Introduction

Photo of a woman with neck pain (PantherMedia / Martin Novak)

Acute neck pain is very common and usually nothing to worry about. Tense muscles are often to blame, for instance after working on the computer for a long time, being exposed to a cold draft, or sleeping in an awkward position. But in many cases there's no clear cause. Acute neck pain usually goes away within about one to two weeks. In some people it comes back again in certain situations, such as after work or intensive sports.

If the symptoms last longer than three months, it's considered to be chronic neck pain. Psychological stress is frequently a factor if the pain becomes chronic.

Some people who have neck pain avoid doing physical activities for fear of making things worse or injuring themselves. But there is no reason to worry as long as no warning signs of more serious problems arise. It's even a good idea to stay active and carry on as usual despite the pain. Exercises that target the neck can help to prevent neck pain.

Symptoms

There are two basic types of neck pain:

  • Axial pain is mostly felt in the part of the spine that belongs to the neck (cervical spine), and sometimes spreads to the shoulders.
  • Radicular pain shoots ("radiates") along the nerves – for example, up the back of your head or down into one of your arms. This type of pain is usually caused by irritated nerves – for instance, because one of the spinal disks in the neck area has changed and is pushing against a nerve. That may also affect your arm reflexes and muscle strength or result in a tingling feeling ("pins and needles").

Neck pain is only very rarely a sign of a more serious condition or an emergency, but urgent medical attention is important if any of the following occur:

  • The symptoms arise after an accident
  • Stiff neck
  • Loss of bladder or bowel control
  • Headache together with nausea, vomiting, dizziness or sensitivity to light
  • Pain that stays the same, whether you're at rest or moving
  • Unexplained weight loss, fever or chills
  • Nerve problems and signs of paralysis such as tingling or difficulties moving your arm or fingers

Other symptoms that require medical attention include persistent "pins and needles," frequent "falling asleep" of your hands or legs, leg weakness, and trouble keeping your balance when walking.

Causes

Neck pain can be caused by many different things. These include:

  • Weak and overused neck muscles: For instance, sitting at a desk for a long time – particularly in awkward positions with slightly tensed muscles – can cause pain and stiffness in the neck or shoulder areas, and sometimes headaches too. Activities that involve tilting your head back against your neck can also cause muscles problems in the neck area. These include things like painting a ceiling, or certain types of sports such as riding a racing bike or swimming breaststroke with your head in a fixed position.
  • Wear and tear on the cervical spine: Over the course of a lifetime, various normal signs of wear and tear arise in the spine. The spinal disks become flatter, and small bone growths (spurs) may form along the edges of the vertebral bodies (the front part of the bones in the spine). This is called osteochondrosis. Osteoarthritis of the joints between the neck vertebrae is called cervical spondylosis. These changes can make it harder to move your neck, but they rarely cause neck pain on their own.
  • Whiplash: This is an injury that can occur if someone drives into the back of your car in a road accident. The impact of the collision causes the head to rapidly jerk forwards and then back again. This usually causes small injuries in the muscle and connective tissue, painfully tense muscles, and difficulty moving your head for several days. The symptoms typically go away completely after a short time.
  • Narrowing of the vertebral canal, or a slipped disk: If the vertebral canal is too narrow, or if spinal disk tissue bulges or leaks out and puts pressure on a nerve root, it can cause neck pain that radiates (shoots) into your shoulder or arm. A slipped disk may – but doesn't always – cause symptoms.

Neck pain also sometimes comes from inflammatory conditions of the spine, jaw joint problems or severe headaches.

Often it's not possible to find a clear cause of neck pain: The bones, tendons, and nerves in the cervical spine are usually too close together to be able to determine exactly what caused the symptoms in the first place.

If no specific cause can be found, doctors refer to the pain as "non-specific neck pain." It's often particularly hard to determine the cause of the neck pain if it's chronic.

Illustration: Structure of the cervical spine: Bones, spinal disks and nervesStructure of the cervical spine: Bones, spinal disks and nerves

Prevalence and outlook

Neck pain is very common. It is estimated that about 1 in 3 people are affected once a year – women more often than men. The symptoms are usually harmless and go away on their own after a while. But they might keep coming back again, too.

The risk of neck pain problems becoming chronic generally increases with age. Neck pain is also often more persistent in people who have already had back pain or a slipped disk.

How long neck pain caused by whiplash will last depends on factors like the force of the collision. The problem often lasts longer and is more severe in people who have been psychologically traumatized by the accident or worry a lot about the consequences.

Diagnosis

Your doctor will first ask you several questions, such as whether you have been in an accident, exactly where it hurts, and whether physical strain or mental stress might be playing a role.

They will then perform a physical examination in order to first rule out any serious causes. This will include feeling ("palpating") your neck with their hands, checking how well you can move your head, as well as checking your reflexes and muscle strength in your arms and shoulders.

X-ray, CT or MRI scans are usually only needed if there are signs of serious disease or if doctors believe there is a specific cause. These imaging techniques typically don't help if there are no such signs because it's not possible to draw any reliable conclusions from the images: One reason for this is because many people have visible signs of wear and tear on their cervical spine which don't cause any problems. Also, people who have neck pain often don't have any visible irregularities, or only have slight irregularities. So x-rays and other imaging techniques aren't helpful when trying to find the cause of non-specific neck pain.

Treatment

There isn't enough research on the effectiveness of most treatments for non-specific neck pain. Applying heat with hot water bottles or cushions is one easy way to try to reduce the pain. Other treatments include stretching and strengthening exercises, massages and painkillers.

Surgery is only considered if a clear cause has been found and the procedure might help. It may be an option, for instance, if spinal disk tissue is squashing or "pinching" a nerve. But slipped disks often improve on their own, so surgery usually doesn't have any major benefits. Spinal surgery in the neck area also carries risks, so it's important to carefully consider the advantages and disadvantages of surgery before deciding.

People who have severe chronic pain may benefit from pain management therapy. This is offered by doctors or psychotherapists who have specialized in helping people with long-lasting or severe pain. Pain management therapy can help you manage the pain in such a way that it no longer dominates your everyday life.

Learn more

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.