When To Call a Doctor

Call 911 or other emergency services immediately if you have been injured and you have:

• A severe neck injury, such as an injury caused by a:
  • Serious car accident.
  • Fall from a height of 15 ft (4.6 m) or more.
  • Major sports-related injury.
  • Very forceful blow to the head or neck.
  • High-energy strike on top of the head.
  • Penetrating injury, such as a stab or gunshot wound.

• Signs of a spinal cord injury, such as:
  • Weakness or inability to move the arms or legs.
  • Continuous numbness of one or both arms or legs.
  • Loss of bowel or bladder control.

• Neck pain that occurs with chest pain and other symptoms of a heart attack. These include:
  • Chest pain that is crushing or squeezing or feels like a heavy weight on the chest.
  • Chest pain that occurs with:
    • Sweating, shortness of breath, nausea, or vomiting.
    • Pain that spreads from the chest to the back, neck, or jaw, or one or both shoulders or arms.
    • Dizziness or lightheadedness.
    • A fast or irregular pulse.

Call your doctor immediately if you have:

• A stiff neck and/or severe headache, fever, vomiting, confusion, and/or difficulty staying awake or alert.
• Neck pain and severe arm pain.
• Neck pain and suddenly developing numbness, tingling, or weakness in one or both of your arms.
• Severe neck pain following an injury.
• Severe neck pain with no known cause.
• A new weakness in your arms and legs.
• A new loss of bladder or bowel control.

Call your doctor today if you have:

• Severe restriction of neck movements.
• Neck pain or stiffness after starting a new medicine.
• Constant numbness or tingling in one arm or hand.
• Constant weakness in one arm.
• Moderate pain following an injury.
• Arm weakness, numbness, or tingling that has become worse since you were evaluated by your doctor.
• Ongoing (chronic) pain that is getting worse.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Most neck pain does not require medical care. In general, pain relief and neck movement should improve after a couple of days of home treatment that includes:

• Limiting activities that increase neck pain.
• Taking nonprescription pain relievers and using ice to reduce pain.
• Doing gentle exercises to keep the neck flexible.

If you have severe neck pain that has not gone away after 1 or 2 days and you are not able to do your normal daily activities, call your doctor.

Treatment for neck pain consists of reducing the pain with ice and medication, improving neck movement and flexibility with exercises or physical therapy, and avoiding further neck injury by changing activities and body mechanics, such as how you sit or sleep. The specific treatment may depend on whether your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain.

Because most neck pain is caused by repeated or prolonged movements to the neck’s muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain caused by activities resolve within 4 to 6 weeks.

Acute neck pain

For sudden (acute) neck pain:

• Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
• Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
• Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after a neck-strain injury helps resolve some symptoms faster than taking time off from work and using neck immobilization.²
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
• Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For severe pain or muscle spasm, your doctor also may prescribe:

• Muscle relaxants, which treat severe pain spasms when neck pain begins. They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
• Narcotic pain relievers, which are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).

The treatment that is right for you may be different from the treatment for someone else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven’t been very well researched, even if they are used a lot. A review of multiple studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain.

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. See an illustration of a cervical collar.

Chronic neck pain

For long-lasting (chronic) neck pain, you can use the same treatment used for acute pain, although you do not have to worry about swelling. Your health professional may prescribe other medications, such as antidepressants. These include doxepin (Sinequan) and amitriptyline (Elavil, Endep).

You can aid healing and prevent further injury by:

• Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness.
• Changing or avoiding any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
• Maintaining good health habits. If possible, reduce stress and tension at work and home. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.
• Trying manual therapy. A trained practitioner may use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as “mobilization.” Avoid rapid, forceful movements, which are known as “manipulation.” Talk to your doctor before trying manual therapy.

Surgery

Surgery is rarely required for neck pain. It may be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include:

• Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
• Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
• Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

What To Think About

A review of studies reports that:

• Exercise reduced pain better than medication for muscle pain or spasm, stress management, or no exercise.
• There is not enough evidence to determine whether medications, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain.

In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for 1 year. Compared with people who had chronic neck pain and were not using the exercises, the exercise group had less pain and disability.

Keeping your neck moving improves its function and helps it heal. In general, cervical collars are only used after a surgery or for a day or two after a neck sprain.

People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling in addition to medical treatment may help in recovery.

For sudden (acute) neck pain:

• Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
• Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
• Return to your normal daily activities as soon as possible. One study found some evidence that continuing normal activities after an acute whiplash injury helps heal some symptoms faster than taking time off from work and using neck immobilization.
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
• Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Motrin), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For long-lasting (chronic) pain, you can use the same pain relief measures used for acute pain, but you do not have to worry about swelling.

You can aid healing in both acute and chronic neck pain and prevent further injury by:

• Doing stretching and strengthening exercises for your neck to keep your neck flexible and strong and prevent stiffness.
• Avoiding or modifying any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
• Maintaining good health habits. Try to reduce stress and tension at work and home. Practice muscle relaxation exercises and consider getting a massage. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.

You can help prevent future neck pain by paying attention to how you move and hold yourself (body mechanics). This includes:

• Avoiding slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Avoid sitting for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
• Adjusting your workstation if you work at the computer. Keep the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. For more information, see the topic Office Ergonomics.
• Using a headset or speaker phone if you use the telephone a lot. Do not cradle the phone on your shoulder.
• Adjusting your car seat to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
• Using a pillow that keeps your neck straight, neither too high nor too flat. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 4 in. (10 cm) wide, wrap it around your neck, and pin it in position for good support. Avoid sleeping on your stomach with your neck twisted or bent. See an illustration of proper sleeping positions.
• Having the right posture when reading in bed. Prop the book up so you are not using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.
• Using proper lifting techniques. Lifting with your knees, not your back, can also help prevent neck pain.

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. Once the pain begins to get better, start doing gentle neck exercises. See an illustration of a cervical collar.