Neck pain

Understanding neck pain

Neck pain can occur from the top of your shoulders to the bottom of your head and is commonly experienced by most people, at some point in their life.

Common causes of neck pain include:

sitting at an awkward angle watching TV, reading a book or even talking on the phone
sitting at a desk in an uncomfortable posture
sleeping with a pillow that is too high or too flat or sleeping on your stomach
muscle tension as the result of worry or stress
overdoing activities such as painting or gardening

In most cases, the pain will often last less than a few weeks but can be very debilitating, affecting your everyday activities.

It is important to see your GP if:

your neck pain came on following a fall or trauma

you have pain, tingling, numbness or weakness in your arms or legs

you have dizziness, have had blackouts, double vision, slurred speech or problems swallowing following the onset of neck pain

you suddenly develop stiffness in the neck along with stiffness in both shoulders

About the neck

The neck, also referred to as the cervical spine region, consists of seven vertebrae bones (C1-C7). Between the vertebrae are round rubbery pads called discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. The spine also provides protection to important neurological structures such as the spinal cord, which is contained within the centre of the spine called the spinal canal.

Neck pain or a stiff neck is a common problem that will affect almost everybody at some stage in their life. Around 50% of people with neck pain will experience a recurrence of their problem. Most neck pain is "mechanical" (the pain originates from the joints, bones or soft tissues in and around the spine).

Symptoms usually get better after a few days or weeks with simple self help treatments, and will not cause any long-term damage. It’s rarely a sign of anything serious.

A diagram outline the head, with lines putting to the skull, the spine and the spinal cord. A zoomed in diagram of the spine points to the facet joint and nerve roots from the spinal cord to the arm.

Common causes of neck pain

Osteoarthritis

Osteoarthritis, is a condition which affects the joints of the body, causing pain and stiffness. It can also be known as 'wear and tear', 'age related changes', 'degeneration' and in the neck it is called cervical spondylosis.

This condition is common as you get older and can cause stiffness and pain in the neck. Arthritis does not always cause pain but can increase the risk of having a flare of neck pain.

Stiffness and restriction, particularly on turning or looking upwards may be felt. There may be pain, particularly at night and difficulty finding a comfortable position.

You may hear grinding, grating or clicking noises from the neck. The noises in your neck seem louder as it is close to your ears. This is called crepitus, as the structures in the neck move across one another. This may be more noticeable during a flare up or at certain times of the day. This is a common symptom and may be alarming but is not serious and is very common.

Stress can make neck pain worse as it causes the muscles to become tight and over-protective. Learning how to reduce the effect of stress can help relax your muscles. There are many meditation and mindfulness resources available online. Massage, stretching and heat can also help.

You can apply a heat or ice pack throughout the day to ease pain and stiffness. Ensure you protect your skin to avoid burns or irritation. Do not use ice if you have poor sensation over the area, an infected wound, Raynaud’s Syndrome, or Cryoglobulinaemia.

Neck exercises

Read below for advice and exercises to manage neck pain.This guidance has been produced by the Dynamic Health physiotherapy service. It offers simple measures to help you manage your neck problem safely. Often the right advice and exercises are all you need to improve the problem.

This information has been made available to your GP, who may ask you to try the advice and exercises prior to consulting a physiotherapist.

Seek urgent medical advice if your neck pain started suddenly after a recent trauma, or if you have any of the following symptoms:

arms and/or legs are becoming progressively weaker or losing co-ordination

progressive worsening of balance and unsteadiness on walking

new recent changes to bladder or bowel function such as urgency to pass urine, difficulty passing urine or faeces or lack of control leading to incontinence.

any rapid muscle wastage in the upper body

Exercise aims

The aim of exercise is to get your neck moving in a normal way and improve your range of motion. It can also prevent you developing secondary stiffness and weakness around the area, which can arise from avoidance of movement.

Regularly changing position and posture can prevent pain resulting from prolonged stationary positions. Practicing the exercises little and often throughout the day can help.

It is also important to find general exercises you like doing to keep your neck moving and which help to improve your general fitness. For example, walking, swimming, exercise classes and pilates.

Ache, discomfort and a feeling of tightness are all expected during exercises and can even continue after you have finished the exercises for a short period of time.The exercises should not produce any severe pain or make your neck pain worse.

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise every other day

Allowing enough rest is important to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 5 to 10 repetitions of each exercise, 3 to 5 times a day.

Rest

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it

Increase the number of repetitions (you could aim to increase it by 2 to 5 repetitions every 2 weeks). Or hold the positions for longer or move to a more challenging exercise.

How much pain is too much pain?

Read below for advice and exercises to manage neck pain.

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Range of movement exercises

Neck flexion

Neck rotation

Neck side flexion

Neck flexion with controlled shoulder position

Chin tucks

Scapula retraction

Trunk rotation

Seated row without equipment

Strength exercises

All these exercises which involve lying down, can be adapted to be done sat in a chair.

Scapula retraction in front of mirror

Resisted neck side flexion

Resisted neck rotation

Resisted neck flexion

Prone scapula retraction with dumbbells

Lie on your stomach on your bed with your arms straight by your sides, holding a small weight in both hands is optional if it is initially too easy.

Rest your forehead on the bed and gently lengthen your neck.

Keeping your elbows straight, lift your arms and upper body off the bed.

In a controlled manner, return to starting position.

Shoulder blade retraction (middle trapezius)

Prone shoulder blade retraction with arms bent (middle trapezius)

Lie on your stomach on your bed.

Take your arms out to the side with your elbows at right angles.

Lengthen and align your body through your toes to the top of your head.

Maintain the width of your chest and back.

Lift your arms up and feel your shoulder blades moving towards your spine.

In a controlled manner, lower your arms to the bed.

Prone arm lift (lower trapezius)

Lie on your stomach on your bed, arms diagonally above your head.

Lengthen and align your body through your toes to the top of your head.

Maintain the width of your chest and back.

Lift your arms up and feel your shoulder blades moving towards your spine.

In a controlled manner, lower your arms back to the bed.

Dumbbell shrug

Seated dumbbell bent over row

Resistance band exercise with 1 arm

Resistance band exercise with 2 arms

Thera-band cervical extension

Place the middle of the band around the back of your head.

Grasp the ends of the band in front of your head.

Keep your neck in a neutral position with the chin slightly tucked.

Extend your elbows, stretching the band in front of you.

Slowly return, and keep your neck stable.

This exercise aims to help strengthen the deep neck stabilisers, including the deep neck flexors.

Lateral raise

Shoulder scaption

Top tips

Read our top tips about neck pain exercises.

Keep active whilst reducing activities that are aggravating your symptoms, for example, the length of time spent at your desk or the amount of heavy lifting.
A hot or cold pack can provide short-term pain relief. Apply this to the area for up to 15 minutes, every 3 hours and up to 4 times a day. Ensure it is never in direct contact with the skin.
Increased levels of stress can cause neck and back pain. Learning to practise relaxation, meditation or mindfulness techniques may be a useful management tool to reduce stress and general wellbeing.
Pain relief can help manage the discomfort in the short term. Normally painkillers bought from a pharmacist will work. If you have any questions please speak to a pharmacist or your GP.
Exercise aiming to strengthen and help the way you move in order to return to your normal activities. You do not need to do them all in one go. Try and build them into your everyday activities.
It is normal for it to take 6 to 12 weeks before you see a good improvement in your pain, movement and strength.
General exercise can really help your recovery so try to keep going with other activities you enjoy to keep fit. Even a brisk walk can really help.

Need more help? Consider self referring using the link below

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy

Senior white woman in a white blazer sitting in front of a desk with a computer as a practitioner explains during a physiotherapy appointment

Need more information?

Other help and advice

Cervical myelopathy and radiculopathy