What You Can Do About Neck Pain

Among all neck pain treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation.

Almost everyone has neck pain at some point in their lives, says Frank Pedlow, MD, an orthopedic spine surgeon at Harvard-affiliated Massachusetts General. Acute cases usually resolve within two months, but up to a third of this group still have recurrences more than a year later.

Neck pain has many causes, including poor posture, stress, a lack of sleep, poor positioning while sleeping, bad computer habits, or weakening muscles.

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Far fewer instances of neck pain are the result of diseases such as arthritis and degenerative disks, injuries, accidents, heavy lifting, and other spinal problems.

(If your neck pain accompanies numbness or weakness in your arms or hand, or shooting pains in your shoulder or your arm, seek medical attention.)

Those disparate causes, however, funnel back to anatomy. The Arthritis Foundation offers the analogy of a “bowling ball propped on our tiny neck bones.”

“The anatomy of the cervical spine is a marvelous construct that provides support for the head and allows for a high degree of mobility and range of motion,” adds Spine-health, a subscription site for doctors. “But the same engineering that allows this area of the spine to be so flexible also leaves it vulnerable to injury.”

If you have chronic neck pain, try conservative, self-treatment first. The simplest advice is to move. Among all treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation in different contexts.

Correcting bad posture takes focused work, but if you just get up and move around enough, your neck is less likely to have muscle strain from being in one position too long. That’s especially likely to happen at work.

Next, try to stay calm. Stress triggers muscle tension, so be mindful of what gets to you — and learn to practice relaxation techniques such as sequenced, deep breathing. You can add mediation, yoga, and exercise to that list. Even just listening to music or sounds designed for peace of mind can work. Listen to some whales sing, for instance.

There’s all sorts of advice based on ergonomics, the science of how you use chairs, desks, and other devices for comfort and usability. Make sure, for instance, that your computer is eye level so it’s easy to see. Keep related work materials at eye level as well. Use a speakerphone or a headset instead of tucking the handset between your neck and your shoulder.

Become aware of habits that put your neck in positions that strain its muscles. When you’re paying attention, you’ll probably be surprised at how many things you do to strain your neck.

You can also try cold packs and heat. While the cold helps reduce inflammation, heat helps promote blood flow. Both can lead to recovery. Cold also numbs pain, and heat eases stiff muscles.

For sleep, use a quality mattress to keep your head and spine aligned, and use a low, comfortable pillow; using too many pillows can force your neck into unnatural positions.

Get a good night’s sleep. Lack of sleep increases the risk of sore muscles and neck pain. Research suggests one sleep disorder in particular, sleep apnea, may contribute to osteoporosis.  

Being fit and trim can lessen, or eliminate, neck pain. You probably already know that being overweight can strain all of the body’s muscles. If you’re a normal weight and you stay in shape, you’ll put less stress on your body, and your stronger muscles will better support your neck.

You particularly benefit from strengthening your core — athletes from all walks have taken that advice — because it lessens the risk of injury elsewhere in the body. Weak stomach muscles force the upper back and neck into positions that create tension.

Exercise specific to the neck helps as well. A study in Finland looked at the effectiveness of strength training in the neck, compared with stretching or no exercise. Results showed the strength-training exercises worked best to relieve neck pain.

“The emphasis previously has been on stretching exercises, but the study showed their effectiveness alone is poor for chronic neck pain,” said lead researcher Jari Ylinen. “Stretching should be combined with strengthening neck and shoulder muscle exercises.”

You should also consider an occasional analgesic.  Acetaminophen (Tylenol) or ibuprofen (Motrin) reduce inflammation and pain, which may be all you need for a short-term problem.

If you’ve had a massage before, you know how much it can help sore, tense muscles. At home, have someone rub your neck and shoulders with a lotion or oil. Topical analgesics, such as Tiger Balm or Icy Hot, may also help.

Some people like to make their own “natural” massage oil with analgesic properties, containing ingredients such as camphor, menthol, or eucalyptus oil. If no one is available, rub your neck yourself for up to 15 minutes.

A review of 23 randomized controlled trials concluded that combining manual therapy and exercise was better than either alone.

Especially for severe cases, you may need professional help, such as — a physical therapist, chiropractor, or orthopedic specialist.

A study, led by pain specialists at Johns Hopkins University School of Medicine, reported that combination therapy seems most effective for a “common form” of neck pain — a herniated disc or narrowing of the spinal canal, called stenosis. The results suggested that spinal steroid injections and conservative treatment with physical therapy work equally well, but over time a combination of the two worked even better.

“We designed our study to answer the question that primary care doctors face when they see patients with neck pain: `Should I send them for a series of injections, try conservative measures first or do both?’” said Steven P. Cohen, MD, one of the study authors. Cohen added that the combination therapy has become a “cornerstone” in rehabilitation medicine. The rationale is that without the reinforcement of the physical therapy, relief from injections is usually temporary.

Either way, you have options. Many people don’t seek relief or treatment, choosing to suffer in silence. But you may not have to suffer, so why not be good to yourself?

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