Neck Pain

Neck strains and sprains

The most common causes of neck pain are sprains and strains. A sprain is an injury to the ligaments, the bands of tissue that connects bones to one another at a joint. A strain is an injury of muscles or tendons, the connective tissue that attaches muscles to bones. 

Strains and sprains typically improve with use of ice, heat, and over-the-counter pain relievers. 

Symptoms of strains and sprains include mild to severe pain that frequently worsens with movement. The pain may be accompanied by stiffness, tightness in the back or shoulders, tension headaches, muscle spasms, and reduced range of motion. 

Neck strains and sprains often result from overworking the neck muscles and ligaments during everyday movements, such as carrying heavy bags, sitting at a computer for long periods, and physical stress from lifting heavy objects or making sudden neck movements. Other causes are poor posture, sleeping awkwardly, and whiplash. 

Arthritis and other degenerative conditions of the neck

Several degenerative conditions of the neck, including osteoarthritis, cervical spondylolisthesis, cervical spondylolysis, and cervical stenosis, can cause neck pain. 

Osteoarthritis. Osteoarthritis, also known as degenerative joint disease, is caused by a breakdown of the cartilage in the joints. Without the cartilage to act as a buffer, the bones can rub or grind against each other. 

Symptoms of neck osteoarthritis include pain and stiffness that worsens with movement. Other symptoms include:

• A headache that begins in the neck
• Shoulder and arm pain
• Decreased range of motion when turning the head or bending the neck
• A grinding noise when turning the neck

Treatment includes placing ice packs on the affected area, over-the-counter pain relievers, range-of-motion exercises, and strengthening and stretching exercises.

Cervical spondylolisthesis. Cervical spondylolisthesis results when one of the bones in your spine, called vertebra, moves forward and presses on the spinal cord and nerves. The most common cause is osteoarthritis, but it can also result from injury, repeated minor fractures, or a congenital disability. Symptoms include:

• Neck stiffness 
• Headache
• Pain or numbness in the neck that can travel to the shoulders and arms
• Weakness in the arms
• Balance issues

Treatment options are similar to those noted above for cervical osteoarthritis. In addition, steroid injections, traction, and electrical stimulation are sometimes offered. For severe, persistent symptoms, surgery may be appropriate.

Cervical spondylolysis. Cervical spondylolysis is a fracture of the small area of bone that connects the front and back of the vertebrae on each side. Uneven wear on the cartilage and bones in the neck contributes to this condition. It is a frequent cause of chronic neck pain. Symptoms include:

• Pain
• Stiffness
• Numbness
• Weakness

Treatment includes physical therapy, stretching, over-the-counter pain relievers, muscle relaxing drugs, and corticosteroid injections. Surgery may be necessary. 

Cervical spinal stenosis. Cervical spinal stenosis is a narrowing of the canal in which the spinal cord lies. It usually develops due to a combination of osteoarthritis and disc degeneration, but it can also be congenital (present at birth). Symptoms include:

• An aching pain worsened by movement and activity
• Pain that is relieved by bending forward
• Radiating pain and weakness down the arms and legs

Not everyone with this condition has symptoms. The disease is sometimes seen on MRI scans of people without symptoms.  

Treatment focuses on strengthening neck and back muscles and preserving spine motion. Other treatments include pain medications, epidural injections (in which an anesthetic or steroid is injected around the spinal nerves), or nerve root block injections (in which an anesthetic or steroid is injected where the nerve exits the spine). Some people find acupuncture helpful. Surgery is considered as a last resort. 

What is whiplash?

Whiplash occurs when your body and neck suddenly are thrust forward, while your head moves back and then snaps forward. It is commonly associated with car crashes but can happen in other situations, such as roller coasters or getting punched in the face. 

Whiplash causes the neck muscles to strain and the ligaments to stretch or tear. It can affect the spinal nerves, intervertebral discs, facet joints (the connections between the bones of the spine), and other structures within the neck. 

Whiplash symptoms include neck stiffness and pain that worsen with movement, shoulder pain, muscle spasms in the neck or upper shoulders, decreased range of motion, headache, and tingling or weakness in the arms. Some people also experience sleep problems, which can lead to irritability, fatigue, and poor concentration.

Treatment for whiplash may include ice packs on the affected area, over-the-counter pain medication, gentle range-of-motion exercises, isometric neck strengthening exercises, a prescription muscle relaxant, and facet joint injections. Most people with whiplash improve within a few weeks, but in some people, symptoms may linger long after the injury. Lingering pain is usually mild.

Pinched nerves and other nerve pain

A pinched nerve (also called cervical radiculopathy) occurs when a condition of the spine, such as herniated disc, spinal stenosis, or degenerative disc disease, causes a structure within the neck to press on a nerve. 

Symptoms of a pinched nerve include shooting pain in the neck, arms, shoulders, or upper back that may worsen with movement or coughing. Some people experience numbness and tingling in their fingers and problems with fine motor coordination tasks, such as writing.

Treatments for a pinched nerve include over-the-counter pain relievers, using a cervical pillow, oral steroids, and exercises that strengthen the muscles around the affected area. Anticonvulsant medications may also be prescribed. If these treatments don't work, surgery may be needed. 

How to relieve neck pain?

Neck pain can last for weeks, months, or years. The time it takes to heal depends on many factors including the cause, previous neck injuries, a person’s age and general health, and which treatments are used. 

The goals of treatment for neck pain include relieving pain and restoring function.

For pain relief, your doctor might suggest rest, ice, heat, over-the-counter pain relievers, and avoiding quick movements. A foam cervical collar used for the short term also can help rest the neck muscles. 

To restore neck function, common treatments include:

• Physical therapy
• Neck stretching and strengthening exercises
• Shoulder strengthening exercises
• Therapeutic ultrasound, which converts sound waves into heat that penetrates into deep tissues
• Use of a neck pillow that supports the natural curve of your neck
• TENS (transcutaneous electrical nerve stimulation), which delivers low-voltage electrical currents at or near your nerves to block or change your perception of pain
• Traction, in which a physical therapist uses hands, weights, or specialized equipment to create a sustained pull on the neck in order to make space for a pinched nerve