Spine : Neck Pain in Adults

Who gets neck pain and what are the causes?

Neck pain is common. More than half of people develop a bout of neck pain at some time in their life. One survey done in the UK found that, of adults aged 45-75 years, about 1 in 4 women and about 1 in 5 men had current neck pain. Types and causes of neck pain include:

’Mechanical’ neck pain is the most common type. This is sometimes called ’simple’ or ’nonspecific’ neck pain. Causes include minor injuries or sprains to muscles or ligaments in the neck. Bad posture is also a common cause. For example, neck pain is more common in people who spend much of their working day at a desk with a ’bent-forward’ posture. Often the exact cause or origin of the pain is not known.

A whiplash injury, most commonly due to a car crash, causes neck pain. See separate leaflet called ’Whiplash Injury’ for details.

Acute (sudden onset) primary torticollis. This is sometimes called ’wry neck’. A torticollis is when the head becomes twisted to one side and it is very painful to move the head back straight. Most cases are thought to be due to a minor injury or poor posture while sleeping which causes one or more muscles on one side of the neck to go into ’spasm’. The pain and spasm usually ease and clear away over a few days without any treatment. Occasionally, torticollis is due to more serious causes.

Degeneration (’wear and tear’) of the spinal bones (vertebrae) and the ’discs’ between the vertebrae is a common cause in older people. This is sometimes called cervical spondylosis. Cervical radiculopathy is when the root of a nerve is pressed on or is injured as it comes out from the spinal cord in the neck (cervical) region. This causes symptoms such as numbness, pins and needles, and weakness in parts of an arm supplied by the nerve in addition to neck pain. The common causes are cervical spondylosis and a disc problem. (The disc is the softer tissue between the bony vertebrae. A disc may push on the nerve - similar to a ’slipped disc’ which causes low back pain.) Various less common disorders can cause a cervical radiculopathy.

More serious and rarer causes include: rheumatoid arthritis, bone disorders, cancers, and serious injuries that damage the vertebrae, spinal cord or nerves in the neck.

The rest of this article deals only with the common ’mechanical’ type of neck pain.

What are the symptoms of common mechanical neck pain?

Pain develops in the neck and may spread to the base of the skull and shoulders. Movement of the neck may make the pain worse. The pain may spread down an arm to a hand or fingers. This is due to irritation of a nerve going to the arm from the spinal cord in the neck. Some numbness or pins and needles may occur in part of the arm or hand. It is best to tell a doctor if these symptoms occur as they may indicate a problem with a nerve in the neck. Acute (sudden onset) bouts of neck pain are commonly due to minor injuries or bad posture. Full recovery occurs in most cases. The usual advice is to keep the neck active. Painkillers are helpful until the pain eases. Chronic (persistent) pain develops in some cases, and further treatment may then be needed.

What is the outlook for a bout of mechanical neck pain?

The outlook is usually good in most cases of acute (sudden onset) neck pain. Symptoms commonly begin to improve after a few days, and are usually gone within a few weeks. However, the time taken for symptoms to settle varies from person to person. Some people develop chronic (persistent) neck pain. If you develop chronic neck pain, the tendency is for the pain to wax and wane with ’flare-ups’ from time to time.

How can I tell if the pain is due to a more serious cause?

A doctor’s assessment and examination can usually determine that a bout of neck pain is mechanical and not due to a more serious cause. The following are the sort of symptoms that may indicate a more serious problem.


  • If neck pain develops when you are ill with other problems such as rheumatoid arthritis, AIDS, or cancer.

  • If the pain becomes worse and worse.

  • If some function of an arm is affected. For example, weakness or clumsiness of a hand or arm, or persistent numbness. (As mentioned, some numbness and pins and needles may occur with mechanical neck pain. However, this is mild and usually goes within four weeks.)

  • If you feel ill with other symptoms such as weight loss, fever, etc.

  • If the neck bones (vertebrae) are tender (which may indicate a bone problem).

What are the treatments for common mechanical neck pain?

Exercise your neck and keep active.

Aim to keep your neck moving as normally as possible. At first the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able. You should not let it ’stiffen up’. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities.

In the past, some people have worn a neck collar for long periods when a bout of neck pain developed. The problem with collars is that they prevent you from moving your neck properly.
Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar. Also, if you keep the neck active during a bout of neck pain, it is thought to help prevent chronic (persistent) neck pain from developing.

Medicines:

Painkillers are often helpful. It is best to take painkillers regularly until the pain eases. This is better than taking them now and again just when the pain is very bad. If you take them regularly, it may prevent the pain from getting severe, and enable you to exercise and keep your neck active.
Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.

Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.

A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.

A muscle relaxant such as diazepam is sometimes prescribed for a few days if your neck muscles become tense and make the pain worse.

Other advice:

Some other advice which is commonly given includes:


  • A good posture may help. Brace your shoulders slightly backwards, and walk ’like a model’. Try not to stoop when you sit at a desk. Sit upright.

  • A firm supporting pillow seems to help some people when sleeping.

  • Physiotherapy. It is not clear whether this makes much difference to the outcome of mechanical neck pain. Therapies such as traction, heat, cold, manipulation, etc, may be tried, but the evidence that these help is not strong. However, what is often helpful is the advice a physiotherapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises. If symptoms do not begin to settle over a week or so, you may then be referred to a physiotherapist to help with pain relief and for advice on specific neck exercises.


Treatment may vary and you should go back to see a doctor
1. if the pain becomes worse.
2. if the pain persists beyond 4-6 weeks.
3. if other symptoms develop such as numbness, weakness, or pins and needles in an arm or hand.

Other pain relieving techniques may be tried if the pain becomes chronic (persistent). Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated.

What about driving?

To drive safely you must be able to turn your head quickly. It is be best not to drive until any bad pain or stiffness has settled.

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