Neck pain

Episodes of neck pain can occur in anyone with wide ranging occupations, hobbies and levels of activity.

In recent years, our lifestyles and work situations have become more sedentary and more people are experiencing discomfort in the neck. This can be reduced by exercises and regular movement. Many people believe that ‘perfect posture’ will manage neck pain, but evidence does not support this. Our bodies are designed to move. Staying in one position for any length of time, no matter what that position is, can become uncomfortable. So it’s not about perfect posture but generally moving more.

Other, factors such as stress, tiredness or eye strain can contribute to ongoing or persistent neck pain. This can lead to pain or discomfort in the areas that tighten up when we are stressed leading to the feeling of stiffness.

Those with physical jobs and people who take part in regular exercise can also develop neck pain. Some people feel their symptoms come on after a specific event or injury but for others symptoms can seem to come from nowhere. The above factors including stress and tiredness can contribute to their symptoms and affect their recovery, as well as fear that their job or hobby could be harmful and prolong their episode.

In addition to neck pain, if a nerve gets irritated in your neck it can cause some pain going into the arm, we call this Radicular arm pain and people will often describe this as a ‘trapped nerve’ pain. This type of pain may be accompanied by pins and needles, numbness and sometimes weakness. These symptoms can start as a result of a specific event or for no apparent cause. The phrase ‘trapped nerve’ much like ‘slipped disc’ is misleading as there are lots of factors that can influence the nerve becoming irritated.

An MRI is not needed in the early stages as symptoms are likely to improve; it is unlikely to change your management and does not provide a prediction of your outcome.

If arm symptoms have persisted for a significant amount of time and have not responded to conservative management an MRI scan at that stage can be useful to aid further management. MRI scanning is rarely indicated with the presence of neck pain alone.

Reassuringly, many people find they have a natural recovery from an episode of neck pain without requiring any treatment. The timeframe for this can vary and for some people it can take several months.

Keeping active is important and neck pain can be eased through movement. If you are normally an active person or have a physical job, initially you may need to modify the type, intensity or frequency of activity and gradually build up to your normal levels.

It may be uncomfortable to move, but this does not mean that movement is harmful.  Painkillers like paracetamol or ibuprofen can reduce pain allowing you to move more comfortably. In general people that use pain control to help them to start to move and return to activity, recover quicker than people that hold themselves stiff and continue to avoid activity.

Taking regular pain relief is important to help manage your pain. When taking any new medication please follow the instructions on the packet and inform the pharmacist of any other conditions you have.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help.

Some gentle exercises to try:

If it is too painful to do the exercise in sitting, then you can start them lying on your back with your head on a pillow.

1. Bend your head forward until you feel a stretch behind your neck, bring your head back to neutral repeat this little and often throughout the day.

2. Tilt your head toward one shoulder until you feel the stretch on the opposite side. Bring your head back to neutral. Repeat this little and often throughout the day.

3. Pull your chin in, keeping your neck and back straight (not tipping your head forwards). Hold at the end position and feel the stretch in your neck. Repeat this exercise little and often throughout the day.

 4. Look up as far as you are happy to go feel the stretch then bring head back to starting position.  Do the exercise slowly and relaxed repeating this little and often throughout the day.

    5. In sitting. Turn your head to one side until you feel a stretch. Repeat to other side. Repeat this exercise little and often throughout the day.

Often, people try to ‘protect’ their neck to stop the pain coming back by becoming more guarded with their movements. They may be more cautious with activities such as lifting and carrying. These movements and activities are normal and safe. As your pain starts to improve gradually increase these movements and activities, increasing the amount of weight as appropriate to you.  If you have regular hobbies, you should try to get back to these as soon as you can, although you may need to build up gradually.

If your neck pain doesn’t settle, you may need some help from your local physiotherapist.

If neck pain remains severe and functionally limiting you may be referred on to a spinal service. They may consider limited injection therapy to complement and enhance engagement in long term self-management and this is quite often delivered by a pain service.

Radicular pain (nerve pain and symptoms in the arm)

Managing this is much the same as advised for neck pain above. 90% of people improve with no help at all. The emphasis is on pain relief as needed and keeping moving. If the arm pain is the most significant feature the addition of a neuropathic medication such as Amitriptyline, Duloxetine, Gabapentin or Pregabalin can be effective (NICE 2018).

If your neck pain and/or arm pain doesn’t settle, you may need some help from your local physiotherapist. If your arm pain is associated with weakness and loss of muscle bulk in the arm then make your GP aware.

If your arm symptoms do not settle with the conservative management tried above and remains severe and effecting your daily life and function you may be referred on for further assessment. At this stage you may have an MRI scan to see if there is any ongoing cause for the arm symptoms. Depending on the scan you may be offered a steroid injection into the neck to help with the arm symptoms by a specialist service.

Surgery for arm pain may be considered in the most severe cases but all conservative efforts should be exhausted in the first instance. Any surgery would only be considered if felt appropriate by a surgical team. The surgery will be aiming to help reduce the arm pain.

Today’s lifestyles can involve a lot of static and sustained postures, leading to increased muscle tension and sensitising the structures around the neck. By identifying these points in our day and breaking up these patterns with regular movement, we can help prevent the onset of neck pain.

Emotional stress for whatever reason in our lives will also increase tension in our body and make us more prone to perceiving pain in sensitised structures. We are becoming more aware of the need to look after our mental health and there are many resources available to help with mindfulness and relaxation. Making something like abdominal breathing a regular part of your day could reduce the build–up of tension (see ‘understanding the complexity of pain and other influencing factors’ section for links to helpful resources).

Poor sleep also contributes to pain.  Getting into good sleep routine such as relaxing or mindfulness at bedtime will have an impact on decreasing your sensitivity to pain.

General exercise is good for our physical and mental health as well as helping to manage neck pain. Using the government guidelines of at least 150 minutes of moderate intensity (or 75 minutes vigorous such as running) cardiovascular exercise over a week as well as 2 days of strength and balance exercise, is a good way to help judge if you are as active as you could/should be.

Understanding the complexity of pain and other influencing factors

What we have learnt through research is that pain, especially persistent pain is more complex than just what is going on locally to where you feel the pain. It can be affected by many things including poor sleep, poor general health, reduced fitness, stress, past experience of pain and our beliefs about pain and our physical structure. These factors have a very real physical effect on pain and how your body functions. The links below provide some insight into understanding pain, understanding your own beliefs around your pain and then looking at positive changes you can make that can in turn have a positive effect on your pain and levels of function.

Understanding pain in less than 5 minutes – Online video looking at the complexity of pain and the brain.

Sleep and pain 

Why things hurt – Online explain pain video from Lorimer Mosley

Tame the Beast – Website with information on persistent pain

Pain Tool Kit – Website created by a patient to help manage persistent pain providing education and knowledge on how to improve self-management.

Pain-ed – Website providing patient and clinician information regarding pain and specifically back pain and Cognitive Functional Therapy

Abdominal breathing, relaxation and sleep

Stress and tension are common with persistent pain. For some it may be part of the underlying cause for many it’s a consequence as pain itself causes more stress and anxiety. What we know is that if we can use tools to help reduce our muscle tension and stress this can help with pain, sleep and function. Below are links you may find useful

Abdominal breathing – a written description from the NHS website. 

Headspace – This is a website and APP that uses meditation and breathing.

Breathe2relax. This is an APP specifically for abdominal/diaphragmatic breathing – go onto your smart phones APP store for more details

Sleep well with pain –  Leaflet to help try and improve sleep

Below are links to local services that can help with aspects of physical and mental health that you feel may be impacting your pain and general health.

Live well Dorset – Weight management, stop smoking, exercise advice, lifestyle change 0800 8401628/ 01305 233105

Steps to wellbeing – for help with feelings of anxiety, depression, bereavement and trauma/PTSD

Welcome to the moodzone – for help with self-management of stress, anxiety and depression

Dorset Pain Management Service website – This website contains a lot of further information and links about pain and also gives you the opportunity to see if you feel a referral to the Pain Service may be beneficial for you.

Understanding persistent pain – this booklet is commonly used by the Dorset Pain Management Service.

If your symptoms are not becoming manageable with the advice in previous sections then discuss with your GP

If your radicular arm pain is associated with weakness and loss of muscle bulk in the arm then make your GP aware.

On some rare occasions the nerves in the spinal canal may become compromised. This may lead to a variety of symptoms:

• Unexplained (and possibly pain free) arm weakness in one or both arms.
• Finding it difficult for you to use your hands for tasks such as undoing and doing up buttons or unscrewing jars
• Experiencing a loss of balance or co-ordination when walking.
• Weakness, tingling or numbness into the legs.
• Changes to the control of your bladder and bowels. Including difficulty initiating flow of urine or fully emptying the bladder
• Erectile dysfunction
• Dizziness, vomiting or blackout associated with neck movements

Thankfully these are rare but if you feel you are experiencing a combination of these, you should contact to your GP (or spinal clinician if you have already been seen in the spinal service). If the symptoms are severe or progressing rapidly you should seek urgent medical advice and attend ED.

There are other rare but serious causes of neck and arm pain and you need to seek medical advice if:

• You feel generally unwell and suffer symptoms such as fever, night sweats or unexplained weight loss
• you experience pain at night, possibly worse than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.

If any of these symptoms occur, you should contact your GP.

Versus Arthritis guide to neck pain

Chartered Society of Physiotherapy guide to neck pain