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A Pain in the Neck

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All around the country, including near my practice in Portland, Oregon, many adults and teens experience neck pain with a similar prevalence as low back pain. It’s been estimated that approximately 10% of the adult population has neck pain on any given day. Most people with neck pain will recover with conservative treatments like physical therapy, heat/cold, time, and occasionally medication. 

Most mild to moderate neck strains improve within the first three weeks. We describe neck pain as acute if it has been present for less than six weeks, subacute if it’s been present for 6 to 12 weeks, and chronic neck pain if it’s been present for more than 12 weeks. Initial treatment for people with acute neck pain include education about their condition, postural exercises, gentle stretching, and medications if needed.  Education can include reassurance about the likelihood of recovery from this injury in a short period, the natural progression of the neck, pain, and the importance of physical fitness good posture, good seating, ergonomics at work, and good sleep. Sometimes I’ll see individuals in my sports medicine clinic who present with documented imaging findings, such as a disc bulge, osteoarthritis, or even a disc herniation. I spend time educating my patients regarding the high prevalence of these findings, even among people who do not have any symptoms. It is important to help individuals who are experiencing acute neck pain, avoid over focusing on certain imaging abnormalities.

Simple posture changes can be an essential part of treating neck pain. These can include sitting upright with the shoulder blades retracted. When doing desk work which so many of us do daily, the natural tendency is to shrug and round the shoulders forward, and sometimes even hold our breath which creates neck tension.   Learning to recognize and adopt a more neutral posture and performing regular breathing, can help correct these contributors to neck pain such and neck muscle tension. Another important consideration is having a good ergonomic set up for your workstation. There are many useful online resources and videos regarding appropriate ergonomics for desk work. I commonly encourage my patients who have sedentary jobs that require a lot of sitting to make efforts to stand and walk during the day and perform gentle shoulder and neck range of motion exercises while at work. I commonly get asked about neck pain and sleep position. The preferred position is to sleep on your back with a relatively small pillow under the head and neck. For side sleepers, use of a slightly larger pillow can help maintain good neck alignment. At my sports injury clinic, we commonly educate individuals on gentle home exercises. For individuals with neck, pain, gentle shoulder, shrug exercises, shoulder blade retraction exercises, and neck rotation exercises can be helpful for treating and preventing neck pain.

When it comes to medication options, I usually recommend NSAID medication like ibuprofen or acetaminophen as first line treatments.  Sometimes a short course of prescription anti-inflammatory medicine can be utilized for pain relief. This is more commonly utilized in patients with more severe symptoms or pain due to a whiplash injury.

In individuals with higher risks for chronic pain, like neck trauma, headache, radiation of pain, and previous episodes of pain, we utilize multiple strategies including physical therapy, medication, psychological therapies, manual therapies, like massage, joint mobilization, and spinal manipulation are appropriate for younger patients. When individuals have chronic or severe persisting pain, sometimes we will utilize interventional treatments such as trigger point injections. Therapies that we do not recommend include neck collars, low level laser therapy, TENS, neck traction, and electromagnetic therapy. Surgical interventions are rarely used for non-radicular neck pain.

In summary, most mild to moderate neck strains, resolve within several weeks. Initial therapy for all individuals includes education, postural improvements, home exercises, and medication if needed. Some additional treatments for individuals with more severe neck pain can include physical therapy, manipulation, massage therapy, and even psychological therapies.

If you are experiencing acute or chronic neck pain, we are here to help. At Sports Health Northwest we provide unique and individually tailored approaches to help identify and treat your underlying cause of neck pain. We utilize the best and most evidence-based treatment options, available for our patients.


Dr Westerdahl David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.

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