To understand some of the causes of neck pain, it’s helpful to understand some basics about how your spine works.

Your spine is made up of bones called vertebrae that are stacked together to form a column. There are 24 vertebrae in your spine, each cushioned by spongy tissue called intervertebral discs. These discs have a tough outer layer and soft jelly-like inside. They’re your spine’s shock absorbers and give your spine its flexibility. Vertebrae are joined by pairs of small joints known as facet joints. Tough fibres (or ligaments) hold your spine together.

Your vertebrae are divided into four sections: 7 cervical or neck vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae and the sacrum and coccyx vertebrae which are joined together.

Layers of muscle provide structural support and allow you to move. Your spinal cord runs through the centre of the vertebral column and connects your brain to the rest of your body via nerves which pass through spaces between the vertebrae.

Most people with neck pain don’t have any significant damage to their spine. The pain they’re experiencing is often coming from the soft tissues such as muscles and ligaments.   

Common causes of neck pain include:

• muscle strain – this may be caused by things such as poor posture (e.g. while using a computer or smartphone, slouching), poor neck support while sleeping, watching TV, sports or work activities, anxiety and stress.
  

• cervical spondylosis – this arthritis of the neck is related to ageing. As you age, your intervertebral discs lose moisture and some of their cushioning effect. The space between your vertebrae becomes narrower and your vertebrae may begin to rub together. Your body tries to repair this damage by creating bony growths (bone spurs). Most people with this condition don’t have any symptoms, however when they do occur, the most common symptoms are neck pain and stiffness. Some people may experience other symptoms such as tingling or numbness in their arms and legs if bone spurs press against nerves. There can also be a narrowing of the spinal canal (stenosis). 
  

• slipped disc – also called a herniated or bulging disc. This occurs when the tough outside layer of a disc tears or ruptures and the soft jelly-like inside bulges out and presses on the nerves in your spine. 
  

• whiplash – this is a form of neck sprain caused when the neck is suddenly whipped backwards and then forwards. This stretches the neck muscles and ligaments more than normal, causing a sprain. Whiplash most commonly occurs following a car accident, and may occur days after the accident. 
  

The symptoms you experience will depend on what’s causing your neck pain, but may include:

• pain in the neck, shoulders and/or upper chest

• stiff neck 

• difficulty turning your head

• headache.
  

In most cases neck pain will go away in a few days. If it doesn’t get better, or you develop other symptoms, you should see your doctor. 

Your doctor will discuss your neck pain with you and will:

• ask about potential causes or triggers, if you’ve had neck pain before, things that make your pain worse, things that make it better

• conduct a thorough physical exam.
  
  

Your doctor may also refer you for some tests, especially if they think there may be a more serious cause for your neck pain. 

A thorough examination by your doctor will decide whether more investigations (e.g. x-rays, CT or MRI scans) are appropriate or helpful in developing a treatment plan that’s right for you.  

It‘s important to know that many investigations show ‘changes’ to your spine that are likely to represent the normal passage of time, not damage to your spine.

For more information about questions to ask your doctor before you get any test, treatment or procedure visit the Choosing Wisely Australia website.   

Most cases of neck pain will get better within a few days without you needing to see your doctor. During this time try to keep active and carry on with your normal activities as much as possible. 

The following may help relieve your symptoms and speed up your recovery: 

• work out what’s triggering your neck pain – e.g. staying in one position for long periods of time, sleeping on your stomach, poor posture. Once you know what causes your neck pain, you can look for ways to prevent it happening – e.g. regular stretch breaks, sleeping on your side, correcting your posture. 

• use heat or cold – it can help relieve pain and stiffness. Some people prefer heat (e.g. heat packs, heat rubs, warm shower, hot water bottle), others prefer cold (e.g. ice packs, bag of frozen peas, cold gels). Always wrap heat or cold packs in a towel or cloth to help protect your skin from burns and tissue damage. Don’t use for longer than 10 to 15 minutes at a time, and wait for your skin temperature to return to normal before reapplying.

• rest (temporarily) – when you first develop neck pain you might find it helps to rest your neck, but don’t rest it for too long. Too much rest can stiffen your neck muscles and make your pain last longer. Try gentle exercises and stretches to loosen the muscles and ligaments as soon as possible. If in doubt talk with your doctor. 

• sleep on a low, firm pillow – too many pillows will cause your neck to bend unnaturally, and pillows that are too soft won’t provide your neck with adequate support. 

• be aware of your posture – bad posture can sneak up on you and can cause neck pain, or make existing neck pain worse. Poor posture puts stress on your neck muscles and makes them work harder than they need to. If you’re slouched or hunched – whether you’re standing or sitting - make a conscious effort to adjust your posture.   

• massage your pain away – massage can help you deal with your physical pain and it also helps relieve stress and muscle tension. You can give yourself a massage, see a qualified therapist or ask a family member or friend to give you a gentle massage.

• take time to relax – try some relaxation exercises (e.g. mindfulness, visualisation, progressive muscle relaxation) that help reduce muscle tension in your neck and shoulders. 

• try an anti-inflammatory or analgesic cream or gel – they may provide temporary pain relief. Talk with your doctor or pharmacist for advice.

• use medication for temporary pain relief – always follow the instructions and talk to your doctor about alternatives if you find they don’t help. 
  
  

Sometimes neck pain lasts longer than a few days, and you may have ongoing neck pain. There are things you can do to manage this:

• see your doctor if the pain is worse or doesn’t ease up in a week or so, if you have other symptoms in addition to your neck pain such as numbness, pins and needles, fever or any difficulty with your bladder or bowel.

• see a physiotherapist or exercise physiologist – they can provide you with stretching and strengthening exercises to help relieve your neck pain and stiffness. 

• injections – some people with persistent neck pain may benefit from a long-acting steroid injection into the affected area. Talk with your doctor about whether this is right
  for you.

• surgery – may be required in very rare cases, if the pain is very severe or your spinal cord or nerves are affected. 

The key to preventing neck pain is keeping your spine flexible and strong. In most cases neck pain can be prevented by making a few lifestyle changes.  

Exercise regularly – this will improve your posture and improve muscle strength. Aim for 30 minutes of moderate physical activity most days. This can be broken into shorter blocks of exercise if you prefer. Exercising with a friend or as part of a team is also a great idea and helps keep you motivated. If you need help getting started, or you haven’t exercised in a while, talk with your doctor, a physiotherapist or an exercise physiologist for advice.  

Develop good posture – try to be aware of your posture particularly when sitting at home, at work or in the car. Avoid slouching, poking your chin out and working with your head down for long periods of time.

Avoid sleeping on your stomach – this overextends your neck. Choose a pillow that supports your neck properly. 

Take regular stretch breaks – when you’re driving, standing or sitting for long periods of time. Every hour or so, take a moment to stretch or move about. This will help change the position of your joints and loosen your muscles. 

• Your GP

• Physiotherapist 
  

• Exercise physiologist

• MOVE muscle, bone & joint health
  National Help Line: 1800 263 265
  

• Neck pain is a common problem

• There are many things that you can do to live well with it

• Learning about your neck pain and the best ways to manage it is the first step

Need medical information regarding your condition and commonly prescribed treatments? Or assistance navigating the health, disability and social services systems? Contact our nurses on the Help Line on 1800 263 265 or email helpline@move.org.au.

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• Australian Physiotherapy Association

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• Pain Australia

• Choosing Wisely

• Medicines Line 1300 633 424