• Reference Number: HEY1039/2019
• Departments:
• Last Updated: 8 November 2019

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What causes Neck Pain?

Neck pain is common even without an accident or injury and is rarely due to any serious disease. Your neck is strong. Like the rest of your spine, your neck is made of solid bony blocks known as vertebrae which are joined by discs to give it strength and flexibility. It is reinforced by strong ligaments and surrounded by large and powerful muscles that protect it. Most simple neck strains do not cause lasting damage.

Symptoms

Pain and stiffness:

Pain may be in the middle of your neck or to one side or the other. The pain may travel to your shoulder or shoulder blade or to the upper chest. Stiffness is often worse after prolonged rest or sitting in the same position for a long time.

Numbness and tingling:

If there is pressure on a nerve you may have numbness and/or pins and needles down your arm, sometimes all the way down to your fingers. The nerve can be affected in this way for a variety of reasons but often resolves on its own.

Clicking/grating:

You may hear or feel clicking or grating as you move your head – this is known as crepitus. It is caused by bony surfaces moving against each other or by ligaments moving over bone. Other joints often make these sounds but they often seem louder in the neck because they are happening closer to the ears. This is quite common and can sound alarming but is not serious.

Causes

There are a number of possible causes for the symptoms most of which will resolve on their own if you follow the advice in this leaflet.

Non-specific neck pain

Many people develop a stiff and painful neck for no obvious reason; it may happen after a minor twisting injury. This type of neck pain is thought to be caused by spasm in the muscles supporting the neck and will usually disappear after a few days or weeks.

Whiplash

Whiplash injuries are most commonly seen as a result of a car accident, which in itself is certainly frightening. Patients often present to the Emergency Department after even a minor whiplash as it can be very painful. The facts below show this is not usually the case:

• Permanent injury is rare. The long term outlook is good.
• Most whiplash injuries are not serious. There is usually no damage to the bones, discs or nerves in the spine and any serious injuries are nearly always detected early.
• There is often a delay of a day or two after the accident before you feel any pain or stiffness. This is a good sign that there is nothing serious and usually caused by muscle spasm where your body naturally tries to protect you from experiencing pain.
• Whiplash causes neck pain but can also cause back pain. Again there is rarely a serious injury to the back.
• Headaches are common in whiplash injuries caused by the tension in the neck. Other symptoms such as arm or jaw pain or dizziness are also common but usually improve along with the neck pain.
• Most of these injuries improve within a few days or weeks, at least enough to get on with your life.
• Aches and pains can sometimes persist or recur for quite a long time after a whiplash injury.
• What you do in the early stages is very important – following the advice in this booklet is really important to help you recover.

Cervical spondylosis

Spondylosis is a term used to describe osteoarthritis of the spine. It is a degenerative condition which occurs due to everyday use over many years and is quite a normal finding as we age. In many people degenerative changes will not cause pain but it may increase the risk of having spells of neck pain.

Tension

Most muscles of the body relax completely when they are not being used but some muscles have to work all the time to keep you upright. Muscles at the back of your neck must always be tensed, otherwise your head would fall forwards when sitting or standing. When we are worried or stressed we often tighten these muscles even more which can cause neck pain and tension headaches. Tension headaches are very common and may be mistaken for migraines.

The pain caused by tension headaches often travels to the back of the head and sometimes behind the eye, to the side of the head or even to the ear.

How are neck problems diagnosed?

The clinician you were assessed by may not have pinpointed the source of pain and given you an exact diagnosis but sometimes this is not possible. It may be frustrating not to know exactly what is wrong but actually in another way you should see it positively as it means you do not have anything serious.

An X-ray or scan is not usually required to diagnose your neck pain. Normal age related degenerative changes which would be picked up on an X-ray or scan can cause people to avoid movement and exercise which they should be doing to get better.

However, in very rare cases, there may be something more serious or underlying that requires further investigation. An emergency scan may be arranged for you if experience any of the following:

• Pain that’s getting much worse despite following the advice in this leaflet
• Lack of co-ordination – for example trouble with tasks like buttoning a shirt
• Heaviness or weakness in your arms or legs
• Pins and needles in an arm as well as pain
• Problems walking
• Loss of bladder or bowel control

If you do develop any of the symptoms listed above then we recommend you attend or return to the Emergency Department immediately for a further assessment.

How long will the pain last?

The complex structure of your neck means that even a mild sprain to any of the structures can cause a lot of pain and discomfort. The spine is one of the strongest structures in the body and in time this pain will improve – much like a sprained ankle.

Many factors can contribute to the amount of neck pain that you experience and how long it persists. There may be combination of factors such as:

• Physical such as wanting to protect the neck and avoiding movements
• Psychological including a fear of damage or not getting better, feeling down or being stressed
• General health and lifestyle like being tired and rundown, being overweight and not getting enough physical activity and sleep
• Social triggers such as difficult relationships at home or work, low job satisfaction or stressful life events, like a family death or illness

Each of the factors above can increase your feeling of pain but by gaining a greater understanding of these puts you in a better position to recognise them and learn how to control and reduce the pain.

Following the advice in the sections below will help you achieve  a normal recovery and prevent your neck pain becoming a long term problem.

Pain relief medication

You should not hesitate to use pain relief medication if you need to ease the pain. Simple pain relief medication (e.g. paracetamol) that you can purchase over the counter is often the most effective.  You should follow the instructions on the packet and  take the full recommended dose.  This helps to keep on top of the pain. .  It can be taken 4 hourly up to a maximum of 8 tablets in 24 hours. You should usually take them for a few days, but you may need them for a week or two.

Anti-inflammatory medication such as Ibuprofen can also be useful. Please follow the information on the packet and if you have further queries regarding whether Ibuprofen is safe for you talk to your local pharmacist.

You may be given a muscle relaxant medication called diazepam for a few days to help reduce the muscle spasms you are experiencing. These may make you drowsy and so you MUST NOT drive or operate machinery whilst using these.

There is no strong evidence that pain relief will speed up recovery and they can have side effects however in the short term it is advised that they are used in order to allow you to follow the advice below.

Exercise and Rest

 What you do in the early stages is very important.  If you avoid activity and rest for more than a day or two, this actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work. This is because the lack of activity will weaken the neck muscles and as a result will tire more easily and become more vulnerable to further strain.

Your neck is designed for movement and it needs movement. The sooner you get it moving and are doing your ordinary activities as normally as possible the sooner you will feel better. Where possible it is recommended that you try to stay at work, adjusting or altering your duties in the short term if necessary. The people who cope best with neck pain are those who stay active despite the pain.

You may find heat packs or a cold compress for 5-10 minutes at a time will help to reduce pain and muscle spasm in the early stages. Whichever you choose is personal preference but always be careful not to burn the skin by not having the water too hot and if applying ice ensure there is a barrier such as a damp tea towel between your skin and the ice pack. When using ice always check the skin regularly and stop using immediately if the area becomes white, blue or blotchy or the area becomes excessively painful, numb or tingly.

Physical exercise, such as brisk walking, gym classes, swimming or a sports activity, is shown to be very helpful in easing pain and the most effective way of preventing further episodes.

Regular physical activity will:

• Give you stronger bones
• Strengthen your muscles
• Keep you supple
• Improve your fitness
• Make you feel good
• Release natural chemical that reduce the pain

There is no one type of exercise that is proven to be more effective than another so pick something that you will enjoy and that fits in with your daily schedule. Whatever you choose start slowly and build up both the amount that you do and the intensity. You may initially find that you are a little sore during or after you exercise but over time and with perseverance you will find that this will reduce.

Posture

Check your desk height and chair design in the home and at work – this is important to prevent further problems.

When sitting, your hips and knees should be at right angles and you should have a good support for your lower back. Hard back, upright chairs are better for your posture than low, soft upholstered chairs and sofas. Back supports to lean against can help your posture when sitting at home, at work or in the car.

If you work at a computer screen it is important to have the screen, desk and chair at the correct height. Many employers have occupational health specialists who can check workstations are set up according to individual needs. You may want to take a look at the Health and Safety Executive (HSE) website for guidance on ‘Working with display screen equipment’.

Sleep

The importance of sleep in easing pain has become increasingly clear in recent years. Sleep reduces stress and improves your overall feeling of wellbeing; making you less susceptible to the triggers of pain and helping you cope if it does occur.  Aim for 7.5 – 8 hours’ sleep a night and try to aim for a regular routine, as far as possible. There is no recommended position for sleep or particular type of mattress or number of pillows – do whatever feels most comfortable for you.

Is surgery an option?

A very small amount of people with neck pain actually need surgery.

There are however some uncommon neck conditions where there is pressure on the nerves or spinal cord and the patient reports symptoms, such as severe pain, weakness, pins and needles or numbness. For these conditions, surgery can help these symptoms but it is not always required as it often resolves on its own.

Usually, the outcomes for patients undergoing surgery are no better in the medium or long term than non-surgical intervention such as exercise. As a result non-surgical options such as exercise and activity should always be tried first.

When to seek further help

If your neck pain does not settle after 6 – 8 weeks, you should refer yourself to a physiotherapist if you have not already done so. Physiotherapists provide expert advice, guidance and treatment for neck pain. This is to help reduce the risk of experiencing future episodes, while improving your overall health and wellbeing.

Hull GP patients call (01482) 300003

East Riding GP patients call (01377) 208300 (open Monday – Friday 09.00am – 13.00pm, excluding bank holiday) or self-refer online at www.chcpmsk.org.uk

If you live outside of the Hull area, please seek a referral from your doctor.

If the physiotherapist has any concerns following their assessment of your neck they will refer you on to the appropriate care provider to address your needs.