With more than 20 muscles, eight pairs of nerves and seven bones, the neck is a complex pedestal charged with supporting an 11-pound braincase through all manner of motion. So it’s no surprise that things sometimes go wrong. And when they do, the neck is, well, literally a pain in itself.
“There’s a lot going on in the neck,” says Seth A. Waldman, MD, MBE, Director of the Division of Pain Management and the C.V. Starr Endowed Chair in Pain Management at HSS. “It’s one of the areas of the body with a tremendous number of overlapping nerves and other structures. As a result, problems with the neck can lead to pain not only in the neck itself but also in referred pain and other symptoms in the head, chest, arms and legs.”
Although neck pain often goes away with simple treatments like rest and over-the-counter painkillers, certain red flags signal the need for prompt medical attention, Dr. Waldman says. These include:
“If you bend your chin down and feel a shock in your extremities, that could be a sign of a compression of the spinal cord and should be immediately evaluated by a physician,” Dr. Waldman says. (Neck pain in the aftermath of a traumatic injury, such as a car accident or a fall, should always be considered an urgent condition requiring immediate medical attention, he says.)
For people with neck pain but none of the red flags mentioned above, Dr. Waldman recommends an initial course of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), or acetaminophen (Tylenol); applying heat, such as with a heating pad; and gentle stretching of the muscles in the neck, upper back and shoulders.
If you’ve tried these for a week and the pain either doesn’t improve or worsens, it’s time to see a clinician with expertise in spine care.
During your appointment, the clinician will take a medical history and perform a physical examination. The importance of the physical examination is “to make sure we’re not missing any signs of compression, such as changes in reflexes, sensation, or strength,” Dr. Waldman says. “Sometimes these signs are not apparent to the person experiencing them.”
A doctor may also order imaging tests, such as a x-rays, MRI or CT scan. These tests can help guide additional treatments, which could include epidural steroid injection, trigger point injection, radiofrequency ablation, or, when necessary, surgery.
In the absence of serious nerve compression, patients typically are referred to a physical therapist. “That’s the most important thing -- being in the hands of an experienced physical therapist is key,” Dr. Waldman says.
Physical therapy will involve a regimen of strengthening and stretching of the muscles in the neck as well as exercises designed to improve posture – a significant source of neck pain for many people, particularly those who spend their days staring at computer screens.
“Neck pain is an epidemic, and we saw lots more of it during the Covid-19 pandemic because of changes in work habits,” Dr. Waldman says. Another culprit: smartphones, which have changed our postures significantly for the worse, he adds.
If you catch yourself hunching over at your desk or craning your neck to read a new text on your phone, correct that poor posture by squeezing your shoulder blades together and down toward the floor. It might help to imagine that you’re trying to pinch a pencil between them, Dr. Waldman adds.
A variety of clinicians may be involved in the care of people with neck pain. These include pain medicine specialists like Dr. Waldman; physiatrists; neurologists; sports medicine doctors; spine surgeons, and physical therapists.
“With a good physical therapist and participation in a corrective exercise program, most people will get better,” Dr. Waldman says.