Neck pain

Neck pain can occur at any age but is more common as you get older. It may come on as a result of trauma e.g., whiplash injury. You may wake with pain or it may come on gradually for no apparent reason.

The structure of the neck

The neck (cervical spine) is made up of seven bones called vertebrae, with discs between each vertebrae which act as shock absorbers and allow the neck to move.

The vertebrae are supported by strong ligaments (fibres that link the bones together) and muscles which enable the neck to move.

Within the vertebrae is the spinal cord which contains nerves carrying messages to and from the brain. Nerves come out from between the vertebrae in the neck to take and receive messages to the arms.

A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the brain.

X-rays are rarely useful in diagnosing neck pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

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Causes and symptoms

Causes of neck pain

Non-specific neck pain – many people have a stiff and painful neck for no obvious reason. It may be due to spasm in the neck muscles, made worse by static postures and positions.

Cervical spondylosis – occurs due to normal age related changes of the discs and small joints in the neck. This is quite normal as we get older. The discs become thinner and the spaces between bones get narrower. Spurs of bone known as osteophytes form at the edge of the vertebrae and small joints.

Whiplash – usually due to the head carried forward and backwards at speed in a car accident. It is thought the pain is due to muscle spasm and stretching of ligaments and other soft tissues.

Muscular neck pain – muscles at the back of your neck have to work all the time to hold your head up. When we are worried or stressed we often tighten these muscles even more which can cause neck pain and tension headaches.

Torticollis or wry neck – when the head becomes twisted to one side and it is very painful to move the head back straight. The cause is often not known however, it may be due to a minor strain or sprain to a muscle or ligament in the neck. It is common for people to go to bed feeling fine and to wake up the next morning with torticollis. The pain usually eases and clears away over a few days without any treatment.

Cervical radiculopathy – when the nerve irritated as it is as it comes out from the spinal cord in the neck. Neck and arm pain can occur including loss of feeling (numbness), pins and needles, and weakness in parts of an arm supplied by the nerve.

Symptoms of neck pain

Pain and stiffness – pain may be in middle of the neck or to one side. Pain may travel to the shoulder or shoulder blade. Muscles may feel tight and stiffness may be worse after rest.
Numbness and tingling – if a nerve is compressed you may feel numbness or tingling down the arm to the fingers.
Clicking or grating noises – you may hear or feel this as you move your head. It is a common symptom but is not serious.
Dizziness and blackouts – if you feel dizzy when looking up or turning your head, this may be due to pinching of the vertebral arteries. With these symptoms it is best to seek medical advice.

The symptoms below are very rare, but make sure you contact your GP if you experience:

Severe head, neck or arm pain that is constant or disturbs sleep.
Weakness and loss of feeling in the arms or legs.
A history of inflammatory arthritis, immuno-suppression, cancer, TB, drug abuse, or other infection.
If you feel unwell, have a fever or unexplained weight loss.
A history of violent trauma (e.g. a road traffic accident or a fall from height) or a history of neck surgery.

Diagnosis of neck pain

X-rays are rarely useful in diagnosing neck pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

Self management of neck pain

Regular pain relief

Discuss with your community pharmacist or GP.

Heat or ice packs

These can be used for pain relief e.g., frozen peas in a damp towel applied for 20 minutes, a hot water bottle or shower.

Posture

Be aware of your posture and try not to stay in one position for too long.
When sitting, sit well back in the chair and place a rolled towel in the small of your back. Make sure your shoulders are in line with your hips and your chin is not poking forward. Sitting correctly reduces the strain on muscles and ligaments.
When standing make sure your shoulders are back and your chin tucked in.
When sleeping avoid sleeping on your front as this strains your neck. Change the number, firmness and position of pillows for comfort.

Exercise

Keep active and try to exercise the neck to keep the joints mobile and the muscles flexible. At first the pain may be quite uncomfortable. However, gently exercise the neck as soon as you are able.

See your doctor if the pain becomes worse and or lasts longer than 4–6 weeks. Also if other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in part of an arm or hand or you have problems with walking or balance.

Exercises for neck pain

Exercise 1: flexion and extension

In sitting bend your neck forwards, chin to chest
Return to neutral
Look up to the ceiling – return to neutral
Do this exercise within comfort

Exercise 2: rotation right and left

In sitting – good position
Turn head to the right
Return to neutral
Turn head to the left
Return to neutral

Exercise 3: neck retraction

In sitting good position
Retract neck back
Tuck chin in – keep level
Return to neutral

Exercise 4: side flexion right and left

In sitting – good position
Side bend neck towards the left shoulder
Return to neutral
Side bend neck to the right shoulder
Return to neutral

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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