A pain in the Neck

Advice and Self-help to combat neck pain

Signs and Symptoms

Most people will suffer from neck pain at some point in their life. Although the pain is often in the neck itself, it can radiate across the top of the back or shoulders. Sometimes pain felt in the arm or hand can relate to a neck problem.  Stiffness or a restriction of movement is another complaint, for example when turning your head to reverse your car. There may be additional symptoms such as pins and needles, numbness, headaches or dizziness. A good physiotherapist will be able to accurately assess your signs and symptoms and determine the cause of your pain.

The neck is the top of the vertebral column, also known as the cervical spine. Small facet joints and a spongy material called the intervertebral disc connect each vertebra. Lots of muscles attach across the vertebra. The balance of these muscles has a role in maintaining good alignment of our head on our neck.

Causes of neck pain

  • Non-specific neck pain : It is not uncommon for neck pain to arise spontaneously without any injury. This is sometimes called an acute wry neck. Typical examples are pain felt suddenly after waking up in the morning, turning your head in the shower or after sitting in a draft. This type of pain is usually due to muscle spasm. It often clears up within a few days but the pain can last longer if there are some contributing factors such as poor posture, which may be making the neck muscles tenser or putting more strain on ligaments.
  • Cervical Spondylosis: This is often diagnosed on an X-ray of somebody who has a history of chronic neck pain. It occurs with wear and tear over years and the age at which it occurs may be linked to both posture and genetics. The intervertebral discs become thinner and the facet joints worn, with osteophytes (bone spurs) forming around the edges of the vertebrae and joints. This can be associated with pain, clicking and stiffness. Occasionally a compressed disc can press onto one of the exiting nerve roots causing symptoms to refer into the arm, hand or fingers.
  • Whiplash: This is common after a car accident, where the head flips backwards and then immediately forwards as the body stops suddenly. The pain is due to stretching of the ligaments and capsules of the neck joints and overlying protective muscle spasm. After an accident there can be a delay of a few days, where inflammation develops, before the onset of pain. The healing time for an injury usually depends on the severity of the accident, for example the speed the car was travelling at and the force of the collision, which determine how much strain the neck was under. Underlying factors such as previous fitness levels can also play a role in recovery.

Treatment for neck Problems

No matter what the cause of the neck pain, posture is regarded as a key factor in both prolonging symptoms and their recurrence. The head is very heavy and if it is not aligned correctly on the body certain muscle groups, such as the deep neck flexors and shoulder blade stabilisers are not able to work as efficiently to support it. This increases the load on other muscles, such as the upper trapezius, which may already be in spasm and causing pain.

Massage and acupuncture can both be helpful in the short term to ease some of the pain felt in the neck muscles. However at the same time as relaxing the muscles which are overworking, it is important to activate some of the muscles which are underworking.

Your physiotherapist may use joint mobilisations or manipulation to move some of the stiffer joints in your neck. Again this treatment needs to be reinforced by good posture alignment or the stiffness is likely to re-occur.

Good Posture

  • To make sure you have good neck posture in standing you need to ensure the rest of your body is lined up correctly.
  • Try to balance your weight evenly on your feet and ensure that your pelvis is in a neutral position –not tilted forwards or backwards. Make sure your shoulder blades are relaxed down your back and then imagine lengthening the crown of your head to make yourself a little taller.
  • Your physiotherapist or Pilates teacher can help you to achieve this position initially. It is a good idea to practice finding it regularly through the day.

Good Ergonomics

The majority of people spend a large amount of time sitting down at work and so good ergonomics are essential to support the neck properly during the day.

  • Make sure you sit correctly with your pelvis at the back of your chair and the back rest supporting the lower and upper back.
  • Sit close into your work station to ensure you are not over reaching with your arms to avoid creating excess shoulder tension.
  • If you use a phone regularly consider switching to a hands free head set.
  • Adjust the height of your computer screen if needed to help you maintain correct neck posture.
  • Try to take regular breaks to ease tension and stress build up.
  • If you continue to have problems getting comfortable at work ask your employer to organise a work station assessment for you.

Regular Exercise

The Cochrane research medical data base* supports the role of exercise in the treatment of neck pain. You may need to reduce the intensity or load during an acute episode of pain but try to return to some level of activity as soon as possible. Pilates and Yoga are both often recommended to people with neck pain after the acute stage has settled as they both involve elements of core strengthening, flexibility and postural alignment.

The Chartered society of Physiotherapy recommends the following exercises*, which can be done easily at your desk.

  • Neck tilt: Tilt your head down to rest your chin on your chest. Gently tense your neck muscles and hold for 5 seconds. Return to a neutral position and repeat 5 times.
  • Neck turn: 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 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 stretch: Keeping the rest of the body straight, push your 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.

Your physiotherapist can teach you additional exercises, including strengthening for the neck and shoulder blade muscles, general core strengthening to improve your posture and stretching for the thoracic spine and chest muscles. These may all be useful in preventing re-occurrence of the problem.

By Nikki Richards MPHTY (Sports) BSc(hons)Physio

  • *Exercise for neck pain (2012) Kay TM, Gross A, Goldsmith CH, Rutherford S, Voth S, Hoving JL, Brønfort G, Santaguida PL. The Cochrane Library.
  • **Neck Pain-Arthritis Research UK in association with The Chartered Society of Physiotherapy.