Most episodes of neck pain are due to muscle strain or soft tissue sprain (ligaments, tendons), but it can also be caused by a sudden force (whiplash). These types of neck pain often improve with time and non-surgical care such as medication and chiropractic manipulation. But if neck pain continues or worsens, there is often a specific condition that requires treatment, such as cervical degenerative disc disease, cervical herniated disc, cervical stenosis, or cervical arthritis.
- Acute. Pain that lasts less than 4 weeks.
- Subacute. Pain that lasts 4 to 12 weeks.
- Chronic. Pain that lasts 3 or more months.
For acute, a specific cause is oftentimes not known or even sought. The pain goes away within 4 weeks, so most people are just happy to get on with their lives and aren’t concerned with what specifically caused the temporary nuisance.
But when neck pain becomes subacute or chronic, then it’s likely that some form of medical treatment or guidance is needed to alleviate the pain. Depending on the cause, there may be more effective treatments for certain conditions.
As a first step to diagnosing the specific cause of neck pain, typically a doctor will take a thorough history of the patient. In addition to learning about the person’s medical background, the doctor will ask the person questions about the following:
- Description of neck pain. When did the pain start? Does it come and go? Is the pain in one spot, or does it radiate into the shoulders, arms, or fingers? Are there any other symptoms in addition to neck pain?
- Occupation. What type of work does the person do? Does the person perform manual labor or sit in front of a computer all day? What is the commute like?
- Lifestyle. What type of hobbies or activities does the person enjoy? Does the person tend to be more active or sedentary—for instance, do hobbies include gardening, watching TV, or swimming?
- Posture. Does the person often slouch or tilt the head forward? What type of chairs are used?
- Sleep habits. Does the person usually sleep on the side, stomach, or back? What type of mattress and pillows are used?
- Recent injuries. Did the person do or feel anything unusual recently that might have led to this neck pain? Maybe the person had an accident or fall? Or perhaps the neck was tweaked while lifting something?
- Old injuries. Thinking further back in life, do any significant injuries stand out? Perhaps an old sports injury, car accident, or a fall that was particularly hard or scary?
The doctor does the complete history in order to better understand the nature of the patient’s pain, such as if the pain is worse at certain times of day or exacerbated by certain activities.
Causes of neck pain
- Sleeping in wrong position. Often referred to as a “crick” in the neck, a person might wake up in the morning with neck pain due to sleeping in an awkward or atypical position that overextended the neck.
- Sports injury. A person could move the neck suddenly and/or in an unusual way in a new sport, or a player could have a collision or fall. A common sports collision injury is a stinger, which happens when nerves in the neck/shoulder are impacted and pain, numbness, and weakness can radiate down the shoulder, arm, and hand.
- Poor posture. Whether it’s at work, home, and/or commuting, poor posture can lead to neck problems. If a person’s head is often tilted forward for long periods of time, then the neck’s muscles, tendons, and ligaments need to work harder. Poor posture can be problematic during any number of activities, including working at a computer, watching TV, riding the train, reading a book, gardening, and more. Text neck, for example, is an increasingly common problem that develops in anyone who spends hours looking down at the phone while texting.
- Repetitive motions. Turning the head in a repetitive manner, such as side to side while dancing or swimming, may lead to overuse of the neck’s muscles, tendons, and ligaments.
- Holding the head in unusual position. Anything that requires holding the head in an unusual way for long periods of time could cause neck strains and sprains. Some examples include having a long conversation while cradling a phone between the head and shoulder, or spending an afternoon looking up at an air show.
- Whiplash. In a whiplash injury, the head and neck are forced suddenly backward and immediately forward with a great deal of force. The soft tissues along and near the cervical spine can be torn or ruptured as a result. This type of injury commonly occurs in an auto accident that involves a rear-end collision.
- Rest. With most neck strains and sprains, going easy for a few days is all that is needed while the muscles and tendons heal on their own. It is important to be careful to avoid strenuous activities or movements that are causing more pain.
- Ice and/or heat. Applying ice can work as an anti-inflammatory to reduce swelling and pain. Initially, it’s better to apply ice or cold packs for neck pain because they can temporarily close small blood vessels and prevent swelling from becoming worse. After a couple days, ice or heat can be applied on an alternating basis. Applying continuous heat can cause increased swelling.
- Massage. Often employed after applying ice or heat, a massage can soothe muscle tension and spasms, reducing pain.
- Better posture. If poor posture is causing the neck pain, then simple changes might be the solution. This could include changing a workstation to become more ergonomically friendly, with a chair, monitor, and keyboard positioned in ways to keep the body, head, and neck more aligned in a natural position; or learning to sleep on the back (instead of the stomach or side) with an ergonomically-friendly pillow and mattress.
- Modify lifestyle. If certain activities are found to cause neck pain that keeps coming back, then those activities might need to be limited or avoided. For example, if someone spends a few hours every day with their neck craned over a smartphone while texting friends and checking updates, then that activity should be reduced; and the phone should be held up closer to eye level to keep the neck more upright while texting.