Pain in the Neck

Muscular neck pain – Cervicalgia – is a horrible thing; sharp, stabbing pains in your neck radiating to your scalp and shoulders, an exhausting heaviness in your head and feeling of rigidity in your neck and shoulders; along with a paralysing fear of moving.

When I was a child I remember my mum having episodes of neck pain that dragged on for weeks and even confined her to her bed. On a few occasions she even visited A+E and was given a big restrictive collar to wear. It was then my turn to get neck pain in my late 20’s and even though by then we stopped immobilising necks with collars, I remember being in agony for about 5 days, dosing myself up with pain killers, before it eventually settled down.

I have learned a lot about muscle pain since then and as a GP I have managed people with this type of acute muscular pain regularly; but it wasn’t until 2 years ago that I truly understood how to fix it.

When we have neck pain it is the muscle spasm and tension that causes all the pain. Your natural instinct is to hold yourself still and move as little as possible.

For years patients have been receiving high dose pain killers and even benzodiazepines (sedative muscle relaxants and anxiolytics) to relieve the muscle pain and spasm of neck pain. It’s not unusual for neck pain to drag on for weeks, months or even years managing it in this way (10% become chronic¹). When the pain is severe, patients tell me they simply cannot move their neck due to the pain. Yet, if we do move and stretch the muscles the pain does start to relieve and it resolves much faster. Of course there will be some patients who have a more complicated picture; or even chronic pain that may require a slightly different approach but exercise is evidenced to be associated with better outcomes (see here).

My own revelation came a couple of years ago as I woke with the classic symptoms of a neck pain. My muscles were extremely tight and sore, even a tiny movement shot pain up my neck into my head like a bullet. As with many people, one side was much more painful that the other and I struggled to wash and dress because of the pain.

By now I had learned a bit more about neck pain and realised that despite the pain I needed to move my neck as much as possible to try and ease it off. That morning I was booked into a circuit training class at the gym and I was determined not to get a black mark for late cancellation so I edged into the class anxious about how I would cope, wondering if I would be in a worse state an hour later. The class involved 30 stations of various body weight and weighted exercises including burpees, press ups, weight lifting, kettle bell swings and many others. Once the music started everyone got into full swing and so did I. The atmosphere in the class was both electric and adrenaline fuelled. I enjoyed every minute. It wasn’t until walking out of the class that I remembered my sore neck. I moved it from side to side and realised it felt free again and miraculously it no longer hurt.

Of course my cure wasn’t a miracle, I had stretched and pulled and strengthened the muscles in my neck so much during the class, that the tension was relieved and the muscle pain resolved. This level of exercise is not for everyone with neck pain and there was a risk I could have hurt my neck more with this approach. However, a year later I had a similar severe muscle spasm in my upper back. This time I tried gentle exercise for 24hours with no relief so I attended a pilates class which again resolved my pain.

So why am I telling this tale now? Well, last week my receptionist came to work in agony, I could tell immediately what her problem was as she stood in front of me. Her shoulders were raised and tense, holding her neck rigidly in place, she had a pained expression on her exhausted looking face and she made every effort not to move her neck while she did her morning duties.

I talked to her about neck exercises and she was extremely reluctant. She told me her story of suffering from neck pain since her early 20’s, being bed ridden for days in the past, of pain killers and exercise not helping and that she expected it to last for weeks as it always did. I told her my story of the revelation that exercise can ease muscle pain much more rapidly than pain killers. Amazingly, she agreed to try a different approach.

I gave her some simple neck exercises and shoulder exercises to do that morning, encouraging her to do them as often as she could, explaining that it would be more painful to begin with to pull on the sore muscles, but to stretch them as far as she could without getting sharp pain.

I met her at lunchtime and she looked much better. She still had pain and stiffness but could now move her neck a little from side to side and her shoulders were more relaxed. The following day her neck movements had improved substantially and by day 3 her symptoms had resolved. She was amazed with the results and has even continued the exercises to improve her neck flexibility further.

My receptionist’s story is not unusual. I encounter patients every day with muscular pain who are frightened to exercise for fear of causing more damage. If we can overcome this fear we have an opportunity to encourage a quicker resolution, reduce pain killer use, sickness absence, chronic pain and suffering.

For more information on managing neck pain or any other acute muscular pain, the Chartered Society of Physiotherapists website is an excellent resource for patients and doctors.

References

1. Binder AI. Neck pain. BMJ Clin Evid. 2008 Aug 4;2008:1103. PMID: 19445809; PMCID: PMC2907992.