Neck Pain

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Neck Pain

Topic Overview

What is neck pain?

Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It may limit how much you can move your head and neck.

Neck pain is common, especially in people older than 50.

What causes neck pain?

Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted are some things that can cause neck pain. These kinds of activities can lead to neck strain, a spasm of the neck muscles, or swelling of the neck joints.

Neck pain can also be caused by an injury. A fall from a ladder or whiplash from a car crash can cause neck pain. Some less common medical problems can also lead to neck pain, such as:

What are the symptoms?

You may feel a knot, stiffness, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may get a headache. You may not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.

If your neck pain is long-lasting (chronic), you may have trouble coping with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety.

How is neck pain diagnosed?

Your doctor will ask questions about your symptoms and do a physical examination. He or she may also ask about any injuries, illnesses, or activities that may be causing your neck pain.

During the physical examination, your doctor will check how well you can move your neck. He or she will also look for tenderness or numbness, tingling, or weakness in your arms or hands.

If your pain started after an injury, or if it doesn't improve after a few weeks, your doctor may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests may be done to check the neck bones, spinal discs, spinal nerve roots, and spinal cord.

How is it treated?

The type of treatment you need will depend on whether your neck pain is caused by activities, an injury, or another medical condition. Most neck pain caused by activities can be treated at home.

For neck pain that occurs suddenly:

  • Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. Or you can try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help. But you can try them to see if they help.
  • Take acetaminophen (such as Tylenol). ASA, ibuprofen, or another anti-inflammatory medicine can also help relieve pain.
  • Avoid more injury to your neck by changing activities and habits, such as how you sit or sleep.
  • Try exercises or physiotherapy to help you move your head and neck more easily.

To treat chronic neck pain, your doctor may prescribe medicine to relax your neck muscles. Or you may get medicines to relieve pain and help you sleep. You might also try massage or yoga to relieve neck stress.

Surgery is rarely done to treat neck pain. But it may be done if your pain is caused by a medical problem, such as pressure on the spinal nerve roots, a tumour, or narrowing of the spinal canal.

Can you prevent neck pain?

You can avoid neck pain caused by stress or muscle strain with some new habits. Avoid spending a lot of time in positions that stress your neck. This can include sitting at a computer for a long time.

If your neck pain is worse at the end of the day, think about how you sit during the day. Sit straight in your chair with your feet flat on the floor. Take short breaks several times an hour.

If your neck pain is worse in the morning, check your pillow and the position you sleep in. Use a pillow that keeps your neck straight. Avoid sleeping on your stomach with your neck twisted or bent.

Learning about neck pain:

Being diagnosed:

Getting treatment:

Living with neck pain:

Cause

Neck pain can be caused by:

  • An activity that harms the neck.
  • An injury.
  • Another medical condition.

Activities that cause neck pain

Most neck pain is caused by activities that involve repeated or prolonged movements in the neck. This can result in a strain (an overstretched or overused muscle), a sprain (injury to a ligament), a spasm of the neck muscles, or inflammation of the neck joints.

These activities include:

  • Holding your head in a forward or odd position for long periods of time while working, reading, watching TV, or talking on the telephone.
  • Sleeping on a pillow that is too high or too flat or that doesn't support your head, or sleeping on your stomach with your neck twisted or bent.
  • Spending long periods of time resting your forehead on your upright fist or arm ("thinker's pose").
  • Work or exercise that uses the upper body and arms, such as painting a ceiling or other overhead work.

Stress and focusing intensely on a task can also cause neck pain. Tension may develop in one or more of the muscles that connect the head, neck, and shoulders. They may feel tight and painful.

Injuries that cause neck pain

Minor injuries may occur from tripping or falling a short distance or from excessive motion of the cervical spine.

Severe neck injuries may occur from:

  • Whiplash in a car crash.
  • Falls from significant heights.
  • Direct blows to the face or to the back or top of the head.
  • Sports-related accidents.
  • A penetrating injury such as a stab wound.
  • Pressure applied to the outside of the neck, such as strangulation.

Medical conditions that cause neck pain

Certain medical problems can cause neck pain. These include:

  • Problems related to aging, such as:
  • Illnesses such as:
    • Meningitis, which causes inflammation around the tissues of the brain and spinal cord.
    • Flu, which tends to make the neck and the rest of the body ache all over.
  • Chronic conditions such as:
  • Torticollis (wryneck). Torticollis is caused by severe muscle tightness or a shortened muscle on one side of the neck, causing the head to be tilted to one side. Torticollis is usually a symptom of another medical problem.
  • Referred pain. Referred pain occurs when a problem in one place in the body causes pain in another place. For example, a problem with your jaw (temporomandibular disorder) or your heart (such as a heart attack) can cause neck pain.
  • Infection or a tumour in the neck area.

Some medicines can cause neck pain as a side effect.

Symptoms

Neck pain may:

  • Spread to the upper back or arms.
  • Be worse with movement.
  • Make your neck stiff or tender.
  • Cause headaches. These are common and may last for months.

Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord include:

  • Numbness, tingling, or weakness in your arm or hand.
  • A burning feeling when you are touched on the skin of the arm or hand.
  • A pain that feels like a shock and extends into your arm or hand.
  • Leg numbness or weakness, and loss of the ability to control urination (bladder control) or bowel movements. This can occur when there is pressure on or injury to the spinal cord.

What Happens

When neck pain is caused by activities, such as computer use or sleeping position, it usually gets better within 4 to 6 weeks with treatment that includes taking steps to relieve pain, modifying activities, and doing exercises or physiotherapy.1

When neck pain is caused by injuries, such as a fall resulting in a herniated disc, it usually improves within 3 months with non-surgical treatment. Neck pain caused by an injury such as whiplash may take longer but usually improves within 6 to 12 months with occasional recurring pain.1

Chronic neck pain

Neck pain may become long-lasting (chronic) when it occurs in combination with other health conditions, such as conditions associated with increasing age. These include narrowing of the spinal canal (cervical spinal stenosis) and arthritis of the neck (cervical spondylosis). In some cases, chronic neck pain can be caused by repeated and prolonged movements, such as long hours working at a computer.

Chronic neck pain can make it hard to cope with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety. For more information, see the topic Chronic Pain.

What Increases Your Risk

Risk factors for neck pain that you cannot control include:

Risk factors that you can control include:

  • Awkward positions that put stress on the neck, or poor posture at home or at work.
  • Stress or depression, or boredom at or unhappiness with work.
  • Heavy physical work.
  • Smoking or drug abuse.
  • Poor physical condition and lack of exercise.

When To Call a Doctor

Call 911 or other emergency services immediately if:

  • A person has signs of damage to the spine after an injury (such as a car crash, a fall, or a direct blow to the spine). Signs may include:
    • Being unable to move part of the body.
    • Severe back or neck pain.
    • Weakness, tingling, or numbness in the arms or legs.
    • Loss of bladder or bowel control.
  • You suddenly lose bowel or bladder control or your ability to stand, even if you were not injured.
  • You have neck pain that occurs with chest pain and other symptoms of a heart attack.

Call your doctor if you have:

  • Severe pain that does not improve after a few days of home treatment.
  • Numbness, tingling, or weakness in your chest, belly, buttocks, arms, or legs.
  • Neck pain with severe arm pain.
  • Other pain that isn't better after 2 weeks of home treatment.

Watchful Waiting

Most neck pain doesn't require a visit to a doctor.

If the pain doesn't get better after 1 or 2 days and you can't do your normal daily activities, call your doctor.

If you still have mild to moderate pain after at least 2 weeks of home treatment, talk with your doctor. He or she may want to check for problems that may be causing your neck pain.

Who to See

Health professionals who can evaluate and treat neck pain include:

If your neck pain is severe or long-lasting, health professionals who can treat you include:

You can also get care from:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Initial testing

Neck pain is usually evaluated with a medical history and physical examination. Your doctor will ask about your symptoms, injuries or illnesses, any previous treatment, and habits and activities that may be causing your neck pain. During the physical examination, your doctor will check your neck's range of motion and check for pain caused by movement. He or she will look for areas of tenderness and any nerve-related changes, such as numbness, tingling, or weakness in the arm or hand.

Blood tests may be done to check for an illness or infection.

Imaging, electromyogram, and nerve conduction tests

You may not need X-rays or other imaging tests at first. But tests may help if your neck pain doesn't get better, especially when:

  • You have signs of nerve damage.
  • Another serious problem is suspected.
  • The cause of your condition cannot be clearly identified.
  • Your doctor is asked to provide documentation of your condition, such as when a lawsuit is involved.

Besides X-rays, tests may include:

Treatment Overview

Neck pain is most often caused by repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints. Non-surgical treatment works well on this type of pain. Most cases of neck pain caused by activities get better in 4 to 6 weeks.1

Acute (short-term) neck pain

Home treatment includes applying heat or ice, taking it easy but staying as active as you can, and using over-the-counter pain relievers. For more information, see Home Treatment.

For severe pain or muscle spasm, your doctor may prescribe stronger medicines. For more information, see Medications.

A review of studies shows that exercise and manual therapy, used either separately or together, are likely to help non-specific neck pain.2 (Pain is "non-specific" when its cause isn't clear.) Manual therapy is done by a trained practitioner, such as a chiropractor or physiotherapist. It involves slow twisting, pulling, or pushing movements known as "mobilization." Rapid, forceful movements, which are known as "manipulation," should not be used. Talk to your doctor before trying manual therapy.

Your doctor may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should only be used for a day or two. See a picture of a cervical collar.

Chronic (long-term) neck pain

For long-lasting neck pain, you can use the same pain relief measures used for acute pain. For more information, see Home Treatment.

Your doctor may also prescribe antidepressants.

People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counselling along with medical treatment may help in recovery.

Surgery

Surgery is rarely required for neck pain. It may be an option when neck pain is caused by certain conditions. For more information, see Surgery.

Prevention

To help prevent neck pain caused by posture or body mechanics:

  • Avoid slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Don't sit for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
  • If you work at a computer, adjust the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. See a picture of using a computer workstation. For more information, see the topic Office Ergonomics.
  • If you use the telephone a lot, use a headset or speakerphone. Don't cradle the phone on your shoulder.
  • Adjust the seat of your car to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
  • Use proper lifting techniques. Lift with your knees, not your back.

To help prevent neck pain caused by your sleep habits:

  • Use a pillow that keeps your neck straight. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 10 cm (4 in.) wide, wrap it around your neck, and pin it in position for good support.
  • Don't sleep on your stomach with your neck twisted or bent.
  • If you read in bed, prop up the book so you aren't using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.

Other prevention tips:

Home Treatment

Even if you need medical treatment such as prescription medicines for your neck pain, the following home treatment measures will help speed your recovery.

Heat or ice

There is not strong evidence that either heat or ice will help. But it won't hurt to try them.

  • Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours.
  • Take a warm shower in place of one session with the heating pad.
  • You can buy single-use heat wraps that last up to 8 hours.
  • Try an ice pack for 10 to 15 minutes every 2 to 3 hours.

Get moving, but carefully

  • Ease back into your normal daily activities as soon as you can. Movement helps your muscles stay strong.
  • Avoid activities such as lifting and sports that make pain and stiffness worse.
  • Do stretching and strengthening exercises to keep your neck flexible and strong and prevent stiffness.
  • Avoid or change any activities that may be causing your neck pain, such as sitting for a long time at the computer or doing too much overhead work at a time.
  • Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the injured area if it causes pain. Non-prescription creams or gels, such as Bengay, may provide pain relief.

Take pain relievers

Practice good health habits

  • Try to reduce stress and tension at work and home.
  • Practice muscle relaxation exercises.
  • Consider getting a massage.
  • Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair.
  • Exercise regularly, including aerobic exercise such as walking.

For more information, see the topics Stress Management, Quitting Smoking, and Fitness.

An important part of home treatment is learning how to keep from hurting your neck again. For more information, see Prevention.

Medications

Medicines can relieve neck pain and reduce inflammation of the soft tissues. Pain relief will allow you to move your neck gently, so you can begin easy exercises and start the healing process.

Although pain relievers, muscle relaxants, and antidepressants are commonly used for neck pain, none are well-proven treatments.2

Non-prescription pain relievers include:

  • Creams or gels, such as Bengay, that are rubbed into the neck.
  • Acetaminophen, such as Tylenol, which reduces pain.
  • Non-steroidal anti-inflammatory drugs, including ASA (such as Aspirin), ibuprofen (such as Advil), or naproxen (such as Aleve), that can help relieve pain and reduce inflammation. Do not give ASA to anyone younger than 20 because of the risk of Reye syndrome.

Prescription pain relievers include:

  • Muscle relaxants, which are used to treat severe neck pain and spasms when neck pain begins (acute neck pain). They include diazepam (such as Valium) and cyclobenzaprine.
  • Narcotic pain relievers, which are used to treat severe short-term (acute) neck pain. They include codeine, acetaminophen and hydrocodone (such as Hycodan), ASA and oxycodone (such as Ratio-Oxycodan), and acetaminophen and oxycodone (such as Percocet).
  • Antidepressants, which are used to treat long-lasting (chronic) pain. They include doxepin (such as Sinequan) and amitriptyline.

Surgery

Surgery is rarely needed for neck pain. It may be an option when:

  • A neck injury causes a fracture or abnormal motion (instability). Surgery may be done to stabilize the spine and prevent a bone fracture from causing instability and possible paralysis.
  • Pressure on the nerve roots or spinal cord causes numbness or arm, hand, or leg weakness; severe pain that lasts for months; or loss of bladder or bowel control.3
  • You have a narrowing of the spinal canal (cervical spinal stenosis).
  • You have arthritis of the neck (cervical spondylosis).

Surgery Choices

  • Discectomy (with or without fusion). The surgeon removes herniated disc material that is pressing on a nerve root or the spinal cord.
  • Cervical spinal fusion. Selected bones in the neck are joined (fused) together.
  • Spinal decompression. Pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

Some people can consider artificial disc replacement instead of spinal fusion. This surgery is currently just for carefully selected patients, and it is done by specially trained surgeons. Doctors have not yet done long-term studies to know how well this works over time.

Some people with chronic facet joint pain have a surgery called percutaneous radiofrequency neurotomy. The facet joint is a portion of the spine in the neck that is sometimes responsible for neck pain after whiplash. One review suggests that this surgery offers short-term relief for chronic neck pain. Almost 60 out of 100 people with whiplash said they were pain-free more than 6 months after treatment.2 That means the surgery did not get rid of the pain in 40 out of 100 people. And the pain will most likely come back over time.

Other Treatment

Other types of treatment for neck pain may help relieve your symptoms, restore movement, and strengthen the muscles around your spine to help prevent further injury.

Other Treatment Choices

Other types of treatment include:

  • Physiotherapy. At home, you can use heat and massage to improve blood flow. A physiotherapist can teach you stretching and strengthening exercises that you can also do at home. Physiotherapy can also include treatments like heat therapy to improve blood circulation (ultrasound). For more information, see the topic Physiotherapy.
  • Cervical (neck) collars. These may be used for short periods of time to help reduce pain by restricting neck movement. See a picture of a cervical collar.
  • Traction. This is a technique used to stretch the neck and relax the spinal nerve root openings. It may be used if there is no risk of instability in the neck.
  • Low-level laser therapy. This uses targeted light energy to decrease pain and promote healing. A review of studies suggests that it can help both sudden (acute) and long-term (chronic) neck pain.4

Complementary and alternative treatments

Complementary and alternative treatments are sometimes used to relieve pain and restore neck mobility. Although the effectiveness of some of these treatments has not been proved, they seem to be helpful for some people and may relieve stress and improve quality of life. They include:

  • Manual therapy, such as that found in massage and physiotherapy and in chiropractic and osteopathic treatments. The goals of manual therapy include relaxation, decreased pain, and increased flexibility.
  • Yoga, a program of exercises to help improve flexibility and breathing, decrease stress, and maintain health. The basic components of yoga are proper breathing and posture.
  • Acupuncture, which is done by inserting very thin needles into the skin. Acupuncture is used to relieve pain and to treat many health conditions.

Other Places To Get Help

Organizations

Canadian Association of Occupational Therapists (CAOT)
CTTC Building, Suite 3400, 1125 Colonel By Drive
Ottawa, ON  K1S 5R1
Phone: (613) 523-2268
1-800-434-2268 (toll-free from Canada and continental U.S.)
Fax: (613) 523-2552
Web Address: http://www.caot.ca/

Canadian Chiropractic Association
1396 Eglinton Avenue West
Toronto, ON  M6C 2E4
Phone: (416) 781-5656
Fax: (416) 781-0923
Email: ccachiro@ccachiro.org
Web Address: www.ccachiro.org
 

The Canadian Chiropractic Association (CCA) is a professional association. Its mission is to help Canadians live healthier lives by informing the public about the benefits of chiropractic health care, incorporating chiropractic into the health care system, and facilitating chiropractic research. A variety of information on chiropractic for both professionals and the general public is available on the CCA Web site.


Canadian Orthopaedic Association
4150 St. Catherine Street West
Suite 360
Westmount, QC  H3Z 2Y5
Phone: (514) 874-9003
Fax: (514) 874-0464
Web Address: www.coa-aco.org

Canadian Physiotherapy Association
2345 Yonge Street
Suite 410
Toronto, ON  M4P 2E5
Phone: (416) 932-1888
1-800-387-8679
Fax: (416) 932-9708
Email: information@physiotherapy.ca
Web Address: http://www.physiotherapy.ca

References

Citations

  1. American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, (2005). Cervical sprain. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 746-750. Rosemont, IL: American Academy of Orthopaedic Surgeons.
  2. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  3. Bagley CA, et al. (2007). Neck pain. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1157–1165. Philadelphia: Lippincott Williams and Wilkins.
  4. Chow RT et al. (2009). Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet, 34(9705): 1897–1908.

Other Works Consulted

  • Garra G, et al. (2010). Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Academic Emergency Medicine, 17(5): 484–489.
  • Lord SM, et al. (1996). Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. New England Journal of Medicine, 335(23): 1721–1726.
  • Peloso P, et al. (2007). Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews (3).
  • Sasso RC, et al. (2007). Artificial disc versus fusion: A prospective, randomized study with 2-year follow-up on 99 patients. Spine, 32(26): 2933–2940.
  • Trinh KV, et al. (2006). Acupuncture for neck disorders. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
Last Revised June 13, 2011

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