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    Neck Pain

    What is neck pain?

    • Simple/non-specific neck pain is pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms. In most cases, no specific cause can be found.

    How common is neck pain?

    • Very common.
    • Approximately 60% of the world’s population will have neck pain at some stage in their life.
    • It is common in workers with desk-based jobs (4).

    Should I worry?

    • No.
    • With the right rehabilitation approach, neck pain recovers well.
    • It is uncommon that neck pain is linked to more serious conditions.

    Who is most likely to suffer from neck pain?

    • Females (4).
    • Those with high job demand/work stress (5).
    • People over the age of 40.
    • Smokers and obese people (6).
    • Those who have had traumatic injuries (7).

    What are the common symptoms?

    • Pain that is aggravated by movements, posture and activities (1).
    • Pain that radiates down the arm, up into the head, into the shoulder or across the scapulae (shoulder blades) (2).
    • Pain associated with pins and needles or numbness, but with no actual loss of sensation or muscle strength.
    • Asymmetrical posture.
    • Limited range of movements, often more one side than the other (7).
    • Tenderness in neck joints or tight muscles that may feel like “knots” or tight bands (8).

    What can I do?

    • Modify your activity, posture and/or workspace.
    • Take painkillers.
    • Exercises.
    • Advice from a qualified physiotherapist will be helpful in most cases.

    How long will it take to recover?

    • Most cases of acute neck pain resolve within 2 months.
    • However, around half of people continue to have low-grade symptoms or recurrences for more than a year (7).
    • Non-specific neck pain usually resolves within days or weeks but can recur or become chronic (8).
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    1. Introduction

    Simple (or non-specific) neck pain is pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms. In most cases, no specific cause can be found. Symptoms vary with physical activity and over time (1, 2, 3).

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    2. Signs & Symptoms

    The features of non-specific neck pain include:

    3. Causes

    The cause of non-specific neck pain is usually as a result of several factors and includes poor posture, neck strain, sporting and occupational activities, anxiety and depression. Some will, if scanned, show some bony changes in their neck however, it should be noted that many people aged over 30 years show similar changes and the boundary between normal ageing and something causing the symptoms is difficult to define. Neck pain may also be a result of whiplash, following a sudden acceleration-deceleration injury to the neck. For more information see our section on whiplash (8).

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    4. Risk Factors

    This is not an exhaustive list. These factors could increase the likelihood of someone developing non-specific neck pain. It does not mean everyone with these risk factors will develop symptoms.

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    5. Prevalence

    Approximately 60% of the world’s population will have neck pain at some stage in their life. This figure has been reported as 6%-22% at any one time, with higher figures reported in the elderly.

    6. Assessment & Diagnosis

    Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

    Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or ultrasound scans are usually not required to achieve a working diagnosis, but in unusual/more serious situations, they may be warranted.

    7. Self-Management

    As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from neck pain. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

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    8. Rehabilitation

    Research is clear that modifying the factors that could be contributing to your symptoms can have a significant impact on easing them.

    Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing non-specific neck pain. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.

    9. Neck Pain Rehabilitation Plans

    Early Plan

    This programme focuses on maintaining a range of movement within the neck and maintenance of muscle and joint flexibility. Try to do these exercises regularly. Do each one a few times to start with to get used to them and gradually increase how much you do. Allow for mild discomfort when exercising. This should not exceed any more than 4/10 on your perceived pain scale.

    Early Plan - Rating

    Intermediate Plan

    This is the next progression. More focus is given to the progressive strengthening of the neck. As with the early programme, some pain is to be expected but ideally, this should not exceed any more than 4/10 on your perceived pain scale.

    Intermediate Plan - Rating

    Advanced Plan

    This programme is a further progression with challenging progressive strengthening of the neck. Again, some pain is acceptable but ideally, this should not exceed any more than 4/10 on your perceived pain scale.

    Advanced Plan - Rating
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    10. Return to Sport/Normal Life

    For patients wanting to achieve an elevated level of function or return to sport, we would encourage a consultation with a physiotherapist as you may require further progression beyond the advanced rehabilitation stage.

    As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish an appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

    11. Other Treatment Options

    • Simple painkillers can often help reduce or ease your symptoms. If you need advice on stronger painkillers, speak to your local pharmacist or GP (7).
    • Please do not drive if the range of motion of the neck is restricted (8, 9).
    • The use of neck collars is not advised because this restricts mobility and may prolong symptoms (8, 9).
    • A firm pillow may provide comfort at night. Only use one pillow if possible. It should provide support for the sides and hollow of the neck, and the position should be comfortable (8, 9).
    • A referral for psychological therapy, if appropriate (1).
    • A referral to occupational health may be considered if your neck pain is related to work (1).

    If you have had symptoms for more than 12 weeks and failed these treatments, a referral to a pain clinic may be indicated (1). Surgery is not recommended for this condition.

    12. Links for Further Reading

    https://www.nhs.uk/conditions/neck-pain-and-stiff-neck/

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    Book an Appointment

    Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

    We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.

    References

    1. Jones, R. (2005). Oxford textbook of primary medical care. Oxford University Press. 2, 1111-1116.
    2.  Binder, A.I. (2007). Cervical spondylosis and neck pain. British Medical Journal 334(7592), 527-531.
    3.  Kjaer, P., Kongsted, A., Hartvigsen, J., Isenberg-Jørgensen, A., Schiøttz-Christensen, B., Søborg, B., Krog, C., Møller, C.M., Halling, C.M.B., Lauridsen, H.H. and Hansen, I.R. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal, 26(9), 2242-2257.
    4.  BMJ. (2018). Assessment of neck pain. BMJ Best Practice. http://www.bestpractice.bmj.com.
    5.  McLean, S.M., May, S., Klaber-Moffett, J., Sharp, D.M. and Gardiner, E. (2010). Risk factors for the onset of non-specific neck pain: a systematic review. Journal of Epidemiology & Community Health, 64(7), 565-572.
    6. Paksaichol, A., Janwantanakul, P., Purepong, N., et al. (2012). Office workers’ risk factors for the development of non-specific neck pain: a systematic review of prospective cohort studies. Occupational and Environmental Medicine 69(9), 610-618.
    7. Cohen, S.P. and Hooten, W.M. (2017). Advances in the diagnosis and management of neck pain. British Medical Journal. https://www.bmj.com/content/358/bmj.j3221.
    8.  Binder, A. (2007). The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica 43(1), 79-89.
    9. Barry, M. and Jenner, J.R. (1995). Pain in neck, shoulder, and arm. British Medical Journal 310(6973), 183-186.
    Other Conditions in Neck, Orthopaedics

    Whiplash Disorders

    An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.

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    Thoracic Outlet Syndrome

    A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.

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    Cervical Disc Dysfunction

    Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.

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    Cervical Spinal Stenosis

    Narrowing of the spaces through which the neck spinal nerves travel which can result in weakness, pain and reduced function.

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