It’s a pain in the neck!
Neck pain is a common complaint. Many people experience neck pain or stiffness at some time in their lives. The neck muscles can be strained from overuse or poor posture. Sometimes, neck pain may also be due to a traumatic injury (e.g., whiplash) or degenerative causes.
The neck comprises of seven vertebrae (cervical vertebrae) that are bony building blocks of the neck (cervical spine). These vertebrae are linked together by facet joints that, together with your neck muscles, allow you to move your head flexibly. Also, between each vertebra are jelly-like discs that act as shock absorbers, preventing the vertebrae from rubbing together.
Within the neck, there are muscles, ligaments, tendons, and bones that work together to support the head and allow it to move flexibly. It can be vulnerable to injuries or overuse that cause pain and restricted motion.
The neck region is also home to arteries veins, nerves, lymph nodes, thyroid gland, parathyroid glands, esophagus, larynx, and trachea. A disease or injury to any of these structures can cause neck pain.
Neck pain or stiffness can be due to numerous reasons.
Muscle tension and strain
Muscles at the back of the neck can become tensed or strain when its tightened for a prolonged period. This is due to:
- Poor posture
- Sleeping with your neck in the wrong position
- Hunching at a desk for an extended period without changing position
- Jerking your neck during exercise
Cervical spondylosis (neck osteoarthritis)
As you age, the cervical discs and cartilages may degenerate. This wear-and-tear condition is known as cervical spondylosis or osteoarthritis of the neck. It can narrow the space between the vertebrae and exert stress on the joints. It worsens with age.
Although cervical spondylosis doesn’t always have symptoms, it may increase the risk of having neck pain and stiffness. The discomfort may improve when you lie down.
Herniated cervical disc
The cervical disc may become herniated when the outer portion of the disc tears. As a result, the inner core of the cervical disc leaks out and irritates the adjacent nerves. It is also known as a slipped disc or bulging disc.
While a herniated cervical disc may be triggered by neck trauma or injury, the symptoms tend to precipitate spontaneously. The herniated cervical disc may also cause pain that radiates along the shoulders, arms, and hands. If the disc ruptures, it can cause excruciating pain in the back of the neck and head.
Cervical radiculopathy (pinched nerve in the neck)
The cervical nerves do not have an ample of space surrounding it. Even a minor herniation of the cervical discs or a small bone spur in the area can irritate the nerves in the neck, resulting in cervical radiculopathy.
Symptoms include shooting, electric-like pains along the length of the cervical nerve. The pain may radiate down your shoulder blade and arm. You may also experience muscle spasms, muscle weakness, numbness, and tingling sensation. Furthermore, you may occasionally get a stiff neck, facial pain, and throbbing headache in the back of your head.
Cervical stenosis and myelopathy
Cervical spinal stenosis is a common cause of neck pain, especially in older people. It is the narrowing of the spinal canal in the neck region or upper area of the spine, exerting pressure on the spinal cord. While some people are born with this narrowing, it most commonly occurs in people over the age of 50 as a result of wear-and-tear. Many patients with cervical stenosis have a prior history of injury or trauma to the neck.
The symptoms of cervical spinal stenosis include:
- Neck pain
- Pain, numbness, burning sensations, or weakness in the shoulders and arms
- Disturbances in gait and balance
- Hand clumsiness
If the cervical stenosis is extensive, neurologic deficits may result from spinal cord compression (myelopathy).
The neck region is particularly vulnerable to injury, whereby the neck structures are forced to move in an abnormal range of motion. Injury of the neck due to sudden jerking of the head is known as whiplash.
Whiplash, or neck strain, occurs when the ligaments in the neck are overstretched or torn. It occurs when a sudden impact causes the head to whip violently forward, backward or sideways. Risk factors for whiplash injury include involvement in contact sports, car accidents, bull or bronco horse riding, etc.
A common symptom of whiplash is neck pain, including pain in front of the neck that comes on 24-48 hours after the impact. Other possible symptoms include ligament sprain, muscle strain, neck stiffness, numbness, headache, dizziness, and tingling in the extremities.
One of the symptoms of a heart attack is a pain in the neck. But it is often present with other symptoms, such as:
- Arm pain
- Jaw pain
- Shortness of breath
- Nausea and vomiting
Call an ambulance immediately if you have a combination of these symptoms.
Meningitis is a severe infection that causes inflammation of the lining around the brain and spinal cord.
Common symptoms of meningitis include:
- Stiff neck
- Purple-bruise-like marks on the skin
- Sudden high fever
Meningitis can be extremely dangerous and potentially fatal. If you suspect that you may have meningitis, you should contact emergency services immediately.
Other causes of neck pain include:
- Rheumatoid arthritis causes pain and swelling of the joints.
- Cervical dystonia, also known as torticollis, a condition whereby neck muscles tighten involuntarily and cause the neck to twist to one side.
- Fibromyalgia causes widespread muscle pain, especially in the neck and shoulder area.
- Osteoporosis weakens bones and may lead to minor fractures.
- Ankylosing spondylitis, an inflammatory condition that causes spinal vertebrae to fuse.
- Temporomandibular joint disorders, also known as TMJ or TMD, which affect the jaw and muscles around it.
The neck may become stiff when muscles in the neck become strained, stretched or damaged. A stiff neck may become painful when you try to move your neck or head.
Neck stiffness often results from minor misuse, possibly due to:
- Poor posture
- Looking down at your computer all-day
- Driving or looking at your smartphone for long periods
- Sitting or slouching for long periods
- Sustaining a sports injury
- Sleeping awkwardly
- Having tense muscles due to stress
Over time, the strain can add up, and your neck becomes stiff. You may not be able to turn your neck as far as it usually does.
Sometimes a stiff neck may be a cause for concern. If the pain and stiffness come on quickly, and you have difficulty lifting your arms overhead, it could be a sign of polymyalgia rheumatica. More worryingly, if you have a stiff neck in addition to severe pulsating headaches and high fever, you may have a meningitis infection and require immediate care.
Muscle spasm or cramp
Neck muscle spasms are the involuntary stiffening of muscles on one side of the neck, which makes it painful to turn your head. When sustained from a period, it is known as muscle cramps.
A neck cramp may trigger other symptoms, including:
- Severe, sharp pain
- Increased pain when moving the neck
- Headache or dizziness
- Tingling at the base of the neck
Neck cramps may result from overuse, injury, poor posture, or stress. For instance, people who continuously work on the computer are prone to neck cramps.
Pain from neck cramps usually lasts only a few hours or days.
To prevent neck cramps:
- Take regular screen breaks
- Use a laptop stand to adjust the screen height
- Use supportive pillows
- Make sure office chairs are ergonomic
- Stretch as soon as you have neck pain
- Improve posture with strengthening exercises
Numbness or tingling
A nerve can become pinched when the tissues, bones, or muscles surrounding it exert pressure on it. As a result, you may feel a tingling sensation and numbness that can radiate down your arm. The symptoms will resolve by itself.
Cervicogenic headaches can be caused by problems in the neck, such as the stiff neck, herniated disc, or pinched nerves. Depending on which cervical nerves affected, you may experience sharp stabbing pain behind one eye, temple, or behind the skull. The pain may also radiate down your spine and cause middle back pain or shoulder weakness.
Tight muscles in the back of the neck or base of the skull can also cause tension headaches or cluster-like headaches. This can cause thumping pain in the front of the head, top of the head, back of the head, or temples.
The upper part of your neck and base of the skull contain occipital nerves. When irritated, it causes a sharp recurring headache known as occipital neuralgia. It may feel like a dull throbbing ache or jabbing pain at the back of the head.
Clicking and grating noises
You may feel or hear clicking or grating as you move your neck, known as crepitus. It can be caused by joints and bones grating over each other, or by air bubbles popping.
Neck pain may be accompanied by back pain, in conditions such as inflammation of the spine that arise from ankylosing spondylitis.
Dizziness and blackouts
If you feel dizzy when turning your head or looking up, this may be due to pinching of the vertebral arteries. You may also blackout.
However, there are other reasons for blackouts, so you should seek medical advice if this is happening to you.
When to see a doctor
If your neck is injured by a blow, like after a fall, or in a car accident, see a doctor immediately. You might be having a whiplash or internal injuries.
See your doctor if you have:
- Sudden, severe pain after an injury or car collision
- Pain, numbness, weakness, or tingling that radiates down your arms or legs
- Pain that does not improve after six weeks
- Sudden stiffness in the neck and arms
- Lump in the neck
- Trouble swallowing or breathing
- Fever (might be a sign of meningitis)
- Nasty headache
- Weight loss without dieting
Some causes of neck pain are more severe than others. Be sure to call your doctor right away if your symptoms don’t get better after a week or if your neck pain is the result of an injury or fall. You should also call your doctor if neck pain or spasms keep you up at night.
Physical examination and medical history
In diagnosing the neck pain, it is essential to review the medical history and have a physical exam. Your doctor will note the location, intensity, and duration of the pain. Any past injury to the neck or radiated pain will also be noted. Your neck will be examined at rest and in motion.
Be prepared to inform your doctor about the specifics of your symptoms or any aggravating motions in the neck. You should also enlighten them about the medications you’re taking.
Your doctor might order imaging tests to understand the cause of your neck pain better. Tests include:
- X-rays may reveal bone spurs or other degenerative changes in the neck
- CT scans combine multiple crosssections of X-ray images to produce an intricate view of the internal structures of the neck
- MRI uses radio waves and magnetic field to compose detailed images of the soft tissues and bones
Imaging tests are best used as an adjunct to physical examination.
- Electromyography (EMG) can detect any nerve-related injuries by measuring nerve conduction.
- Blood tests may provide evidence of underlying inflammation or infection that is contributing to your neck pain.
Treatment for neck pain depends on its underlying cause.
Try over-the-counter (OTC) pain relievers, such as ibuprofen (Advil, Motrin IB), aspirin, naproxen sodium (Aleve), and acetaminophen (Tylenol). OTC pain relievers ease neck pain by reducing inflammation.
Your doctor may prescribe stronger painkillers if your pain is intense. They might also prescribe you with muscle relaxants and tricyclic antidepressants for pain relief.
Consult your doctor if you’re keen to try alternative treatments for your neck pain. There are benefits and risks for each option.
Physical therapy. A physical therapist can advise you on the correct posture, alignment, and neck-strengthening exercises. They may also use heat, ice, electrical stimulation, and other measures to help ease pain and prevent a recurrence.
Cervical traction uses weights or pulleys to stretch your neck gently to reduce pressure on the nerve root. It may provide relief of some types of neck pain, especially pain related to nerve root irritation. It does not work for everyone. Be sure to perform this therapy under the supervision of a medical professional or physical therapist.
Transcutaneous electrical nerve stimulation (TENS) is a device that delivers electrical impulses to the painful areas via the electrodes.
Short-term immobilization with a soft neck collar can help relieve pain by reducing pressure on the neck. Nevertheless, if used for more than three hours at a time or more than two weeks, a neck collar might do more harm than good.
Acupuncture involves inserting thin needles into specific pressure points on your body.
Chiropractic. A chiropractor applies a controlled, abrupt force to the spine and neck. It provides short-term pain relief and carries minimal risk.
Steroid injections. Your doctor might inject cortisone near the nerve roots, into the neck muscles, or the facet joints to help with the neck pain.
Lifestyle and Home remedies
Most neck pain improves within two to three weeks with home treatment. If not, see your doctor.
Alternate heat and cold
Reduce inflammation and numb pain by applying a cold compress or ice pack for up to 20 minutes several times a day. It is most beneficial within the first 48 hours of a muscle injury when the swelling is most significant.
Likewise, heat wraps and heating pads can resolve muscle spasms and ease sore joints in the neck. It is also commonly used to alleviate pain associated with osteoarthritis. Place the heat wrap, heating pad, heat pack, or heat patch on the nape of your neck at the base of your skull. DO NOT use heat if you have inflammation.
Ideally, you should alternate between hot and cold treatments. Apply ice for the first 38 to 72 hours, followed by heat.
Chamomile oil contains pain-relieving, anti-inflammatory, and antioxidative properties. German chamomile, in particular, is soothing and calming.
Sweet marjoram oil is excellent for neck pain because it is warming, soothing, and eases the inflammation sore joints and muscles. It also has a sedative effect that can help relieve muscle pain and muscle spasms.
Basil oil is ideal for relaxing tensed muscles. It is also excellent for nerve fatigue.
Eucalyptus oil is a warming and soothing oil that contains strong anti-inflammatory qualities. These anti-inflammatory properties, paired with its potent analgesic effect, make it effective at relieving aches, pain, and stiffness.
Ginger oil is a warming oil that is a perfect fit for sore, painful neck muscles.
Rosemary oil great for muscle and joint pain due to it’s antispasmodic and analgesic compounds.
Clary sage has an anti-spasmodic and anti-inflammatory compound and is well-known for being calming and soothing to the mind and body.
Cannabidiol may influence how we feel pain by acting on the body’s endocannabinoid system. Topical CBD oil application to the neck may provide consistent pain relief and ease joint inflammation.
Use a neck pillow that suits your sleeping position.
For side sleepers, a firmer and larger pillow may be ideal. Back sleepers, on the other hand, may need a flatter pillow that provides adequate support without forcing the neck to strain forward.
Once the worst of your neck pain has subsided, begin stretching it gently every day. Neck stretching can help to ease tension and stiffness from your neck muscles and ligaments and also strengthen your neck. It’s essential to stretch gently and slowly.
These stretches could also help you prevent a recurrence of an old injury, or prevent new pain.
Learning how to manage stress can reduce tension and stiffness in the neck. You may reduce stress in a variety of ways, including:
- Taking regular breaks
- Listening to relaxing music
- Meditation or deep breathing
- Doing something you enjoy
Neck pain is commonly associated with poor posture as well as wear-and-tear. Simple lifestyle changes may help prevent neck pain.
Avoiding injury to the neck. Minimize the risk of neck injuries during sports activities by using appropriate equipment and neck strengthening exercises.
Use good posture
Practice proper posture, especially if you sit at a desk for long periods. Keep your neck and back supported, and ensure that your computer monitor is at eye level.
When you stand or sit, keep your head and shoulders are in a straight line centered over your spine. Visualize yourself suspended by a line connecting your chest to the sky.
Avoid driving for long periods of time
Driving the car for too long can strain your neck. If you have to drive for long-distance, here are some preventive measures:
- Take breaks to stretch at least once per hour
- Check your posture while driving
- Set your seat in an ergonomic position that provides adequate support
Many people work at a workstation for eight hours every day, which can contribute to neck pain. Hence an ergonomic workstation is essential. Some tips:
- Keep the screen at eye level
- Support your arms on your chair’s armrests
- Keep the feet flat on the floor, with knees slightly lower than the hips
Avoid cradling phone between neck and shoulders
Avoid holding the phone between your ear and shoulders when you talk. Use a headset, earpiece or speakerphone instead.
Limit mobile phone usage
Looking down at your phone for extended periods can strain your neck muscles. Hold it at eye level whenever possible, and take frequent breaks.
Change your sleep position
When you sleep, your neck should be aligned with your body. Try sleeping on your back with the thighs elevated on a pillow, which will flatten your spinal muscles.
The Bottom Line
Neck pain is usually due to poor posture and muscle strain. In such cases, your neck pain should dissipate if you rest sufficiently and maintain proper posture. You can also use ice, heat, or stretching.
If your neck pain does not subside after a few days or you have additional symptoms, you should see a doctor.