Neck Pain

doctor shaking patient's hand

Fast Facts

  • Whiplash from motor vehicle accidents is a common cause of neck pain.
  • The diagnosis of neck pain is determined by a medical history and physical examination, and rarely requires expensive or uncomfortable tests.
  • The vast majority of individuals improve by taking over-the-counter medication and remaining active.
  • Most individuals are better in 1 - 2 weeks; more than 90% have no more pain after 8 weeks.

Neck pain can signal overuse problems, most commonly with the structures of the cervical spine (neck). Only in rare instances is neck pain a sign of a systemic illness. Although the pain may be severe, the good news is that most people with neck pain improve within 1 - 2 weeks, and the vast majority are over their episodes in 8 - 12 weeks.

Neck pain is just that – pain in the neck. Pain can be localized to the cervical spine or may travel down an arm (radiculopathy). All age groups are at risk of developing neck pain. People who sit in one location staring at computer screens for long periods of time may be at an increased risk. About 30% of the population has an episode of neck pain each year. Neck pain may occur slightly more frequently in women than men.

What causes neck pain?

Most episodes of neck pain are caused by the wearing out of the structures (mechanical) of the neck, which can be related to aging or overuse of the neck or arms. About 10% of neck pain is associated with systemic illnesses, such as polymyalgia rheumatica, axial spondyloarthritis, rheumatoid arthritis, tumors, and infections.

The common mechanical disorders that cause neck pain are the following:

  • Muscle strains usually related to prolonged physical activity such as sitting at computer terminals for extended periods of time. Acute strain also may occur after sleeping in an awkward position.
  • Osteoarthritis resulting from the narrowing of the intervertebral discs (pieces of cartilage between the bones known as vertebra) of the spine. The neighboring vertebrae grow spurs (growths of bone) in response to the increasing pressure placed on them. The bony growths can cause localized pain in the neck or arm related to nerve compression.
  • Herniated intervertebral discs cause arm pain more frequently than neck pain. The pinching of a nerve in the neck causes severe arm pain (brachialgia). Disc herniation may cause a loss of function of the nerve that may include a loss of reflex, feeling, or muscle strength.
  • Spinal stenosis is narrowing of the spinal canal that causes compression of the spinal cord (cervical myelopathy). The narrowing is caused by disc bulging, bony spurs, and thickening of spinal ligaments. The squeezing of the spinal cord may not cause neck pain in all cases but is associated with leg numbness, weakness, and loss of bladder or rectum control.
  • Whiplash is a suddenly fast forward and backward injury to the soft tissues of the neck, most commonly caused by rear-impact car accidents. The pain and stiffness associated with these accidents generally develop 24 - 48 hours after the injury.

Diagnosing neck pain and treating neck pain

In most circumstances, a medical history and physical examination are the key parts of an evaluation required to diagnose neck pain/disorders. In some cases, individuals who do not respond to starting therapy may undergo specialized radiographic tests, such as plain X-rays, magnetic resonance imaging (MRI), or computerized tomography to screen for additional problems of soft tissues, herniated discs, spinal stenosis, tumors, or nerve injuries.

Maintaining motion is an important part of therapy for neck pain. The use of neck braces should be kept to a minimum.

While regular exercise should be stopped until the neck pain is improved, movement of the neck is encouraged. Slow movement in all directions of motion of the neck stretches muscles that may be overly tight. This exercise may be mostly helpful while under a stream of warm water during a shower. You may also consider seeing a physical therapist or occupational therapist to help you determine the best exercise and stretching plan to manage your neck pain.

Five to 10-minute ice massages applied to a painful area within the first 48 hours of the start of pain can help relieve pain as can heat, which relaxes the muscles. Heat should be applied for pain that lasts longer than 48 hours. Over-the-counter pain relievers such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, frequently are enough to control episodes of neck pain, and muscle relaxants may help those with limited motion secondary to muscle tightness.

Individuals with increased stress may have contracted neck muscles. Massage therapy has proven helpful for those with chronic muscular neck pain.

A small number of neck pain patients, particularly those with arm pain or signs of spinal cord compression, require cervical spine surgery. A new option for neck surgery is an artificial disc. This device made of metal and plastic, is the correct choice for a very small number of individuals with neck pain only and no other abnormality in the cervical spine than a worn out disc.

Living with neck pain

The best way to live with neck pain is to try to prevent it. The best things you can do to prevent neck pain are pay attention to your body, exercise, eat right, and maintain a healthy lifestyle. In addition, do not sit at the computer for hours without getting up frequently to stretch the neck and back. Take the stress of the day out of your neck muscles and do your exercise routine. If you smoke, stop. Smoking is a predisposing factor for neck pain. If you are overweight, try to increase your activity level and eat healthier to get into shape.

Updated December 2020 by Cheryl Crow, MOT, OTR/L, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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