Neck Pain

Neck pain is a common problem and will affect most of us at some point during our lives. The neck is made of bones (vertebrae) separated by softer cartilage known as spinal discs. The neck, like all other joints, has ligaments, muscles and tendons that work together to support the neck and help perform movement. In most cases neck pain might just be caused by a simple strain to a muscle or ligament.

Neck problems are normally caused by an injury, accident, or normal age-related changes and lifestyle factors. These include:

• An accident or injury (e.g., following a fall or whiplash from a road traffic collision)
• Sleeping awkwardly
• Holding your neck in the same posture for too long (e.g., sitting slouched on the sofa, looking down at a laptop/mobile phone, painting and decorating)
• Worry or stress
• Having low levels of physical activity

The spine has two main functions; one is to perform and allow movement while the second is to cover and protect the spinal cord and nerves that serve the rest of the body. The many vertebrae and discs allow movement in all directions while still protecting the spinal cord.

Neck problems can cause a range of symptoms and can vary from person to person. For some people neck pain comes on suddenly, perhaps after an injury (e.g. a whiplash injury) or they can wake up with a painful stiff neck. For others, it may come on gradually over time and for no obvious reason. Some people get a dull pain in their neck, while others describe it as more severe. For most people with neck pain, some postures and activities make the pain worse, for example sitting for too long. Where other things help to relieve it, for example gently moving the neck. Most people find their neck pain improves by itself within a few weeks. 

The most common symptoms of neck pain are:

• Pain in the back or sides of your neck, which can sometimes extend to the upper shoulder regions
• Have tension headaches, where the pain can travel to the back of your head and sometimes into your ear or behind your eye
• Have pain when resting or when moving
• Have tightness in the muscles of your neck and upper shoulders, especially if you’ve been still such as sitting or sleeping in one position for a long time
• Reduced mobility - your neck won’t turn as far as it normally does, for example when you try to look over your shoulder while reversing the car
• The muscles and joint of the neck feel tender or tight to touch
• Gentle activity may help relieve pain and increase your flexibility

Some people may describe clicking noises when moving the neck. This is called crepitus, and it can be caused by air bubbles popping, or tissues and bones moving over each other, in the joint. Other joints often do this too, and is a normal part of body movement, but noises from your neck usually seem louder because they’re happening closer to your ears. While this can sound alarming, it is a common symptom and should not limit your usual activity.

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.

An image or investigation is generally not needed to confirm pain. If the Health Care Professional needs further information to finalise the diagnosis, they will organise further tests or they will refer you to a specialist.

The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments.

Once your pain is under control, working on the movement and strength of your neck is what will help long term.  Keeping your neck moving is an essential part of your treatment and recovery. Remain as active as the pain allows. Keep moving, even if only slowly at first, and move your neck for short periods every hour, therefore the use of a collar is not usually required.

Some people find that relaxation, meditation, or mindfulness helps to reduce stress and tension across your shoulders and neck.

If your sleep is affected, changing the number of pillows may be helpful. Versus Arthritis suggest your head and neck should be supported so your head is level with your body in a neutral position. The pillow should fill in the natural hollow between the neck and shoulders – a soft or moulded pillow may be useful, or a supportive roll inside your pillowcase can support the hollow of your neck.

If your work requires you to maintain a static position for long periods (sitting at a desk, driving a HGV, standing at a checkout), it is important to change positions as often as possible and realistic. This can include standing up from your chair and working at a higher surface, going for a walk, doing some stretches, or simply moving the area of the body that feels stiff and sore. The only wrong position is the one that you stay in all day. 

You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by Keeping Active. Below are some basic exercises specific to your neck to get you started.

Exercise has been shown to be the most helpful treatment for on-going neck pain. Neck stretches and good posture tend to be useful and improve neck pain. Choose something that you like to do it and keep at it.

It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.

The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.

Finding a good sitting posture

Sit upright on a chair with your hands on your hips and your feet flat on the floor. Begin by slumping, rounding your shoulders and dropping your head. Your body weight should be settled through your tail bone. Gradually roll yourself upwards from your tail bone until your weight is through your seat bones. Lift your head up and look straight ahead. Bring your shoulders back and down, pushing your chest out a little. Repeat this movement. When you are sitting as tall as you can, relax back a little and hold. This is the pelvic neutral position.

Cervical Rotation

Sit upright in a chair looking straight ahead. Look over one shoulder as far as you can, moving only your head, not your body. Return back to the starting position and then relax and repeat.

Seated cervical flexion and extension

Start by sitting with your neck and shoulders relaxed. Bring the chin towards your chest and look downwards. Slowly return to the center. Continue to lift your chin upwards and look towards the ceiling. Then return to the starting position.

Chin Tuck

Stand or sit straight, looking ahead, and place two fingers on your chin. Push your chin so that your head goes straight back, lengthening through the back of your neck, and keeping your eyes forwards. Hold, and then relax.

Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your neck pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional

You should see your Health Care Professional if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have new pain, tingling, numbness or weakness in your face, arms or legs
• Suddenly develop neck stiffness along with difficultly lifting both arms above your head, particularly in the morning when you wake up 
• Develop sudden stiffness in the neck and/or shoulders resulting in a lack of movement 
• Are experiencing double vision, dizziness, nausea or sudden fainting
• Are noticing changes with your speech and/or difficulty swallowing
• Are noticing changes to your balance or walking pattern 
• Are feeling clumsy or are falling more often
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of neck surgery
• Experience a loss of feeling/pins and needles between your inner thighs or genitals
• Have numbness in or around your back passage or buttocks
• Have altered feeling when using toilet paper to wipe yourself
• Have increasing difficulty when you try to urinate
• Have increasing difficulty when you try to stop or control your flow of urine
• Have a loss of sensation when you pass urine
• Are leaking urine or recent need to use pads
• Can't tell when your bladder is either full or empty
• Experience the inability to stop bowel motion
• Have a change in ability to achieve an erection or ejaculate
• Experience a loss of sensation in genitals during sexual intercourse

This information is also available as a card created by the East Midlands Spinal Network. These cards are available in many different languages from the East Midlands Spinal Network website.

If you do not have any of the above, you may be able to effectively self manage your condition