Neck Pain: Causes, Exercises and Treatment

203 millionPeople worldwide living with neck pain (2020)

%32Expected increase by 2050

45–74Most commonly affected age range

%50–85Pain returns within 1–5 years after a first episode

What is it?

Neck pain is pain anywhere from the base of the skull down to the shoulders. It usually comes from the muscles, the ligaments and the small joints between the vertebrae. Doctors call this mechanical or non-specific neck pain: the pain is real, but there is no serious disease behind it.

If the pain spreads into your arm and fingers with numbness, tingling or electric-shock sensations, a nerve root may be involved. We cover this on a separate page: Cervical disc herniation and pinched nerve →

What causes it?

Staying in the same position for hours: working at a desk, bending over your phone for long periods
Your neck being strained for a long time while you sleep, or a "crick" that comes on with a sudden movement
Stress, anxiety and poor sleep: they increase muscle tension and sensitivity to pain
Lack of activity and weak shoulder and upper back muscles
Age-related wear in the spine (osteoarthritis). Many people with no pain at all have this finding too.
Sudden whiplash-type injuries, such as in a traffic accident

Four types of neck pain

Physiotherapy guidelines divide neck pain into four groups. Treatment is shaped accordingly.

With limited movement

The familiar "crick in the neck". Your neck will not turn in some directions, and the pain gets worse when you move. This is the most common type.

With headache

Pain spreads from the neck to the back of the head, sometimes to the forehead, and is set off by neck movements. This is called cervicogenic headache.

With pain spreading into the arm

A nerve root is affected. There is pain, numbness, tingling or weakness in the arm.

Cervical disc herniation page →

With poor movement control

Mostly seen after a traffic accident. The neck muscles lose some of their coordination and endurance.

About a straightened neck and "bad posture"

Seeing "straightening of the neck" on an X-ray report worries many people. A study compared 107 people, 54 with neck pain and 53 without, and found no difference in neck curvature between the two groups. According to the researchers, findings like this are not the cause of the pain but incidental changes.

Posture is a similar story: there is no single "correct posture" for everyone. The best posture is the one you change often. The problem is usually not the position itself, but staying in the same position for too long.

Treatment

Most neck pain does not need an X-ray or MRI; the diagnosis is made through an examination. Treatment is planned according to the type of pain and how long it has lasted.

Staying activeBed rest and wearing a neck collar for long periods are not recommended. Carrying on with your daily activities as far as the pain allows speeds up recovery.
ExerciseThis is the cornerstone of treatment. Exercises that strengthen the neck, the shoulders and the muscles around the shoulder blades have been shown to reduce long-lasting neck pain moderately to markedly. Stretching exercises on their own may not be enough.
Manual therapyMobilisation and manipulation of the neck and upper back, combined with exercise, improve pain and movement. They should be done by a trained physiotherapist after an examination.
Dry needling, TENS, laserGuidelines list these among the supportive options for long-lasting neck pain. They are worthwhile alongside exercise, not on their own.
MedicationPainkillers recommended by your doctor can give short-term relief.
Stress and sleepWhen pain lasts a long time, managing stress and getting regular sleep are also part of treatment. Take a look at breathing exercises →

Exercises at home

Six basic exercises for your neck

Do the exercises slowly and with control. A mild stretch is normal, but do not push into sharp pain. If the pain starts to spread into your arm, stop that exercise and talk to your physiotherapist.

Chin tuck

Sit up straight, looking straight ahead. Without tilting your head, draw your chin straight back, as if making a double chin. Feel the back of your neck lengthen; hold for 5 seconds, then relax.

10 reps, 2–3 times a day

Neck rotation

Keep your shoulders still. Slowly turn your head to the right and hold for 2–3 seconds at the furthest comfortable point, then turn to the left in the same way.

10 reps in each direction

Side stretch

With your right hand, hold the edge of the chair you are sitting on. Bring your left ear towards your left shoulder. You will feel a gentle stretch on the right side of your neck. Do not lift your shoulder.

Hold for 20–30 seconds, 3 times on each side

Shoulder blade squeeze

Stand or sit up straight. Without lifting your shoulders towards your ears, draw your shoulder blades back and slightly down towards each other. Hold for 5 seconds, then relax.

10–15 reps, twice a day

Isometric strengthening

Place your palm on your forehead. Without moving your head, push gently into your hand while your hand pushes back. Repeat for the back and both sides of your head. Half your strength is enough.

5 seconds in each direction, 5 reps

Upper back (thoracic) extension

Sit on a chair with a low back and clasp your hands behind your neck. Using the top of the backrest as a pivot, open your chest towards the ceiling and gently lean back. Stretch your upper back, not your neck.

5–10 reps

Looking after your neck at your desk

Hours spent in front of a screen are one of the most common triggers of neck pain. Small changes make a big difference.

Have the top edge of the screen at eye level or slightly below.
If you work on a laptop for long periods, use a laptop stand and a separate keyboard.
Raise your phone to eye level; lower your eyes, not your head.
Every half hour, get up, roll your shoulders and walk a few steps.
When you are on the phone, do not wedge it between your shoulder and your ear.

Video

Exercise videos for neck pain

From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.

The one neck exercise everyone should do

How to do the most basic neck pain exercise correctly.

Six exercises for a stiff neck

A short programme to get a stiff neck moving again.

Videos belong to the Bob & Brad channel.

Frequently asked questions

How long does neck pain last?

Most neck pain eases noticeably within days or a few weeks. However, it tends to come back: more than half of people who have it once get it again within 1–5 years. That is why it is important to keep up the exercises even after the pain has gone.

Should I use heat or cold?

For a stiff neck and muscle tension, gentle warmth helps most people. If you have had a recent knock or there is swelling, cold may be better in the first few days. Use whichever brings relief, for no more than 15–20 minutes, and protect your skin with a cloth.

Which pillow should I use?

There is no single best pillow for everyone. Choose a height that keeps your head level with your shoulder when you lie on your side, and does not push your head forwards when you lie on your back. Sleeping on your front can make the pain worse, because it keeps your neck turned to one side for a long time.

Should I wear a neck collar?

Not for ordinary neck pain. Wearing one for a long time can weaken the muscles and slow down recovery. After an accident, or when your doctor specifically recommends one, it is a different matter.

Do I need an X-ray or an MRI?

For most neck pain, no. Age-related wear and tear is common in people with no pain too, and often does not explain the pain. If you have one of the warning signs below, or the pain has not improved within a few weeks, your doctor will decide.

Is a straightened neck dangerous?

On its own, usually not. A reduced neck curve is common in people without pain too, and no link with pain has been shown. What matters are your symptoms and the examination findings.

When to seek help right away

Neck pain is usually harmless. However, see a doctor without delay if:

The pain started after a traffic accident, a fall or a blow
You have loss of strength in your arms or legs, clumsy hands (difficulty doing up buttons) or unsteadiness when walking
There has been a change in your bladder or bowel control
The pain comes with fever, chills, unexplained weight loss or a history of cancer
You have severe night pain that keeps getting worse and does not ease with rest
You have a sudden, very severe headache, neck stiffness and a fever (call 112)
You also have dizziness, double vision, or difficulty speaking or swallowing (call 112)
Your neck pain comes with chest pain, shortness of breath or sweating (it may be your heart; call 112)

Sources

Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(7):A1-A83.
Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S75-S82.
Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain. 2021;25(2):275-295.
GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142-e155.
Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16(5):669-678.
Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1:CD004250.
Physiopedia. Mechanical Neck Pain.