Why does neck pain become persistent?

In some cases of persistent pain the cause of the pain (such as a facet joint or a disc) can be identified. However, it is important to realise that pain can sometimes continue even after the original cause (whiplash, facet or disc) has long since settled down.

Pain may at first cause you to avoid normal activities and movement. If your initial spell of neck pain lasts a long time, lack of activity can cause the neck muscles to become weak, and this reduces the ability of the cervical spine to take further knocks. You may also lose confidence in your ability to resume your normal activities. This may affect your work, your social life and your personal relationships. Naturally, you may feel depressed and anxious in this situation and this could lead to further loss of confidence, frustration and anger, particularly if family members and the medical profession appear unhelpful or unsympathetic. If you are anxious or depressed as a result of the pain, you may not feel like exercising, so your muscles become weaker still, and so it goes on.

This can happen to anyone, and the longer it continues the harder it will be for you to recover your movement and confidence. The sections that follow explain what can be done to prevent or break this cycle of pain.

How can I help myself?

Most attacks of neck pain settle down within a few days and do not need medical treatment. Resting for a few days is often all you need.

Painkillers

You can take simple painkillers such as paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, available at chemists, often help but can sometimes cause indigestion, so be careful if you have a history of stomach upsets. As an alternative you can rub anti-inflammatory gels or creams onto tender areas with less risk to the digestion.

Massage

Gentle massage of the neck muscles, particularly with aromatic oils, often helps. Please note, however, that some oils can be poisonous (toxic) in large quantities and can be harmful during pregnancy or with conditions such as epilepsy. Rubbing the area with liniments can also help – these produce a feeling of warmth and reduce pain. Some liniments available over the counter contain capsaicin (an extract of the capsicum, or pepper, plant), and a similar but stronger preparation is available on prescription.

Exercises

Simple exercises can help to restore your range of movement, promote strength, ease localised stiffness and help get your neck back to normal. You should start by exercising very gently and gradually build up. You can expect to feel some slight discomfort at first.

Figure 4 shows some simple stretching and strengthening exercises. Gently tense your neck muscles for a few seconds in each position. If you do this every day, the neck movements will increase your muscle strength.

Relaxation

Stress can make neck pain worse. One way of reducing the effects of stress is to learn how to relax the neck muscles. Relaxation and exercises are not mutually exclusive – they complement each other. You can sometimes get audiotapes to help with relaxation from your doctor or a physiotherapist. They can also be bought from the Pain Relief Foundation.

Posture

Pain and stiffness can be caused by poor standing posture or by too soft a bed or the wrong thickness of pillow. If your desk is too low, so that your head is bent forward for long periods, then the neck may be stretched and you may develop muscle pain. Check your desk height and chair design at work and in the home – this is important to prevent problems (see Figure 5). Similarly, if you work at a computer screen it is important to have screen, desk and chair set at the correct heights. Many firms employ people to check that their employees are sitting properly – check with your line manager or occupational health nurse.

The Alexander Technique is a method of teaching bodily awareness and reducing unwanted muscle tension. Lessons are given by qualified teachers who will assess you and advise you on things such as your standing and sitting posture and your patterns of movement.