Neck Pain

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 ‘non-specific’.

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.

‘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. 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 the results of any imaging do not change your management.

The current scientific recommendations for the management of ‘non-specific’ neck pain are to perform exercises to maintain your neck movement and strength, to pace your activity and to stay active. Simple analgesia (paracetamol, anti-inflammatory medications) may also be recommended.

Like many other pain conditions, currently, there is no cure for neck pain, but there are many things that, taken together, can help. Our Neck Pain Fact Sheet may be helpful.

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 its own, is not enough¹)
• Exercises to improve the strength and control of your neck and shoulder girdle muscles
• 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
• Change your posture regularly whilst working at a computer/desk
• Modify your work position and possibly 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 every day. Exercise is good for your general wellbeing, 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 (exercise, 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.

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:

• paracetamol
• anti-inflammatories

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.

Acute non-specific neck pain is usually 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 from 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.

Whiplash-associated disorders can occur in some people following a motor vehicle crash or other injury⁵. Here’s a brief video below produced by the State Insurance Regulatory Authority (SIRA) of New South Wales about whiplash. For more information about whiplash and whiplash management exercises, see the Whiplash Injury Recovery: a self-help guide or the My Whiplash website.

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 crash 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 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 direct you along the best treatment pathway.

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.

There is some evidence to show that adding techniques to address stress to an exercise program can assist recovery⁸.

Routine treatments currently recommended for whiplash-associated disorders where there is 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 above 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.

There are many different causes of 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 for 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.

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.

For external information about neck pain, go to Arthritis Australia, Arthritis Victoria. 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 State Insurance Regulatory Authority or Whiplash evidence based resource. Alternatively, if you want to talk to someone about Neck Pain, please seek Further Assistance.