Neck Pain: Complete Guide to Causes, Symptoms, and Treatments
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Neck pain affects approximately 50% of adults each year. It is one of the most common musculoskeletal problems after back pain. This prevalence causes a great deal of concern. However, here is the good news: the vast majority of neck pain is not dangerous and resolves without major intervention. Your neck is stronger than you think.
This guide explores what modern science tells us about neck pain. You'll discover why it happens, what it really means, and most importantly, why your neck is much stronger than most people think. Physical therapy is the recommended first line of treatment for neck pain. To understand how this discipline can help you, check out our comprehensive guide to physical therapy.
What is neck pain and why is it so common?
Neck pain is discomfort felt between the base of the skull and the top of the shoulders. It affects approximately 50% of adults each year. Its frequency can be explained by the anatomical complexity of the neck and its exceptional mobility among all regions of the spine.
The neck is made up of seven cervical vertebrae (C1 to C7) separated by intervertebral discs. Muscles, ligaments, and nerves surround this structure. These cervical nerves control the movement and sensation of the arms and hands. The cervical region has a remarkable task: supporting the weight of your head (approximately 5 kg) while allowing exceptional mobility in all directions.
Why do so many people suffer from neck pain? An interesting theory suggests that the brain can add up several minor irritations and perceive them as a single, more significant pain. This is called spatial summation. It means that several small problems can create a lot of pain, even if none of them are serious on their own.
In many cases, neck pain can be more persistent than back pain. It tends to last longer. However, it is also less studied. Since 2010, approximately 9,000 studies have been published on back pain, compared to only 1,600 on neck pain.
What is the difference between acute and chronic neck pain?
Acute neck pain lasts less than 6 weeks and often goes away without treatment. Chronic pain lasts more than 3 months. About 35% of cases become chronic, but "chronic" does not mean "permanent" — many chronic cases continue to improve.
Healthcare professionals classify neck pain according to its duration:
| Type | Duration | Prognosis |
|------|-------|-----------|
| Acute pain | Less than 6 weeks | Often resolves spontaneously |
| Subacute pain | 6 to 12 weeks | Significant transition period |
| Chronic pain | More than 12 weeks | Generally continues to improve |
A major study (Côté et al.) found that nearly half of episodes of neck pain resolve quickly. However, 35% of cases become persistent. The good news? Even cases labeled "chronic" usually continue to improve with time and proper care. The term "chronic" simply describes the duration so far, not necessarily the future prognosis.
What is a "crick" in the neck and why is it so uncomfortable?
A "crick" is that feeling of stiffness or tightness in the neck. It is not always painful in the traditional sense, but it is deeply irritating. It is like having a "thorn" in your neck that you cannot remove—a sensation that can be as disturbing as intense pain.
Cervical crick—or "stiff neck" as we say in Quebec—is a peculiar phenomenon. Unlike the lower back, the neck seems particularly susceptible to these feelings of stiffness. The pain may be minor, or even absent, but the feeling of "being stuck" is impossible to ignore. It's like a deep itch that you can't scratch.
Interesting fact: neck "cricks" are much more common than lower back "cricks." This difference could be explained by the greater mobility of the cervical joints. Another hypothesis suggests that the brain may be more vigilant about the condition of the cervical spine.
These feelings of blockage deserve to be taken seriously, even if they are not "painful" in the traditional sense.
Can my neck really be "locked" or "out of place"?
No. The idea that your neck is "out of place" or "dislocated" is a persistent myth. The cervical vertebrae do not move easily. You may feel stuck without there being any actual joint displacement. The structure of your cervical spine is remarkably stable.
This is one of the most widespread and erroneous beliefs about the neck. Generations of patients have been convinced that their vertebrae were "out of place" or "misaligned." This idea has been perpetuated for over a century, particularly in certain therapeutic approaches.
Here is the anatomical reality: nerve roots have plenty of room to move. The holes through which they pass are generous. To actually pinch a nerve, you would have to move a vertebra well beyond its normal limits, which would severely damage other joint structures long before that. Even major traumatic dislocations do not always pinch nerves!
An illustrative case: a man born with part of his cervical vertebra completely missing had no serious symptoms until he fell one day. His neck had not been "locked" during all those years, despite this major structural abnormality.
The sensation of being "locked up" is real, but it does not correspond to joint displacement. This sensation probably comes from temporary irritation of the joint structures—it is temporary irritation, not displacement.
Does "text neck" really exist?
No, "text neck" is not a real medical condition. Studies show that regularly looking at your phone has no clear causal link to neck pain. It is a source of unnecessary fear that is not based on solid scientific data.^5,6^
The term "text neck" was coined to describe neck pain allegedly caused by excessive smartphone use. This idea has been widely publicized and has generated a lot of unnecessary anxiety. However, scientific studies tell a different story.
Richards et al. and Damasceno et al. have provided good evidence that "text neck" is likely an exaggerated concern. The forward-head posture is not as dangerous as claimed.
Interesting fact: there is a wide range of "normal" cervical postures. Many people with seemingly "abnormal" cervical curvatures have no pain. Others with necks that appear perfectly normal suffer intensely. This observation suggests that the relationship between posture and pain is much more complex than a simple cause-and-effect relationship.
Does posture really cause neck pain?
Scientific evidence shows a weak correlation between posture and neck pain. People with "perfect" posture can suffer greatly. Others with very curved necks have no pain at all. Posture is overrated as a cause of neck pain.
In 2007, the European Spine Journal published an in-depth study on this topic. Swiss researchers X-rayed 54 people with a history of neck pain and 53 without pain, then carefully measured their necks. What did they find? Nothing: no significant difference between the two groups.
"The presence of such structural abnormalities in patients suffering from neck pain should be considered coincidental," the authors concluded.
This discovery calls into question "structuralism"—the excessive tendency to blame biomechanical problems for pain. Many therapies have been built on the idea that "bad" posture causes pain and must be "corrected." However, science does not support this hypothesis.
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Those who have had the greatest impact on my patients' lives. 1 per day, 2 min.
Do degenerative changes such as cervical osteoarthritis cause pain?
Not as much as we think. MRIs show degenerative "abnormalities" in 90% of people aged 60 who have NO pain. Cervical osteoarthritis is often normal with age and does not always correspond to the pain felt. Seeing an "abnormality" on an MRI does not mean that it is causing your pain.
This reality overturns what most people believe about their necks. For decades, patients and healthcare professionals have been conditioned to think mechanically. It is assumed that something in the neck must be broken, displaced, degenerated, or damaged to explain the pain.
However, a large study conducted in 2015 (Brinjikji et al.)—the first of its kind specifically for the neck—found disc bulging in 90% of 1,200 people without any pain! Even among young people: 75% of people in their twenties had disc bulging. This is not a statistical anomaly. It is the norm.
An illustrative case comes from physical therapist Paul McCambridge. He had severe neurological symptoms in his left arm—pain, tingling, weakness. His MRI showed classic, significant stenosis exactly where you would expect it... except it was on the WRONG SIDE. The degeneration was on the right side, but all his symptoms were on the left. "The pain is really weird!" he commented.
The moral of this story: the condition of the spine is not the only factor determining whether or not there is pain, and probably not the most important one either. To learn more about cervical osteoarthritis and its implications, see our comprehensive guide to cervical osteoarthritis.
Are MRI results reliable in explaining my pain?
Often not. Radiologists do not even agree on what they see. One study showed that the same person scanned by 10 radiologists received 10 different reports. An "abnormality" visible on an image does not necessarily cause pain.
This remarkable study deserves to be described. A 63-year-old woman volunteered to be scanned ten times by ten different radiologists over a three-week period. The results varied enormously:
- 49 distinct "discoveries" identified in total
- 16 were unique to a single report
- No findings appeared in the ten reports.
- Only one appeared in nine
On average, each radiologist made about a dozen errors—seeing one or two things that weren't there and missing about ten things that were there.
The classic disastrous diagnosis occurs when a patient has a visible abnormality that is NOT the actual source of their pain, but is falsely accused simply because it is visible. Most patients, when confronted with an MRI image showing "something out of place," find it impossible not to fear it. But the evidence clearly shows that an "abnormality" does NOT usually cause pain.
What specific conditions can cause neck pain?
Several conditions can affect the neck: cervical sprain, whiplash, cervical disc herniation, cervicobrachialgia, osteoarthritis, torticollis, and cervical stenosis. Each has distinct characteristics. However, these diagnoses do not always explain the severity or duration of the pain.
This section briefly outlines specific diagnostic conditions you may encounter. It is crucial to remember that even when one of these conditions is diagnosed, it tells only part of the story.
What is whiplash?
A cervical sprain refers to a stretching or tearing of the ligaments or muscles in the cervical region. It usually occurs as a result of a sudden movement or twisting. In Quebec, this is commonly referred to as "se barrer le cou" (twisting your neck) or having a "tour de cou" (stiff neck).
The pain typically occurs suddenly during or immediately after the triggering activity. It causes stiffness and limited movement. The good news is that these muscle and ligament injuries heal naturally in the vast majority of cases. For more information, see our comprehensive guide to whiplash.
What is whiplash?
Whiplash is an acceleration-deceleration injury to the neck, typically caused by a car accident. The term refers to the "whipping" motion of the head during a sudden impact.
A fascinating British study has revealed that the severity of the accident is not the most important factor in predicting chronic pain. Psychological factors and pre-accident health status are actually better predictors than the violence of the impact itself. For more details, see our comprehensive guide to whiplash.
What is a cervical disc herniation?
A cervical disc herniation occurs when the gelatinous material in the center of the intervertebral disc pushes through the outer fibrous layers. Contrary to popular belief, disc herniations are NOT a major cause of chronic neck pain. Instead, they cause symptoms in the shoulders and arms.
Reassuringly, herniated discs often heal spontaneously. The herniated material is actively reabsorbed by the body. And paradoxically, it is often the most severe hernias that resolve most completely! For more information, see our comprehensive guide to cervical disc herniation.
What is cervicobrachialgia?
Cervicobrachialgia (or cervical radiculopathy) is pain that radiates from the neck to the arm. It is caused by irritation of a cervical nerve root. Symptoms include pain, numbness, tingling, or weakness following a specific path in the arm.
However, here is an important fact: pain radiating to the arm is not always radiculopathy. Trigger points in the neck muscles can reproduce these same sensations—and this is much more common than a true pinched nerve. For more information, see our comprehensive guide to cervicobrachialgia.
What is torticollis?
Torticollis is an acute muscle spasm that forces the neck into an abnormal position. It can occur upon waking (you slept in an awkward position) or suddenly during the day. It is uncomfortable and sometimes very painful, but generally not serious.
Untreated torticollis usually resolves on its own within a few days to a few weeks. However, proper treatment can speed up recovery. For more information, see our comprehensive guide to torticollis.
When should I be concerned about my neck pain?
Serious problems are rare—less than 1% of cases of neck pain. Seek immediate medical attention if you have a fever with severe neck stiffness, intense headache, weakness in both arms or legs, difficulty walking or urinating. These "red flags" require urgent evaluation.
The most worrying possibility for anyone suffering from neck pain is that a serious problem may be overlooked. This fear is understandable but generally unjustified. Rest assured: the vast majority of neck pain has no dangerous cause.
A useful rule of thumb: be concerned if three conditions are met—pain lasting more than 6 weeks, severe pain or pain that is gradually getting worse, PLUS at least one "red flag." Without this combination, your pain is probably benign.
What are the red flags to watch out for?
| Symptom | What it could indicate | Action required |
|----------|------------------------------|----------------|
| Fever + severe neck stiffness + headache + sensitivity to light | Possible meningitis | Emergency — Call 911 |
| Weakness in both arms or legs + difficulty walking | Spinal cord compression | Emergency — Immediate consultation |
| Difficulty urinating or incontinence + weakness in the legs | Severe spinal cord compression | Emergency — Call 911 |
| Sudden severe pain after trauma | Possible cervical fracture | Emergency — Do not move your neck |
| Unexplained weight loss + nighttime pain not relieved by rest | Possible tumor or infection | Prompt consultation required |
| Facial numbness or difficulty swallowing | Serious infection or other serious condition | Prompt medical attention required |
When is neck pain NOT an emergency?
In the vast majority of cases—more than 99%. Even intense pain, severe stiffness, or numbness in an arm are not usually emergencies. These symptoms are uncomfortable but rarely dangerous.
Even if you strained yourself lifting something heavy or made a sudden movement, if you don't have any of the red flags listed above, you can breathe easy. Your neck is fine. The muscles may be irritated, the joints may be temporarily stuck, but the important structures are almost always intact.
Need professional advice?
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Book an appointmentCan neck pain cause headaches?
Yes, absolutely. Cervicogenic headaches are headaches that originate in the neck. The pain often starts at the base of the skull and can radiate to the forehead or temples. It is different from a classic migraine and often responds better to treatments targeting the neck.
The muscles in the neck, particularly those in the occipital region (base of the skull), can refer pain to the head. Trigger points in these muscles frequently reproduce headaches, sinus pain, pain behind the eyes, and even jaw pain.
This relationship between neck and headaches is one of the reasons why treating the neck muscles can sometimes eliminate chronic headaches. When a massage therapist or physical therapist works on a sensitive spot in the neck and the patient says, "That's exactly where it hurts in my head, that's my headache!", it's a classic sign of cervicogenic headache.
What is the prognosis for neck pain?
Variable but generally favorable. About 50% of cases resolve quickly. Even chronic cases continue to improve with time and proper care. Neck pain can last a long time but is not necessarily permanent—there is always hope.
The prognosis for neck pain is difficult to predict accurately. Some cases that appear minor become chronic. Other cases that appear severe resolve quickly. This unpredictability is frustrating but also encouraging: even the worst cases can improve.
An inspiring example: a man suffered from neck pain for 35 years. One day, a particularly well-targeted massage completely eliminated his pain—and it never returned. This kind of case is not the norm, but it illustrates that even long-standing cases can sometimes find an unexpected resolution.
What is central sensitization and how does it affect my pain?
Central sensitization occurs when your nervous system becomes overly sensitive to pain signals. It's like a home alarm going off for no reason. Your brain amplifies normal signals from the neck and interprets them as dangerous, even without actual tissue damage.
After several months of pain, your nervous system may change the way it processes signals. The brain and spinal cord become hypersensitive. Stimuli that should not hurt begin to hurt. This is a real, biological phenomenon—not "in your head" in the imaginary sense.
Interestingly, women seem to be more susceptible to this phenomenon than men. This may be why being female is one of the only clearly established risk factors for chronic neck pain.
The good news: even with central sensitization, improvement is possible. Understanding what is happening in your nervous system can be therapeutic in itself. Pain education has become an important tool in the treatment of chronic pain.
How does physical therapy help neck pain?
Physical therapy uses manual therapy, exercises, and education to treat neck pain. The goal is to restore mobility, reduce pain, and help you understand why you are in pain. It is the first-line treatment recommended by clinical guidelines.
Physical therapy for neck pain includes several approaches:
- Manual therapy: manual techniques to mobilize joints and relax tense muscles
- Exercises: to restore mobility, strengthen stabilizing muscles, and improve functional posture
- Education: to understand one's condition, reduce fears, and adopt self-management strategies
An important component is education about pain. Understanding that your neck is not "fragile" or "damaged" can in itself significantly reduce pain. Research shows that negative beliefs and fear of movement are important factors in the chronicization of pain.
If you suffer from neck pain and would like to consult a physical therapist, visit our page on neck pain.
Frequently asked questions about neck pain
How long does typical neck pain last?
Variable—from a few days to several months. Most acute episodes resolve within 2 to 4 weeks. Chronic cases may last longer but generally continue to improve with time and appropriate treatment.
Should I wear a neck brace?
Generally not. Immobilization slows down healing. Movement is beneficial for recovery. Brief use (24-48 hours) may be acceptable for very severe cases, but beyond that, movement should be encouraged. Studies show that prolonged immobilization promotes chronic pain.
Do massages really help?
Yes, they can help. Massage addresses the muscle tension that often accompanies neck pain. Results vary—some people experience dramatic relief, while others see only modest improvement. Massage seems to be particularly effective when trigger points are involved.
Can I exercise with neck pain?
Generally yes, with modifications. Gentle movement aids recovery. Temporarily avoid high-impact activities or contact sports. Listen to your body and avoid movements that significantly aggravate the pain.
When should an MRI be performed for neck pain?
Rarely. MRI is only recommended if red flags are present or if conservative treatment fails after more than 6 weeks. Most neck pain does not require imaging. Early imaging can even be counterproductive by creating unnecessary anxiety.
Can stress cause neck pain?
Probably yes. Chronic stress keeps the nervous system on high alert, lowering the pain threshold. It also increases muscle tension. A 2015 study identified depression as a direct risk factor for the development of neck pain. Poor sleep quality also exacerbates pain.
