Neck pain is a common musculoskeletal condition and in most cases settles down with simple management. Neck pain is usually referred to as 'specific' or 'nonspecific'.
What is Specific Neck Pain?
Your health professional can screen for specific spinal pathology that may suggest a higher risk of serious disorders causing neck pain and guide you about how best to help treat and manage your neck pain.
What is Non-Specific Neck Pain?
'Non-specific' neck pain is by far the most common type of neck pain. Most cases of 'non-specific' neck pain settle within a few days and simple management is usually effective. 'Non-specific' means that the cause for the pain is unclear and refers to neck pain not attributed to specific pathology (e.g. conditions like infection, tumour, osteoporosis, fractures, an inflammatory disease like rheumatoid arthritis, or nerve compression).
'Non-specific' neck pain typically occurs with sustained postures (bending the neck for long periods at work), sleeping in an unusual position or with an unfamiliar pillow or sometimes for no apparent reason. Normal age-related wear and tear changes in our spines can also be associated with neck pain and stiffness. Unless there is nerve compression (pain going down your arm(s) or weakness in your arms or hands or other serious medical conditions such as rheumatoid arthritis), Xrays or other imaging (like CT or MRI) are usually not required and and the results of any imaging does not change your management.
The current scientific recommendations for the management of non-specific' neck pain are to maintain your neck movement, to pace your activity and to stay active. Simple analgesia (paracetamol, anti-inflammatory medications) may also be recommended.
What treatments are available for 'non-specific' neck pain?
Like many other pain conditions, currently there is no cure for neck pain, but there are many things that, taken together, can help. For example, if the neck pain is due to normal age-related age-related changes, then your neck pain can come and go, so you have good periods and periods of pain and stiffness. The key is to try and work out what are the main triggers for your neck pain that you may be able to address e.g. is it your work posture or sleeping position? Does stress have an effect?
Once you identify the triggers, you can plan what you can do. You may like to draw a pie chart and allocate the “pieces of the pie” that are part of your neck pain condition and that need management. Rather than tackling all pieces of the pie in one go, try setting your focus on 1 or 2 small achievable goals. Here are some examples of treatments that may be helpful:
- education about how to move and gently and safely stretch your muscles and joints can be helpful (but on it’s own is not enough1)
- joint mobilisation (gentle manual joint movement - in some cases manipulation can be indicated) may provide some immediate benefit but typically, this benefit is not sustained longer term2
- assess/modify your work position or posture regularly or ask for an ergonomic review of your work station3
- regular relaxation and gentle stretching of your neck muscles can provide relief4
- check you have a comfortable, supportive pillow to help establish a better sleep routine
- improved sleep means less pain and allows you to undertake carefully paced activity and exercise
- pace your activities: this means doing small bits often or taking the middle road, rather than overdoing or underdoing
- exercise a little everyday. Exercise is good for your general well being, your mood, heart and lungs, joints and muscles, your balance and your bone health
- planning your work and social activities ahead helps you think about ways you can better manage demanding work periods or pain flares
Rather than using a single approach (like medications), a few combined simple strategies (sleep, medications and stretches/relaxation and paced activity) may be more helpful for you. Discuss this with your health professional (team) and ask what the current evidence is for the treatments being recommended.
What is the role of medications in managing neck pain?
Like many other pain disorders, medications can play a role in the management of neck pain, but are not recommended as a standalone treatment. The use of medications is designed to help keep you moving and stay engaged in the things you love to do. Side effects from medications can vary and you should ask your doctor about the risks and benefits of your medicines.
The medications recommended for ‘non-specific’ neck pain (without nerve pain) include:
You can read more in our medicines and procedures training module which outlines the different medicines, their pros and cons and how they fit in your overall management.
Why hasn’t my neck pain gone?
Acute non-specific neck pain is short-lived and resolves in many cases. Sometimes, following an initial injury pain persists, or becomes recurrent: we are starting to better understand why this may occur.
A number of factors contribute to persistent or complex neck pain including our beliefs and attitudes about pain (yours and your healthcare professionals); fear of pain and re-injury which may stop us moving; being hypervigilant or overprotective of our neck; our sense of self control and self belief; work, environmental, social factors and genetic factors.
For more information about acute and persistent pain, go to about pain.
What about whiplash and neck pain?
Whiplash-associated disorders can occur in some people following a motor vehicle collision or other injury5. Here's a brief video below produced by the Motor Accidents Authority of New South Wales about whiplash. For more information about whiplash and whiplash management exercises, see the Motor Accidents Authority Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney: 20145 and the Motor Accidents Authority NSW Youtube channel.
In rare cases, it is possible to get a fracture or broken bone in your neck. Therefore, it is important to consult your health professional as soon as possible after a motor vehicle accident so they can examine you and advise you regarding the best approach for your problem. Getting the right approach, at the right time, means that you can recover more quickly.
Factors that may suggest a less favourable recovery after whiplash include initially higher levels of pain, very restricted movement of your neck, heightened sensitivity to cold and a higher level of disability (not being able to function normally in your work and social life)5. Worrying about the neck pain, high stress levels, and not expecting to recover well can also predict slower recovery5. If any of these apply to you, it is important to discuss this with your health professional as early as possible. There are specific screening checks your health professional can do and when combined with a physical examination, these are important to directing you along the best treatment pathway.
What about treatments for whiplash?
At this stage, current evidence indicates that no one combined (multimodal) approach has demonstrated benefits greater than another6, so it is important to discuss your needs with your health professional.
Routine treatments currently recommended for whiplash-associated disorders where there in NO serious pathology include5:
- education and reassurance that hurt does not mean harm and it is normal to experience some pain as you recover. Don’t be afraid to move!
- pacing your activity (doing little bits often) to stay moving and avoid pain flares
- doing your usual activities in your usual way
- simple analgesia (Paracetamol and anti-inflammatory medications) is appropriate in most cases.
- neck specific exercises such as range of movement exercises, strengthening and postural exercises
Watch the video below that discusses treatment options. It also provides some examples of exercises you could perform.
Your physiotherapist or health professional can show you specific exercises that are helpful for your neck problem, including relaxation and breathing strategies.
As part of your treatment, joint mobilisation may be appropriate but not as a standalone treatment.
In some cases, if you experience dizziness or imbalance, re-training your neck muscles to improve their ability to position you in space may be appropriate. Rest, collars and procedures (such as facet joint injections) are NOT recommended.
What about neck pain and headaches?
There are many different causes for headaches. It is important to discuss your headaches with your health professional, to ensure you receive the right treatment. Trying to establish the cause of your headaches is a good starting point to informing what treatment(s) are right for you.
Consider when you get the headaches (e.g. time of day, week) what the symptoms are (e.g. sensitivity to light, nausea, disturbed vision), where you feel the headaches (the location in your head), what the triggers are (food, stress, sleep position, work posture) and what you find eases the headaches (e.g. avoiding certain foods, relaxation, stretching).
Sometimes, headaches can be related to stiff joints in the neck (cervicogenic headache) and your physiotherapist can assess this and advise you about the right treatments for your problem7. If your health professional assesses you and finds that the headaches are related to a stiff neck, then you may also find our pain management training modules helpful.
Want more information?
If you're experiencing neck pain or are concerned about your neck pain use our pain self-checks to help you screen for conditions that may suggest you should consult a Health Professional. We recommend the following pain management training modules:
For external information about neck pain, go to Arthritis Australia, Arthritis Victoria and for specific treatment evidence for neck pain go to Cochrane Summaries. If you're experiencing whiplash or would like further information about whiplash go to the Motor Accidents Authority NSW or Whiplash evidence based resource. Alternatively, if you want to talk to someone about Neck Pain, please seek further assistance.
- Yu H, Cote P, Southerst D, et al. Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The spine journal : official journal of the North American Spine Society 2014. [PubMed]
- Takasaki H, May S. Mechanical diagnosis and therapy has similar effects on pain and disability as 'wait and see' and other approaches in people with neck pain: a systematic review. Journal of physiotherapy 2014; 60(2): 78-84. [PubMed]
- Varatharajan S, Cote P, Shearer HM, et al. Are work disability prevention interventions effective for the management of neck pain or upper extremity disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. Journal of occupational rehabilitation 2014; 24(4): 692-708. [PubMed]
- Southerst D, Nordin MC, Cote P, et al. Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The spine journal : official journal of the North American Spine Society 2014. [PubMed]
- Motor Accidents Authority. Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney, 2014. [PDF]
- Sutton DA, Cote P, Wong JJ, et al. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The spine journal : official journal of the North American Spine Society 2014. [PubMed]
- Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain 2014; 15: 67. [PubMed]