain should help to rule out serious causes. Good luck.