Neck Pain: Complete Guide to Causes, Symptoms, and Treatments

Neck pain is pain felt in the neck. It can interfere with head movement, sleep, and daily activities. A review published in 2014 estimated that 4.9% of the world’s population experienced neck pain at some point, based on data from 2010^[11]. This prevalence does not indicate the severity of your specific episode. Your symptoms and the circumstances surrounding them determine whether an evaluation is necessary.

Physical therapists evaluate neck pain and its impact on your daily activities. This guide explains the symptoms, the signs that indicate you should seek medical attention, and possible treatments. Our comprehensive guide to physical therapy provides an overview of this field.

What is neck pain?

Neck pain is an unpleasant sensory and emotional experience felt in the neck region. The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or which resembles that caused by such damage.^[12] Nociception—the activity of the nervous system that detects and processes signals of tissue danger—can contribute to this sensation without being synonymous with pain. Symptoms depend on several factors and, on their own, do not allow for the identification of a cause.

The neck consists of seven bones called vertebrae, numbered C1 through C7. Discs—small cushions that facilitate movement—separate the vertebrae from C2 to C7. There is no disc between C1 and C2. C1 lacks a vertebral body, the thick part of the bone. Its anterior arch articulates with the odontoid process of C2, a bony protrusion^[13]. The nerves in the neck contribute to movement and sensation in the arms and hands. A nerve root is the part of a nerve located near the spinal cord—the nerve cord protected by the spine that transmits messages between the brain and the body. Damage to a nerve root can cause numbness, weakness, or altered reflexes. A reflex is an automatic muscular response that a healthcare professional can test^[14]. The neck also allows you to turn, tilt, and lift your head.

Several factors can influence pain at the same time: the condition of the tissues and the nervous system, emotions, expectations, work, and support from those around the person. The biopsychosocial model describes how these factors interact. It considers biological, psychological, and social factors together^[15]. The presence of any one of these factors is not sufficient to determine the cause or severity of your pain.

Neck pain may recur or persist in some people, while it improves more quickly in others. A review of studies in the general population describes this variability^[16]. The evaluation therefore focuses on your symptoms and the activities you wish to resume.

What is the difference between acute and chronic neck pain?

We often refer to pain as acute during the first few weeks and as chronic when it persists. In the International Classification of Diseases, ICD-11, pain is considered chronic when it persists or recurs for more than three months.^[17] After a whiplash injury, the course of the condition varies greatly from person to person.⁴ In a review of the best available data on whiplash, about half of the people still reported neck symptoms one year after the injury, and more severe pain or greater disability at the outset was associated with a slower recovery.^[18] Pain that persists is not necessarily permanent.

The categories “acute” and “subacute” follow the thresholds established in the 2024 Cochrane Review on massage. Not all studies use the same thresholds. ICD-11 defines chronic pain as pain lasting more than three months, without characterizing it as irreversible^[17]. Some episodes subside quickly; others persist or recur. The time elapsed alone is not sufficient to predict the outcome.

What does it mean when your neck feels stiff?

A stiff neck refers to stiffness or difficulty moving the head, which may be painful. It does not indicate that a joint is dislocated or physically blocked.

The professional examines your movements and associated symptoms to determine what is limiting the range of motion in your neck. The sensation alone is not enough to determine the cause.

Does a stiff neck mean that a vertebra is out of place?

A sensation of a stiff neck does not necessarily mean that a vertebra is out of alignment. It may be accompanied by pain or stiffness. A significant injury, weakness, or new numbness requires evaluation; urgent signs are detailed below.

The evaluation includes neck movement, strength, sensation, and reflexes. These observations help distinguish stiffness from a problem affecting a nerve or the spinal cord.

Pain that radiates down the arm may be caused by an irritated or compressed nerve root. Damage to this nerve root, known as cervical radiculopathy, can cause tingling, numbness, or weakness in the arm^[19]. Other tissues in the neck can also cause pain felt in the arm, known as referred pain. A physical examination helps distinguish between these possibilities and identify any loss of strength, loss of sensation, or altered reflexes^[14].

Does using a cell phone cause neck pain?

Excessive cell phone use is associated with neck pain, but this association does not prove that it causes it. A meta-analysis of seven retrospective studies—which analyze previously collected data—reports an adjusted odds ratio of 2.34^[21]. An odds ratio compares the number of people with pain to the number of people without pain. The ratio of 2.34 compares these odds between the groups after certain statistical adjustments. It does not mean that the probability of pain is exactly 2.34 times greater.

The English term “text neck” often refers to the forward-bent neck position while using a cell phone. A review of 41 articles found that definitions varied widely and did not establish a link between this specific concept and pain^[20]. Another review of 21 studies—90% of which were observational—applied Hill’s criteria, a set of benchmarks used to examine a cause-and-effect relationship. None of these criteria were met in the selected articles^[22].

If using the phone triggers your symptoms, try changing your posture, taking breaks, and adjusting the duration based on your tolerance. Persistent pain or pain accompanied by symptoms in the arm warrants an evaluation.

Cervical posture varies from person to person and throughout the day. A single image or position observed at one point in time is not enough to explain the pain.

Posture and symptoms:

Posture can affect symptoms in some people, but it does not, on its own, explain neck pain. Posture can be adjusted for comfort or to suit a specific task without striving for a "perfect" position.

A single observed posture does not explain why you are in pain. The review on mobile device use does not demonstrate that posture causes pain^[22]. This limitation does not preclude seeking a more comfortable position for a given task.

Do osteoarthritis and changes visible on imaging always explain the pain?

Changes visible on imaging, such as osteoarthritis or disc degeneration, do not always explain neck pain. Osteoarthritis refers to changes in a joint, particularly in its cartilage—the smooth layer that covers the ends of bones. It can be painful or asymptomatic. A review of spinal imaging studies found that these changes become more common with age^[23]. It describes, in particular, changes in disc structure and bulging, where the disc protrudes beyond its normal outline. It does not provide a specific measurement for the neck for each individual. The image must be interpreted in conjunction with symptoms and a physical examination^[6].

Nakashima and his colleagues analyzed magnetic resonance imaging (MRI) scans of the necks of 1,211 asymptomatic volunteers. Disc bulging was present in 87.6% of the participants^[7]. Kato and colleagues also analyzed 1,211 volunteers to describe the size of the spinal canal—the bony passageway that contains the spinal cord—and the changes observed with age^[24]. These results show that an imaging finding must be interpreted in the context of your symptoms and your physical examination. They do not render every observation insignificant.

In Kato’s study, 64 of the 1,211 participants showed spinal cord compression on MRI. In 28 participants, the spinal cord contained a lighter-appearing area on a type of image called a T2-weighted image^[24]. These participants were asymptomatic^[8]. However, difficulty walking, new clumsiness in the hands, or associated urinary problems may indicate spinal cord involvement. These signs require prompt or urgent medical evaluation depending on when they appear and their severity, as outlined in the NHS guidance on signs of cervical spinal cord injury.

To learn more about cervical osteoarthritis and its implications, you can read our comprehensive guide to cervical osteoarthritis.

Are MRI results reliable for explaining my pain?

An MRI can help answer a specific question, such as whether there is damage to the spinal cord or a nerve root. It does not automatically identify the source of the pain. Its usefulness depends on your symptoms and whether the results might change your treatment plan. Reports may also vary depending on the reader and the facility.

A study focusing on the lower back—rather than the neck—showed that a single 63-year-old patient, who underwent scans at 10 different centers, received 10 very different imaging reports: of all the abnormalities identified, none appeared in all 10 reports.^[9] The ten exams were performed over three weeks; a total of 49 distinct findings were reported, and overall agreement among the centers was low.^[25]

An imaging finding may be relevant, incidental, or of uncertain significance. It must be interpreted in conjunction with the patient’s symptoms, physical examination, and clinical presentation. To understand the limitations of imaging, see our article on medical imaging.

What problems can be associated with neck pain?

A sprain, whiplash, a herniated disc, cervicobrachial pain, osteoarthritis, torticollis, or cervical stenosis can all be accompanied by neck pain. Stenosis is a narrowing of the space through which the spinal cord or nerves pass. These conditions can produce similar symptoms. An evaluation helps determine their cause and the level of urgency.

What is a Neck Sprain?

A whiplash injury refers to an injury to the tissues of the neck, including the muscles, ligaments, and joint capsules. Ligaments connect bones; joint capsules surround the joints^[26]. This injury can result from a sudden movement, a twist, or a collision. Treatment depends on your symptoms and your functional abilities, not just the name of the injury. Our comprehensive guide to whiplash provides more details.

What is whiplash?

Whiplash, also known as a neck sprain, occurs when the head accelerates and then decelerates abruptly, often during a collision^[27]. The NHS states that improvement typically occurs within 2 to 3 months, though symptoms may sometimes persist longer. Improvement does not mean the complete disappearance of all pain. In the review by Carroll and colleagues, more severe initial pain, a greater number of symptoms, greater difficulty with daily activities, and certain psychological factors were associated with a slower recovery^[18]. Our comprehensive guide to whiplash explains these injuries.

What is a Herniated Disc in the Neck?

A cervical herniated disc occurs when part of a disc protrudes beyond its normal boundaries. It can irritate or compress a nerve root and contribute to pain in the neck, shoulder, or arm. The examination also looks for loss of sensation, weakness, and abnormal reflexes^[14]. Imaging alone is not sufficient to establish a diagnosis.

A hernia can sometimes shrink in size without surgery: this is known as spontaneous resolution. A meta-analysis of eleven follow-up studies on lower back pain estimates this resolution rate at 66.7% following non-surgical treatment^[10][28]. This figure does not predict the course of a neck herniation. Our comprehensive guide to cervical disc herniation explains the available treatment options.

Nakashima's study shows that some cases of spinal cord compression occur without symptoms^[7]. However, this does not mean you should ignore new weakness, clumsiness in the hands, or difficulty walking. These signs require immediate medical evaluation.

What is cervicobrachialgia?

Cervicobrachialgia refers to pain felt in the neck and arm. This term is one of several labels used to describe pain that originates in the neck and radiates down the arm, but these labels do not specify which mechanism is predominant.^[29] Irritation of a nerve root is one possibility, especially when accompanied by numbness, tingling, weakness, or altered reflexes; however, the examination also looks for other explanations. The review on cervical radiculopathy recommends distinguishing, through physical examination and imaging, conditions that may mimic nerve root compression.^[14] For more information, see our comprehensive guide on cervicobrachialgia.

What is torticollis?

Torticollis refers to a tilted or turned position of the head, which is sometimes painful and difficult to correct. It may be present at birth or develop later in life. Its causes may involve the muscles, bones, eyes, brain, or nerves; certain medications can also cause torticollis^[30]. Seek medical attention if the stiffness worsens or significantly limits your activities. A fever, an unusual headache, weakness, or a major trauma requires prompt or urgent evaluation, depending on the signs detailed below. Our comprehensive guide to torticollis outlines the various situations.

When should I be concerned about my neck pain?

Neck pain following a significant injury, or accompanied by weakness, fever, an unusual headache, or difficulty walking, requires prompt medical evaluation. Certain signs require calling 911 immediately, such as sudden difficulty walking or speaking. The table lists these urgent situations.

A serious condition is rare, but even a single warning sign may warrant prompt evaluation. Do not wait several weeks if you experience new weakness, difficulty walking, a fever accompanied by severe stiffness, an unusual headache, or a significant deterioration in your condition.

What warning signs require medical attention?

Damage to the spinal cord in the neck is called cervical myelopathy. It can cause loss of sensation or strength in the arms and hands, difficulty walking, or bladder problems. Age-related changes in the spine can contribute to this condition^[31]. The NHS’s advice on the signs of cervicalspinal cord injury, meningitis, andstroke supports the warnings in the table. In Quebec, the emergency number is 911. Do not wait until all the signs are present.

When can you manage pain without going to the emergency room?

Isolated pain or stiffness can be monitored if it improves and there are no warning signs. However, new weakness, progressive numbness, or loss of coordination requires medical attention. Sudden difficulty walking, sudden speech problems, or sudden facial symptoms require urgent care.

If there are no warning signs, temporarily adjust any activities that significantly worsen your symptoms and monitor how things progress. Seek an evaluation if your abilities decline, if the pain worsens, or if a new symptom appears.

Can a neck problem contribute to headaches?

A neck problem can contribute to certain types of headaches, known as cervicogenic headaches. Diagnosis requires several corroborating signs. A review of 39 clinical trials—studies that compare treatments—found that the criteria for selecting participants varied widely^[32]. Some trials required pain on only one side and pain that was reproduced by a specific neck movement or posture. Neither of these signs alone is sufficient to confirm a cervical origin. Treatment depends on the diagnosis, your symptoms, and your goals.

Neck movements can affect certain types of headaches. The healthcare professional will ask you how the pain began, then examine your neck and look for signs that might point to another cause.

If pressing on a tender point in the neck exactly replicates your headache, this reaction provides a clue. It does not, on its own, prove a cervicogenic headache. In the studies reviewed, researchers combined several criteria and distinguished between possible, probable, and definite forms^[32].

How long can neck pain last?

Neck pain may subside within a few weeks, but some episodes last longer or recur. The NHS’s advice on neck pain provides this general guideline; it does not apply to all injuries. After whiplash, it often takes 2 to 3 months to improve, and symptoms may sometimes persist.

A review of the general population reports that between half and three-quarters of people who had neck pain still reported it—or experienced it again—one to five years later^[16]. This includes recurring pain and does not imply continuous pain throughout all those years. Request a reevaluation if your functional abilities decline, if new symptoms appear, or if your progress does not align with the treatment plan.

You can use specific cues, such as turning your head to look around, sleeping, or resuming a task at work. These cues help you notice what’s changing and adjust your care accordingly.

Past experience alone is not enough to predict what will happen next. The plan can be reassessed based on current constraints, objectives, and the response to proposed changes.

What is meant by "central sensitization"?

Central sensitization refers to an increase in the response of certain nerve cells in the brain and spinal cord. These cells, known as nociceptors, are involved in processing signals related to tissue damage. As a result, they may react more strongly to normal or weaker signals^[33]. This neural activity is not pain itself.

Persistent pain or a questionnaire alone is not sufficient to confirm this mechanism in an individual. A 2015 review of neck pain without trauma or a specific cause identified six studies comparing groups. Their results were inconsistent. Central sensitization did not appear to characterize this entire population, although it may be present in some individuals^[33]. These findings do not apply to pain following a whiplash injury.

When pain persists, the condition of the tissues, the nervous system’s responses, emotions, expectations, and the social context can all interact^[15]. The healthcare professional will review these factors with you. Their presence does not automatically confirm central sensitization.

Previous pain, job demands, and available support are associated with neck pain in some studies of workers⁵. Another review found links to a high workload, little support from coworkers, little control over tasks, and low job satisfaction^[34]. The strength of the evidence varies depending on the factor. Sleep and mood may also be factors to consider when they affect your daily life.

A clear explanation can help in discussing symptoms, goals, and the care plan. Our article on the neuroscience of pain introduces this concept, which is not a substitute for an evaluation when new or unusual signs appear.

What can physical therapy do to help with neck pain?

Physical therapy offers exercises, explanations, and sometimes manual therapy to reduce pain and make it easier for you to perform daily activities. Strengthening exercises for the neck, shoulders, and upper back can improve pain and functional ability in cases of persistent neck pain. A Cochrane review of 27 trials in adults supports certain programs that combine strengthening, endurance training, and stretching. Some participants also had headaches attributed to neck issues or nerve root compression; the results are not the same for all exercises or all conditions^[35]. The choice depends on your symptoms, activities, and goals.

A 2025 Cochrane review included nine trials and 694 participants, most of whom had persistent pain. At around four weeks, the combination of manual therapy and exercise could reduce pain by about 2.4 points out of 10 and improve functional ability compared with no treatment. Compared with a sham treatment, which served as a control, improvement in functional ability was still possible, but the difference in pain was not clearly demonstrated. The evidence was of low certainty^[36]. These comparisons do not isolate the effect of manual therapy from that of exercise.

Education is meant to answer questions, explain options, and agree on a realistic plan. Fear of movement, beliefs, sleep, mood, and context can be discussed when they seem relevant. This education about your health issue complements the evaluation.

If you are experiencing neck pain and would like to see a physical therapist, you can visit our page on physical therapy for neck pain.

What role should manual therapy play?

Manual therapy can complement exercises. Mobilization involves gradually moving a joint; manipulation uses a brief, rapid movement. The Cochrane review of 51 trials reports similar results for neck mobilizations and manipulations in several comparisons. Upper-back manipulations improved pain in the short term compared with a no-intervention control group in some trials, although there is a risk of overestimating the benefits^[1]. The results and their certainty varied depending on the techniques and study groups.

A 2010 review also found that manual therapy combined with exercises provided better short-term relief than exercises alone. It did not find any lasting differences in several outcomes². These findings apply to specific programs.

Temporary muscle soreness may follow a manual therapy session. Neck manipulations also carry a rare risk of serious complications, and clinical trials do not fully describe the adverse effects^[37]. The practitioner must explain the procedure, the potential benefits, the risks, and alternative options. You have the right to refuse a particular technique. Exercises and education remain appropriate based on your assessment.

The plan can be adjusted based on changes in symptoms, exercise tolerance, affected activities, and the ability to incorporate changes into daily life. Possible signs of nerve root involvement, such as new weakness or loss of sensation, require an appropriate evaluation. Work posture can also be modified if it affects symptoms, without striving for a perfect position.

If your symptoms change significantly or if the plan does not allow you to gradually resume your activities, a reevaluation may be necessary to review the diagnosis and your options.

What are the frequently asked questions about neck pain?

Frequently asked questions about neck pain include its duration, neck braces, massage, returning to sports, imaging tests, and stress.

Neck pain often subsides within a few weeks; the choice of neck brace, massage, resuming sports, and imaging tests depends on the symptoms and the evaluation. Stress may also be a contributing factor, though it does not account for every instance of pain.

How long does typical neck pain last?

According to the NHS’s guidance on neck pain, neck pain often lasts a few weeks. After whiplash, it often takes 2 to 3 months to improve. Some pain lasts longer or recurs. Have your condition reevaluated if your functional abilities decline, if the pain worsens, or if new symptoms appear. Urgent signs require care before these timeframes.

Should I wear a cervical collar?

A neck brace is not recommended for ordinary neck pain. According to the NHS’s guidance on neck pain, it is generally better to maintain a range of motion that is comfortable for you. If a doctor has prescribed a neck brace for an injury or another specific reason, follow their instructions and use it for the recommended duration.

Do massages really help?

Massage can be considered as a complementary option, but its effects depend on the program and the treatment it is being compared to. The 2024 Cochrane review on massage reports little or no average difference in pain compared to sham massage, up to about 12 weeks, with limited evidence. Some programs with more sessions showed a benefit, but these analyses are not sufficient to guarantee the same outcome for you. Massage remains optional; it is not a substitute for a tailored exercise plan.

Can I exercise with neck pain?

Your return to activity depends on the cause, the sport, and your symptoms. If you’ve experienced an injury accompanied by weakness, progressive numbness, or loss of coordination—or if you’re involved in a contact sport—get an evaluation before resuming activity. Otherwise, gradually adjust the intensity and monitor your body’s response.

When is an MRI needed for neck pain?

An MRI may be useful if the examination raises suspicion of spinal cord or nerve root involvement, or another serious condition. After a trauma, the healthcare provider selects the type of imaging based on the specific injury being investigated. An MRI is not necessary for every case of neck pain. The cited review shows no benefit to routine imaging and recommends considering it only for clear symptoms that do not improve after 4 to 6 weeks^[38]. Warning signs require an earlier evaluation. The physician determines which test is appropriate and the best time to perform it.

Can stress cause neck pain?

Stress, mood, and sleep may be associated with the intensity or impact of pain in some people. These are associations, not evidence of a cause-and-effect relationship. A review of 23 highly diverse studies found a link between depressive symptoms, anxiety, distress, or stress and poorer outcomes in only some of the analyses. The data were of low quality, and several studies found no link^[39]. Among adolescents, a review combining the results of several studies reported a link between neck pain and depression, anxiety, stress, and sleep problems^[40]. These factors are part of the broader context to be considered, though they do not, on their own, explain neck pain.

References

1. Gross A, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;(9):CD004249.

2. Miller J, et al. Manual therapy and exercise for neck pain: A systematic review. Man Ther. 2010;15(4):334-354.

3. Hoy D, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1309-1315.

4. Carroll LJ, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Eur Spine J. 2008;17 Suppl 1:S83-92.

5. Côté P, et al. The burden and determinants of neck pain in workers. Eur Spine J. 2008;17 Suppl 1:S60-74.

6. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015.

7. Nakashima H, et al. Abnormal findings on magnetic resonance images of the cervical spine in 1,211 asymptomatic subjects. Spine (Phila, Pa, 1976). 2015.

8. Kato F, et al. Normal morphology, age-related changes, and abnormal findings of the cervical spine. Part II: Magnetic resonance imaging of over 1,200 asymptomatic subjects. Eur Spine J. 2012.

9. Herzog R, et al. Variability in diagnostic error rates at 10 MRI centers performing lumbar spine MRI examinations on the same patient over a 3-week period. Spine J. 2017;17(4):554-561.

10. Zhong M, et al. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician. 2017.