Self-care: Neck

• Neck pain is rarely linked to serious disease or tissue damage.
• Clicking and creaking of the neck is common and is rarely a sign of harm or damage.
• Necks do not ‘go out of place’.
• There is no one ideal posture, changing posture regularly will help symptoms.
• Treatments such as surgery, injections or strong pain medications and not very effective for most common neck pain in the long term. They can also often have negative side effects.
• Even if you have had neck pain for a long time, it can often improve with the right management – consistency is key!
• X-ray and scans are not usually needed to diagnose neck pain.
• X-ray and scans are not able to tell us how much pain you are experiencing.
• X-rays and scans often will identify osteoarthritis and disc bulging which are common finding, even in those that do not have neck pain and this will often not change the management of the condition.
• X-rays and scans are best used when there is suspicion of serious injury ie broken bone, or conditions such as cancer or infections.

• Pain in the neck which may move to the upper area of your back and/or down your arm.
• Stiffness with movement after a period of rest or reduced movement.
• Increased tension in the muscles and/or headaches.

• Generally, keeping moving is the best thing to do to aid recovery and return to usual function.
• Within the first 48 hours, it may be necessary to ease back a little on usual activities and ‘relatively rest’ the painful areas.
• Try not to stop using your neck and carry out a few movements every hour to prevent stiffness.
• After 48 hours, you may wish to increase the use of your neck gradually.
• Most people will find keeping mobile ‘little and often’ is beneficial, as our muscles, nerves and joints respond well to movement. This is needed to keep them healthy. 
• Improving your sleep and general health is also important for neck pain.

• It is very important that you are coping well with your pain.
• It is important to manage your pain so that you are able to move more comfortably. Taking regular pain relief will maximise its effect.
• You may wish to speak with your community pharmacist, allied health prescriber or GP about pain relief.

• Usually, keeping time off work to a minimum has been shown to have better outcomes for recovery. It is not always necessary to be pain free before returning to work.
• You may wish to avoid recreational activities or sports which involve significant demand until your pain has reduced and your movement has returned.

• Seek advice if there has been significant trauma (fall from height) or a direct injury to the neck
• If you have severe pain and are unable to move your neck at all due to pain
• If you develop worsening arm pain or loss of function affecting one or both your arms

A rare but serious spinal condition, myelopathy, can lead to permanent damage or disability. You will need to be seen by an emergency specialist spinal team. It is the medical term for spinal cord compression at the neck or chest level (thoracic) of the spine. Symptoms usually start slowly over time, more rarely they can progress suddenly.  Pain is not always the primary concern for this condition. Please see below some of the symptoms that can be experienced with myelopathy. Should you have any combination of these symptoms, seek care urgently through your GP:

• Clumsiness and loss of finger dexterity, including difficulty doing buttons up, writing, using cutlery
• Pins and needles and numbness affecting both arms or both legs
• Loss of co-ordination in your legs, such as tripping, falling or feeling unsteady
• Difficulty walking.
• Your legs may become weak or feel stiff
• Altered sensations such as trickling water
• Muscle weakness

In some cases of myelopathy, patients may deteriorate very quickly (over 4 weeks) and may require immediate medical attention. If this happens, you may experience symptoms detailed below. Should you have any combination of these symptoms in addition to any of those above, seek emergency attention via A&E:

• Loss of feeling/pins and needles between your inner thighs or genitals
• Numbness in or around your back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increasing difficulty when you try to urinate or loss of sensation when you pass urine
• Leaking urine or recent need to use pads
• Not knowing when your bladder is either full or empty
• Inability to stop a bowel movement or leaking
• Loss of sensation when you pass a bowel motion
• Change in ability to achieve an erection or ejaculate
• Loss of sensation in genitals during intercourse

Useful advice and exercise on the self-management of neck and arm pain from the Tyneside Musculoskeletal Service - https://www.tims.nhs.uk/wp-content/uploads/2020/07/TIMS-Management-of-Neck-Pain-New.pdf

Versus Arthritis advice - https://www.versusarthritis.org/media/23110/neck-pain-information-booklet.pdf

Working from home (Institute of Ergonomics) - https://www.versusarthritis.org/media/23110/neck-pain-information-booklet.pdf

Help and support

• If after six weeks you have tried the advice and exercise suggested and your symptoms haven’t improved, a self-referral to NTIMS may be beneficial.
• Click here for self-referral