Neck pain

November, 15th, 2023

, Overview, ,

Neck pain is common. Poor posture — whether from leaning over a computer or hunching over a workbench — strains neck muscles. Osteoarthritis also is a common cause of neck pain.

Rarely, neck pain can be a symptom of a more serious problem. Seek medical care for neck pain with numbness or loss of strength in the arms or hands or for pain that shoots into a shoulder or down an arm.

Symptoms

Symptoms include:

• Pain that’s often worsened by holding the head in one place for long periods, such as when driving or working at a computer
• Muscle tightness and spasms
• Decreased ability to move the head
• Headache

When to see a doctor

Seek immediate care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident or fall.

Contact a health care provider if neck pain:

• Is severe
• Persists for several days without relief
• Spreads down arms or legs
• Comes with headache, numbness, weakness or tingling

Causes

Because the neck supports the weight of the head, it can be at risk of injuries and conditions that cause pain and restrict motion. Neck pain causes include:

• Muscle strains. Overuse, such as too many hours hunched over a computer or a smartphone, often triggers muscle strains. Even minor things, such as reading in bed, can strain neck muscles.
• Worn joints. As with other joints in the body, neck joints tend to wear with age. In response to this wear and tear, the body often forms bone spurs that can affect joint motion and cause pain.
• Nerve compression. Herniated disks or bone spurs in the vertebrae of the neck can press on the nerves branching out from the spinal cord.
• Injuries. Rear-end auto collisions often result in whiplash injury. This occurs when the head jerks backward and then forward, straining the soft tissues of the neck.
• Diseases. Certain diseases, such as rheumatoid arthritis, meningitis or cancer, can cause neck pain.

Prevention

Most neck pain is associated with poor posture combined with age-related wear and tear. To help prevent neck pain, keep your head centered over your spine. Some simple changes in your daily routine may help. Consider trying to:

• Use good posture. When standing and sitting, be sure your shoulders are in a straight line over your hips and your ears are directly over your shoulders. When using cell phones, tablets and other small screens, keep your head up and hold the device straight out rather than bending your neck to look down at the device.
• Take frequent breaks. If you travel long distances or work long hours at your computer, get up, move around, and stretch your neck and shoulders.
• Adjust your desk, chair and computer so that the monitor is at eye level. Knees should be slightly lower than hips. Use your chair’s armrests.
• If you smoke, quit. Smoking can increase the risk of developing neck pain.
• Avoid carrying heavy bags with straps over your shoulder. The weight can strain your neck.
• Sleep in a healthy position. Your head and neck should be aligned with your body. Use a small pillow under your neck. Try sleeping on your back with your thighs elevated on pillows, which will flatten your spinal muscles.
• Stay active. If you don’t move much, increase your activity level.

Diagnosis

Your health care provider will take a medical history and do an exam. The exam will include checking for tenderness, numbness and muscle weakness. And it will test how far you can move your head forward, backward and side to side.

Imaging tests

Imaging tests might help find the cause of the neck pain. Examples include:

• X-rays. X-rays can reveal areas in the neck where the nerves or spinal cord might be pinched by bone spurs or other changes.
• CT scan. CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of structures inside the neck.
• MRI. MRI uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues. The soft tissues include the disks, the spinal cord and the nerves coming from the spinal cord.

It’s possible to have X-ray or MRI evidence of structural problems in the neck without having symptoms. Imaging studies are best used with a careful history and physical exam to determine the cause of pain.

Other tests

• Electromyography (EMG). An EMG can determine whether neck pain might be related to a pinched nerve. It involves inserting fine needles through the skin into a muscle. The test measures the speed of nerve conduction to determine whether nerves are working properly.
• Blood tests. Blood tests can sometimes provide evidence of inflammation or infections that might be causing or contributing to neck pain.

Treatment

The most common types of mild to moderate neck pain usually respond within two or three weeks to self-care. Pain relievers and the use of heat might be all that’s needed.

Medications

Pain relievers might include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), or acetaminophen (Tylenol, others). Take these medications only as directed. Overuse can cause serious side effects.

If pain relievers you can buy without a prescription don’t help, your health care provider might suggest prescription NSAIDs or muscle relaxers.

Therapy

• Physical therapy. A physical therapist can teach correct posture, alignment and neck-strengthening exercises. Physical therapy might also involve the use of heat, ice and other measures to help ease pain.
• Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin near the painful areas deliver tiny electrical impulses that may relieve pain. However, there’s little evidence that TENS works for neck pain.
• Soft neck collar. A soft collar that supports the neck may help relieve pain by taking pressure off the neck. However, if used for more than three hours at a time or for more than 1 to 2 weeks, a collar might do more harm than good.

Surgical and other procedures

• Steroid injections. A health care provider might inject steroid medications near the nerve roots, into the spinal joints or into the muscles in the neck. Numbing medications, such as lidocaine, also can be injected to relieve neck pain.
• Surgery. Rarely needed for neck pain, surgery might be an option for relieving nerve root or spinal cord compression.

Lifestyle and home remedies

Besides taking pain relievers, self-care measures that might relieve neck pain include:

• Alternate heat and cold. Reduce inflammation by applying cold, such as an ice pack or ice wrapped in a towel, for up to 15 minutes several times a day during the first 48 hours. After that, use heat. Try taking a warm shower or using a heating pad on the low setting.
• Home exercises. Keeping the neck moving is important. Begin daily gentle stretching, including neck rolls and shoulder rolls, once the worst of the pain lessens. Gently tilt, bend and rotate the neck. Warm the neck and back with a heating pad or in the shower or bath before doing these exercises.

Alternative medicine

A number of alternative treatments might ease back pain. Always discuss the benefits and risks with your health care provider before starting a new alternative therapy.

• Acupuncture. A practitioner of acupuncture inserts thin, sterilized needles into the skin at specific points on the body. Achieving best results might require several acupuncture sessions. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
• Chiropractic. Performed mainly on the spine, a chiropractic adjustment applies a controlled, abrupt force to a joint. Chiropractic treatments to the neck can provide short-term pain relief and, for many people, carry minimal risks.
• Massage. During a massage, a trained practitioner kneads the muscles in the neck. Massage might help people with chronic neck pain from tightened muscles.

Preparing for an appointment

You might initially contact your primary care provider about your neck pain. You then might be referred to:

• A doctor who specializes in nonoperative treatment of musculoskeletal conditions (physical medicine and rehabilitation specialist)
• A doctor who specializes in arthritis and other diseases that affect the joints (rheumatologist)
• A doctor who specializes in treating nerve-related disorders (neurologist)
• A doctor who operates on bones and joints (orthopedic surgeon)

What you can do

Before your appointment, be prepared to answer the following questions:

• When did your symptoms begin?
• Have you ever injured your neck? If so, when?
• Do certain neck movements improve or worsen the pain?
• What medications and supplements do you take regularly?

What to expect from your doctor

Your provider might ask some of the following questions:

• Where exactly is your pain?
• Is the pain dull, sharp or shooting?
• Do you have numbness or weakness?
• Does the pain radiate into your arm?
• Is the pain made worse by straining, coughing or sneezing?
• Do you have other physical problems?