September 01, 2018

Neck pain

Maintain good posture, keep moving

Your neck pain has returned with its usual dull ache and stiffness — and your natural inclination is to spend a few days resting your neck. While this is a common instinct among the estimated 10 percent of adults experiencing neck pain at any given time, it's often not the best plan. As long as you're not dealing with a serious problem, staying active and improving fitness and function of neck muscles are two of the most effective forms of therapy for neck pain.

Unclear causes

Neck pain can be mild to severe and can have a wide variety of causes. Most often neck pain involves sharp or dull pain, or neck stiffness. Although the pain and stiffness can be enough to interfere with daily tasks, it's usually not related to a serious problem. Occasionally, neck pain warrants prompt medical care. This includes pain related to a neck injury, or pain, numbness or tingling that radiates to the shoulder or arm or coincides with arm or leg weakness, walking difficulty, or bladder or bowel dysfunction. Pain that worsens at night, is associated with fever or weight loss, or comes on before or with a headache also may signal a condition that needs prompt evaluation.

Muscle tension and strain is one of the most common causes of neck pain, and it typically occurs at the back of the neck and upper back. A common cause is poor posture combined with too many hours hunched over while doing tasks such as driving, computer work, handicrafts or a project at a workbench. Other contributing causes can include tension, stress or poor sleep. Even seemingly minor things such as sleeping in an awkward position, holding a telephone against your head and shoulder, or clenching your jaw can be contributing causes.

With age, cushioning disks between the vertebrae of your spine can stiffen or degenerate, providing less shock absorption and reducing the neck's ability to evenly distribute weight on the small joints in the neck (facet joints). Facet joints can wear over time and become painful. Disk and joint degeneration can cause pain in their own right, but they can also trigger painful muscle tension.

The main step of neck pain diagnosis is to rule out more serious medical problems. These may include infection, inflammatory arthritis — such as rheumatoid arthritis — shingles, injury related problems, cardiovascular issues or cancer. Beyond that, trying to identify a cause is often unproductive. Neck function and pain perception are very complicated with many interwoven elements. Research has shown that it's difficult to find a cause-and-effect relationship between X-ray or MRI findings and what exactly is causing your neck pain. In most cases, determining a cause doesn't usually change initial treatment. Fortunately, with basic care, most people experience a complete recovery in four to six weeks.

Basic first steps

During the first few weeks of neck pain, basic self-care steps are often the optimal form of treatment to speed recovery. Steps include:

Good posture

Keeping your head upright and in a neutral position is key to good posture. Find your neutral position with the following steps: 1. Slowly move your head back and up as if you were pressing your neck against a wall. 2. Slowly move our chin forward as if you were moving your neck away from a wall. 3. Move between these two positions to find your most comfortable, neutral position.

  • Staying active — If there has been no serious injury, staying active is one of the best ways to speed healing. Still, be sure to pace yourself and take occasional 10- to 15-minute breaks to rest your neck if you feel you need it.
  • Reducing stress with relaxation — Tense muscles may benefit from stress reduction techniques such as deep breathing, meditation and progressive muscle relaxation. A heating pad, or a warm bath or shower — used for 10 to 15 minutes at a time — may aid in muscle relaxation. Gentle massage also may be helpful. Gentle exercise — such as walking — can help reduce stress and promote relaxation.
  • Short-term nonprescription pain medication use or an ice pack — Basic pain-relieving drugs may help you feel better and help you stay active. An ice pack wrapped in a towel applied to the painful area for up to 20 minutes several times a day also may help relieve pain.
  • Improving posture — Avoid positions that cause your head to lean to one side or tilt downward or upward for extended periods. If you can't avoid leaning or hunching, take frequent breaks to relax your neck or to use it in a different way.
  • Neck rotation

    Neck rotation — Slowly rotate your head from side to side, keeping your chin level as you turn. For added stretch, use your fingertips to gently press your chin in the direction of the stretch.

  • Gentle neck stretching — This can help restore or sustain neck range of motion and stretch tense muscles, reducing pain. Ask your doctor about stretching exercises and techniques that are appropriate for your circumstances. If you have sharp or electric pain while stretching, talk to your doctor or physical therapist.

Neck rotation and neck tilting, shown at right, are common neck stretches. Once the worst pain has subsided, start the exercises slowly and gently. Move only as far as your discomfort allows. Generally, you'll want to hold each stretch for at least 30 seconds. A third stretching exercise is neck bending, in which you bend your neck forward as if trying to touch your chin to your chest.

Pain that nags

Neck tilting

Neck tilting — Gently tip your head to one side, hold, then gently tip your head to the other side and hold.


If neck pain doesn't respond to these basic care steps within two weeks, additional treatment options may be considered. Prescription medications — such as pain medications, muscle relaxants or certain low-dose antidepressants — may help provide pain relief and allow for better sleep.

Physical therapy is an effective treatment option for neck pain. This may include learning more-targeted stretching and strengthening exercises.

A number of other treatment techniques can be helpful, including trigger point injections, acupuncture, nonforceful chiropractic manipulation or manual therapy treatments, or injections of a pain-reducing drug into arthritic facet joints. However, even when these techniques are helpful, they typically work best on a foundation of strength, posture and function improvement gained through physical therapy.