Neck Pain: Causes, Diagnosis, and Effective Treatments

Neck pain and stiffness are very common and are usually not a sign of anything serious. Many cases improve within a few days or weeks with simple self-care, although persistent pain or symptoms such as weakness, numbness or pins and needles should be assessed by a healthcare professional.

Contents

• What Causes Neck Pain?
• How is Neck Pain Diagnosed?
• How is Neck Pain Treated and Managed?
• What Can I Do to Relieve Neck Pain at Home?
• When Should I Get Medical Help?
• How Long Does Neck Pain Take to Get Better?
• How Can I Prevent Neck Pain?

What Causes Neck Pain?

Neck pain can have many causes. Often it is related to the muscles, joints or other tissues around the neck rather than a serious underlying condition.

Common causes include:

• Sleeping in an awkward position: Holding the neck at an uncomfortable angle overnight can leave it stiff or painful the following morning.
• Posture and prolonged positions: Spending long periods looking down at a phone, laptop or desk can contribute to neck discomfort.
• Muscle strains and tension: Repetitive movements, stress and unfamiliar physical activity can affect the muscles around the neck and shoulders.
• Injury: Falls, sports injuries and whiplash following a road traffic accident can cause neck pain.
• Nerve irritation: A nerve in the neck can sometimes become irritated or compressed, causing pain that may travel into the shoulder or arm, sometimes with pins and needles or numbness.
• Age-related changes: Changes to the joints and discs of the neck become increasingly common with age. Cervical spondylosis is one example and does not always cause symptoms.

How is Neck Pain Diagnosed?

In many cases, a medical history and physical examination are enough for a healthcare professional to assess neck pain. They will also look for signs that could indicate a more serious problem, such as significant nerve compression, infection or another underlying condition.

Medical History

Your GP or other healthcare professional may ask about previous neck injuries, your work and activities, and anything that could be contributing to the pain. They will usually ask when the pain started, where it is located, whether it travels into your arms or shoulders, what makes it better or worse, and whether you have other symptoms.

Physical Examination

A physical examination may include checking the position and movement of your head and neck, testing your range of movement and feeling the neck and surrounding muscles for tenderness. Depending on your symptoms, strength, reflexes and sensation in your arms may also be assessed.

Imaging Tests

Most people with uncomplicated neck pain do not need an X-ray, MRI or CT scan. Imaging may be considered if there has been significant trauma, symptoms suggest nerve or spinal cord involvement, a serious underlying cause is suspected, or symptoms are not improving as expected.

X-rays

X-rays mainly show the bones of the neck and can be useful for identifying fractures, changes in alignment and some forms of arthritis or age-related bone change. Discs, nerves and other soft tissues are not shown clearly on a standard X-ray.

Magnetic Resonance Imaging (MRI)

An MRI provides detailed images of structures including the spinal cord, discs, nerves and other soft tissues. It may be requested when symptoms suggest significant nerve or spinal cord compression, infection, a tumour or another condition that requires further investigation.

Computed Tomography (CT) Scan

A CT scan provides detailed images of the bones and may be useful following certain injuries or when more information about the bony structures of the cervical spine is required.

Additional investigations are occasionally needed. These may include:

• Electrodiagnostic tests: Nerve conduction studies or electromyography may sometimes be used when a healthcare professional needs more information about nerve or muscle function.
• Laboratory tests: Blood tests may be requested if symptoms suggest an inflammatory condition, infection or another medical cause rather than straightforward mechanical neck pain.

How is Neck Pain Treated and Managed?

Treatment depends on the cause and severity of the pain. Many cases of uncomplicated neck pain improve with time, gentle movement and appropriate self-care. A GP, pharmacist or physiotherapist can advise on suitable treatment if symptoms are troublesome or persistent.

Options may include:

• Pain relief: Medicines such as paracetamol or ibuprofen may be suitable for some people. Follow the instructions supplied with the medicine and ask a pharmacist or GP for advice if you are unsure whether a particular painkiller is suitable for you.
• Physiotherapy: A physiotherapist can assess your symptoms and recommend exercises to maintain movement, improve strength and help you gradually return to normal activities.
• TENS: Transcutaneous electrical nerve stimulation uses mild electrical impulses delivered through electrode pads on the skin. Some people find that TENS provides temporary pain relief, but it does not work for everyone and the evidence varies according to the type of pain being treated. NICE does not recommend TENS for chronic primary pain.
• Injections: In selected cases, a specialist may consider an injection as part of treatment for a specific source of neck or nerve pain. This is not routinely required for uncomplicated neck pain.
• Other therapies: Some people try treatments such as massage or acupuncture. Their suitability and effectiveness depend on the individual and the cause of the symptoms.
• Surgery: Surgery is rarely needed for ordinary neck pain. It may be considered when a specific structural problem is seriously affecting nerves or the spinal cord and specialist assessment indicates that an operation is appropriate.

Severe, persistent or complicated neck pain may require assessment by a musculoskeletal, spinal or pain specialist.

What Can I Do to Relieve Neck Pain at Home?

For straightforward neck pain without warning symptoms, simple self-care measures can often make the neck more comfortable while it recovers.

• Keep moving: Try to continue normal everyday activities where possible rather than keeping your neck completely still. Gentle movement can help prevent additional stiffness.
• Use pain relief if appropriate: Paracetamol or ibuprofen may help some people. Follow the instructions on the packet and speak to a pharmacist if you have other medical conditions, take other medicines or are unsure what is suitable.
• Try heat: A warm shower, wrapped hot water bottle or heat pack may help relax tense muscles. Avoid excessive heat and protect your skin. Heat Relief Pads are another convenient option.
• Try cold therapy: Some people find a wrapped cold pack helpful, particularly after a recent strain or injury. Never apply ice directly to the skin. A Deep Freeze Pain Relief Cold Patch provides another option for cooling the affected area.
• Gentle exercise: Gradually moving the neck and shoulders can help maintain mobility. Stop and seek advice if an exercise causes significant worsening of pain or neurological symptoms such as weakness or numbness.
• Take regular breaks: If you spend long periods at a computer or looking down at a device, change position frequently and take short movement breaks.
• Manage stress: Stress can contribute to muscle tension. Relaxation techniques, breathing exercises, mindfulness, yoga or other gentle activity may help some people.
• Do not smoke: Smoking is associated with poorer musculoskeletal and spinal health and can impair the body’s healing processes. Support is available from the NHS if you would like help to stop smoking.

When Should I Get Medical Help?

Most neck pain settles without specialist treatment, but some symptoms need medical assessment.

Contact your GP if your neck pain or stiffness has not improved after a few weeks, pain relief has not helped, you are worried about the symptoms, or you develop persistent pins and needles, numbness or a cold sensation in an arm.

Seek urgent medical advice if neck pain follows a significant injury or you develop symptoms that could indicate pressure on the spinal cord or nerves, such as:

• new or worsening weakness in an arm or leg
• difficulty walking, poor balance or loss of coordination
• numbness or tingling affecting both arms or legs
• difficulty with fine hand movements that is new or worsening
• new changes in bladder or bowel control
• rapidly worsening neurological symptoms

If you are unsure how urgently you need help, NHS 111 can advise you on the appropriate service.

How Long Does Neck Pain Take to Get Better?

Recovery time depends on the cause of the pain. Many episodes of uncomplicated neck pain begin to improve within days or a few weeks, although some symptoms can take longer to settle completely. Nerve-related pain and more significant injuries may take longer to improve.

If your neck pain is not starting to improve after a few weeks, keeps returning, or is interfering substantially with everyday activities, speak to your GP or another appropriate healthcare professional.

How Can I Prevent Neck Pain?

Not every episode of neck pain can be prevented, but keeping active and avoiding long periods in the same position may reduce unnecessary strain on the neck.

• Change position regularly: Avoid sitting in one position for long periods. If you work at a desk, take regular breaks to stand, walk and move your neck and shoulders.
• Position screens comfortably: Arrange laptops, monitors and other devices so you do not repeatedly have to bend your neck or hold your head in an uncomfortable position.
• Find a comfortable sleeping position: Use a pillow that keeps your head and neck comfortably supported and broadly aligned with the rest of your body.
• Stay physically active: Regular activity helps maintain general strength and mobility. Include movements for the upper back, shoulders and neck as appropriate.
• Be sensible when carrying loads: Avoid regularly carrying unnecessarily heavy bags on one shoulder. Distribute weight evenly where possible.

Simple Upper Back Exercises

Exercises that strengthen the muscles around the shoulders and upper back may be useful for some people. Examples include:

• Scapular squeezes: Sit or stand comfortably and gently draw your shoulder blades towards each other before relaxing.
• Wall push-ups: Stand facing a wall, place your hands against it and perform controlled push-ups while keeping your body aligned.
• Resistance-band rows: With a securely anchored resistance band, draw your elbows backwards in a controlled rowing movement while keeping your shoulders relaxed.

If you have an existing neck condition, recent injury or symptoms affecting your arms or nerves, ask a physiotherapist or healthcare professional whether particular exercises are suitable for you.

Summary

Neck pain is common and most episodes are caused by relatively minor problems involving the muscles, joints and other tissues of the neck. Staying active, changing position regularly and using appropriate pain relief, heat or cold can help many people while the neck recovers. TENS may provide temporary relief for some types of pain, although its effectiveness varies and it is not suitable as a treatment for every type of neck pain.

Persistent pain, symptoms spreading into an arm, or new neurological symptoms should not simply be ignored. Seek medical advice if symptoms are not improving, and get urgent help for significant weakness, problems with balance or walking, or changes in bladder or bowel control.

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