Neck pain: treatment
There are various treatments available for neck pain – a common problem that affects about two-thirds of all Australian adults at some point in their lives. The most suitable treatment for you will depend on the cause of your neck pain and how severe it is. For many people, neck pain treatment involves a combination of self-care measures, medicines, exercises and relaxation therapies.
It’s important to note that there is limited scientific evidence proving the effectiveness of many therapies used to treat neck pain. Your doctor can advise you of the treatments that are most likely to be of benefit to you.
Neck pain needing immediate medical treatment
Severe neck pain that occurs after a neck injury can be a serious problem, and you should see your doctor immediately. Also, if you have problems with neck pain and experience symptoms such as shooting pains, numbness, tingling or weakness in the arms or legs, especially if these symptoms come on suddenly or get worse quickly, you should see your doctor straight away.
Whiplash is a neck injury that results from sudden movement of the neck in one direction (backwards, forwards or sideways) and then back again. Car accidents, especially when the car is hit from behind, are a common cause of whiplash.
Neck pain from whiplash may be felt straight away, or come on several days after your accident. You should see your doctor if you have been in an accident and are experiencing neck pain.
A combination of several treatments for neck pain, including heat and cold packs, staying active as much as possible, neck exercises, physiotherapy, massage and pain relievers, are usually recommended for whiplash. Using a neck brace or collar is not usually recommended for whiplash.
Treatment options for neck pain
There are several treatments available for neck pain, many of which are self-care measures. A combination of treatment options is often recommended.
These days, total or prolonged bed rest is generally not recommended for neck pain. In fact, most health professionals recommend that rest should be avoided for most causes of short-term neck pain. The exceptions to this are if you have nerve root compression (pinched nerves), or an injury such as a ruptured disc or fracture.
There is no evidence that supportive neck collars relieve pain or improve function in people with neck pain.
So you should continue with your normal activities as much as possible. Keeping as active as possible can help speed up recovery if you have whiplash. By continuing to move your head and neck as usual, you can reduce pain and prevent further neck stiffness developing. However, your doctor may recommend that you should still try to avoid quick movements and any activities you think may have caused the pain.
Exercises for neck pain
Specific exercises may help reduce symptoms in people with neck pain. It is uncertain whether exercises help by having a specific effect on the neck structures, or by simply encouraging activity.
Your doctor or physiotherapist can recommend exercises involving gentle tilting, rotating and bending of the neck. If doing the exercises is painful or uncomfortable, it can help to do the neck movement exercises while lying down. You can later progress to doing the exercises sitting up.
A physiotherapist can also tailor a programme of exercises to help you to increase muscle flexibility and strength, stretch your muscles and reduce spasm.
Physiotherapists can give information about good posture and ergonomics that can further help reduce neck pain. General exercise such as walking can also be of benefit.
Neck exercises are an important part of recovery from whiplash injury.
Heat or ice packs
Short-term problems, such as neck pain resulting from a minor whiplash injury, may benefit from the application of a cold pack. Cold packs can help reduce inflammation and swelling after an injury and numb the pain.
Heat helps relax stiff or tense muscles, but you should wait a day or 2 after an injury before using a heat pack (to make sure any swelling has gone down).
Neck support during sleep
People with ongoing neck pain that tends to be worse after sleeping can benefit from neck support while sleeping.
Use a pillow that is the right height for you and supports the natural curve of your neck. There are pillows available that have a contoured surface that comes up to support the neck and recedes to leave more room in the head support zone. Alternatively, you can try inserting a rolled-up towel in your pillowcase to help support your neck.
Also, use a firm mattress and try to avoid sleeping on your stomach (which can put strain on your neck).
Remedial massage is offered by a number of healthcare providers, including physiotherapists and osteopaths. It involves your healthcare provider using their hands to apply pressure and movement to your skin, muscles and tendons. Massage can relieve muscle tension and spasm, help loosen stiff joints and promote relaxation.
If pain relievers are used, they should be given in combination with other treatments for neck pain. Pain-relieving medicines are often used to control pain and discomfort so that you can resume your usual activities.
Over-the-counter medicines such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen, are often tried first. Paracetamol can also be used in combination with NSAIDs to treat more severe neck pain.
Sometimes stronger pain relievers (such as codeine) are used for a limited time if neck pain is interfering with the ability to carry out usual activities.
There is currently no evidence that muscle relaxants (including benzodiazepines) are effective in the treatment of short-term neck pain. These medicines are associated with significant side effects and can cause dependency.
Certain antidepressants (the so-called tricyclic antidepressants) have been found to relieve certain types of pain, and can be prescribed to help control neck pain that is not responding to regular pain relievers. These medicines may also relieve pain that is worse at night, and pain that is caused by compression or damage to a nerve root in the neck.
Physiotherapists can help treat your neck pain with a variety of treatments, including:
- ultrasound (which can reduce muscle and joint pain);
- transcutaneous electrical nerve stimulation – TENS (a therapy that uses mild electrical currents to treat pain);
- mobilisation (a manual treatment that can improve joint function as well as stretch tight muscles and ligaments); and
- traction (which involves creating a sustained pull on the neck, and can bring fast relief for some people with neck pain, especially if the pain is related to nerve root irritation or muscle spasms).
Spinal manipulation (usually performed by osteopaths or physiotherapists) is another treatment option for certain neck conditions. The therapist uses their hands to adjust the joints in your neck with the aim of relieving pain and stiffness. Manipulation is not suitable for some people, and there is a small risk of serious side effects, including neck injuries and even stroke, so check with your doctor before receiving this treatment.
Complementary therapies for neck pain
Another treatment that may provide relief from neck pain is acupuncture, which involves having small needles inserted into specific areas called acupuncture points just below the surface of the skin. While many people report that acupuncture improves their pain, there is currently no evidence from clinical trials to either prove or disprove its effectiveness as a treatment for neck pain.
Stress management and relaxation techniques are also useful, as they can help relieve chronic muscle tension that may be contributing to neck pain.
Some doctors recommend psychological treatments such as cognitive behavioural therapy (CBT) for ongoing problems with neck pain. CBT can help you gain a sense of control over your pain and help you manage it more effectively.
Additional treatments for severe neck pain
Corticosteroids reduce inflammation and may be used to relieve neck pain in some cases. Corticosteroid medicines can be given by corticosteroid injection into the joints and muscles in the neck, the epidural space (the space between the outer covering of the spinal cord and the vertebrae), or the space around nerve roots.
When given as an injection, corticosteroids are often mixed with a local anaesthetic, and can be used to treat neck pain resulting from:
- inflamed and painful facet joints in the neck (the joints between the vertebrae);
- trigger points (hard, knot-like areas in muscles that are painful to touch and result from repetitive stress on the muscles);
- cervical nerve root irritation — where disc fragments or bone spurs are impinging on a spinal nerve root as it exits the spine; and
- herniated (or slipped) discs.
Surgery for neck pain
Surgery is rarely needed for pain alone, and in most cases is usually performed only after non-surgical therapies have been tried. However, if you have spinal cord compression, surgery is generally required sooner rather than later. Spinal surgery is of benefit only for pain involving nerves — it does not help pain from spondylosis or soft tissue pain.
Preventing neck pain
If you’ve had trouble with neck pain in the past, there are ways of preventing further problems.
One of the most important things you can do is to maintain good posture. Keeping your head centred over your spine helps reduce much of the strain on your neck muscles. People who work long hours driving, sitting at a desk or hunching over a workbench often suffer from neck pain due to their posture.
Make sure you follow advice for ergonomic workstation comfort and safety. Try the following:
- make sure you take regular breaks and take the time to stretch your back and neck muscles;
- if you are working on a computer, make sure that the top of the monitor is at eye level;
- don't leave your arms unsupported;
- sit with your knees slightly lower than your hips; and
- avoid clenching your teeth.
Posture-correcting exercise processes that re-educate the body, such as the Alexander Technique and Pilates, can also help prevent neck pain, as can yoga and tai chi.
You can also help prevent neck pain by using a supportive neck pillow and sleeping on a firm mattress.
Relaxation techniques and regular exercise are also important in preventing stress and tension in the neck muscles. Maintaining general fitness helps prevent further exacerbations of neck pain by improving muscle tone and posture.
2. Mayo Clinic. Neck pain (updated 9 Jul 2015). http://www.mayoclinic.org/diseases-conditions/neck-pain/basics/definition/con-20028772 (accessed Jun 2016).
3. National Institute of Neurological Disorders and Stroke (NINDS). Whiplash (updated 3 Nov 2015). http://www.ninds.nih.gov/disorders/whiplash/whiplash.htm (accessed Jun 2016).