In most cases, neck pain can be treated conservatively with over-the-counter pain medications, ice, heat and massage, and stretching exercises at home. If pain does not improve after a few weeks of conservative treatment, further evaluation is usually recommended.
Acetaminophen (eg, Tylenol and others) or a nonsteroidal antiinflammatory medication (eg, ibuprofen, naproxen) may be helpful to relieve mild to moderate neck pain.
For people with severe muscle spasm, a muscle relaxant may be recommended. Both tricyclic antidepressants and muscle relaxants can cause a person to feel sleepy.
For some people, ice can reduce the severity of neck pain. It can be applied directly to the sore area of the neck. Ice can be frozen in a paper cup, then the upper edge of the cup can be torn away. The ice should be moved continuously in strokes on the neck muscles for five to seven minutes.
To control sudden onset muscle tightness, place a bag of ice, bag of frozen peas or a frozen towel, wrapped in a dry towel, on the painful area. The ice should be left in place for 15 to 20 minutes to deeply penetrate the tissues; this can be repeated every two to four hours until symptoms improve.
The skin can become injured with excessive use of ice massage. The skin should be inspected daily for changes in pigmentation (eg, lighter or darker colored skin) and any changes should be reported to a healthcare provider.
Heat can help to reduce pain in the neck muscles. Moist heat can be applied for 10 to 15 minutes in a shower, hot bath, or with a moist towel warmed in a microwave.
It is important to avoid overheating the towel and potentially injuring the skin, especially in people with poor skin sensation. The skin can become pigmented (discoloured) in a blotchy pattern in people who use heat frequently.
Massage can be helpful for relieving muscle spasm and can be performed after heating or icing the neck. Massage can be done with the hands by applying pressure to both sides of the neck and the upper back muscles, or with an electric hand-held vibrator. The neck muscles should be relaxed during massage by supporting the head or lying down.
The range of motion of the neck must be restored and preserved after an injury; this is done with exercises that stretch and strengthen the neck muscles. Range of motion exercises and stretching may help decrease pain from muscle injury.
Exercises can be performed in the morning to relieve stiffness and again at night before going to bed. Expect mild, achy muscle pain; sharp or electric pain in the shoulder or arm is not normal and should be reported to a healthcare provider.
Do not attempt to perform these exercises if you have a pinched nerve in the neck, especially if there is pain or numbness into the arm and hand, unless recommended by a healthcare provider. While these exercises can dramatically improve symptoms of a pinched nerve, they can actually make the problem worse if performed improperly.
The most useful stretching exercises for the neck include the following:
Tilt the head forward and try to touch your chin to your neck. Hold for a few seconds, breathe in gradually, and exhale slowly with each exercise. Exhaling with the movement helps relax the muscles. Repeat 10 to 15 times. Relax the neck and back muscles with each neck bend.
In the sitting or standing position, hold the arms at the side with the elbows bent. Try to pinch the shoulder blades together. Roll the shoulders backwards 10 to 15 times, moving in a rhythmic, rowing motion. Rest. Roll the shoulders forwards 10 to 15 times.
Exercise tips may include neck rotation, neck tilting, vertical shoulder stretches, upper back stretches, and back bending.
Slowly look to the right. Hold for a few seconds. Look to the center. Rest for a few seconds between movements. Repeat 10 to 15 times. Perform on the left side.
Look straight forward, then tilt the top of the head to the right, trying to touch your right ear to the right shoulder (without moving the shoulder). Hold in place for a few seconds. Return the head to the center. Repeat 10 to 15 times. Repeat on the left side.
Vertical shoulder stretches
In the sitting or standing position, use the right hand to hold the left wrist and pull the arm (and shoulder) up and over the head, towards the right. Hold for five seconds. Keep the left shoulder and back muscles relaxed. Rest and repeat 10 to 15 times. Repeat using left hand to hold right wrist.
Upper back stretches
In the standing position, lean forward from the hips and rest both hands on a low counter with the elbows straight. Exhale, relax the neck and shoulders, and allow the head to fall forward as you round the upper back. This requires the shoulder blades to spread apart and mimics the motion of a cat stretching its back. Exhaling with the motion helps to relax the muscles. Return to the standing position with hands on a counter. Repeat slowly 10 times.
Upper back side bends
Stand or sit up straight in a chair. Bend the trunk to the right while holding the hands together slightly behind the neck for support. Hold for five seconds, and then return to center. Repeat to the left. Repeat 10 to 15 times. Keep the lower back straight or supported against a chair.
Emotional stress can increase neck tension and interfere with or delay the recovery process. Reducing stress may help to prevent a recurrence of neck pain. Relaxation techniques can relieve musculoskeletal tension. An example of a relaxation exercise is to take a deep breath in, hold it for a few seconds, and then exhale completely. Breathe normally for a few seconds, and then repeat. Tips for activities that may help to reduce stress include meditation, progressive muscle relaxation, prayer, self-hypnosis, or biofeedback.
Activities and body positions that prevent or reduce neck pain include those that emphasize a neutral neck position and minimize tension across the supporting muscles and ligaments of the neck. Extremes of range of motion, activities, and body positions that cause constant tension should be minimized or avoided: Avoid sitting in the same position for prolonged periods of time. Take periodic five minute breaks from the desk, work station, etc. Avoid looking up or down at a computer monitor; adjust it to eye level. Avoid placing pressure over the upper back with backpacks, over-the-shoulder purses, or children riding on your shoulders. Alternatives may include wheeled backpacks or cases, handbags, and having a child walk or ride in a stroller.
Do not perform overhead work for prolonged periods at a time. Maintain good posture by holding your head up and keeping your shoulders back and down.
Use the car or chair arm rests to keep the arms supported.
Sleep with your neck in a neutral position by sleeping with a small pillow under the nape of your neck (sleeping on your back) or sleeping with enough pillows to keep your neck straight in line with your body (sleeping on your side). If you sleep on your back, putting a pillow under the knees can help to flatten the spine and relax the neck muscles. Avoid sleeping on the stomach with the head turned. Carry heavy objects close to your body rather than with outstretched arms.