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Pain - neck; Neck stiffness

Neck pain may begin in any of the structures in the neck. These include muscles and nerves as well as spinal vertebrae and the cushioning disks in between. Neck pain may also come from regions near the neck, like the shoulder, jaw, head, and upper arms.

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

If neck pain involves nerves (for example, significant muscle spasm pinching on a nerve or a slipped disk pressing on a nerve), you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere.

See also:

• Whiplash
• Herniated disk
• Spinal stenosis

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, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising.

Traumatic accidents or falls can cause severe neck injuries like vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include:

• Other medical conditions, such as fibromyalgia
• Cervical arthritis or spondylosis
• Ruptured disk
• Small fractures to the spine from osteoporosis
• Spinal stenosis (narrowing of the spinal canal)
• Infection of the spine (osteomyelitis, diskitis, abscess)
• Cancer that involves the spine

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. One good method is to use ice for the first 48 - 72 hours, then use heat after that. Heat may be applied with hot showers, hot compresses, or a heating pad. Be careful not to fall asleep with a heating pad on.
• Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
• Perform slow range-of-motion exercises -- up-and-down, side-to-side, and from ear-to-ear -- to 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.
• Use a soft neck collar for a short period of time to relieve discomfort.

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

AVOID the following exercises during your initial 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)

Seek immediate medical help 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.

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
• You have pain that gets worse when you lie down or wakes you up at night
• You have such severe pain that you cannot get comfortable
• You lose control over urine or stool (incontinence)

Your doctor will perform a physical examination and ask detailed questions 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?

These questions help your 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 - 6 weeks using these approaches.

Your doctor 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:

• X-rays of the neck
• CT scan of the neck or head
• Blood tests such as a complete blood count (CBC)
• A spinal tap for a cerebrospinal fluid analysis if meningitis is suspected
• MRI of the neck

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

If meningitis is suspected, you will be sent to an emergency department for further tests, antibiotics, and hospital admission.

• Use relaxation techniques and regular exercise to prevent unwanted 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 help.
• If you tend to get neck pain from exercise, apply ice to your neck after physical activity.
• 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.

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

Graham N, Gross A, Goldsmith CH, Klaber Moffett J, Haines T, Burnie SJ, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006408.