Neck Pain

This page is a starting point, not a diagnosis

Neck pain is one of the most common reasons anyone sees a doctor, and the great majority of it resolves without anything being done to it.

What this page does is help sort which kind you have, because the answer changes where you should go next. There are essentially three groups.

Group one: the neck itself

Aching, stiffness, reduced range of movement, pain across the neck and into the shoulders, often worse after a long day or a sustained position. No numbness, no weakness, nothing happening in the arms.

This is by far the largest group, and it is where most people land. The cause is usually muscular, or arthritic change in the facet joints, or some combination.

It does not generally need imaging. It responds to movement, to changing position frequently rather than holding one, to conditioning, and to time. Physical therapy helps a good number of people. A great many recover with nothing more than reassurance and a few weeks.

If this describes you and things are improving, you probably do not need a spine surgeon.

Group two: the pain goes into the arm

Pain running from the neck into the shoulder blade, the upper arm or the forearm, particularly with pins and needles or numbness in specific fingers, or weakness in a specific movement.

That pattern points at a nerve root rather than the neck. It is cervical radiculopathy, and it is worth reading that page rather than this one.

It is often still treated without surgery, and frequently settles. But it is a different problem with a different assessment, and the examination matters, because identifying which nerve root is involved determines everything that follows.

Group three: hand function or balance has changed

This is the smallest group and the one most worth catching.

Buttons and coins have become fiddly. Handwriting has changed. You are dropping things. Walking feels less certain, or you have started watching your feet. Both hands are affected rather than one.

Those signs point at the spinal cord rather than a nerve root, and the neck may not even hurt. That combination is covered under cervical spinal stenosis and myelopathy, and it is the one situation in the neck where waiting has a genuine cost.

If this describes you, do not wait several months to see whether it settles.

What about a whiplash injury?

Neck pain following a car accident or a fall belongs in its own category, mainly because the assessment has to rule out things that ordinary neck pain does not.

Most whiplash-type injuries are soft tissue injuries that improve over weeks. The history, the mechanism and the examination determine whether imaging is warranted, and significant trauma changes that threshold considerably.

Injuries sustained at work have a separate pathway, described under injured patients.

When to be seen

Any of the red flags above, promptly.

Arm symptoms that are not settling, or any weakness, sooner rather than later.

Neck pain alone that has not begun improving after several weeks, or that is getting worse rather than better, is reasonable to have examined. The aim of that visit is to identify which of the three groups you are in, which mostly comes from the history and the examination rather than from a scan.