Neck Pain

Neck Pain

Illustration of the spine

Summary

Got a pain in the neck? Any part of your neck - muscles, bones, joints, tendons, ligaments or nerves - can cause it. Pain may also come from your shoulder, jaw, head or upper arms.

Muscle strain or tension often causes neck pain. The problem is usually overuse, such as from sitting at a computer for too long. Sometimes you can strain your neck muscles from sleeping in an awkward position or overdoing it during exercise. Falls or accidents, including car accidents, are another common cause of neck pain. Whiplash, a soft tissue injury to the neck, is also called neck sprain or strain.

Treatment depends on the cause, but may include applying ice, taking pain relievers, getting physical therapy or wearing a cervical collar. You rarely need surgery.

Possible Causes Of Neck Pain And Headaches

One of the most common causes of neck pain, and sometimes headaches, is poor posture. It's easy to get into bad posture habits without even realizing it-even an activity as "innocent" as reading in bed can ultimately lead to pain, headaches, and more serious problems.

The basic rule is simple: keep your neck in a "neutral" position whenever possible. In other words, don't bend or hunch your neck forward for long periods. Also, try not to sit in one position for a long time. If you must sit for an extended period, make sure your posture is good: Keep your head in a neutral position, make sure your back is supported, keep your knees slightly lower than your hips, and rest your arms if possible.

What is Whiplash?

Whiplash-a soft tissue injury to the neck-is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion. The disorder commonly occurs as the result of an automobile accident and may include injury to intervertebral joints, discs, and ligaments, cervical muscles, and nerve roots. Symptoms such as neck pain may be present directly after the injury or may be delayed for several days. In addition to neck pain, other symptoms may include neck stiffness, injuries to the muscles and ligaments (myofascial injuries), headache, dizziness, abnormal sensations such as burning or prickling (paresthesias), or shoulder or back pain. In addition, some people experience cognitive, somatic, or psychological conditions such as memory loss, concentration impairment, nervousness/irritability, sleep disturbances, fatigue, or depression.

Treatment for individuals with whiplash may include pain medications, nonsteroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and a cervical collar (usually worn for 2 to 3 weeks). Range of motion exercises, physical therapy, and cervical traction may also be prescribed. Supplemental heat application may relieve muscle tension.

Generally, prognosis for individuals with whiplash is good. The neck and head pain clears within a few days or weeks. Most patients recover within 3 months after the injury, however, some may continue to have residual neck pain and headaches.

Pain relief

Acetaminophen (eg, Tylenol and others) or a non-steroidal antiinflammatory medication (eg, ibuprofen, naproxen) may be helpful to relieve mild to moderate neck pain.

For people with chronic pain that interferes with sleep, a low dose tricyclic antidepressant (eg, amitriptyline or nortriptyline 10 to 30 mg at bedtime) may be helpful. For people with severe muscle spasm, a muscle relaxant at night and very low dose muscle relaxant during the daytime may be recommended. Both tricyclic antidepressants and muscle relaxants can cause a person to feel sleepy.

Ice — Ice should be applied directly to muscles of the neck that are in spasm. An iced towel wrapped around the neck, blue ice packs, or an ice bag will effectively control acute muscle spasms that often accompany neck strain. The ice must be left in place for 15 to 20 minutes to deeply penetrate the tissues; treatment is repeated every four to six hours until symptoms improve.

Heat and massage — Heat should be applied to the neck muscles prior to performing the stretching exercises described below. A shower, a hot bath, or a moist towel warmed in a microwave and applied for 10 to 15 minutes are all effective.

Massage is helpful if you continue to have muscle spasms for more than one to two weeks. After heating the neck, massage is applied to both sides of the neck and the upper back muscles using hand pressure or an electric hand-held vibrator. Your neck muscles should be relaxed during massage either by supporting your head or by lying down.

Stretching exercises — The range of motion of the neck must be restored and preserved after an injury. Stretching exercises are begun once the acute symptoms have been controlled.