Soft Tissue Injury: Neck pain

  • Reference Number: HEY1039/2019
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Introduction

This leaflet has been produced to give you general information about your neck pain. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If, after reading it, you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What causes Neck Pain?

 Neck pain is common even without an accident or injury and is rarely due to any serious disease. Your neck is strong. Like the rest of your spine, your neck is made of solid bony blocks known as vertebrae which are joined by discs to give it strength and flexibility. It is reinforced by strong ligaments (tissue connecting bones) and surrounded by large and powerful muscles that protect it. Most simple neck strains do not cause lasting damage.

There are a number of possible causes for the symptoms you experience most of which will resolve on their own if you follow the advice in this leaflet.

Non-specific neck pain

Many people develop a stiff and painful neck for no obvious reason; it may happen after a minor twisting injury. This type of neck pain is thought to be caused by spasm in the muscles supporting the neck and will usually disappear after a few days or weeks.

Whiplash

Whiplash injuries are most commonly seen as a result of a car accident.  Patients often present to the Emergency Department with a minor whiplash as it can be very painful and it is natural to think that an injury may have occurred.  However the facts below show that this is not usually the case:

  • Permanent injury is rare. The long term prognosis is good
  • Most whiplash injuries are not serious. There is usually no damage to the bones, discs or nerves in the spine and any serious injuries are usually detected early.
  • There is often a delay before you feel any pain or stiffness and this may get worse over several days after the accident. This is a good sign that there is nothing seriously wrong and it is usually caused by muscle spasm where your body naturally trying to protect you from experiencing pain.
  • Whiplash causes neck pain but can also cause back pain, again there is rarely a serious injury to the back.
  • Headaches are common in whiplash injuries: they are caused by tension in the neck. Other symptoms such as arm, jaw pain or dizziness are also common but usually improve along with the neck pain.
  • Most of these injuries improve within a few days or weeks.
  • Aches and pains can sometimes persist and may recur for quite a long time after a whiplash injury.
  • What you do in the early stages is very important – following the advice in this leaflet is really important to help you recover

Cervical spondylosis

Spondylosis is a term used to describe osteoarthritis of the spine. It is a degenerative condition and is quite a normal finding as we age. In many people degenerative changes will not cause pain but it may increase the risk of developing neck pain.

Tension

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

What symptoms may I experience?

Pain and stiffness

Pain may be in the middle of your neck or to one side or the other. The pain may travel to your shoulder or shoulder blade or to the upper chest. You may find it painful to move and muscles may feel tight. Stiffness is often worse after prolonged rest or sitting in the same position for a long time.

In tension headaches the pain often travels to the back of the head and sometimes behind the eye, to the side of the head or even to the ear.

Numbness and tingling

If there is pressure on a nerve you may have numbness and/or pins and needles down your arm, sometimes all the way down to your fingers. The nerve can be affected in this way but often resolves on its own.

Clicking / grating

You may hear or feel clicking or grating as you move your head – this is known as crepitus. It is caused by bony surfaces moving against each other or by ligaments moving over bone. Other joints often make these sounds but they often seem louder in the neck because they are happening closer to the ears. This is quite common and can sound alarming but is not serious.

How are neck problems diagnosed?

The member of the clinical team who assessed you may have identified the source of your pain and given you an exact diagnosis.  If this has not been possible, we understand that this can be frustrating for you.

An X-ray or scan is not usually required to diagnose your neck pain.  However, in very rare cases, there may be something more serious or underlying that requires further investigation.  A scan or X-ray may be arranged for you if experience any of the following:

  • Pain that is getting much worse despite following the advice in this leaflet
  • Lack of co-ordination: for example trouble with tasks like buttoning a shirt
  • Heaviness or weakness in your arms or legs
  • Pins and needles in an arm as well as pain
  • Problems walking
  • Loss of bladder or bowel control

If you do develop any of the symptoms listed above then we recommend you attend or return to the Emergency Department immediately for a further assessment.

Why have I got neck pain?

Many factors can contribute to the severity of neck pain that you experience and how long it persists. There is often a combination of the factors involved:

  • Physical factors such as wanting to protect the neck and avoiding movements
  • Psychological factors including a fear of damage or not getting better or being stressed
  • General health and lifestyle factors like being tired and rundown, being overweight and not getting enough physical activity and sleep

Each of the factors above can impact on the severity of your pain, raising your awareness to these will enable you to recognise them and take action to reduce the impact.

Advice to help your recovery

To manage your pain, we advise that you regularly take simple pain relief which can be bought over the counter. If you have allergies or conditions which prevent the use of pain-relieving or anti-inflammatory medication, please seek advice from your GP or a pharmacist.

You may have been given a muscle relaxant medication called diazepam for a few days to help reduce the muscle spasms you are experiencing. These may make you drowsy and you MUST NOT drive or operate machinery whilst using these.

Exercise and rest

Scientific studies now indicate rest and activity avoidance for more than a day or two actually leads to higher levels of pain, greater disability, delayed recovery and longer absence from work. This is because the lack of activity may weaken the neck muscles and as a result the neck muscles will tire more easily and become more vulnerable to further strain.

Your neck is designed for movement and the sooner you resume your ordinary activities as normally as possible the sooner you will start to feel better. Where possible it is recommended you try to stay at work, amending your duties in the short term if necessary.

You may find heat packs or a cold compress for 5 – 10 minutes at a time will help to reduce pain and muscle spasm. Whichever you choose is personal preference but always be careful not to burn the skin by not having the water too hot and if applying ice ensure there is a barrier such as a damp tea towel between your skin and the ice pack. When using ice always check the skin regularly and stop using immediately if the area becomes white, blue or blotchy or the area becomes extremely painful, numb or tingly.

Physical exercise, such as brisk walking, gym classes, swimming or a sports activity, are shown to be very helpful in tackling pain and the most effective way of preventing further episodes.

Regular physical activity will:

  • Give you stronger bones
  • Strengthen your muscles
  • Keep you supple
  • Improve your fitness
  • Release natural chemicals that can help reduce your pain

There is no one type of exercise that is proven to be more effective than another so choose something that you will enjoy and that fits in with your daily routine. Whatever you choose start slowly and build up both the amount that you do and the intensity. You may initially find you a little sore during or after your exercise but over time and with determination you will find that this will reduce.

Posture

Check your desk height and chair design both at home and work, this is important to prevent further problems.

When sitting your hips and knees should be at right angles and you should have a good support for you lower back. Hardback, upright chairs are better for your posture than low soft upholstered chairs and sofas. Back supports to lean against can help your posture when sitting at home, work or in the car.

If you work at a computer screen it is important to have the screen, desk and chair at the correct height. Many employers have occupational health specialists who can check workstations are set up according to individual needs. You may want to look at the Health and Safety Executive (HSE) website for guidance on ‘Working with display screen equipment’

Sleep

The importance of sleep in tackling pain has become increasingly apparent in recent years. Sleep reduces stress and improves your overall feeling of wellbeing; making you less prone to the triggers of pain and helping you cope if it does occur.  It is advised that you aim for 7.5 – 8 hours sleep at night and try to keep to a regular routine, as far as possible. There is no recommended position for sleep or particular type of mattress or number of pillows, whatever feels most comfortable to you is the best.

Is surgery an option?

Sometimes due to the nature and injury of the neck, surgery may be required.

Evidence suggests that the outcomes for patients undergoing surgery are no better in the medium or long term than non-surgical treatment such as exercise.  Non-surgical treatments, such as exercise and activity, should always be considered as the first options.

When to seek further help

If your neck pain does not settle after 6 – 8 weeks and you have not already done so, you should refer yourself to a physiotherapist.  Physiotherapists provide expert advice, guidance and treatment for neck pain. This is to help reduce the possibility of a recurrence, whilst helping to improve your overall health and well-being.

If you have a Hull GP telephone (01482) 300003

If you have an East Riding GP telephone (01377) 208300 or you can self-refer online at www.yourphysio.org.uk

If your GP is not in Hull or the East Riding please contact your GP for advice.

If the physiotherapist has any concerns following their assessment of your neck they will refer you on to the appropriate care provider to address your needs.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.