Summary

  • The neck is highly mobile to allow us to see in all directions.
  • Strains from poor postures, trauma and arthritis are common causes of neck pain.
  • Treatments provided by physiotherapists, osteopaths, chiropractors or remedial masseurs can generally help neck pain.

The neck supports the head. It is made up of seven bones (vertebrae) stacked one on top of the other. The vertebrae are connected by two facet joints and a disc. The vertebrae are also bound together with ligaments. Muscles provide movement and vital support for all structures of the neck.

The neck is very mobile, to allow us to see in all directions. Strains from poor postures, trauma and degenerative diseases, such as arthritis, are the most common causes of neck pain. There is good evidence to show that exercise helps reduce these symptoms.

Treatment for neck pain

Neck pain can generally be successfully treated by physiotherapists, although there are other options such as osteopathy, chiropractic or remedial massage to consider. If you need short-term pain relief from medication, talk to your doctor or pharmacist.

Treatment depends on the cause, but may include:

  • information on how to look after your neck to prevent unnecessary strains from work and everyday activities
  • specific exercise programs to retrain and then strengthen the neck muscles
  • posture training exercises
  • passive joint mobilisation or manipulation
  • soft tissue massage
  • taping to guide correction of posture
  • relaxation therapy.

Poor postures and neck pain

Poor sitting or working postures commonly cause neck pain by putting extra strain on the joints and muscles. Sitting and working with the shoulders slouched and chin poking forward, such as when working for many hours on a computer, may strain the neck as may playing with devices with your head down for long periods of time. 

Sleeping on your stomach with your head turned around to breathe may also be a strain on your neck. 

Suggestions on how to prevent posture-related neck pain include:

  • Ensure your workstation is set up to help you sit in a good supported posture. When using a computer, ensure the screen is at a height so that your head is upright and the centre of the computer is viewed when you lower your eyes slightly. 
  • Change your posture regularly when either sitting or standing. To do this, grow tall by rolling up from your pelvis. Then gently elongate the back of your neck and draw your shoulders back. Use no more than 10 per cent effort. Hold the position for 10 seconds and then relax. 
  • Perform posture correction frequently while you are working (two to three times per hour). This exercise keeps tone in the supporting muscles of the neck.
  • Combat the tight or tired feeling of your neck by regularly performing the posture exercise.
  • Try not to sleep on your stomach, which may strain your neck.
  • Check whether your pillow is the right size for you. Choice of pillows is very individual – there is no one pillow that suits everyone. Check the distance between the side of your neck and your shoulder. That gives you an idea of the pillow height you need to keep your head and neck supported when you sleep on your side.
  • Move and exercise regularly to improve muscle tone and posture.

Osteoarthritis and neck pain

Osteoarthritis is a common type of arthritis that affects many people. Its incidence increases as we grow older. Osteoarthritis can result from:

  • previous joint injury 
  • overuse
  • overweight (in cases of hip or knee osteoarthritis) 
  • genetic predisposition (in some people).

Symptoms of osteoarthritis include pain and stiffness and weakening of the muscles. Commonly affected areas include the neck, lower back, hands, hip and knee. There is no cure for osteoarthritis, but it can be managed well with exercise. Keeping the joints mobile and the muscles strong are the best ways to manage osteoarthritis.

Osteoarthritis in the joints of the neck commonly results in local neck pain. If the upper joints of the neck are affected, the neck pain may develop into a headache as well. 
Osteoarthritis may occasionally cause some irritation of the nerves as they exit the neck. If you experience shooting pains down your arm, or numbness or lack of power in your arm or hand, then see your doctor, as you may need further investigations, such as an x-ray.

You can manage neck pain related to osteoarthritis with:

  • advice and education on how to care for and self-manage your neck
  • pain management – speak to your doctor about taking pain relieving medication or using a heat pack to relieve neck pain
  • gentle active mobilisation exercises to maintain neck movement
  • gentle exercises focussing on retraining and maintaining muscle function 
  • gentle soft-tissue and joint mobilisation 
  • posture exercises
  • strengthening exercises.

Neck pain – whiplash

An injury to the neck due to a motor vehicle crash is often referred to as a whiplash injury. Typically, this occurs as a result of a rear-end collision and any structure of the neck might be strained.

Symptoms of whiplash

Common symptoms of a whiplash injury include neck pain, headache and neck stiffness. Some people may also feel unsteady or light headed. Recovery from whiplash depends on the individual and the extent of the injury, but can vary from a few weeks to months.

Early treatment for whiplash may include:

  • advice and education on how to care for and manage your neck to help recovery
  • pain-relieving or anti-inflammatory medication
  • gentle active mobilisation exercises
  • gentle exercises focussing on retraining muscle function 
  • gentle soft-tissue and joint mobilisation 
  • posture exercises
  • strengthening exercises
  • resumption of usual activities, as your neck tolerates.

Maintaining as many of your normal daily activities as you can is ideal, although modifications in the early stages may be necessary to assist in the recovery of your neck. 
Be adaptable and remain positive. If pain is severe or persists or if you have unusual symptoms associated with the injury, further examination or investigation by a healthcare professional may be required.

Acute neck pain – wry neck

Wry neck is the term used to describe a condition where your neck temporarily becomes stiff and painful. It can occur at any age, but is more common in the teenage or young adult population. Turning your head to the side (generally one side more than the other) and looking up can produce an acute pain.

One or both sides of the neck may also go into spasm, and pain may be felt from the top of the neck down to the shoulder blade and even out to the top of the shoulder.

Causes of wry neck

There are many causes including:

  • sleeping in an awkward posture
  • a sudden flicking or jerking of the head
  • carrying heavy unbalanced loads – such as a suitcase
  • viral infection.

Treatment for wry neck

In most cases, if treated early, wry necks respond well to treatment in a few days. Heat and passive joint mobilisation can be used to loosen the neck joints and reduce the pain and muscle spasm.

In rare cases, particularly for people over 40, or very rarely in infants, wry neck can be caused by a medical condition. Your doctor or therapist can help with this diagnosis and give you a referral for appropriate care.

Self-care of wry neck

While you are recovering from wry neck:

  • avoid sitting or lying with your neck in an awkward position
  • avoid going out in the cold without being well wrapped up
  • keep moving your neck (as pain allows)
  • use a small heat pack (such as a wheat pack or similar) at home or at work for pain relief, or hot showers can help
  • keep warm. 

Talk to your doctor or pharmacist about pain medication if your pain is severe.

Where to get help 

More information

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This page has been produced in consultation with and approved by: Australian Physiotherapy Association

Last updated: February 2019

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