Neck pain

• Pain - Depending on the problem, the pain may be central or to one side of the neck; pain may also be felt in the shoulder or the upper chest; headaches caused by tension in the neck are often felt at the back of the head but sometimes behind the eye or even in the ear.
• Stiffness – This is a common symptom. The muscles feel tight so movement is difficult, particularly after resting or sitting in a fixed position
• Clicking and grating – You may hear or feel clicking or grating (called crepitus) as you move your head. This is caused by roughened bony surfaces moving against each other or by ligaments rubbing against bone. This is quite common and doesn't mean there is anything seriously wrong with your neck
• Dizziness and blackouts – You may feel dizzy when looking up or may occasionally have blackouts. These symptoms can occur in a condition called cervical spondylosis when changes in the vertebrae cause pinching of the vertebral artery
• Muscle spasms – Occasionally muscle spasms occur alongside neck pain and in more severe cases can even cause the head to turn to one side (torticollis)
• Numbness or tingling – If a nerve root is pinched then you may have numbness or tingling that can be felt down the arm to the fingers.

Non-specific neck pain

Many people develop a stiff and painful neck for no obvious reason. Having non-specific neck pain doesn't necessarily mean that your neck is damaged and x-rays may appear completely normal. Non-specific neck pain is the most common type of neck pain and usually disappears after a few days.

Cervical spondylosis

With everyday use over many years the intervertebral discs and the facet joints in the spine can become worn. The discs become thinner and the spaces between the vertebrae become narrower. Spurs of bone, known as osteophytes, may form at the edges of the vertebrae.

These changes are a particular form of osteoarthritis but are usually known as cervical spondylosis. The changes in the spine can be seen on x-rays and are present in almost everyone by the age of 65 but they don't always cause problems or pain.

When these changes do cause problems, they may come either from the linings of worn joints or from stretched ligaments.

• Occasionally, either bulging discs or osteophytes may pinch the nerve roots  causing pain or numbness
• If the vertebral artery is pinched the blood supply to the brain can be affected causing dizziness or blackouts
• Sometimes an extra rib (cervical rib) can cause partial blockage of the blood supply to the arms, resulting in pain and numbness in the hands
• Very rarely, in severe spondylosis, the spinal cord can be squeezed, which causes weakness and numbness in the arms and legs.

Whiplash

Whiplash injuries are usually caused by impact trauma and are most often seen as a result of car accidents. Whiplash is caused by the body being carried forward causing the head to flip back – then, as the body stops, the head is thrown forwards. There is often a delay before you feel any pain or stiffness from whiplash.

Although whiplash can badly damage your neck, most of these injuries improve within a few weeks or months. Seat belts and properly adjusted headrests in cars significantly reduce neck damage from whiplash injuries.

Tension

Most muscles of the body relax completely when they are not being used but some muscles are working all the time to keep your body upright. Muscles at the back of your neck must always be tensed, otherwise your head would fall forwards when you are sitting or standing. When we are worried or stressed we tighten these muscles even more, which can cause neck pain and tension headaches.

Other neck problems can be diagnosed and treated after a simple examination and it is unlikely that any special tests will be needed.

In some cases a doctor may ask for an x-ray, a magnetic resonance imaging (MRI) scan or blood tests. Blood tests and x-rays can help to rule out an infection or a condition such as ankylosing spondylitis which causes stiffening of the spine. MRI scans are usually only carried out if your doctor suspects a nerve is being pinched.

Drugs

In some cases an injection may help. The injection may be a long-acting local anaesthetic or a steroid preparation, and may be given into the small facet joints of the neck or sometimes into the narrow spaces where the nerves emerge from the spine.

Injections are usually performed in an x-ray department so the specialist can position the needle precisely.

Physical therapies

Physiotherapists, chiropractors and osteopaths can offer manual treatments to treat neck problems. Manipulation of the neck can sometimes be uncomfortable at the time, but often brings relief from pain quite quickly.

There is no evidence that reflexology helps with neck pain. However, acupuncture can bring pain relief.

Surgery

Surgery is only rarely needed. It may be helpful if a nerve is pinched and is causing weakness or severe pain that won't go away. The surgeon will ask for a scan to look at the nerves and bones before discussing with you whether to go ahead with surgery.

Painkillers

You can take simple painkillers (analgesics) such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which are available from chemists or supermarkets. Anti-inflammatory gels or creams can be rubbed directly into tender areas and are a useful alternative if you have problems taking tablets.

Exercise

Massage

Gentle massage of the neck muscles, particularly with aromatic oils, often helps. And rubbing the area with liniments can also help. Some over-the-counter liniments contain capsaicin (an extract of the capsicum, or pepper, plant), which has a warming, soothing effect. Similar but stronger preparations are available on prescription.

Relaxation

Stress can make neck pain worse. One way of reducing the effects of stress is to learn how to relax the neck muscles. Relaxation and exercises are not mutually exclusive – they complement each other.

Posture – at work and rest

Pain and stiffness can be caused by a number of factors:

• by poor standing posture
• by too soft a bed
• by the wrong thickness of pillow
• by poor posture at work – if your desk is too low, so that your head is bent forward for long periods, then the neck may be stretched and you may develop muscle pain.

Many employers have occupational health specialists who can check that workstations are set up according to people's individual needs.

The Alexander Technique is a method of improving your bodily awareness and reducing muscle tension. This can help to heal existing problems and to reduce the likelihood of further injury. A qualified teacher of the technique will advise on your posture and your patterns of movement.

Collars

There's no evidence that special collars will help with the causes of either short-term or long-term neck pain. They can be helpful if you have a pinched nerve causing pain radiating down the arm, although it's best not to wear them for long periods of time.