How is the neck structured?
Your neck and back are made up of small bones called vertebrae. These are stacked on top of each other to form the spinal column.
The spinal column supports your head and protects the spinal cord. This is the main structure which links the network of nerves throughout your body. Messages travel along this network sending sensations, such as pain, to your brain.
The top seven bones in the spinal column form your neck, and these are called the cervical vertebrae. The bones are linked together by facet joints. These are small joints between your vertebrae that, together with your neck muscles, allow you to move your head in any direction.
Between the vertebrae are discs of cartilage. The discs act as shock absorbers and give the spine its flexibility. A slipped disc occurs when one of these discs slips slightly out of its natural position in the spine.
When to see a doctor
If your neck pain lasts more than a few days, you should see a healthcare professional. You should also speak to them if you:
- have symptoms other than pain and stiffness
- have pain, tingling, numbness or weakness in your arms or legs
- have sudden severe pain after a fall or injury
- suddenly develop neck stiffness along with difficulty lifting both arms above your head.
Some rare causes of neck pain include:
- a fracture
- an infection
- a tumour
- inflammation – which can happen in ankylosing spondylitis or meningitis.
If you suspect you have any of the above, see your doctor urgently.
The most common symptoms are:
Pain and stiffness
- You may feel pain in the middle or on either side of your neck, but it may also extend to the shoulder or to the upper chest.
- You may have pain or weakness in your arms.
- You may have tension headaches, where the pain can travel to the back of your head and sometimes into your ear or behind your eye.
- It may be painful to move your neck and your muscles may feel tight, especially if you’ve been sitting or sleeping in one position for a long time.
- You may notice that your neck won’t turn as far as it normally does, for example when you try to look over your shoulder while reversing the car.
If you have pain and stiffness in the neck that came on quickly, possibly overnight, and you have difficulty lifting both arms over your head, this could be a sign of a condition called polymyalgia rheumatica (PMR). This is an inflammatory condition of the muscles. It’s more common in people over the age of 65. If you think you have this condition, you should see a doctor as soon as possible.
Numbness or tingling
A nerve can become pinched when the muscles, bones or tissues surrounding it apply too much pressure. As a result, you may feel numbness, pins and needles or a tingling sensation that can be felt down your arm, sometimes right down to your fingers.
You’ll find that numbness and tingling will go away once the problem resolves itself. However, if your symptoms are severe, talk to your doctor; they may be able to prescribe drugs that target the pinched nerve, such as gabapentin or pregabalin.
Clicking and grating noises
You may hear or feel clicking or grating as you move your head. This is called crepitus, and it can be caused by air bubbles popping, or tissues and bones moving over each other, in the joint. Other joints often do this too, but noises from your neck usually seem louder because they’re happening closer to your ears. You may also find they’re more noticeable at night. While this is a common symptom and can sound alarming, it’s not serious.
Dizziness and blackouts
If you feel dizzy when looking up or turning your head, this may be due to pinching of the arteries that run alongside the spine, otherwise known as vertebral arteries. This can sometimes happen as a result of changes in the vertebrae. Pinching of these vertebral arteries can occasionally cause blackouts as the blood flow is temporarily reduced. However, blackouts can have other causes so it’s important to seek medical advice if this is happening to you.
Muscle spasms are the sudden stiffening of a muscle or groups of muscles in your body. Often there is no known cause and they can be very unpleasant. When it occurs in the neck it usually causes pain and stiffness down one side, which can make it difficult to turn your head.
It usually only lasts a few hours or days, although rarely it may continue for several weeks. You can try to ease the pain at home with gentle stretches, over-the-counter painkillers as well as heat or ice packs. People with muscle spasms report that applying heat is particularly soothing.
If you have long-lasting neck pain and stiffness, particularly if your sleep is disturbed, then you may feel very tired and, not surprisingly, you may start to feel rather down or low in mood. Talking about your pain with friends, family or your doctor may help.
Neck pain is very common and most of us will have it at some point in our lives. Usually, neck pain is the result of holding your neck in the same position for too long. However, other things can also cause or contribute to neck pain, such as:
- worry or stress
- sleeping awkwardly
- an accident, which can cause whiplash
- a sprain or a strain
- a flare-up of cervical spondylosis; which can happen as the discs and joints in the spine age.
Many people develop a stiff and painful neck for no obvious reason. It may happen after sitting in a draught or after a minor twisting injury, for example while gardening. This is called non-specific neck pain. This is the most common type of neck pain and usually disappears after a few days, providing you keep gently moving your neck and rest when you need to.
You can often manage short spells of neck pain yourself using over-the-counter painkillers and gentle stretches. However, if your neck problem persists or significantly affects your everyday activities then it’s sensible to see a doctor or other healthcare professional.
Most neck problems can be diagnosed and treated based on your symptoms and a simple examination, and it’s unlikely that you’ll need any special tests. Occasionally, your doctor may ask you to have an x-ray, a blood test or an MRI scan to rule out other important causes of neck pain.
Simple self-help treatments and a day or two’s rest are often enough to clear up a spell of neck pain. But if you have a more complex or a continuing neck problem, a healthcare professional will be able to recommend other treatments and therapies that should help. If your pain isn’t settling, your doctor may also be able to prescribe stronger painkillers, although these aren’t suitable for everyone.
Physiotherapists, chiropractors and osteopaths are all trained to treat neck problems. Treatment carried out by one of these therapists, along with home exercises, are often all that’s needed. They can suggest general or specific stretching and strengthening exercises for the neck.
It’s important to make sure that any physical treatments are given by qualified practitioners who are registered with the relevant body.
Simple self-help treatments and a day or two's rest are often enough to clear up a spell of neck pain. If you do have a more complex or persistent neck problem, your doctor will be able to recommend other treatments and therapies.
Painkillers such as paracetamol will often help. It’s best to take them before the pain becomes very bad, but you shouldn’t take them more often than prescribed.
Over-the-counter non-steroidal anti-inflammatory drugs, such as ibuprofen, can also help. You can use these for a short course of treatment (about 5 – 10 days), but if they’ve not helped within this time then they’re unlikely to. If the pain returns when you stop taking the tablets, try another short course. You can rub anti-inflammatory gels or creams onto tender areas if you prefer.
NSAIDs can interact with other drugs such as warfarin, so it’s best to check with a pharmacist before you start taking them.
You shouldn’t take ibuprofen or aspirin if you’re pregnant, if you have asthma, a stomach ulcer or any heart problems, until you’ve spoken with your doctor or pharmacist.
Persistent neck pain
In some cases, persistent neck pain has a specific cause, such as a damaged facet joint or disc. However, neck pain quite often continues even after the original problem has settled down. Lack of movement can cause your neck muscles to become weak and stiff. They will then tire more easily and will be more likely to hurt when you move them.
Over time you may start avoiding more and more activities and this can start to affect your work, social life, personal relationships, hobbies and interests.
As you do less of the things you enjoy and start to lose confidence you may start to feel anxious or depressed. You may feel that family members and medical professionals appear unhelpful or unsympathetic. If you’re anxious or depressed, you may not feel like exercising or doing everyday activities, so your muscles become weaker still, and so it goes on.
This can happen to anyone, and the longer it continues the harder it’ll be for you to recover your movement, activities and confidence.
Working with neck pain
Overall, getting back to work sooner rather than later is helpful for most people. In the past, people were advised to rest up in bed, but we now realise that it does more harm than good. It’s much better to keep moving, even if you need to take some painkillers to allow you to do so.
Most people are able to return to work within 2−3 days, although this varies from person to person and depends on the type of job you do.
You don’t need to wait until your neck problem has gone. In many cases, the longer you’re off work the more likely you are to develop longer-term problems and the less likely you are to return to work.
It’s important to keep in contact with your employer and discuss what can be done to help you return to work. If your work involves physically demanding tasks, you might find it useful to work shorter hours or move to more desk-based duties for a couple of weeks.
If you have an occupational health adviser at your workplace, they can help advise what work you are fit to do and arrange any simple adjustments to help you to cope. If you are having difficulties travelling to or from work or need an item of equipment, the Government’s Access to Work Scheme might be able to help.
If you are unable to get back to work after two weeks of absence because of your neck pain, you should talk to your doctor and employer about getting physiotherapy or other treatments that can get you moving again.
You can get further advice through your local Jobcentre Plus and the Government’s Fit for Work website.
Research and new developments
Research has helped us to understand the make-up and function of the discs between our vertebrae and has demonstrated that inherited factors affect the normal wear of the spine. Research has also shown that acupuncture can be an effective treatment for back and neck pain.
Discoveries about the effect of stress, anxiety and depression as well as the importance of exercises, are changing the way doctors think about neck pain. This will be improved further as a result of ongoing research to monitor the differences in musculoskeletal care across the UK.
Exercises to manage neck pain
Neck pain is common but most cases aren’t caused by a serious problem. Your pain should ease within two weeks and you should recover over approximately a 4–6 week period. You should use the suggested exercises for at least 6–8 weeks to help prevent symptoms returning. These exercises for neck pain (PDF, 297 KB) are also available to download and keep.
Keeping the rest of the body straight, push you chin forward so your throat is stretched. Gently tense your neck muscles and hold for 5 seconds. Return your head to the centre and push it backwards, keeping your chin up. Hold for 5 seconds. Repeat 5 times.
Neck tilt (side to side)
Tilt your head down towards your shoulder, leading with your ear. Gently tense your neck muscles and hold for 5 seconds. Return your head to centre and repeat on the opposite side. Repeat 5 times on each side.
Neck tilt down
Sit or stand, keeping a good posture. It’s best to sit down if you have trouble balancing. Slowly tilt your head down to rest your chin on your chest. Gently tense your neck muscles and hold for five seconds. Repeat five times.
Turn your head towards one side, keeping your chin at the same height and moving within comfortable limits. Gently tense your neck muscles and hold for 5 seconds. Return your head to the centre and repeat on the opposite side. Repeat 5 times on each side.
- Neck pain is common but most cases aren't caused by a serious problem.
- Most cases of neck pain get better on their own within a few weeks.
- Stay active. Bed rest for more than a couple of days makes it harder to get going. Gradually increase your normal activities and do regular exercise.
- Take painkillers if needed so you can stay active.
Your pain should ease within 2 weeks and you should recover over approximately a 4-6 week period.
If you have severe neck pain or weakness in your arms/hands, contact a doctor.
You may find a short period of rest is helpful initially, but to prevent your neck muscles weakening and your joints stiffening, you should rest for as short a time as possible and certainly no more than a day or two. As soon as possible, start some gentle stretches and neck movements as these can help the muscles and ligaments to relax and ease your pain and stiffness.
Try simple stretching and strengthening exercises. If you do these every day, they’ll increase the strength of your muscles, ease stiffness, and help to restore your range of movement. Start by exercising very gently and gradually build up.
As with any physical activity, you’ll need to use some common sense when doing these. You should expect some normal aches or discomfort during or following the exercises, but if a particular one makes your symptoms significantly worse you should stop doing it.
It's also important to find some form of exercise that you enjoy and to keep doing it. Walking, swimming, and exercise classes such as yoga or Pilates are all popular and will help with your general health and fitness.
Read more about exercise and arthritis.
If your neck pain continues despite treatment and is affecting your day-to-day activities or perhaps is affecting your mood, a pain management programme may help you. These programmes focus on improved coping techniques and better long-term self-management strategies.
While they won’t cure the pain, they should help you to have a better quality of life in spite of the pain. Pain management programmes are generally outpatient group sessions run by a team of healthcare professionals including doctors, physiotherapists, psychologists and sometimes nurses, occupational therapists and other specialist clinicians.
Make sure you talk to your doctor as they may be able to refer you for a pain management programme if they think you would benefit from it.
Yoga, Pilates and other similar classes are a great way to keep fit while simultaneously improving your wellbeing.
If you have any questions or want to talk to someone about neck pain, you can try giving our helpline a ring on 0800 5200 520 for free.