Neck pain may be caused by muscle or ligament strain, arthritis, or a pinched nerve. It typically improves with conservative therapy. Your doctor will perform a physical exam and take your complete medical history. Your provider may order a magnetic resonance imaging (MRI) scan of your cervical spine to look for herniated disks, signs of spinal stenosis and masses such as cysts or tumors.
Physical Therapy
A good neck pain therapy program starts with a careful medical exam. You may need a series of diagnostic tests, such as an X-ray, CT scan or an MRI to identify the type and cause of your neck problems. Your health care provider will ask you about your symptoms, past injuries and your work and exercise routines. You will also have a physical exam of your neck and shoulders. Then, your health care provider will order lab tests to look for causes of neck pain other than musculoskeletal injuries, such as infections, rheumatological conditions or cancers.
Most neck problems are not life threatening and will resolve with time and conservative treatment. Medication, including nonsteroidal anti-inflammatory drugs (NSAIDs) to ease inflammation and muscle relaxants to reduce stiffness, can help control pain and swelling. If your pain persists, your doctor may recommend steroid injections near the painful area to relieve pain and swelling.
Neck exercises can strengthen and stretch the muscles in your neck, improving your range of motion and flexibility. Your therapist can show you the right moves and suggest a stretching schedule to help prevent the problem from recurring. Your health care provider may also prescribe heat or ice to relieve pain and stiffness.
Many neck issues are caused by poor posture and injury, arthritis or normal aging. Treatments provided by a physiotherapist, osteopath or chiropractor can help to restore the alignment of your spine and loosen tight muscles that are contributing to your neck pain.
A click or grating noise when you move your neck can indicate that the nerves in your neck are being pinched. This is called crepitus and it is common. It’s usually not a serious symptom, but it can be alarming.
If you have severe neck pain, it is important to talk to your health care provider as soon as possible. This is especially true if you have muscle weakness, a disc herniation or neck pain that gets worse over time. You may need surgery if other treatments don’t relieve your neck pain or if you have neck pain that is accompanied by problems with your balance and coordination, changes in your bowel or bladder function or numbness or tingling in your arms or legs.
Massage
The neck supports the head and is made up of 7 bones (vertebrae) stacked one on top of each other, connected by 2 facet joints and a disc. It is surrounded by muscle that provides movement and support. Tension in these muscles and other problems of the joints or spine can cause neck pain. Massage can help relax tight neck muscles and improve flexibility. Some people also find it reduces stress and anxiety. In addition, it can improve circulation and blood flow to the tissues of the neck, which can decrease swelling, and improve range of motion.
A variety of techniques are used in massage, including kneading, friction, pressure and vibration. People can get massaged in a clinic or at home, although it is important to find a practitioner who has been trained.
Massage might not be a good treatment for people with certain health conditions, such as heart disease or diabetes. It is also not a good choice if you have open wounds, edema or pressure sores. Pressure sores are areas of swelling that develop in the skin and surrounding tissues. They may be a result of immobility or surgery.
Alternative therapies, such as acupuncture and chiropractic, might also ease neck pain. Acupuncture involves the insertion of thin, sterilized needles at specific points on the body. It is considered safe when performed by a certified practitioner with sterile needles.
TENS, or transcutaneous electrical nerve stimulation, uses electrodes placed on the skin to deliver low-level electric impulses that might relieve neck pain. It might also reduce inflammation and stiffness. It is usually done in a doctor’s office or physical therapy clinic, and the treatments might last up to half an hour.
Chiropractic Care
Neck pain and stiffness are common problems. Most often they are not serious and can be treated with over-the-counter painkillers, physiotherapy or chiropractic care.
The neck, or cervical spine, consists of seven square-shaped bones (cervical vertebrae) that are stacked on top of each other and connected by ligaments. The bones protect the spinal cord, which runs from the brain down through the throat. The bones are separated by intervertebral discs that allow the neck to move and act as shock absorbers. A herniated disk, bone spur or neck strain can cause neck pain. Aging, trauma, poor posture, repetitive activities and heavy body weight can also lead to neck problems.
Most neck pain is caused by muscle tightness and joint inflammation. If the symptoms do not go away, your health care provider may decide to perform a physical exam and some lab tests to see if there are other causes of the problem, such as a blood test or x-rays.
During the physical examination, your doctor will observe how you move your neck and head, check your posture and touch your neck to feel for areas of tension or tenderness. Your doctor may also do strength, sensation and reflex testing. They will most likely recommend a program of neck exercises, including isometric and range-of-motion exercises that gradually tighten and stretch the neck muscles. They may also use treatments, such as heat or massage, to ease the pain and stiffness.
In some cases, chiropractors or physical therapists will use a technique called cervical traction. This treatment gently extends the neck, opening the spaces between the cervical vertebrae and alleviating pressure on the discs. This is not recommended for patients with a broken bone, tumor, uncontrolled seizures or severe osteoporosis, as the traction can worsen these conditions. A soft neck collar is often used to support the neck and can help relieve pain by taking pressure off the neck. However, the collar should not be worn for more than three hours at a time or for more than two weeks, as it can weaken neck muscles and delay recovery.
Cervical Traction
Cervical traction is a treatment that involves lightly pulling on the neck to create space between the bones in the neck (the cervical vertebrae). This stretching technique helps reduce pressure on the spinal discs, joints and muscles of the neck. It’s a common neck pain therapy that can be done by your physical therapist, or at home using a cervical traction device.
Neck traction is generally considered an effective neck pain therapy because it removes compression from the spine and relieves tension in the neck muscles. It also improves the flow of oxygen and nutrients to the spinal joints, helping them heal faster.
It is often used in conjunction with other neck pain therapies, such as chiropractic and massage. It is also a popular treatment for herniated discs, which can be caused by degeneration or injury to the spine.
This is because traction helps to open up the space in the spinal column, which can relieve nerve pressure caused by the herniated discs. It also stretches the neck muscles and increases the flexibility of the spine. It is recommended to use a light traction force for neck problems such as degeneration and a herniated disc, while heavier traction forces may be better suited for other conditions, such as whiplash.
The traction can be applied in both the seated and supine positions, depending on the patient’s preference. It is usually preferred to apply a brief, intermittent sequence of rest and traction rather than continuous traction. This is because it allows the spinal nerves and bones to relax between traction cycles.
Two trials of moderate quality (Cheung Lau 2011; NNTB 5, Gonzalez-Iglesias 2009 JO) showed that cervical manipulation was more effective than the use of oral medications for acute and subacute neck pain without radicular symptoms at immediate follow up. Another trial of low quality (NNTB 1, Gemmell 2010) showed that a specialized mobilisation technique was more effective than an Activator instrument for improving pain, function and mobility at short-term follow up. However, the number of participants in this trial was too small to draw any conclusions on whether the difference was clinically significant.
