Neck pain

Overview

Many people have neck pain. Poor posture, whether from leaning over a computer or hunching over a workbench, strains neck muscles and is a common cause of neck pain. Osteoarthritis, a condition that wears down the joints, also can cause neck pain.

Most of the time, neck pain is not a sign of a serious medical condition. But sometimes it can be a sign of a bigger issue.

Symptoms

Common symptoms of neck pain include:

• Pain that gets worse when you hold your head in the same position for a long time, such as when driving or working at a computer.
• Muscle tightness and muscle spasms.
• Trouble moving your head.
• Headaches.

When to see a doctor

Get emergency medical care if you have severe neck pain after an injury, such as an injury from a motor vehicle accident, a diving accident or a fall.

Contact your healthcare professional if your neck pain:

• Is very painful or intense.
• Doesn't get better after a few days.
• Spreads into your arms or legs.
• Comes with a headache, numbness, weakness or tingling.

Causes

The neck holds up the head and is less protected than the rest of the spine, which makes it easy to injure. Even small injuries can cause stiffness and pain and limit movement.

Common causes of neck pain include:

• Muscle strain. Sitting hunched over a computer, looking down at a smartphone or even reading in bed can pull on your neck muscles and cause pain. A recent study found that people who sit still for more than six hours a day are more likely to have neck pain. The risk is even higher if that time is spent using a computer or smartphone.
• Worn joints. As with other joints in the body, neck joints tend to wear down with age. Arthritis of the neck can cause pain and make it hard to move your neck.
• Pinched nerves, also called nerve compression. Bulging disks or bone spurs in the neck can press on nearby nerves, causing pain that may spread to your arms.
• Injuries. Car accidents, especially ones where the head jerks forward and backward, can hurt the soft tissues in your neck. This injury is called whiplash.
• Diseases. Certain diseases, such as rheumatoid arthritis, meningitis or cancer, can cause neck pain.

Prevention

Most neck pain is caused by a mix of poor posture and aging. To help prevent neck pain, keep your head centered over your spine. Making a few small changes in your daily habits can help protect your neck. Here are some tips to try:

• Practice good posture. When standing or sitting, keep your shoulders in a straight line over your hips. Keep your ears directly over your shoulders. When using a smartphone, tablet or other small screen, hold the device up at eye level rather than bending your neck to look down.
• Take regular breaks. If you work at a computer or travel long distances, get up often to move around and stretch your neck and shoulders.
• Set up your workspace. Adjust your desk, chair and computer so your monitor is at eye level. When sitting, your knees should be slightly lower than your hips. Use the chair's armrests to support your arms.
• If you smoke, quit. Smoking increases the risk of developing neck pain.
• Be careful with heavy bags. Carrying heavy bags over one shoulder can strain your neck. Keep bags light or use a backpack that spreads weight evenly.
• Sleep in a healthy position. Keep your head and neck aligned with your body when you sleep. Use a small pillow to support your neck. Try sleeping on your back with pillows under your knees or thighs, which can help relax your spine.
• Stay active. Moving your body regularly helps keep your neck and back strong. If you sit a lot, try to add more movement to your day.

Diagnosis

To diagnose neck pain, your healthcare professional asks about your symptoms and medical history. This is followed by a physical exam to check for tenderness, numbness and muscle weakness. Your healthcare professional checks how far you can move your head forward, backward and side to side.

Imaging tests

Imaging tests may be ordered to help find the cause of your neck pain. These may include:

• X-rays. X-rays can show areas in the neck where the nerves or spinal cord may be pinched by bone spurs or other changes.
• CT scan. A CT scan takes many X-ray images from different angles to create a detailed picture of the inside of your neck.
• MRI. An MRI uses radio waves and a strong magnet to make detailed images of bones and soft tissues. The soft tissues include the disks, spinal cord and nerves.

It's possible to have X-ray or MRI images show structural issues in the neck without neck pain. Imaging studies are best used with a careful history and a physical exam to diagnose the cause of neck pain.

Other tests

• Electromyography, also called EMG. This test is done to see if a pinched nerve may be causing your pain. A healthcare professional places small needles into muscles to measure how well your nerves are working.
• Blood tests. Sometimes blood tests can show signs of infection or inflammation that may be causing neck pain or making it worse.

Treatment

Most mild to moderate neck pain gets better within 2 to 3 weeks with simple self-care. Typically, pain medicine you can buy without a prescription and applying ice and heat are enough to ease symptoms.

Medicines

Pain relievers you can buy without a prescription include nonsteroidal anti-inflammatory drugs, also called NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). You also might consider taking acetaminophen (Tylenol, others). Take these medicines only as directed. Taking too much can cause serious side effects.

If pain relievers you can buy without a prescription don't help, your healthcare professional may suggest prescription NSAIDs or muscle relaxers to relieve pain and stiffness.

Therapies

• Physical therapy. A physical therapist can teach you how to improve your posture and strengthen muscles to help you position your neck in healthy ways. Physical therapy also may include heat, ice or other measures to help ease pain.
• Transcutaneous electrical nerve stimulation, also called TENS. This treatment uses tiny electrical impulses delivered through patches on the skin. These electrical impulses may help lessen some types of pain, but there's little evidence that TENS offers any relief for neck pain.
• Neck collar. A soft foam collar that supports your neck may help lessen pain by taking pressure off the neck. This may be especially helpful if you have arm pain associated with a pinched nerve. However, wearing a neck collar for more than three hours at a time or for more than 1 to 2 weeks, can make symptoms worse.

Surgery or other procedures

• Steroid injections. If other therapies don't ease pain, a healthcare professional may suggest steroid injections. Steroid medicine is injected near nerve roots, into spinal joints or into neck muscles to lessen pain and swelling. A numbing medicine, such as lidocaine, also may be used.
• Dry needling. Dry needling may improve blood flow and help relax the muscle to lessen pain and stiffness. A healthcare professional inserts very thin needles into tight or sore areas of muscle. The needle is called "dry" because no medicine is injected.
• Surgery. Surgery is rarely needed for neck pain. It may be considered if pain is caused by pressure on a nerve or the spinal cord and other treatments don't help.

Alternative medicine

Some people find relief from alternative treatments. Always talk with your healthcare professional before starting a new therapy.

• Acupuncture. Very thin needles are placed in specific spots on the body. Acupuncture typically is considered safe when done by a certified professional using sterile needles. Multiple sessions may be needed for best results.
• Chiropractic care. Performed mainly on the spine, a chiropractic adjustment typically applies quick, controlled movements to adjust the spine. Chiropractic treatments to the neck may provide short-term pain relief. Risks typically are low for most people.
• Massage. During a massage, a trained massage therapist gently presses and kneads the neck and shoulder muscles. This may help lessen tightness and pain, especially for people with long-term neck tension.
• Tai chi, qigong and yoga. These gentle activities combine slow movements, deep breathing and relaxation. They can help lessen neck pain and improve flexibility.

Lifestyle and home remedies

Besides taking pain medicine that you can buy without a prescription, you can try these self-care steps:

• Use cold and heat. For the first 48 hours, apply an ice pack wrapped in a thin towel for up to 15 minutes at a time, several times a day. After that, use heat, such as a warm shower, a heating pad on low or a warm compress, to relax muscles.
• Do gentle exercises. Keep your neck moving as the pain begins to ease. Try slow neck rolls and shoulder rolls. Gently tilt, bend and turn your head. Warming up your neck with a heating pad or warm shower before stretching can help.

Preparing for an appointment

If you have neck pain, you'll probably start by seeing your regular healthcare professional. Depending on your symptoms, you may be referred to a specialist such as:

• A doctor who treats muscle and joint issues without surgery, called a physical medicine and rehabilitation specialist.
• A doctor who treats arthritis and other conditions that affect the joints, called a rheumatologist.
• A doctor who treats conditions related to the brain, spine and nerves, called a neurologist.
• A doctor who operates on bones and joints, called an orthopedic surgeon.

What you can do

Before your appointment, be prepared to answer the following questions:

• When did your symptoms start?
• Have you ever hurt your neck? If so, when?
• Do certain neck movements make the pain better or worse?
• What medicines or supplements do you take regularly?

What to expect from your doctor

Your healthcare professional might ask some of the following questions:

• Where exactly is your pain?
• Is the pain dull, sharp or shooting?
• Do you have numbness or weakness?
• Does the pain radiate into your arm?
• Is the pain made worse by straining, coughing or sneezing?
• Do you have other physical issues?