Health Library Neck Problems and InjuriesFrom Healthwise

Most people will have a minor neck problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Neck problems and injuries most commonly occur during sports or recreational activities, work-related tasks, or projects around the home.

Neck pain may feel like a "kink," stiffness, or severe pain. Pain may spread to the shoulders, upper back, or arms, or it may cause a headache. Neck movement may be limited, usually more to one side than the other. Neck pain refers to pain anywhere from the area at the base of the skull into the shoulders. The neck includes:

• The bones and joints of the cervical spine (vertebrae of the neck).
• The discs that separate the cervical vertebrae and absorb shock as you move.
• The muscles and ligaments in the neck that hold the cervical spine together.

Neck pain may be caused by an injury to one or more of these areas, or it may have another cause. Home treatment will often help relieve neck pain caused by minor injuries.

Activities that may cause neck pain

Neck pain is often caused by a strain or spasm of the neck muscles or inflammation of the neck joints. Examples of common activities that may cause this type of minor injury include:

• Holding your head in a forward posture or odd position while working, watching TV, or reading.
• Sleeping on a pillow that is too high, too flat, or doesn't support your head; or sleeping on your stomach with your neck twisted or bent.
• Spending long periods of time resting your forehead on your upright fist or arm ("thinker's pose").
• Stress. Tension may make the muscles that run from the back of the head across the back of the shoulder (trapezius muscle) feel tight and painful.
• Work or exercise that uses your upper body and arms.

Sudden (acute) injuries

Minor neck injuries may result from tripping, falling a short distance, or excessive twisting of the spine. Severe neck injuries may result from whiplash in a car accident, falls from significant heights, direct blows to the back or the top of the head, sports-related injuries, a penetrating injury such as a stab wound, or external pressure applied to the neck, such as strangulation.

Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• An injury to the ligaments or muscles in the neck, such as a sprain or strain. When neck pain is caused by muscle strain, you may have aches and stiffness that spread to your upper arm, shoulder, or upper back. Shooting pain that spreads down the arm into the hand and fingers can be a symptom of a pinched nerve (nerve root compression). Shooting pain is more serious if it occurs in both arms or both hands rather than just one arm or one hand.
• A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis. See first aid for a spinal injury.
• A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate) and press against a nerve or the spinal cord (central disc herniation). You may have a headache, feel dizzy or sick to your stomach, or have pain in your shoulder or down your arm.

Emergency care is required for a neck injury that causes damage to the spinal cord. Symptoms of a spinal cord injury include loss of movement or feeling, numbness, tingling, difficulty controlling the muscles of the arms or legs, or loss of bowel or bladder control.

Conditions that may cause neck problems

Neck problems may not be related to an injury.

• Arthritis or damage to the discs of the neck can cause a pinched nerve. Neck pain caused by a pinched nerve generally affects one side of the neck and the arm on that side. Other symptoms may develop, such as numbness, tingling, or weakness in the arm or hand.
• Meningitis is a serious viral or bacterial illness that causes inflammation around the tissues of the brain and spinal cord. Symptoms come on quickly and include severe headache, stiff neck, fever, and sometimes vomiting. The neck stiffness makes it hard or impossible to touch the chin to the chest.
• The flu, which usually is not serious, can cause symptoms similar to meningitis. When neck pain is caused by flu, the neck and the rest of the body tend to ache all over, but severe neck stiffness is absent.
• Neck pain that occurs with chest pain may be caused by a serious problem with the heart, such as a heart attack.
• Stress and tension may make the muscles that run from the back of the head across the back of the shoulder (trapezius muscle) feel tight and painful. You may not be able to move your head without pain.
• Torticollis is caused by severe muscle contraction on one side of the neck, causing the head to be tilted to one side. The chin is usually rotated toward the opposite side of the neck. Torticollis may be present at birth (congenital) or caused by injury or disease.

Treatment

Treatment for a neck problem or injury may include first aid measures, physical therapy, manipulative therapy (such as chiropractic or osteopathic), medicine, and in some cases surgery. Treatment depends on:

• The location, type, and severity of the injury.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Neck pain that spreads from the chest area with other symptoms of a heart attack
• Severe neck injury, such as an injury caused by a:
  • Motor vehicle accident
  • Fall from a height of 15 ft (5 m) or more
  • Major sports-related injury
  • Direct blow to the head or neck
  • High-energy blow to the top of the head
  • Penetrating injury, such as a stab wound or gunshot wound
  • Strangulation
• Signs of a spinal cord injury:
  • New weakness or inability to move an arm or leg
  • New continuous numbness of one or both arms or legs
  • New loss of bowel or bladder control
• A decrease in level of consciousness:
  • Failure to respond to touch or voice
  • Extremely groggy, drowsy, or hard to wake up
  • Extremely confused or fighting
• Signs of shock:
  • In a child
  • In an adult and older child
• A rapidly forming swelling or lump in the throat that is causing any difficulty breathing:
  • In a child
  • In an adult and older child

Note:

If you think a spinal injury has occurred, do not move the person unless there is an immediate threat to his or her life, such as a fire. If there is immediate danger, keep the person's head and neck supported and in a straight line while you move him or her to a safe place. See first aid for a spinal injury.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Neck pain with chest pain: Go to the topic Chest Pain.
• Neck pain that began after an injury to the head: Go to the topic Head Injury, Age 4 and Older or Head Injury, Age 3 and Younger.
• Bleeding: Go to the topic Cuts or Puncture Wounds.

	Yes	Do you have a stiff neck with signs of a serious illness?
When to See a Doctor See significance of signs of a serious illness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a severe headache? Yes Do you know or think you have a fever? Yes Are you vomiting? Yes Do you think you are confused? Yes Are you having trouble staying awake or alert? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have neck pain with arm pain?
When to See a Doctor See significance of arm pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe arm pain? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had moderate arm pain for 2 days but no other symptoms? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had arm pain that comes and goes for longer than 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have neck pain with numbness or tingling in one or both arms?
When to See a Doctor See significance of numbness or tingling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Has numbness or tingling developed suddenly? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have constant numbness or tingling in one arm or hand? Yes Is your numbness or tingling slowly getting worse? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does numbness or tingling in one arm come and go? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have neck pain with weakness in one or both arms?
When to See a Doctor See significance of weakness in one or both arms if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Has weakness developed suddenly? Yes Do you have weakness or clumsiness in both arms or hands? Yes Do you have weakness in an arm and leg on the same side of your body? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have constant weakness in one arm? Yes Is your arm weakness slowly getting worse? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have ongoing arm weakness that has gotten worse since you have been checked by your doctor? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Did your neck pain start after a recent injury?
When to See a Doctor See significance of an injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain after an injury? Call your health professional today if you answer "Yes" to the following question. Yes Do you have moderate pain after an injury but you do not have other symptoms? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild pain for 2 to 3 days after an injury? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have mild pain that has not improved after 1 week of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have neck pain with no known injury?
When to See a Doctor See significance of neck pain without a known injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have new severe neck pain? Call your health professional today if you answer "Yes" to the following question. Yes Do you have ongoing (chronic) pain that is getting worse? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate pain that has not improved after 2 days of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have mild pain that has not improved after 1 week of home treatment? Yes Have you had neck pain for 2 weeks or longer? Yes Have you had a stiff neck that causes mild pain with movement for 1 week or longer? Yes Have you had a stiff neck that keeps you from moving your neck normally for 1 week or longer? Yes Have you had a stiff neck without other symptoms for 2 weeks or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have swelling in your neck?
When to See a Doctor See significance of neck swelling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Has a lump formed rapidly in your neck or throat, but you are not having trouble breathing? Yes Are you having severe trouble swallowing but no trouble breathing? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a hard lump below your Adam's apple with pain or a feeling of fullness in your throat? Yes Do you have a hard lump below your Adam's apple with trouble swallowing? Yes Do you have a hard lump below your Adam's apple with unexplained hoarseness? Yes Do you have a lump below your Adam's apple and symptoms of hypothyroidism or hyperthyroidism? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had a lump or swollen gland for 1 week or longer that is not getting smaller or less tender? Yes Have you had a lump or swollen gland for 1 week or longer that seems to be improving but has not gone away? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Back pain: Go to the topic Back Problems and Injuries.
• Shoulder pain: Go to the topic Shoulder Problems and Injuries.
• Headache: Go to the topic Headaches.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may help relieve pain, swelling, and stiffness related to a neck problem.

• Apply ice and cold packs to the injured area.
  • Apply ice or cold packs for 15 to 20 minutes, 3 to 4 times a day or up to once an hour for the first 24 to 48 hours. Cold decreases swelling and pain. Keep a towel between your skin and the ice to prevent frostbite. Do not fall asleep with the ice on your skin.
  • 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 careful not to damage your skin (frostbite).
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
• For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
• After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend switching back and forth between heat and cold treatments. You also can begin gentle exercise with the aid of moist heat to help restore and maintain flexibility.
• Continue with your usual daily activities unless you have severe neck and back pain. Modify or avoid any activity that makes your pain worse.
• Practice good posture. Avoid slouching or a head-forward posture.
• When sleeping, place a small support pillow under your neck, not under your head.
• Once the pain begins to get better, start doing neck exercises. Do each exercise twice a day, 5 times each, and gradually increase to 10 times each. Do not do any exercises that cause pain.
• If tension is contributing to your neck pain, massage may be helpful.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Additional home treatment measures can be found in topics related to neck pain. For neck pain that occurs with:

• Headaches: Go to the topic Headaches.
• Back pain: Go to the topic Low Back Pain or Back Problems and Injuries.
• Shoulder pain: Go to the topic Shoulder Problems and Injuries.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• New or increased weakness or numbness in your arms or legs develops.
• You lose control of your bowels or bladder.
• Pain becomes severe or lasts longer than 2 weeks.
• Symptoms do not improve with home treatment.
• Symptoms become more severe or frequent.

Neck pain affects many people. Most neck pain that is not caused by arthritis or an injury can be avoided. Good posture, proper body mechanics, and exercise are important to prevent neck pain.

General tips to prevent neck problems

• Maintain an ideal body weight.
• Practice good posture. Avoid slouching or a head-forward posture.
• Adjust your car seat so that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
• Always wear your seat belt while you are in a motor vehicle.
• Strengthen and protect your neck by doing neck exercises once or twice a day.
• Practice muscle relaxation exercises or consider getting occasional or regular massages if stress is causing your neck pain or making it worse.. For more information, see the topic Stress Management.

Sleep position tips

• Support your neck with a small pillow while you sleep. 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.
• Use a pillow that doesn't force your head forward when you lie on your back and that allows you to align your nose with the center of your body when you lie on your side.

Office ergonomics

Good posture during work or other tasks will reduce your risk for neck problems.

• Sit with your back supported, feet flat on the floor, and shoulders relaxed. See a picture of proper sitting posture.
• Sit straight in your chair with your lower back supported.
• Avoid sitting for long periods without getting up or changing positions. Take short breaks several times each hour to stretch your neck muscles.
• Adjust the monitor of your computer so that the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen.
• Use a headset or speakerphone if using the telephone causes neck pain.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms?
• How long have you had your symptoms?
• If you were injured, how and when did the injury occur? How was it treated?
• What were you doing at the time the neck pain started?
• Have you recently been in a fight or been slapped, punched, or strangled?
• Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
• If you have chronic neck pain, has the pain changed significantly?
• Do you have numbness or weakness in your arms or legs?
• What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
• Do you think that activities related to your job or hobbies caused your symptoms?
• What home treatment measures have you tried? Did they help?
• What nonprescription medicines have you taken? Did they help?
• Are you using alcohol or illegal drugs, such as heroin or marijuana, to control your pain?
• Do you have any health risks?

• Back Problems and Injuries
• Chest Pain
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Headaches
• Herniated Disc
• Influenza
• Meningitis
• Migraine Headaches
• Osteoarthritis
• Osteoporosis
• Quitting Tobacco Use
• Shoulder Problems and Injuries
• Stress Management
• Tension Headaches

Author:	Jan Nissl, RN, BS	Last Updated: August 28, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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