Neck pain is a common complaint among most adults. The neck is an amazing part of the body with a challenging job of supporting the head all day, which weighs about 11 pounds, the weight of a bowling ball. Seven bones at the top of the spine (cervical vertebrae) form the neck, along with muscles and ligaments.
Anything from sleeping wrong, bad posture, or osteoarthritis can cause neck pain (among other conditions). Something as simple as leaning over a computer or hunching over the workbench can strain the neck and cause pain.
The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) and muscles provide stability to the spine.
The neck has a significant amount of motion, while supporting the weight of the head. However, because it is less protected than the rest of the spine, the neck can be more vulnerable to injury and disorders that produce pain and restrict motion.
For many people, neck pain is a temporary condition that disappears with time. However, a pain in the neck that doesn’t go away quickly can be a sign of a serious medical problem that needs medical diagnosis and treatment. Any neck pain that continues for more than a week and is severe, or is accompanied by other symptoms, requires medical attention.
What Causes Neck Pain?
Many different things can cause neck pain including injury, age-related disorders, and inflammatory disease. Many people experience neck pain or stiffness occasionally. In many cases, the pain is the result of poor posture or overuse. Neck pain, however, can result from a fall or sport injury that causes damage to the muscles, tendons, or ligaments of the neck.
Some of the more common causes of neck pain include:
Muscle tension and strains from poor posture or overuse from too many hours hunched over a computer or smartphone will often trigger a muscle strain. Activities such as reading in bed or gritting your teeth can strain neck muscles. Even sleeping with your neck in a bad position can cause neck pain.
Worn joints. Just like the other joints in the body, the neck joints tend to wear down with age. Osteoarthritis causes the cushions (cartilage) between the bones (vertebrae) to deteriorate, which may result in bone spurs that affect joint motion and cause pain.
Nerve compression from herniated disks, bone spurs, or cervical stenosis in the vertebrae of the neck can cause pain.
Injuries such as whiplash injury which occurs when the head is jerked backward and then forward, can cause pain.
Diseases such as rheumatoid arthritis, meningitis (inflammation of the thin tissue that surrounds the brain and spinal cord), fibromyalgia, and cancer can cause pain. Neck pain can also result from common infections, such as virus infection of the throat that leads to lymph node (gland) swelling and neck pain.
Other causes of neck pain can include:
Abnormalities in the bone or joints.
Carrying a heavy shoulder bag or purse.
Cervical (neck) disk degeneration.
Congenital (present at birth) abnormalities of the vertebrae and bones.
Heart Attack (will also experience other symptoms in addition to neck pain).
What are the Symptoms of Neck Pain?
Most patients describe neck pain as a dull ache. Sometimes the pain worsens with movement of the neck or turning of the head. Depending on the cause of the pain, other symptoms can include:
Sharp, shooting pain.
A feeling of fullness.
Swishing sounds in the head.
Dizziness or lightheadedness.
Lymph node (gland) swelling.
Neck pain can also be associated with headache, facial pain, shoulder pain, and arm numbness or tingling. These symptoms are often the result of nerves being pinched in the neck. Depending on the condition, sometimes neck pain is accompanied by upper back and/or lower back pain, as is common in inflammation of the spine from ankylosing spondylitis.
Most neck pain improves gradually with home treatment. If symptoms persist for more than a week, see your doctor. Seek immediate care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident, or fall. You should also see a doctor if you have:
Severe neck pain without an apparent cause.
A lump in your neck.
Trouble swallowing or breathing.
Pain that radiates down your arms or legs.
Pain that spreads to your back.
Inability to move your arms or hands.
Inability to touch your chin to your chest.
Bladder or bowel dysfunction.
If you’ve been in an accident or fall and your neck hurts, seek medical care immediately.
How is Neck Pain Diagnosed?
To accurately diagnose neck pain, the doctor will take a medical history, review the symptoms, and do an exam. The doctor will check for tenderness, numbness and muscle weakness, as well as see how far the patient can move their head forward, backward and side to side.
In some cases, it may be necessary to conduct imaging tests to diagnose the cause of the pain accurately. Some of the imaging tests include:
X-rays. To see if there are areas in the neck where the nerves or spinal cord might be pinched by bone spurs or other degenerative changes, the doctor may order X-rays.
Computed Tomography Scan (CT or CAT scan). Combining X-ray images taken from many different directions, a CT scan produces a detailed, cross-sectional view of the internal structures of the neck.
MRI. Using radio waves and a strong magnetic field, an MRI creates detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.
It’s possible for these imaging test to show evidence of structural problems in the neck without the patient exhibiting typical symptoms. Imaging studies are best used along with a careful history and physical exam to determine the exact cause of the pain.
Electromyography (EMG). If the doctor suspects the neck pain might be related to a pinched nerve, an EMG may be necessary. This test involves inserting fine needles through the skin into a muscle and performing tests to measure the speed of nerve conduction to determine whether specific nerves are functioning properly.
Blood tests. Blood tests can sometimes provide evidence of inflammatory or infectious conditions that might be causing or contributing to your neck pain.
Myelography/CT scanning is sometimes used as an alternative to an MRI.
To prepare for the appointment, the patient should be ready to answer questions such as these:
When did the symptoms begin?
Where exactly does the pain occur?
Do any specific neck movements improve or worsen the pain?
Is the pain dull, sharp, or shooting?
Is there numbness or weakness?
Does the pain radiate into the arms?
Is the pain made worse by straining, coughing, or sneezing?
Has there ever been an injury to the neck? If so, when?
What medications and supplements are being taken regularly?
How is Neck Pain Treated?
The most common types of mild to moderate neck pain usually respond well to self-care within two or three weeks. If the pain persists, other treatments can include:
Lifestyle and Home Remedies
There are several self-care measures neck pain patients can try to relieve the neck pain. These include:
Slow down. Take a few days off from sports, activities that aggravate the pain, and heavy lifting. When you resume regular activities, do so slowly as your symptoms ease.
Over-the-counter pain relievers. Try over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others). Depending on the source of pain, a prescription-strength pain medication, or drugs like muscle relaxants, and even antidepressants may be used.
Alternate heat and cold. To reduce inflammation at the onset of pain, apply cold (an ice pack or ice wrapped in a towel) for up to 20 minutes several times a day for the first 2 to 3 days to help reduce swelling. After that, use moist heat, like a hot shower or a heating pad on the lowest setting to help the neck heal.
Nutrition and Exercise. Healthy eating can help combat nutritional deficiencies that may be contributing to neck pain. Exercise, in addition to increasing flexibility and range of motion, can help release endorphins that are the body’s natural pain relievers. Your doctor or a physical therapist can show you which work best for your specific need and instruct you in proper techniques to avoid causing additional damage.
Depending on the cause of the pain, the doctor may recommend therapy. This can consist of:
Physical therapy. A physical therapist can teach the patient correct posture, alignment, and neck-strengthening exercises. The therapist can also help with the proper application of heat, ice, electrical stimulation, and other measures to help ease the pain and prevent it from recurring.
Transcutaneous electrical nerve stimulation (TENS). The therapist places electrodes on the skin near the painful areas. These deliver tiny electrical impulses that can help relieve the pain.
Traction. By using weights, pulleys, or an air bladder, a therapist can gently stretch the neck. This therapy, under the supervision of a medical professional and physical therapist, may provide relief of some neck pain associated with nerve root irritation.
Short-term immobilization. A soft collar that supports the neck may help relieve pain by taking pressure off the neck. However, the use of immobilization should be used for no more than three hours at a time, and for more than one to two weeks. Otherwise, the collar might do more harm than good.
Minimally Invasive Procedures and Surgery
Should conservative treatments be ineffective, your doctor may suggest:
Steroid injection. The doctor may inject corticosteroid medications near the nerve roots, into the small facet joints in the bones of the cervical spine, or into the muscles of the neck to help with pain. Numbing medications, such as lidocaine, also can be injected to relieve the pain.
Percutaneous discectomy is the surgical removal of a disc (or portion of a disc) with a needle through a tiny slit in the skin. The procedure uses heat or radio waves to remove the disc material and reduce pressure on nerves.
Cervical medial branch block/denervation is a widely used, minimally-invasive, non-surgical procedure using injections to reduce the inflammation and irritation causing pain.
Cervical lysis of adhesions (Racz procedure) is effective in removing excessive scar tissue around the spine. The procedure helps relieve pain, inflammation, and soreness for many neck pain patients.
Cervical Spinal Cord Stimulation (SCS) uses the placement of tiny electrodes close to the spinal cord to inhibit the transmission of pain signals.
Occipital nerve block is an injection of a local anesthetic and corticosteroid over the occipital nerves located in the back of the head. These blocks can dramatically improve the quality of life for a patient with neck pain.
Occipital nerve stimulation. Similar to Cervical Spinal Cord Stimulation, Occipital Nerve Stimulation involves the use of tiny electrodes near the occipital nerves in the back of the head. The electrodes release a small electric current that inhibits pain transmission.
Botox injections can be an effective treatment for whiplash injuries. Patients report not only a reduction in pain, but an increase in range of motion after the injections.
Prolotherapy is a type of injection therapy. Injecting an irritating substance into the painful area causes the body to initiate the healing process of damaged ligaments and tendons.
Surgery. Rarely necessary for neck pain; however, surgery might be an option for relieving nerve root or spinal cord compression.
Talk to your doctor if you’re interested in trying alternative treatments for your neck pain. Your doctor can discuss the benefits and risks. Alternative treatments include:
Acupuncture involves the insertion of thin needles into various points on your body. Studies have found that acupuncture may be helpful for many types of pain. But studies in neck pain have been mixed. For best results, you may need to undergo several acupuncture sessions. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
Biofeedback teaches the patient to become aware of bodily processes normally thought to be involuntary (such as blood pressure and heart rate) to gain some conscious control of these processes and relax. This can prove effective in helping relieve pain.
Chiropractic treatments are 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 therapy is by a trained practitioner who manipulates the muscles in your neck with his or her hands. Little scientific evidence exists to support massage in people with neck pain, though it may provide relief when combined with your doctor’s recommended treatments.
The key to relieving a stiff neck is proper stretching and manipulation. Some simple stretches you can do at home, work, or the car that may help with a stiff neck are:
Roll your shoulders backward and down 10 times.
Squeeze your shoulder blades together 10 times.
Push your head back into your car headrest or hands and hold for 30 seconds.
Bring your ear to your shoulder 10 times on each side.
Is It Possible to Prevent Neck Pain?
With so many of us gazing into computers or staring down at smartphones, it’s no wonder we experience neck pain. A stiff neck is typically a result of muscles weakening over time from poor posture or misuse.
When you pull a muscle or pinch a nerve in the neck, there is immediate pain, and the body reacts with a protective spasm. The tight, clenching sensation makes it feel like you can’t even move, which is the body’s natural protective response to avoid further damage.
If the pain is the result of poor posture and neck muscle strain, the pain should go away if you practice good posture and rest sore neck muscles. Some simple changes to your daily routine can help avoid neck pain. Consider trying to:
Use good posture. When standing and sitting, be sure your head and shoulders are in a straight line over your hips, and your ears are directly over your shoulders. Avoid bending the neck forward for long periods.
Adjust your desk, chair, and computer so that the computer monitor is at eye level. Knees should be slightly lower than hips. Use your chair’s armrests.
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. Don’t sit or stand in one position for long periods.
Avoidcradling the phone between your ear and shoulder when talking. Rather, use a headset or speakerphone.
Avoid carrying heavy bags with straps over your shoulder, which can strain your neck.
If you smoke, quit. Smoking damages the structures and architecture of the spine and slows the healing process, putting you at higher risk of developing neck pain.
Lose weight. Excess weight contributes to disc degeneration and neck and shoulder pain, as well as low back pain. Losing weight can reduce the pressure on the back.
Another important thing to do is to sleep in a good position. Your head and neck should be aligned with your body. The two best sleeping positions for the neck are on your side or your back. Sleeping on your stomach is hard on the spine because the back is arched, and your neck is turned to the side.
If you are a back sleeper, choose a rounded pillow to support the natural curve of the neck, with a flatter pillow to cushion the head. If you sleep on your side, keep your spine straight by using a pillow that is higher under the neck than your head.
Preferred sleeping positions are often set early in life and can be tough to change, not to mention that we don’t usually wake up in the same position in which we fell asleep. Still, it’s worth trying to start the night sleeping on your back or side with the neck well-supported and in a healthy position.
When traveling as a passenger in a plane, train, or car, or even just reclining to watch TV, use a horseshoe-shaped pillow to support your neck. This special pillow will prevent the head from dropping to one side if you doze. Be careful to use an appropriate size. If the pillow is too large behind the neck, it will force your head forward.
Neck pain can only be prevented by avoiding injury to the neck. This includes minimizing the risks of injury during sports activities. Athletes who participate in collision sports can prevent neck injury with appropriate equipment. Consider including neck strengthening exercises as part of training and conditioning.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating neck pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.