Neck Pain: Causes, Treatment and When to Get It Looked At
Medically reviewed by Kim Le on
Neck pain is one of the two most common reasons people book in at Marrickville, and the great majority of it falls into a small number of recognisable patterns. Knowing which one you are in tells you a lot about what to expect.
What is usually going on
Mechanical neck pain. By far the most common. The pain is local to the neck and upper shoulders, changes with position and movement, and is often worse at the end of the day or after sustained desk work. Nothing is torn or damaged; specific structures are simply being loaded more than they can comfortably tolerate.
Acute wry neck. Waking up with the neck locked to one side, unable to turn, in disproportionate pain. Dramatic, frightening, and almost always self-limiting over days to a couple of weeks.
Cervical radiculopathy. Pain that travels from the neck into the arm, usually following a defined path, often with pins and needles or numbness in specific fingers. This means a nerve root is irritated. It needs proper assessment, and it generally takes longer to resolve.
Whiplash-associated disorder. Following a car accident or similar rapid acceleration of the head. Symptoms can appear a day or two later, and often include headache and dizziness as well as neck pain.
Referred pain from elsewhere. The shoulder and upper thoracic spine both refer into the neck region, and the neck refers into the head and arm. Working out where the pain is actually coming from is a good part of the assessment.
Why it develops when nothing happened
Most people who come in with neck pain cannot identify a cause, and find that unsettling. It is worth understanding why the absence of an incident is normal.
The neck’s job is to hold about five kilograms of head in a position that lets your eyes point where you need them. It does this all day, and it does it best when the head is balanced over the shoulders. The further forward the head drifts, the harder the muscles at the back of the neck have to work to hold it, and the more load goes through the joints at the back of the cervical spine.
Nothing about a single instance of this is harmful. The problem is duration. Six hours a day for years of a slightly forward head position is a large cumulative load applied to tissue that is entirely capable of handling it briefly.
Add poor sleep, a stressful period producing sustained muscle tension, and a workstation that never quite got set up properly, and you have the ordinary origin story of most neck pain — no incident required.
What treatment involves
An assessment comes first, and it should include screening for the things that are not mechanical neck pain. That means asking about the red flags below, testing the nerves supplying the arm if there are any arm symptoms, and checking the shoulder and thoracic spine as possible sources.
Treatment for mechanical neck pain typically combines:
Manual therapy. Joint mobilisation or adjustment to the segments that are not moving well, and soft tissue work to the muscles that are carrying the load. This generally produces the fastest change in symptoms.
Loading changes. Screen height, pillow, how long you hold positions. Unglamorous, and the part that determines whether the pain stays away.
Exercise. Specifically endurance work for the deep neck flexors and the muscles between the shoulder blades. Both tend to be underactive in people with persistent neck pain, and both respond to fairly modest amounts of the right work.
Realistically, most simple mechanical neck pain improves substantially within two to four weeks with a small number of treatments. If we are not seeing meaningful change after three or four sessions, the working diagnosis is wrong and it needs revisiting — which is a conversation we would rather have at session four than session fourteen.
Radiculopathy is slower. Expect weeks to months rather than days, with the arm symptoms typically resolving from the hand back toward the shoulder.
Neck pain that needs medical assessment rather than manual therapy. Attend an emergency department for:
- Neck pain after significant trauma — a car accident, a fall from height, a sporting collision — particularly with midline tenderness
- Neck stiffness with fever, severe headache and sensitivity to light
- Sudden severe neck or head pain with dizziness, slurred speech, visual disturbance, facial drooping or difficulty swallowing
- Weakness or clumsiness in both arms, unsteadiness on your feet, or any change in bladder or bowel control
See a GP promptly for progressive arm weakness, neck pain with unexplained weight loss or fever, a history of cancer with new neck pain, or neck pain that is unrelieved by any position and consistently wakes you at night.
Getting it assessed
If your neck pain has not started to improve within a couple of weeks, keeps returning, or comes with any arm symptoms, an assessment is worthwhile. Not because it is likely to be serious — it usually is not — but because the useful part is working out which structures are involved in your particular case, and that is genuinely individual.
Our team sees neck pain daily at both Marrickville and Wetherill Park, and for most people it is a short course of treatment plus a handful of changes to how the neck is loaded during the day.
Common questions
- How long should neck pain last before I get it checked?
- Most simple neck pain improves noticeably within one to two weeks. If it has not started improving by then, is getting worse, or comes with arm symptoms, it is worth having assessed.
- Do I need a scan for neck pain?
- Usually not. Imaging is indicated when there has been significant trauma, when there are neurological signs, or when red-flag features are present. For ordinary mechanical neck pain, scans frequently show age-related changes that are also present in people with no pain at all, which can be misleading rather than helpful.
- Is neck pain from my pillow?
- A pillow can contribute, particularly if it holds your head at an angle for hours. It is rarely the sole cause. If your neck is consistently worse on waking and settles through the morning, the sleeping setup is worth changing before anything else.
- Can stress cause neck pain?
- Yes, in a straightforward mechanical way — sustained low-level muscle tension in the neck and shoulders is a common physical response to stress, and sustained tension is what produces this kind of pain. It is a real cause with a real mechanism, not a way of saying the pain is imagined.
