Neck pain treatment depends on the cause, and in most people the pain is a strained muscle or an ageing joint that settles with simple measures. A smaller group have a pinched nerve or pressure on the spinal cord, and these need a proper examination.
What is cervical spondylosis?
Cervical spondylosis is age-related wear of the discs and small joints of the neck. The discs lose height, the joints thicken, and small bony spurs can form. It is very common after middle age, and X-rays show these changes in many people who have no pain at all. So a report that says "spondylosis" does not by itself explain the symptoms or decide the treatment.
Why a neck goes stiff
A stiff neck most often comes from a strained muscle or joint after an awkward sleeping position, long hours at a screen with the head bent forward, or a sudden movement. It usually eases over days to a couple of weeks. Gentle movement within comfort, regular breaks from the screen, a pillow that keeps the neck in line, and pain medicines taken as advised by the doctor are the usual steps. Forceful neck cracking or manipulation should be avoided unless a doctor has examined you.
Treating neck pain
- Assessment: an examination of neck movement, arm strength, sensation and reflexes. Most simple neck pain needs no scan. An X-ray is used when there has been an injury, when there are arm symptoms or warning signs. An MRI is added for arm weakness, signs of pressure on the spinal cord, or when surgery is being considered.
- Posture and work set-up: screen at eye level, feet supported, and regular short breaks.
- Physiotherapy: neck and shoulder-blade strengthening, mobility work and posture correction, usually the main treatment for lasting neck pain.
- Medicines: pain relief as advised by the doctor, for a short period.
Most people improve over several weeks. If the pain keeps returning or does not improve, get it examined before repeating the same treatment.
Arm pain from the neck (cervical radiculopathy)
Cervical radiculopathy means a nerve is pinched where it leaves the neck, usually by a disc or a bone spur. It causes pain that runs from the neck or shoulder blade into the arm or hand, often with tingling or numbness in particular fingers, and sometimes weakness. Most cases improve over weeks to months without surgery, with the measures above. If arm pain persists, the next options are discussed after the MRI.
Slipped disc in the neck
A slipped disc in the neck is treated in the same way at first. Surgery is considered when arm weakness is getting worse, when severe arm pain has not improved after a proper trial of non-surgical care, or when the spinal cord is being pressed upon. Cervical spine surgery is done from the front or the back of the neck, chosen by the problem and the scan: for example removing the disc through the front of the neck, often with a fusion, or decompression from the back. See decompression and fusion for more on these operations.
Pressure on the spinal cord (cervical myelopathy)
When age-related change narrows the canal, the spinal cord itself can be squeezed. Signs include clumsy hands, difficulty with buttons or writing, an unsteady walk, or a feeling of heavy legs, sometimes with bladder changes. This is different from ordinary neck pain and can progress slowly. Do not wait for it to settle: it should be assessed promptly by a spine surgeon.
Warning signs that need urgent care
Go to a hospital emergency department the same day, without waiting for an OPD visit, for:
- Neck pain after a fall, accident or blow to the head or neck.
- Fever with severe headache and a very stiff neck.
- Neck or arm pain together with chest pain, sweating or breathlessness.
- New weakness in an arm or leg, clumsy hands, loss of balance, or loss of bladder or bowel control.
See a doctor within a few days for neck pain with a past history of cancer, unexplained weight loss, a weakened immune system, or pain that is worst at night and not eased by rest.
Which doctor to see for neck pain
A family doctor or physiotherapist is a reasonable first step for simple neck pain. See an orthopaedic or spine surgeon if the pain has lasted more than a few weeks, if there is arm pain, tingling or weakness, if night pain disturbs sleep, or if the hands feel clumsy. Bring any MRI or X-ray. The wider spine service is described on the spine surgeon page, and back and leg pain on the slip disc and sciatica guide.