Learn more about neck pain: introduction
Neck pain or a stiff neck is a common problem which usually gets better after a few days or weeks. It's rarely a sign of anything serious.
You can often get a painful or stiff neck if you:
- sleep in an awkward position
- use a computer for a prolonged 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.
This page covers:
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)
- try holding 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 seek medical advice
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 a stronger painkiller, such as codeine, to take with your usual over-the-counter painkillers.
If you've had neck pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist.
If your symptoms are particularly severe or don't improve, your GP may consider prescribing more powerful medication or referring you to a pain specialist for further treatment.
Read about living with pain for further information and advice about persistent pain.
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, but it may be caused by bad posture, sleeping without adequate neck support, or 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.
Nearby nerves can also be squashed, resulting in pain that radiates from the arms, pins and needles, and numbness in the hands and legs.
Most cases improve with treatment in a few weeks.
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
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 because your spinal discs start to lose their water content as you get older, making them less flexible and more likely to split.
The pain can sometimes be controlled with painkillers and by following the advice below, although 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 – read about how to sit correctly, posture tips for laptop users, and common posture mistakes and fixes
- 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 relatively firm – a soft mattress could mean your neck is bent while you sleep
Learn more about neck pain: treatment
Most sprains and strains can be managed at home using over-the-counter painkillers to ease any pain.
If the injury is minor, you can look after yourself by using "PRICE therapy" and "avoiding HARM". These are described below.
PRICE stands for:
- Protection – protect the affected area from further injury by using a support or, in the case of an ankle injury, wearing shoes that enclose and support your feet, such as lace-ups.
- Rest – stop the activity that caused the injury and rest the affected joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your GP may recommend you use crutches.
- Ice – for the first 48 to 72 hours after the injury; apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Don't leave the ice on while you're asleep, and don't allow the ice to touch your skin directly because it could cause a cold burn.
- Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or an elasticated tubular bandage available from a pharmacy. It should be wrapped snuggly around the affected area, but not so tightly that it restricts blood flow. Remove the bandage before you go to sleep.
- Elevation – keep the injured area raised and supported on a pillow to help reduce swelling. If your leg is injured, avoid long periods of time where your leg isn't raised.
For the first 72 hours after a sprain or muscle strain, you should avoid HARM. This means you should avoid:
- Heat – such as hot baths, saunas or heat packs.
- Alcohol – drinking alcohol will increase bleeding and swelling, and slow healing.
- Running – or any other form of exercise that could cause more damage.
- Massage – which may increase bleeding and swelling.
Moving sprained joints
Most healthcare professionals recommend you don't stop using a sprained joint. The injury will heal quicker if you begin to move the joint as soon as you're able to do so without experiencing significant pain.
Your doctor may be able to teach you a number of exercises that will help you improve the joint's functionality.
If you have a severe ankle sprain, you may be advised not to use it for a while, or even have it put into a cast for a week or so.
Immobilising strained muscles
Depending on your injury, the advice for muscle strains can vary. You may be advised to keep your injured muscle still for the first few days. Your doctor may recommend using a brace, cast or splint to help keep it as still as possible.
The aim of immobilising the muscle is to allow it to start healing, so you can move it without tearing or pulling it again in the same place. After a few days, you'll probably be advised to start using the muscle again.
Paracetamol is usually recommended for painful sprains or strains. If it doesn't help, you may need an additional stronger painkiller – such as codeine – that's only available on prescription.
Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) cream or gel, such as ibuprofen or ketoprofen, to help treat pain. Gently apply the cream or gel to the injured area and wash your hands immediately afterwards.
Ketoprofen can make your skin sensitive to light (photophobia). You should avoid exposing treated areas of skin to direct sunlight or artificial sources of light, such as sunlamps or sun beds, during treatment and for two weeks afterwards.
Oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, they shouldn't be used in the first 48 hours after the injury because they may delay healing.
For more severe injuries, particularly muscle strains, your doctor may consider referring you for physiotherapy.
Physiotherapy aims to restore movement and function to an injured area of the body. The physiotherapist may show you exercises to help improve the range of motion and return normal function to the injured area.
This may reduce your risk of experiencing long-term problems or injuring the area again.
The length of time it takes to recover from a sprain or strain depends on how severe it is.
Generally, after an ankle sprain you'll probably be able to walk a week or two after the injury. You may be able to use your ankle fully after six to eight weeks, and you'll probably be able to return to sporting activities after eight to 12 weeks.
For muscle strains, the time it can take to recover can vary considerably. Some people recover within a few weeks, whereas others may not be able to return to their normal activities for several months.
Some people may experience continued problems, such as pain, intermittent swelling or instability, for months, or even years, after the original sprain or strain.
Contact your GP if your injury doesn't improve as expected or your symptoms get worse. They may consider referring you to an orthopaedic specialist for further assessment and treatment.