Neck pain
Pain - neck; Neck stiffness; Cervicalgia; Whiplash; Stiff neck
Neck pain is discomfort in any of the structures in the neck. These include the muscles, nerves, bones (vertebrae), joints, and the discs between the bones.
Your neck is sore. It hurts to move your head. Are you sleeping wrong, is it stress, or a result of climbing that ladder to clean your gutters? Let's get to the bottom of those real pains in your neck. When your neck is sore, you may have trouble moving it, especially to one side. Many people describe this as having a stiff neck. If neck pain involves nerves, such as a muscle spasm pinching on a nerve or a slipped disk pressing on a nerve, you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere. A common cause of neck pain is muscle strain or tension. Usually, everyday activities are to blame. Such activities include bending over a desk for hours hunching in place, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning your neck in a jarring manner while exercising. Usually, you can treat minor neck pain at home. Simple posture improvements are a great place to start, sitting straight with shoulders held back, driving with arms on armrests, and avoiding carrying shoulder bags. Take breaks when sitting in front of video displays or holding a telephone. For pain, you might try over-the-counter pain relievers such as Advil or Tylenol. And low level laser therapy can be very effective. Physical therapy can be great for treating or preventing the recurrence of neck pain. Slow range of motion exercises, moving your head up and down, side to side from ear to ear, can gently stretch your neck muscles. Applying heat beforehand may help. Good sleep position is especially important with the head aligned with the body. You can try sleeping with a special neck pillow for that. You may want to see a doctor if your symptoms linger for longer than a week of self care, or if you have numbness, tingling, or weakness in your arm or hand, or if your pain was caused by a fall, blow, or injury. If the pain is due to a muscle spasm or a pinched nerve, your doctor may prescribe a muscle relaxant or a tricyclic antidepressant, and possibly a more powerful pain reliever than you were taking at home. You may be referred to a neurologist if he suspects any nerve damage in your neck. You can help prevent neck pain or keep it from coming back in many ways. Use relaxation techniques and regular exercise to prevent unwanted stress and tension to your neck muscles. Learn stretching exercises for your neck and upper body, stretch every day, before and especially after exercise. Use good posture, especially if you sit at a desk all day, keep your back supported, adjust your computer monitor to eye level, so you don't have to continually look up or down. Talk to your doctor if pain persists, you do not want to go through life with a real pain in the neck.
The spinal vertebrae are separated by cartilage disks filled with a gelatinous substance, that provide cushioning to the spinal column. These disks may move out of place or rupture from trauma or strain, especially if degenerative changes have occurred in the disk. When the disk moves out of place nerve roots (large nerves that branch out from the spinal cord) may become compressed resulting in neurological symptoms, such as pain, sensory and motor changes.
The pain of whiplash may not appear right away after an accident, but sometimes may take hours to weeks to develop. Symptoms include dizziness, headache, pain or stiffness in the neck, jaw, shoulders, or arms.
Whiplash is an injury to the soft tissues of the neck. Whiplash injury strains the muscles and ligaments of the neck beyond their normal range of motion. There is often pain and stiffness in the neck for the first few days following a whiplash injury. The pain can also be felt in the surrounding muscle groups in the head, chest, shoulders, and arms.
Considerations
When your neck is sore, you may have difficulty moving it, such as turning to one side. Many people describe this as having a stiff neck.
If neck pain involves compression of your nerves, you may feel numbness, tingling, or weakness in your arm or hand.
Causes
A common cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such activities include:
- Bending over a desk for a long time (often an hour or more)
- Having poor posture while watching TV or reading
- Having your computer monitor positioned too high or too low
- Sleeping in an uncomfortable position
- Twisting and turning your neck in a jarring manner while exercising
- Lifting things too quickly or with poor posture
Accidents or falls can cause severe neck injuries, such as vertebral fractures, whiplash, blood vessel injury, and even paralysis.
Other causes include:
- Medical conditions, such as fibromyalgia
- Cervical arthritis or spondylosis
- Ruptured disk
- Small fractures to the spine from osteoporosis
- Spinal stenosis (narrowing of the spinal canal)
- Sprains
- Infection of the spine (osteomyelitis, diskitis, abscess)
- Torticollis
- Cancer that involves the spine
Home Care
Treatment and self-care for your neck pain depend on the cause of the pain. You will need to learn:
- How to relieve the pain
- What your activity level should be
- What medicines you can take
For minor, common causes of neck pain:
- Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
- Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, and then use heat after that.
- Apply heat with warm showers, warm compresses, or a heating pad. To prevent injury to your skin, DO NOT fall asleep with a heating pad or ice bag in place.
- Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
- Do slow range-of-motion exercises, up and down, side to side, and from ear to ear. This helps gently stretch the neck muscles.
- Have a partner gently massage the sore or painful areas.
- Try sleeping on a firm mattress with a pillow that supports your neck. You may want to get a special neck pillow.
- Ask your health care provider about using a soft neck collar to relieve discomfort. However, using collar for a long time can weaken neck muscles. Take it off from time to time to allow the muscles to get stronger.
When to Contact a Medical Professional
Seek medical help right away if you have:
- A fever and headache, and your neck is so stiff that you cannot touch your chin to your chest. This may indicate meningitis. Call 911 or the local emergency number or get to a hospital.
- Symptoms of a heart attack, such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain.
Contact your provider if:
- Symptoms do not go away in 1 week with self-care
- You have numbness, tingling, or weakness in your arm or hand
- Your neck pain was caused by a fall, blow, or injury -- if you cannot move your arm or hand, have someone call 911 or the local emergency number
- You have swollen glands or a lump in your neck
- Your pain does not go away with regular doses of over-the-counter pain medicine
- You have difficulty swallowing or breathing along with the neck pain
- The pain gets worse when you lie down or wakes you up at night
- Your pain is so severe that you cannot get comfortable
- You lose control over urination or bowel movements
- You have trouble walking and balancing
What to Expect at Your Office Visit
Your provider will perform a physical exam and ask about your neck pain, including how often it occurs and how much it hurts.
Your provider will probably not order any tests during the first visit. Tests are only done if you have symptoms or a medical history that suggests a tumor, infection, fracture, or serious nerve disorder. In that case, the following tests may be done:
- X-rays of the neck
- CT scan of the neck or head
- Blood tests, such as a complete blood count (CBC)
- MRI of the neck
If the pain is due to muscle spasm or a pinched nerve, your provider may prescribe a muscle relaxant or a more powerful pain reliever. Over-the-counter medicines often work as well as prescription drugs. At times, your provider may give you steroids to reduce swelling. If there is nerve damage, your provider may refer you to a neurologist, neurosurgeon, or orthopedic surgeon for consultation.
References
Hudgins TH, Origenes AK, Pleuhs B, Alleva JT. Cervical sprain or strain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 6.
Kosty J, Nasser R, Vasquez RA, Wong CC, Cheng JS. Neck pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier;2021:chap 48.
Ronthal M. Arm and neck pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 32.
Version Info
Last reviewed on: 2/8/2024
Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
