Neck pain

What is neck pain?

Neck pain, sometimes called cervicalgia, is pain in or around the spine beneath your head. Your neck is also known as your cervical spine12. This region of your spine starts at the base of your skull and has seven bones called vertebrae that are separated from each other by disks made of cartilage and a gel-like substance. These disks cushion your bones as you move3.

Neck pain is a very common condition that will affect most people at some point in their life3. It affects 10% to 20% of adults and is more common in women2. Your chance of developing neck pain increases with age2.

You might experience axial neck pain, which is felt mostly in your neck, or radicular neck pain, which is pain that shoots into other areas such as your shoulders or arms24. Neck pain can be acute, lasting from days to six weeks, or chronic, lasting longer than three months2. If your symptoms last longer than three months, it's considered chronic neck pain. In such cases, psychological stress is frequently a factor4.

Symptoms

Neck pain can feel different for different people. Some describe the pain as a persistent ache, while others experience a stabbing or burning pain. You might also feel a shooting pain that travels from your neck to your shoulders or arms2.

Common symptoms that often accompany neck pain include12:

• Pain that gets worse when you hold your head in one place for long periods, such as when driving or working at a computer
• Muscle tightness and spasms
• Stiffness in your neck, shoulders, and upper back
• Decreased ability to move your head or difficulty turning your neck or tilting your head
• Headache
• Numbness or tingling (pins and needles) feeling in your shoulders or arms

Common causes

Neck pain has many potential causes. Most neck pain is nothing to worry about and is caused by muscle tension4. However, understanding what triggers your neck pain can help you prevent it in the future.

Poor posture is one of the most common causes of neck pain. Whether from leaning over a computer or hunching over a workbench, poor posture strains neck muscles1. Sitting at a desk for a long time, particularly in awkward positions with slightly tensed muscles, can cause pain and stiffness in the neck or shoulder areas4. For example, straining your neck to view a computer screen for long periods is a common cause of neck pain2.

Physical strain from overusing your neck muscles during repetitive or strenuous activities can lead to stiffness and pain2. Weak abdominal muscles and heavier body weight can affect your spine's alignment and contribute to neck pain2. Sleeping with too many pillows or in an awkward position can also cause neck pain3.

Mental stress can cause you to tighten your neck muscles, leading to neck pain and stiffness. Many people who tighten these muscles when they're stressed or agitated don't realize they do it until their neck starts hurting2.

Aging naturally causes wear and tear that can affect parts of your cervical spine. As you age, these parts can deteriorate or degenerate, causing pain. Over the course of a lifetime, various normal signs of wear and tear arise in the spine. The spinal disks become flatter, and small bone growths called bone spurs may form along the edges of the bones4. Degenerative conditions such as osteoarthritis (the wearing down of joint cartilage) and spinal stenosis (narrowing of the spaces in your spine) can lead to neck pain2. Over time, stress and repeated movements can cause the disks in your spine to weaken, causing a herniated disk or pinched nerve2.

Injury can damage muscles, ligaments, disks, vertebral joints, and nerve roots in your spinal cord, leading to neck pain. Trauma and other injuries from accidents are common causes. Whiplash during automobile accidents is a common injury that causes neck pain2.

Other less common causes include23:

• Growths such as tumors, cysts, or bone spurs that can put pressure on the nerves in your neck
• Other health conditions such as meningitis, rheumatoid arthritis, and cancer
• Damage to the vertebrae, spinal cord, or nerves in your neck
• Infection

When to seek medical help

Acute neck pain is very common and usually nothing to worry about. It typically goes away within about one to two weeks4. Most neck pain clears up by itself in a few days and is very rarely a sign of something more serious3.

However, neck pain is only very rarely a sign of a more serious condition or an emergency. You should seek immediate medical care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident, or fall1. If you or someone near you has neck pain and chest pain, call emergency services immediately3.

Contact a healthcare provider if neck pain13:

• Is severe
• Persists for several days without relief or doesn't ease up in a week or so
• Is getting worse
• Spreads down arms or legs
• Comes with headache, numbness, weakness, or tingling
• Is causing you distress or affecting your daily life

You should also see your doctor if your neck pain is accompanied by other symptoms like3:

• Fever, sweats, or chills
• Changes to your vision or hearing
• Pins and needles or numbness
• Numbness or weakness in your arms or legs
• Feeling light-headed, dizzy, or unbalanced
• Struggling to concentrate
• Bowel or bladder problems

Sometimes chronic neck pain can be a sign of a serious problem related to the spinal cord. Warning signs include weakness in the arms, such as dropping objects; urinary or bowel incontinence; or difficulty walking. If you notice any of these symptoms, seek care immediately5.

How neck pain is diagnosed

Your healthcare provider will take a medical history and perform a physical examination. The exam will include checking for tenderness, numbness, and muscle weakness, as well as testing how far you can move your head forward, backward, and side to side6.

Usually, a medical history and a physical exam are enough for a healthcare provider to diagnose the cause of neck pain2. Your provider will ask about previous neck injuries, work or other activities that could strain your neck, and details about your pain, including when it started and where it's located2.

To diagnose a specific cause of your neck pain, your provider may arrange imaging tests such as36:

• X-rays can reveal areas in the neck where nerves or spinal cord might be pinched by bone spurs or other changes
• CT scan (computed tomography) combines X-ray images taken from many different directions to produce detailed cross-sectional views of structures inside the neck
• MRI (magnetic resonance imaging) uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues, including the disks, spinal cord, and nerves

However, imaging is not needed for most people with neck pain3. It's possible to have X-ray or MRI evidence of structural problems in the neck without having symptoms. Imaging studies are best used with a careful history and physical exam to determine the cause of pain6.

Other tests may include6:

• Electromyography (EMG) can determine whether neck pain might be related to a pinched nerve. It involves inserting fine needles through the skin into a muscle and measures the speed of nerve conduction to determine whether nerves are working properly
• Blood tests can sometimes provide evidence of inflammation or infections that might be causing or contributing to neck pain

Treatment options

The most common types of mild to moderate neck pain usually respond within two or three weeks to self-care6. Fortunately, most causes of neck pain aren't serious and improve with conservative treatments like pain medicine, exercise, and stress management2.

Medications may include nonsteroidal anti-inflammatory drugs such as ibuprofen to help reduce inflammation and decrease discomfort. Other over-the-counter medicines like acetaminophen and naproxen can also effectively relieve the pain of a stiff neck7. Your healthcare provider may also prescribe stronger medications such as prescription-strength anti-inflammatories or muscle relaxants5. However, narcotic pain medications have no proven benefit for cervical pain and should be used with caution8.

Physical therapy can help relieve neck pain. Physical therapy experts develop specific exercise programs to help relieve your neck pain, with exercises to do both in therapy sessions and at home9. It is important to stay active in your everyday life and keep gently moving your neck as much as possible34.

Injections and specialized procedures may be recommended for some types of neck pain. For chronic neck pain caused by arthritis, there is a medical procedure that targets specific nerves to minimize pain signals from arthritic joints to the brain5.

Acupuncture and other complementary and alternative therapies may be helpful in some cases85.

Advanced imaging and surgical evaluation may be warranted for patients with worsening neurologic function or persistent pain8.

Home remedies and self-care

If you have neck pain, there are several things you can do at home to help relieve discomfort3:

• Keep gently moving your neck as much as possible
• Adapt any activities that might be causing you pain

Movement and exercise can actually help with neck pain. You may have heard that rest is the best remedy for muscle pain and neck stiffness, but with neck pain, movement can actually help. Exercise improves blood flow to stiff muscles and reduces inflammation. Just make sure to avoid jerking or sharp twisting movements that could increase or cause neck pain7.

Hot and cold therapy can help relieve neck pain fast. Using ice packs or heating pads can be very effective. Ice reduces inflammation, while heat relaxes stiff neck muscles. For best results, you may alternate the two for about 20 minutes each several times a day7. Gentle heat is one of the best ways to loosen stiff neck muscles. You may wrap a heating pad in a towel and place it on your neck, or you may stand under a warm shower for a few minutes7.

Stretching and massage can help release tension in your neck muscles. Once your muscles are warm from heat application, give yourself a gentle neck massage or ask a partner to do it. Make sure to direct the massage movements toward your heart to promote proper blood flow7. Regular stretching can also help release tension. If you spend long hours at a desk, take breaks every one to two hours for a few minutes of stretches to prevent neck stiffness7.

Several simple exercises can help stretch your neck muscles and relieve stiff neck symptoms7:

1. Head presses: Clasp your hands behind your head or sit on a seat with a headrest. Keeping the chin level, gently press the back of your head against your hands or the headrest. Hold for five to 10 seconds and repeat.
2. Head tilts: Instead of rolling your neck, try head tilts. First, move your neck forward and backward by bringing your chin to your chest, pausing for a moment, then lifting your chin to the sky. After you repeat a few times, move to side-to-side tilts. Bring your ear to your right shoulder, hold for a few seconds, and repeat on the other side.
3. Shoulder blade squeezes: Sit with your spine upright and your feet firmly planted on the floor. Gently squeeze your shoulder blades together and hold for 15-30 seconds. Repeat three to four times.
4. Shoulder rolls: Try to sync up your shoulder rolls with your breathing. When you inhale, bring your shoulders up to your ears, then roll them down your back as you exhale. Repeat five to 10 times.

Preventing neck pain

In today's digital age, neck pain is more common than ever. Staring at your smartphone or sitting at a computer all day can cause neck stiffness, discomfort, and tension. Although neck pain isn't always avoidable, you can take some steps to prevent it10.

Improving your posture is one of the most important steps you can take. Whether you're sitting at a desk, looking at your phone, or running errands, your posture can contribute to neck pain. Each inch that your head shifts forward adds about 10 pounds of pressure to your neck muscles10. To improve your posture and prevent neck pain10:

• Draw your shoulders away from your ears
• Gently engage your abdominal muscles
• Hold your head in line with the center of your body
• Lift your chest upward to keep your spine straight

Creating an ergonomic workstation is essential. A workstation that's not ergonomic is one of the most common culprits of neck pain, especially for people who work from home, have desk jobs, or continually bend their head down to look at a laptop screen. To improve your workstation's ergonomics, you may10:

• Adjust your desk height so that your forearms are parallel with the floor when you type
• Choose a chair that allows your feet to plant firmly on the ground with your thighs parallel to the floor
• Position your computer monitor or laptop so that your gaze is in the top third of the screen

Preventing "tech neck" is increasingly important. Continually looking down at your phone can lead to wear and tear in your neck. Over time, continually straining your neck can damage your discs, joints, and ligaments10. To minimize your risk of tech neck10:

• Hold your phone or other device at eye level
• Prop your device up on a pillow to lessen the angle of your head
• Set timers to remind you to take breaks from your phone
• Reduce your texting time

Lifestyle changes can also help prevent neck pain. Several habits can improve your neck health and prevent discs from wearing out quickly10:

• Exercise regularly: Getting regular exercise keeps your muscles strong, improves blood flow, and reduces your chances of injury. Strengthening your back muscles also helps support proper posture.
• Quit smoking: Tobacco constricts your blood vessels, leading to reduced blood flow and increased speed of cervical disc degeneration.
• Stay hydrated: Your cervical discs are mostly made up of water, so staying well-hydrated is crucial to keeping your discs healthy. Most people need around 64 ounces of water daily.
• Use proper sleep support: Don't use too many pillows. Sleeping with several pillows under your head can stifle your neck's range of motion11.

It's also important not to stay in one position for too long. If you get up and move around often enough, you'll avoid getting your neck stuck in an unhealthy position11.