Neck Pain: What's Going On and What Helps

You wake up and your head will not turn to the left. Or you spent a week hunched over a laptop, and now the base of your skull feels like a clenched fist. The neck makes people nervous because so much passes through it.

Here is the reassuring part. Most neck pain is what we call mechanical, meaning it is not caused by a serious disease, and most episodes ease over a few weeks [1][2].

What is neck pain?

Mechanical neck pain, sometimes called a cervical strain, is pain in the neck that changes with movement or position. Common triggers are sleeping in an awkward position, sitting at a desk for a long time, a pinched nerve, or an injury such as whiplash [2]. The physical therapy guideline reports that 10% to 20% of people have neck problems at any given time [1].

The guideline notes that a single direct cause of this kind of neck pain is rarely identifiable [1]. That does not mean the pain is imaginary. It means the goal is to restore movement and capacity instead of chasing one culprit.

What does it feel like?

Most people describe stiffness or an ache that makes it hard to turn the head. Headaches and shoulder or arm pain can come along, and after an injury symptoms may take hours to show up [3].

If a nerve in the neck is irritated, which is called cervical radiculopathy, pain can travel into the arm, sometimes with tingling, numbness, or weakness [1]. The course is often favorable, with symptoms settling over weeks to months, but we watch for any worsening [1].

Red flags that need urgent care

Most neck pain is not dangerous, and we screen for the exceptions at every first visit. Clinicians look for infection, cancer, fracture, and problems with the blood vessels or heart [1].

Call 911 or go to the emergency room if you have neck pain along with:

• Face drooping, weakness in one arm, slurred speech, loss of vision, or a sudden severe headache. These can be signs of a stroke [5].

• Chest pain, since the heart is one of the things we rule out [1].

• New trouble controlling your bladder or bowels [1].

Ask for an urgent appointment the same day if you have hurt your neck, in a crash or a fall for example, and you have severe pain despite painkillers, tingling, trouble walking, weak arms or legs, or a sudden electric shock feeling into your arms or legs. These can mean the nerves in the neck or back are involved [3].

Call your doctor soon if neck pain comes with pins and needles or a cold arm [2], or with fever, feeling generally unwell, or unexplained weight loss, since infection and cancer are part of what clinicians rule out [1].

What can you do at home?

• Keep your neck moving. Gentle neck flexibility exercises are fine. The NHS advises against a neck collar unless a doctor tells you to wear one [2]. After a whiplash-type injury, carrying on with everyday activities may hurt a little, but it will speed up your recovery [3].

• Try heat or cold. The NHS suggests wrapped frozen peas for about 5 minutes, three times a day, or a wrapped hot water bottle for 20 minutes, two or three times a day [2].

• Check your setup. A low, firm pillow and changing position often at a desk can help [2].

How does physical therapy help?

We screen for the red flags above, then work out which movements and positions set your pain off. The guideline from the Academy of Orthopaedic Physical Therapy supports a mix of care that depends on how long you have had the pain [1]:

• For recent pain with limited motion, neck range of motion exercises, strengthening for the shoulder blade and arm muscles, and thoracic (mid-back) manipulation [1].

• For pain that has lingered, endurance exercises for the neck and shoulder girdle [1].

• After a whiplash-type injury, education to return to normal activity, little or no collar use, and reassurance that recovery is expected within two to three months [1].

The research on exercise is encouraging but not perfect. A Cochrane review found moderate-quality evidence that strengthening and endurance exercises for the neck and shoulder region help long-lasting neck pain, while low-quality evidence suggested stretching alone may not change pain or function. For recent-onset neck pain, it found no evidence. The authors noted that no high-quality evidence exists yet [4].

When should you get seen?

Book an evaluation if neck pain has not eased after a few weeks, painkillers are not helping, or you are worried about it [2]. After an injury, get checked if it has not improved after a week [3]. Arm pain with tingling or weakness is worth an evaluation sooner [1][2].

How can Hybrid Physical Therapy help?

We spend the first visit working out what is driving your neck pain, not just where it hurts. You work one-on-one with a Doctor of Physical Therapy every session, and we build the plan around what you want to get back to.

This post is general education and does not replace an exam. If your neck has been bothering you for a couple of weeks, come in and let us take a look.

Let Hybrid Physical Therapy be the ones to optimize your performance.

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References: 

1. Blanpied PR, Gross AR, Elliott JM, et al. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302. PubMed (PMID 28666405)

2. NHS. Neck pain. Source page

3. NHS. Whiplash. Source page

4. Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1(1):CD004250. doi:10.1002/14651858.CD004250.pub5. PubMed (PMID 25629215)

5. NHS. Symptoms of a stroke. Source page