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Neck: painful neck

What causes neck pain?

Pain in the neck is commonly the result of an injury such as a sharp, sudden jerk of the neck as in a motor vehicle accident. Other causes include blows to the head (such as in boxing and wrestling), striking the head on an overhead object or even simple falls. People often wake up with severe neck pain and blame it on a cold draught, but it is caused by an unusual twist in the neck for a long period during sleep. The pain mainly arises from minor injury to the many small swivel joints in the neck (called facet joints) and less often to injury of one of the discs between the vertebrae. In older people, arthritis can develop in these joints.

What are the symptoms?

The main symptom is pain and stiffness in the neck, but the pain can travel to the head, around the eye and ear or to the shoulder and arm. Problems from the cervical spine (the first 7 vertebrae in the spine) can also cause 'pins and needles' in the neck or down the arm.

What is the outlook?

Neck pain, which is rarely a severe problem, can clear up very quickly and usually responds very well to physical treatment such as exercises, massage and mobilisation. However, it can be persistent or recurrent, and for that reason regular exercise of your neck is advisable.

What about cervical collars?

Collars are very helpful for a short period for acutely painful necks, but should not be worn for any longer than 7 days at a time and not at night. Your neck needs to be mobile and exercised naturally.

Dos and Don'ts

To avoid bouts of further neck pain, the following rules are helpful:

Don't:

• look up in a strained position for long periods (e.g. as when painting a ceiling)
• twist your head often towards the painful side (e.g. as when reversing a car)
• lift or tug with your neck bent forwards
• work, read or study with your neck bent for long periods
• become too dependent on 'collars'
• sleep on too many pillows

Do:

• keep your neck upright in a vertical position for reading, typing and so on
• keep a good posture: remember to keep the chin tucked in
• sleep on a low, firm pillow or a special conforming pillow
• sleep with your painful side on the pillow
• use heat and massage: massage your neck firmly 3 times a day using an analgesic ointment

Professional help

Your doctor may prescribe mild pain-killers such as aspirin or paracetamol or other medicine for a short period, especially if arthritis is developing.
A course of exercises to mobilise stiff joints in the neck and strengthen the supporting muscles is probably the best treatment.
To overcome a painful episode, therapy to the muscles and joints by gentle mobilisation from a trained therapist is highly recommended.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia