NECK PAIN AND SPASMS

CONDITION

Neck pain and spasms (involuntary muscle contractions) can occur anywhere from the back of your head, down toward your shoulders and along the sides of your neck, or toward the center of your neck (Figure 1 below). Sometimes, especially if a nerve is being pinched, pain can go down your arm and/or into your hand.

Figure 1

Causes

Many problems can cause neck pain (Figure 2 below) including:

Figure 2

muscle spasms from bad posture or injury
herniated discs (bulging of the round, gel-filled structures that act as shock absorbers between the spinal bones) (Figure 3 below)

Figure 3

degenerative discs (a breakdown of the discs) and arthritis (joint inflammation)
injuries such as sprains or strains that can result from sports or auto accidents. A sprain is an injury to ligaments (fibrous tissue that connects bone to bone or cartilage to bone). A strain is a muscle injury.
a direct blow to the neck or a hit to the head or other part of the body that causes the neck to bend quickly in any direction. Fractures of the bones in the neck and back can be caused by auto accidents, falls and contact sports. More than half of all sports-related neck injuries occur in football.
a tight spinal canal resulting from bulging or degenerated discs and arthritis
infection. Neck pain and stiffness with a fever can be caused by meningitis, a serious infection of the lining of the brain and spinal cord.
heredity. Having a parent with neck problems may increase your risk of developing a neck problem.
having had previous neck injuries, disc problems or arthritis. These may make your neck more prone to injury.

Symptoms and Signs

Pain can start suddenly and quickly become very intense or it can start slowly and build up over time.
The pain can be sharp and stabbing or achy.
It sometimes causes a headache.
The muscles along the sides of the spine usually hurt.
Your neck may be stiff and it may hurt when you turn your head or bend your neck.
Poor posture (slumped shoulders with the head hanging forward), degenerated discs and arthritis usually cause chronic pain that starts slowly and tends to come and go.
Ligament, muscle, bone and disc injuries that happen during sports or as a result of an auto accident that causes whiplash (an injury that occurs when a blow from behind causes the neck to snap back) usually cause immediate, severe neck pain.
Any weakness or numbness and tingling in the arms and hands may indicate pinched nerves in the neck and can be very serious.
Neck pain and stiffness with fever and sometimes headache, especially after a cold or other infection, can signal meningitis.
Some fractures, herniated discs and ligament injuries can be dangerous or unstable and require immediate evaluation, especially if they are causing weakness or problems feeling or using your arms.

WHEN TO CALL YOUR DOCTOR

Call 911 if:

You are alone, in severe pain and cannot get yourself to the hospital.
You have problems moving your arms and legs after an injury.
You have numbness in your limbs or have problems feeling your arms and legs after an injury, especially if both sides are affected.
You have neck pain and were hit hard enough to pass out.
You have any problems breathing after a neck injury.
You have other severe injuries that are cause for concern.

Call your doctor right away (night or day) if:

You have significant neck pain, especially if it came on quickly or occurred after an injury.
You have numbness, tingling or problems feeling in one arm or hand, even if there was no injury.
You have arm or hand weakness, even if there was no injury.
Your neck is so stiff that it is difficult to turn or bend it in any direction.
You have a fever, headache and/or rash with neck stiffness.
You have a sudden change in the level or type of pain that is different from any pain you have had in the past from neck problems.

Call your doctor during regular office hours if you have mild to moderate neck pain and:

You have mild to moderate neck stiffness but can still bend and turn your neck.
You don’t have numbness, tingling or problems feeling your arms and hands.
You don’t have weakness in your arms and hands.
You don’t have a fever or headache.
Your neck pain or muscle spasm has built up slowly over days to weeks or longer.

It is best to see your doctor within the first few days to a week after symptoms appear.

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SELF-CARE AT HOME

Try to avoid putting your neck into positions that increase symptoms.
Do not use a neck collar or support unless told to do so by a doctor.
Use ice (try this first) and/or heat, whichever seems to work better, directly applied to the neck and surrounding muscles for 15 to 20 minutes at a time as often as hourly.
- If you don’t have an ice pack or cold pack, which can be bought at most drugstores, a bag of frozen vegetables will work.
- An electric heating pad works well, but avoid getting it wet.
- You can try alternating ice or cold and heat for 10 to 15 minutes each.
- Gently moving your neck forward, backward and sideways under a warm shower can sometimes help.
You may take ibuprofen (Advil® or Motrin®), naproxen (Aleve®), or acetaminophen (Tylenol®) as needed for pain. (See labels for dosing and risks.)
Gentle exercises can help loosen up your neck.
- Pull your chin back or in before moving your neck in any direction.
- Move your head and neck gently forward and backward, tilt your head to the side toward your shoulders, and rotate your chin and attempt to look over your shoulder. Go only to the point where you feel a slight stretch in your neck muscles. Hold each position for 20 to 30 seconds.

If you get any nerve symptoms such as numbness, tingling or loss of feeling in your arms and hands, stop all exercises until you see a doctor.

PREVENTION

A good neck-strengthening program can help prevent neck injuries.
Avoid “spearing” or head tackling in football.
Practice good posture.
Make sure your work station is set up properly.
Invest in a good mattress and pillow.

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FOR MORE INFORMATION

REFERENCES

Anthony J, Parker R: Cervical spine injuries. In Mellion M, Putukian M, Madden C: Sports Medicine Secrets, Hanley & Belfus, Philadelphia, 288-293, 2002.
Dorshimer G, Kelly M: Cervical pain in the athlete: common conditions and treatment. Primay Care 32(1): 241-243, 2005.
Eddy D, Congeni J, Loud K: A review of spine injuries and return to play. Clinical Journal of Sports Medicine 15(6): 453-458, 2005.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.