Condition · 8 min read · 19 Jul 2021

Learn about neck pain and how to manage your pain and improve your quality of life.

Use this content to learn management strategies to take control of your neck pain.

By Dr Michelle Sterling, Prof Helen Slater and Ms Abbie Norrish

Neck pain is a common pain condition and in most cases settles down with simple management. Neck pain is usually referred to as ‘specific’ or ‘non-specific’.

What is ‘specific’ neck pain?

Your health professional can screen for specific structural or spinal pathology (such as infection, or inflammation) that may be causing your neck pain. Specific causes of neck pain in young people are rare.

This means that the majority of young people with neck pain DO NOT have ‘specific’ pathology, and other known factors are contributing to your neck pain.

What should I do if I have ‘specific’ neck pain?

If your neck pain that has started for no apparent reason, if your neck pain is constant or severe, if you feel unwell or have a fever or rapid weight loss, it’s important to see your doctor.

Completing our medical self-check, helps screen for symptoms or conditions that might need a medical review. Seeking immediate medical review if needed is strongly recommended to ensure you get the right care at the right time and to ensure there is nothing seriously wrong.

While rare, the following conditions can be associated with neck pain:

Inflammatory arthritis – check out our Juvenile Inflammatory Arthritis (JIA) pain condition for more information
If you have a traumatic injury (e.g., a car accident), it is possible to have a neck fracture (broken bone). It is critical to get a medical review right away. Depending on the fracture, you may require special care or surgery. Pain management treatment may be required during this period. Once the neck bone has healed, a graduated rehabilitation process is usually needed to restore normal movement, build your neck strength and your confidence to move freely.
Arm pain from nerve compression due to a disc prolapse can be very painful and distressing. There may be no specific incident that triggers the symptoms, however, for others, there may have been an accident or fall. For most young people, the pain gradually resolves in 6-12 weeks and the disc prolapse is re-absorbed naturally over a 3-6 month period. Surgery is rarely needed unless you lose muscle strength or function.
Spine infections and cancer are extremely rare in young people. If they are present, it’s important to seek urgent medical care. You can also use our medical self-check to help screen for serious conditions that require a medical review.

“Getting the right care straight away is vital”.

What is ‘non-specific’ neck pain?

‘Non-specific’ neck pain is by far the most common type of neck pain. ‘Non-specific’ refers to neck pain that is not associated with specific pathology (e.g. the conditions outlined above).
It’s helpful to know that most cases of ‘non-specific’ neck pain settle within a few days and simple management is usually effective.
Importantly, X-rays or other imaging (like CT or MRI) are usually not necessary and the results of any imaging do not usually change your management.

With non-specific neck pain, spinal structures can become painful and sensitive without specific structural damage or pathology. There are likely other factors that are contributing to your neck pain, these include:

Physical factors such as muscle tension, holding awkward postures for long periods when studying or working, sleeping in an unusual position/with a different pillow, over-protecting the neck during movement or activity due to fear of pain, or fear of damage, and tissue health and condition.
Lifestyle factors such as being sedentary (sitting lots), too little activity or over-activity and poor sleep patterns.
Psychological factors such as thoughts, feelings, beliefs, stress, worries and low mood.
Other health factors such as generalised fatigue and mental health conditions.

While neck pain is always REAL, searching for a tissue cause with this type of neck pain can be unhelpful and can leave you feeling unsure and distressed. Here, your health professional’s role is to first and foremost check that nothing serious is going on, so that you can feel confident that you are safe to move. After this has been done, we can make a plan together to get you back doing the things you really enjoy i.e. riding your bike, reading a book or going out with your friends.

Busting the myths of neck pain

There are lots of myths about neck pain that people commonly believe. Myths can be very unhelpful.

“Understanding what is true and what is false about neck pain is the first step to managing your neck pain”.

Myth: Neck pain is caused by loose joints, or the neck being ‘out’ of place

Fact: Necks are strong, mobile structures and they don’t go ‘out’ of place

Myth: Neck pain means my neck is damaged

Fact: Neck pain can occur from no specific causes and/or can be associated with no tissue damage or pathology as well as through a traumatic injury such as a sporting injury or falls. When neck pain is associated with tissue damage, healing typically occurs within 6-8 weeks.

Myth: Neck pain is just a physical, structural problem

Fact: Neck pain can be related to levels of muscle tension, not being active enough, poor sleep, activity levels, mood, stress or worry

Myth: Painful necks need to be rested and protected

Fact: Good sleep, healthy diet, relaxed movement and regular activity and exercise helps neck pain

Myth: It is dangerous to exercise, move, bend or stretch with neck pain

Fact: Necks get healthier and stronger with graduated movement, activity and exercise

Myth: You need to watch your posture with neck pain

Fact: A range of postures are safe for the neck. Being too sedentary isn’t good for neck pain

Myth: Ongoing neck pain means the spine is becoming more damaged

Fact: Ongoing neck pain is related to the sensitivity of the neck tissues to load and movement. This is related to many factors but is rarely linked to tissue damage.

Myth: There is nothing you can do for neck pain

Fact: Neck pain can be effectively managed with the right care

Myth: Neck pain will get worse with time

Fact: With the right care, neck pain can get better with time

Myth: A neck pain flare-up means I have injured my neck

Fact: Pain flare-ups are common and are usually caused by factors such as inactivity, fatigue, stress and low mood. With the right care, you can develop a set of tools/strategies to recover well from a flare-up

What should I do if I have ‘non-specific pain’?

Neck pain that has a non-specific cause generally ‘comes’ and ‘goes’. The trick is to try and work out what is/are the main trigger(s) for your neck pain.

These questions can help to identify your pain triggers:

Is it your study/work position? Sometimes not moving enough throughout the day when you are studying can trigger neck pain,
Is it your sleeping position or the quality of your sleep that is contributing to your pain?
Or maybe, it’s worse when you’re stressed?
Other factors that can be triggers include being afraid to move (unsure if it’s safe to move, worrying you will hurt yourself, or perhaps you’re trying to guard your neck, fearing pain or a risk of damage). These are completely understandable concerns, however, they can mean you get stuck in a loop of fear, worry and over-protection.

“Once you know what your neck pain trigger(s) are, you can plan what you can do”

The best care for most neck pain is having a good understanding of neck pain. Credible education about pain is really helpful. Knowledge helps put you in the driver’s seat and better supports you in knowing that it’s safe to move, it’s good to change positions and postures throughout the day, and that general movement, exercising and strengthening your neck are helpful approaches to support your recovery.

Having knowledge also means you can reflect on the triggers for your neck pain and learn different habits that help you recover or better manage your neck pain.

Try the following reflection:

“When bending over to pick up a tissue, I notice that I guard and protect my neck”. I can reflect: was it necessary for me to guard my neck– a tissue is so light – why should that hurt? What damage could that do?

Insights and learning: When neck pain persists, much of what we do day to day, including how we move, becomes a habit – some habits are helpful and others are not.

Let’s repeat the experiment: Try bending over to pick the tissue up, and this time, take a slow deep breath, soften your neck and shoulder muscles…sink into the movement…this should be more comfortable. Here, small gains build towards bigger gains over time. Your mind and body take time to learn that it’s safe to move and movement can ease pain.

Things you can do that usually help neck pain include:

Moving gently, relaxing and stretching your muscles can be helpful (but on its own, is not enough¹).
Exercising to improve the strength and control of your neck and shoulder girdle muscles. Your health professional can help you with what exercises are best for you.
Daily exercise is good for your general wellbeing, including your muscles and joints, heart and lungs and your mood. Doing something you like is important. This could be walking, running, swimming, gym, playing sport, yoga, dancing or other enjoyable movement-related activities.
Changing your posture regularly when you’re working/studying at a computer/desk. Getting up and walking around for a few minutes every hour or so is helpful.
Modifying your work/study position so your arms are in a position that feels comfortable and supported. Regular relaxation and gentle stretching of your neck muscles can provide relief.⁴
Having a comfortable, supportive pillow at night helps with neck pain. Good sleep habits are important too, including having about 8-10 hours of sleep each night. Try switching off your devices an hour or so before you go to bed.
Pacing your activities by doing small bits often or taking the middle road, rather than overdoing or underdoing things.
Gradually starting meaningful activities now that you have a different understanding of pain and what it is telling you/means. This can be done by yourself or with the help of a health professional (e.g. physiotherapist).
Planning your work and social activities ahead helps you think about ways you can better manage demanding work/study periods or pain flares. Experiencing some pain as you recover is usual and good planning can help to prevent you from derailing when you have a pain flare.

Rather than using a single approach (like medications), a few combined simple strategies (exercise, sleep, medications and stretches/relaxation and paced activity) may be more helpful for you.

Treatments such as massage and ‘joint mobilisation’ may provide short-term benefits but this alone is not helpful and does not provide lasting relief.^2.

Check out our recommended care fact sheet.

Do medicines help neck pain?

Medications can play a role in the management of neck pain (without nerve pain), but are not recommended as a standalone treatment. Simple pain medications (paracetamol e.g. Panadol), and anti-inflammatories (e.g. Celebrex) may be recommended for short-term use.

The use of medications is designed for short-term use to help keep you moving and stay engaged in the things you love to do. Side effects from medications can vary and you should ask your doctor about the risks and benefits of using medicines.

Check out the medicines and pain management module, for the pros and cons of medicines and how they fit into your overall pain management plan.

Why hasn’t my neck pain gone?

Most acute non-specific neck pain is short-lived and resolves. For some young people, however, neck pain can persist, or they experience repeat episodes. We are starting to better understand why this may occur.

The various factors that can contribute to ongoing or recurrent neck pain that was outlined above are relevant here. Other factors include:

People’s beliefs and attitudes about pain (yours and your healthcare professionals)
Fear of pain and re-injury which may stop us moving (it’s not safe to move; I need to protect my neck)
Feeling out of control or not able to manage neck pain; work/study, environmental, social factors and genetic factors.

Factors that help protect against ongoing neck pain include moving, keeping active and engaged in things you enjoy as much as possible, avoiding sitting for long periods of time, and hanging out with friends or family.

Check out the approaching pain management module to learn more about these factors.

What about whiplash and neck pain?

Whiplash-associated disorders can occur in some people following a sudden impact injury, such as a motor vehicle crash or a sporting injury⁵.

For more information about whiplash and whiplash management exercises, see the Whiplash Injury Recovery: a self-help guide or the My Whiplash website.

Motor Accidents Authority Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney: 2014⁵ and the Motor Accidents Authority NSW Youtube channel. This self-help guide has videos about moving and exercising accessible by QR codes.

In rare cases, it is possible to get a fracture or broken bone in your neck after a car accident or sporting impact injury. Consult your health professional as soon as possible after a motor vehicle crash, so they can examine you and provide the best advice about what care you need. Getting the right approach, at the right time, means that you can recover more quickly and any serious conditions are identified.

Factors that may suggest a slower recovery after whiplash include:

Higher levels of pain, very restricted movement of your neck, very sensitive to cold temperatures and not being able to function normally in your school, university, work and social life⁵.
High stress levels, ongoing distress, and worry about your neck pain.
Not expecting to recover well⁵.

If any of these apply to you, ask your health professional as early as possible how they can help you get the best care at the right time.

What about treatments for whiplash?

A combined approach is recommended⁶ – one that is tailored to your needs and goals. For whiplash, reducing stress, worries and concerns, along with an exercise program to help you keep moving, supports recovery⁸.

Treatments currently recommended for whiplash-associated disorders, where there is NO serious pathology (e.g. fracture), include⁵:

Education and reassurance that neck pain does not mean ongoing damage or harm. It’s helpful to know that experiencing some pain as you recover is usual.
Not being fearful helps recovery. If you are fearful, your health professional can help you with ways to approach moving and exercising safely.
Pacing your activity: doing little bits often (not too much and not too little) helps you get back to the things you love to do. Pacing also helps to reduce the risk of pain flares
Simple analgesia (paracetamol and anti-inflammatory medications) may be appropriate for short term use.
Moving your neck in usual relaxed positions and postures and stretching
Stress management such as relaxation, deep breathing⁸
Joint ‘mobilisation’ may be appropriate but not as a standalone treatment.
If you experience dizziness or imbalance, re-training your neck muscles to improve their ability to position you in space may be appropriate.
Rest, collars and procedures (such as facet joint injections) are NOT recommended.

What about neck pain and headaches?

Tension headaches and migraines are common in young people. It is important to discuss your headaches with your health professional to ensure you receive the right care. Trying to establish the cause of your headaches is a good starting point to finding out which treatments are right for you.

Consider:

When you get headaches (e.g. time of day, week)
What the symptoms are (e.g. sensitivity to light, nausea, disturbed vision),
Where you feel the headaches (the location in your head)
What the triggers are (e.g. food, stress, sleep position, work posture)
What eases the headaches (e.g. avoiding certain foods, relaxation, stretching)

Sometimes, headaches can be coming from sensitive joints in the neck (cervicogenic headache) and your physiotherapist can assess this and advise you about the right treatments for your problem⁷.

Want more information?

If you’re experiencing neck pain or are concerned about your neck pain use our medical self-check to help you screen for conditions that may suggest you should consult a Health Professional.

If you’re experiencing whiplash or would like further information about whiplash go to the State Insurance Regulatory Authority NSW or Recover Centre Whiplash Consumer Resources or mywhiplash

For specific treatment evidence for neck pain go to Cochrane Summaries.

Alternatively, if you want to talk to someone about Neck Pain, please seek further assistance.

Neck Pain recommended care (PDF)

Download a summary of quick tips and information to help you understand and manage Neck Pain.

RECOVER Injury Research Centre

Access a range of helpful information about Whiplash treatment options from the University of Queensland.

Whiplash fact sheet (PDF)

A 12-week Whiplash recovery fact sheet by the NSW Government.

Contributors

This module has been co-created by Dr Michelle Sterling and Prof Helen Slater in collaboration with Ms Abbie Norrish. The information in this module is based on current best evidence research and clinical practice and lived experience of neck pain.

References

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Andias R, Silva AG. Psychosocial Variables and Sleep Associated With Neck Pain in Adolescents: A Systematic Review. Physical Occupational Therapy in Pediatrics. 2020;40(2):168-191. doi: 10.1080/01942638.2019.1647328. Epub 2019 Jul 31. [PubMed]
Dragotta K, Jang B, Quinzi B, Bosco A, Clewley D. Physical therapy management of pediatric and adolescent neck pain: a call to action. Physical Therapy Review. 2019;24(5):208-215. doi: 1080/10833196.2019.1663979
de Zoete, R. M. J., Brown, L., Oliveira, K., Penglaze, L., Rex, R., Sawtell, B., & Sullivan, T. The effectiveness of general physical exercise for individuals with chronic neck pain: a systematic review of randomised controlled trials. European Journal of Physiotherapy. 202; 22(3), 141-147. doi:10.1080/21679169.2018.1561942
Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, Gianola S, Ferrante S, Zanoli G, Moja L. Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database of Systematic Reviews. 2015 May 26;(5):CD010664. doi: 10.1002/14651858.CD010664.pub2. [PubMed]
Silva Guerrero AV, Maujean A, Campbell L, Sterling M. A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clinical Journal of Pain. 2018 Sep;34(9):838-857. doi: 10.1097/AJP.0000000000000601. [PubMed]
State Insurance Regulatory Authority NSW. Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney, 2014. [PDF]
Sutton DA, Cote P, Wong JJ, et al. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The spine journal: official journal of the North American Spine Society 2014. [PubMed]