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Neck pain

Definition

Neck pain is discomfort in any of the structures in the neck. These include the muscles, nerves, bones (vertebrae), and the disks in between the bones.

Alternative Names

Pain - neck; Neck stiffness

Considerations

When your neck is sore, you may have difficulty moving it, especially turning to one side. Many people describe this as having a stiff neck.

If neck pain involves nerves, you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere.

Causes

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
  •   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 neck in a jarring manner while exercising

Accidents or falls can cause severe neck injuries such as vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include:

Home Care

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, then use heat after that. Heat may be applied with hot showers, warm compresses, or a heating pad. To prevent injuring 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, moving 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 without a pillow or with a special neck pillow.
  • Ask your health care provider about using a soft neck collar to relieve discomfort. Do not use the collar for a long time. Doing so can make your neck muscles weaker.

You may want to reduce your activity only for the first couple of days. Then slowly resume your usual activities. Do not do any heavy lifting or twisting of your back or neck for the first 6 weeks after the pain begins. After 2 to 3 weeks, slowly begin exercising again. A physical therapist can help you decide when to begin stretching and strengthening exercises and how to do them.

Do not do the following during your early recovery, unless your doctor or physical therapist says it is okay:

  • Jogging
  • Football
  • Golf
  • Ballet
  • Weight lifting
  • Leg lifts when lying on your stomach
  • Sit-ups with straight legs (rather than bent knees)

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 be meningitis. Call your local emergency number (such as 911) or get to a hospital.
  • You have symptoms of a heart attack, such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain.

Call your health care 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
  • You have swollen glands or a lump in your neck
  • Your pain does not go away with regular doses of over-the-counter pain medication
  • 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

What to Expect at Your Office Visit

Your doctor or nurse will perform a physical exam and ask about your neck pain, including how often it occurs and how much it hurts. Other questions may include:

  • Is your pain in the front, back, or side of your neck?
  • Are both sides of your neck affected equally?
  • When did the pain first develop?
  • Is it painful all the time or does the pain come and go?
  • Can you touch your chin to your chest?
  • What makes your neck feel worse? What makes your neck feel better?
  • Do you have neck weakness or neck stiffness?
  • Do you have any accompanying symptoms like numbness, tingling, or weakness in your arm or hand?
  • Do you have swollen glands or a lump in your neck?

Your answers help the doctor determine the cause of your neck pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, neck pain will get better in 4 to 6 weeks using these approaches.

Your doctor or nurse will probably not order any tests during the first visit, unless 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:

If the pain is due to muscle spasm or a pinched nerve, your health care provider may prescribe a muscle relaxant or a more powerful pain reliever. Over-the-counter medications often work as well as prescription drugs. The health care provider may prescribe a neck collar or, if there is nerve damage, refer you to a neurologist or neurosurgeon for consultation.

If your doctor or nurse thinks your neck pain may be due to meningitis, you will be sent to an emergency department for further tests and treatment.

Prevention

The following steps can prevent neck pain or help your neck pain improve:
  • Use relaxation techniques and regular exercise to prevent stress and tension to the neck muscles.
  • Learn stretching exercises for your neck and upper body. Stretch every day, especially before and after exercise. A physical therapist can teach you these exercises.
  • Use good posture, especially if you sit at a desk all day. Keep your back supported. Adjust your computer monitor to eye level. This prevents you from continually looking up or down.
  • If you work at a computer, stretch your neck every hour or so.
  • Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
  • When reading or typing from documents at your desk, place them in a holder at eye level.
  • Evaluate your sleeping conditions. Make sure your pillow is properly and comfortably supporting your head and neck. You may need a special neck pillow. Make sure your mattress is firm enough.
  • Use seat belts and bike helmets to prevent injuries.

References

Cheng JS, McGirt MJ, Degin C. Neck pain. In: In: Firestein GS, Budd RC, Gabriel SE, et al., eds. Kelly’s Textbook of Rheumotology. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 45.

Devereaux MW. Neck pain. Med Clin North Am. 2009;93:273-284.

Gross A, Miller J, D'Sylva J, et al. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249.


Review Date: 4/16/2013
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.
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