Neck pain - modern management

Neck pain is very common. Most people will have one or more bouts of neck pain at some point in their life. Most bouts resolve within a few weeks, and serious or permanent damage is rare. Very few people with neck pain have a disc problem or ‘trapped nerve’

UNDERSTANDING THE NECK
Your spine is one of the strongest parts of your body. It is made up of solid bony blocks (called vertebrae) joined by discs of strong rubber-like tissue which allows the spine to be flexible .It is reinforced by strong ligaments, and surrounded by large and powerful muscles that protect it

Most cases of neck pain that develop suddenly are due to ‘simple neck strain’ rather than any serious disease. Most neck pain comes from the working parts of your neck - the muscles, ligaments & small joints. Your neck is simply not moving and working as it should. You can think of it ‘being out of condition’

Some people with neck pain may also get headache, arm or chest pain, or mild pins and needles. These symptoms do not mean a ‘trapped nerve’ and the symptoms will generally settle along with the neck pain. What you do about neck pain yourself is usually more important than the exact diagnosis or treatment

WHAT ARE THE TREATMENTS FOR SIMPLE NECK PAIN?
What you do in the early stages is very important. Rest for more than a day or two usually does NOT help and may actually prolong pain and disability

Movement is good for you and your neck - exercise gets your neck moving again by stretching tight muscles and joints, and stops the working parts stiffening up. Wearing a collar is no longer recommended as it stops your neck moving. The sooner you get moving and doing your ordinary activities as normally as possible, the sooner you will feel better. The people who cope best with neck pain are those who stay active and get on with life despite the pain

Even when your neck is painful, you can maintain a normal lifestyle without putting too much stress on it:

• Keep on with your normal activities and hobbies - don't stop doing things, just change the way you do them
• Either stay at work or return to work as soon as possible
• When sitting try to avoid staying in one position for too long . You may need to adjust your chair/desk and computer, and take regular breaks. See our advice on Computer Ergonomics, as poor posture when using computers is a common source of back and neck pain
• When driving adjust your seat so that you can hold the steering wheel comfortably. Take regular breaks – get out of the car and walk around. Use your mirrors for reversing
• When carrying things hold them close to your body or split the load between both hands
• Sports - continuing with your normal sports is fine if it is non-impact or non-contact - just reduce the intensity for a while if necessary
• Sleeping - experiment and find what pillow is best for you - higher or lower; softer or firmer; maybe a different shape

SIMPLE NECK EXERCISES
Exercises on a regular basis will help to increase movement and control pain. Carry out the following exercises slowly and in a comfortable range

1. Flexion/extension Flexion: Sitting upright in a good posture, bend your head forwards gently pulling your chin closer to your chest. Hold for a count of 5 then relax Extension: Sitting upright in a good posture, take your head slowly back until you are looking at the ceiling. Hold for a count of 5 then relax
2. Rotation Sitting upright in a good posture, turn your head to one side until you feel a stretch. Hold for a count of 5 then relax. Repeat to the other side
3. Side flexion Sitting upright in a good posture, keep your head facing forward then tilt your head towards one shoulder, without shrugging your shoulder, until you feel the stretch on the opposite side. Hold for a count of 5 then relax. Repeat on the other side
4. Retraction Sitting upright in a good posture, pull your chin in (not tipping your head forwards). Hold at the end position and feel the stretch in your neck. Hold for a count of 5

Increased discomfort after exercise does not mean that you have damaged anything. Up to 1 hour of increased discomfort is NORMAL. Try to fit your exercises in around your day and make them part of your normal routine. If you get increased discomfort beyond one hour after exercising, reduce the number of each exercise to 5 times 3 times a day. Gradually increase the number of exercises as your neck pain improves

Anxiety and stress can increase the amount of pain we feel. Tension can cause muscle spasm and the muscles themselves can become painful. Many people feel anxious about neck pain – but remember that serious damage is rare and that the long-term outlook is good. People who cope with pain by being positive, staying active and getting on with life tend to get better faster and have fewer problems in the long run

PAIN RELIEF
Regular pain killers may be needed initially to help control the pain and let you get started

• Paracetamol is often effective if taken regularly – for an adult this is usually 1000mg (two 500mg tablets) taken four times a day
• Ibuprofen (anti-inflammatory painkillers) can be taken in addition to Paracetamol if necessary, usually in a dose of 400mg taken three times a day. Some people with asthma, stomach ulcers, high blood pressure, kidney failure or heart failure may not be able to take anti- inflammatory painkillers
• Stronger painkillers such as Codeine are an option if anti-inflammatories do not suit you. Codeine can be taken in addition to Paracetamol. Codeine may cause constipation – have plenty of water & fruit in your diet to prevent this

All these pain killers are available from a pharmacy without a prescription

WHEN DO I NEED TO SEE A DOCTOR?
Most people manage to deal with simple neck pain themselves by following the advice in this leaflet. However if you have severe pain that gets worse over several weeks instead of better, or if you are unwell with neck pain you should see your doctor

Your doctor will normally be able to diagnose simple neck pain from the description of the pain, and by examining you. In most cases no tests are needed. X-rays or scans of the neck are not usually helpful in simple neck pain

Here are a few symptoms, which are all very rare, but if you do have neck pain and develop any of these you should see a doctor straight away:

• Lumps or swelling in your neck
• Difficulty swallowing or breathing
• Dizziness or fainting
• Difficulty lifting your arms, dropping things, or clumsiness in your fingers
• Falling, tripping or dragging your feet

Source: Adapted from The Back Book - A reliable source of information for people suffering from low back pain [Roland et al, 2002]. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice

Back to top

Advice to users

Contact the Web Master

Last revision: April 2011