Neck pain

  • The neck is less protected than the rest of the spine, making it vulnerable to injury.
  • Neck pain is often a temporary condition that disappears with time.
  • Neck pain is usually a symptom of abnormalities in the soft tissues of the neck – the muscles, ligaments and nerves.
  • Most neck pain occurs after a bad night’s sleep or over-exertion during some sort of athletic activity.
  • Serious, persistent neck pain may be indicative of disease or damage to the vertebrae or discs in the neck.

Alternative names

sore neck; pain in the neck; crick in the neck.

What is neck pain?

Everyone is familiar with a crick in the neck. Every time you try to turn your head, you experience a stabbing pain in the neck and to the back of the shoulder, often accompanied by stiffness and severe discomfort. This is because muscles in the neck have gone into spasm.

Most of the time the condition is minor and will go away within a few days. But in some cases, pain in the neck may be indicative of a more serious problem that needs attention from a doctor or an orthopaedic surgeon (specialising in the musculo-skeletal system).

What causes neck pain?

  • Strain. The most common cause of neck pain is strain on the neck muscles, usually from sleeping on a lumpy pillow or over-exertion during activity. Vigorous gardening, competitive sports or sitting in front of the computer for too long can all lead to muscle strain and muscle spasms. A spasm is an uncontrolled, very strong contraction of the muscle. This causes pain because it puts pressure on the nerve endings around the muscles.
  • Injury. The neck is extremely vulnerable to injury because, although it is very flexible and supports the head, it is less protected than the rest of the spine. Motor vehicle accidents, contact sports and falls can all result in neck injury. In a motor collision the neck might be extended beyond its normal limits, causing injury. Most common injuries are to the soft tissues – the muscles and ligaments. Severe injury with fracture or dislocation of the neck may damage the spinal cord and cause paralysis.
  • Degenerative diseases. There are a number of degenerative diseases that can cause neck pain. Osteoarthritis usually occurs in older people and results in a wearing down of the joints between the bones in the neck. Rheumatoid arthritis can also cause destruction of the joints in the neck. Cervical disc disease also causes neck pain. Discs between the vertebrae in the neck act as shock absorbers. In cervical disc degeneration, which occurs typically from the age of 40 onwards, the discs degenerate and the spaces between the vertebrae narrow. As the disc space narrows, added stress is applied to the joints, which causes pain.
  • Influenza. Neck pain can occur with the ’flu and is accompanied by fever, muscle aches and a headache.
  • German measles, glandular fever and in rare cases, malignant tumours. These can also be accompanied by neck pain, and other symptoms, such as fever, may be present.

Who gets neck pain and who is at risk?

Everybody from the very young to the very old can experience neck pain. High-risk groups are those who play contact sports or people in involved in activities requiring physical athletic stress. Neck pain caused by degenerative diseases is experienced mostly by those over 40 years old.

Symptoms and signs of neck pain

The major symptoms are pain, stiffness or discomfort that can be felt on one or more sides of the neck. In some cases this pain travels down one or both arms. In more serious conditions neck pain may be accompanied by weakness, numbness or tingling down the arm or leg.

How is neck pain diagnosed?

Determining the source of the pain is essential to correct treatment and rehabilitation. Therefore a comprehensive examination is required.

Firstly, your doctor will take a complete history of the difficulties you are having with your neck. Medical history questions documenting your neck pain in detail may include:

  • Location: Where in the neck is the pain? Is it on one particular side? If it is on more than one side, is the pain symmetrical?
  • Associated complaints: Are there any accompanying feelings of weakness or loss of speech? Can the chin be bent forward to touch the chest? Is there neck weakness or stiffness? Is there a lump in the neck?
  • Time pattern: When did the pain first develop? Is it there all the time, or intermittently? Is there a pattern to when the pain occurs? Is it getting worse?
  • History: Previous treatment for your neck condition will also be noted.

Next, your doctor will perform a physical examination. This will include an evaluation of neck motion, tenderness and the function of the nerves and muscles in your arms and legs. X-rays will often be taken to give your doctor a closer look at the bones in the neck.

In most cases medical history and a physical examination are enough to determine the cause of the pain and to prescribe effective treatment.

Patients who require further evaluation may need a number of other tests such as:

  • MRI (Magnetic Resonance Imaging). This non-X-ray study allows an evaluation of the spinal cord and nerve roots.
  • CT (Computed Tomography). This specialised X-ray allows careful examination of the bone and spinal canal.
  • Myelogram (injection of dye or contrast material into the spinal canal). This specific X-ray examines the spinal canal and nerve roots.
  • EMG (Electromyogram). This test evaluates nerve and muscle function.
  • Your doctor may also take blood tests and consult with other medical specialists.

Can neck pain be prevented?

If you are prone to neck pain, the best prevention is stretching. Gentle neck stretches for a few minutes each morning can reduce cricks in the neck. Gently tilting of the head from side to side and forwards and backwards is a good stretching technique, but it is important to be slow and careful, avoiding any rapid movements.

Stretching the entire body before and after sport or strenuous activity is thought to be important in preventing possible neck injury.

Eliminating bad habits that cause tension in the neck and shoulders is also vital. It is never too late to correct your posture, which helps remove unnecessary strain on the neck muscles.

Check your home and office for possible causes of strain. At home, your bed and chairs could be contributing to neck pain. If you feel uncomfortable lying down or sitting for a short while, you might need to change your furniture. In the office, check that your computer is at eye level. Ideally you should sit upright with both feet flat on the floor, without resting your arms on arm rests. The way you hold the telephone can also contribute to neck pain. If you spend long periods with the phone resting in the crook of your neck, consider replacing the conventional phone with a headset.

Neck injury can also be prevented by wearing seat belts; avoiding alcohol while driving; avoiding diving into lakes, rivers, and surf; avoiding motorcycles and all-terrain vehicles; avoiding rugby. If someone has a neck or spinal injury, additional movement may cause further damage to the spine. If in doubt about whether a person has received spinal injury, assume he or she has and be sure to keep the person still.

How is neck pain treated?

Treatment is dependent on the cause of the pain.

Warmth can help in treating neck pain caused by muscular strain. A hot shower sprayed lightly on the neck, hot compresses or heating pads placed on the sore area can all help alleviate pain.

If neck strain has just occurred, it may help to hold an ice pack against the stiff area for 15 minutes every hour. This reduces blood flow to the area and may reduce inflammation of the tissue.

Over-the-counter anti-inflammatory medication such as ibuprofen may also reduce swelling and lessen the pain.

Rest is important and in certain cases a neck collar may be prescribed. Neck pain may be slow to improve, taking several weeks to completely go away, so be patient.

When neck pain persists or is chronic, your doctor may recommend a rehabilitation programme that includes exercise and various forms of physical therapy.

Very few patients require surgery to relieve neck pain. Surgery may only be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal.

What is the outcome?

Neck pain from muscular strain can take weeks to heal – the key is to be patient and take it easy. Pain should eventually subside completely. A more serious disease requiring surgery, such as cervical disc disease, may take even longer to heal.

When to call the doctor

  • The pain does not lessen in a week.
  • The pain is severe.
  • The pain is associated with fever and headache, or the neck is so stiff the chin cannot touch the chest.
  • The pain travels down one or both arms, or there is a numbness or tingling in the arms.
  • There are painful or swollen glands in the neck that do not clear up in a few days.

(Reviewed by Dr Sirk Loots, orthopaedic surgeon)

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