Neck pain and stiff neck

About neck pain and stiff neck

You can often get a painful or stiff neck if you:

• sleep in an awkward position
• use a computer for an extended period of time
• strain a muscle because of bad posture

Anxiety and stress can also sometimes cause tension in your neck muscles, leading to neck pain.

Managing neck pain at home

For most types of general neck pain, the advice is to carry on with your normal daily activities, keep active, and take painkillers to relieve the symptoms.

These steps may help you to manage your pain:

• take regular doses of paracetamol, ibuprofen, or a combination of the two, to control pain – ibuprofen gel can be rubbed on to your neck as an alternative to taking tablets (always follow the instructions that come with the medication)
• hold a hot water bottle or heat pack to your neck – this can help reduce the pain and any muscle spasms, although some people find cold packs offer better relief
• sleep on a low, firm pillow at night – using too many pillows may force your neck to bend unnaturally
• check your posture – bad posture can aggravate the pain, and it may have caused it in the first place
• avoid wearing a neck collar – there's no evidence to suggest wearing a neck collar will help to heal your neck, and it's generally better to keep your neck mobile
• avoid driving if you find it difficult to turn your head – this may prevent you being able to view traffic
• if your neck is stiff or twisted, try some neck exercises – gently tense your neck muscles as you tilt your head up and down and from side to side, and as you carefully twist your neck from left to right; these exercises will help strengthen your neck muscles and improve your range of movement

• The Chartered Society of Physiotherapy has more information about neck exercises

When to see your GP

You should see your GP if:

• the pain or stiffness doesn't improve after a few days or weeks
• you can't control the pain using ordinary painkillers
• you're worried your neck pain could have a more serious cause

Your GP will examine your neck and ask some questions to help identify any underlying condition. They may also prescribe medication to help improve your symptoms.

If you've had neck pain or stiffness for a month or more, your GP may refer you to a physiotherapist, if they think it will help you.

If your symptoms are particularly severe or don't improve, your GP may consider referring you to a pain specialist for further treatment.

Causes of neck pain and stiffness

A twisted or locked neck

Some people suddenly wake up one morning to find their neck twisted to one side and stuck in that position. This is known as acute torticollis and is caused by injury to the neck muscles.

The exact cause of acute torticollis is unknown.

It may be caused by:

• bad posture
• sleeping without adequate neck support 
• carrying heavy unbalanced loads (for example, carrying a heavy bag with one arm)

Acute torticollis can take up to a week to get better, but it usually only lasts 24 to 48 hours.

Wear and tear in the neck

Sometimes neck pain is caused by the ’wear and tear’ that occurs to the bones and joints in your neck. This is a type of arthritis called cervical spondylosis.

Cervical spondylosis occurs naturally with age. It doesn't always cause symptoms, although in some people the bone changes can cause neck stiffness.

Nerves that come off the spinal cord, at the level of your neck can become squashed as the bones and joints wear down.

This can result in nerve pain that is felt in the arms, shoulders, or occasionally up towards your head. You may also experience, pins and needles, or numbness.  

Most cases improve with treatment in a few weeks.

Whiplash

Whiplash is a neck injury caused by a sudden movement of the head forwards, backwards or sideways.

It often occurs after a sudden impact such as a road traffic accident. The vigorous movement of the head overstretches and damages the tendons and ligaments in the neck.

As well as neck pain and stiffness, whiplash can cause:

• tenderness in the neck muscles
• reduced and painful neck movements
• headaches

Pinched nerve

Neck pain caused by a squashed nerve is known as cervical radiculopathy.

It's usually caused by one of the discs between the bones of the upper spine (vertebrae) splitting open and the gel inside bulging outwards on to a nearby nerve.

The condition is more common in older people. This is because your spinal discs start to lose their water content as you get older. This makes them less flexible and more likely to split.

The pain can sometimes be controlled with painkillers and by following the advice below.

Surgery may be recommended for some people.

More serious causes

Your neck pain may have a more serious cause if it's persistent and getting progressively worse, or you have additional symptoms, such as:

• a lack of co-ordination (for example, finding fiddly tasks increasingly difficult)
• problems walking
• loss of bladder or bowel control
• a high temperature (fever)
• unexplained weight loss

A serious cause is more likely if you've recently had a significant injury, for example, a car accident or a fall, or you have a history of cancer or conditions that weaken your immune system, such as HIV.

See your GP if you're concerned.

Preventing neck pain and stiffness

You may find the following advice helpful in preventing neck pain:

• make sure you have good posture
• take regular breaks from your desk, from driving, or from any activity where your neck is held in the same position for a long period of time
• if you often feel stressed, try relaxation techniques to help ease any tension in your neck
• avoid sleeping on your front, and make sure your head is in line with your body (not tilted to the side) if you sleep on your side
• only use enough pillows (usually only one) to keep your head level with your body  
• make sure your mattress is quite firm – a soft mattress could mean your neck is bent while you sleep

More useful links

• How to use your health services