Most of us have woken up with a stiff neck at some point. For a lot of people over 45 it isn’t a one-off. The pain can come and go for months, flaring after a long day at the laptop or at the wheel so that it never quite clears.
Neck pain is one of the most common musculoskeletal problems worldwide. It affects a large share of adults at some point in their lives.
Here is what we know about why neck pain lingers, what helps and when to stop waiting for it to get better on its own.
Is it really just posture?
Posture takes a lot of blame, particularly for people who sit at a desk or live on their phone. It can play a part. But the idea of one particular position being defined as “correct posture” (and that we all need to strive for it) is an old-fashioned idea. A 2019 editorial in the Journal of Orthopaedic & Sports Physical Therapy argued that the idea of a single ideal sitting position needs rethinking, and that the bigger problem is often staying in any one position for too long. This is something we have been telling patients here at Sundial for years.
So the best posture is usually the next one. Stiffness tends to build up over hours of habits rather than arrive as soon as you slouch. Stress, poor sleep and low activity can make your neck feel worse even when your chair and screen are set up sensibly (but it’s worth checking on these too. (Read our blog on how to set up your work station here) If you’ve already done that and the pain is still there, something else is probably contributing.
What might be causing your persistent neck pain?
Most neck pain is described as non-specific or mechanical, meaning it comes from the muscles, joints and soft tissues of the neck rather than something serious underneath. NICE Clinical Knowledge Summaries describe it as common and usually self-limiting, though it can come back.
The small joints at the back of the neck are a frequent cause of this pain. They can get stiff or irritated, particularly as we reach our 40s and beyond, when age-related changes are more common. It usually shows up as a deep ache or a pinch on one side, worse when you turn your head suddenly or look up.
Muscle tension is the other major cause. Long stretches of concentration, stress or repetitive tasks leave the muscles around the neck and shoulders tight and tender, often with an ache between the shoulder blades. Tight or overactive muscles can compress or irritate nearby nerves, reducing their blood supply and their mechanical freedom to glide. This makes them more sensitive and leads to pain, tingling or burning along the nerve’s path.
Neck problems can also refer pain elsewhere, including headaches that start at the base of the skull and pain around the shoulder and upper back. This can happen because nerves from different parts of the body often share the same pathways into the spinal cord and brain, so the brain can misread where a signal is coming from and place the sensation in a different area. And sometimes the pain travels into the arm, with pins and needles, numbness or weakness. That can mean a nerve in the neck is irritated or compressed, often called a “pinched nerve” or cervical radiculopathy. Many cases settle with time and conservative care, but they are worth having assessed, particularly if the symptoms have been going on for more than a few weeks or are getting worse.
These patterns can look alike from the outside. This means that an assessment is the most reliable way to tell which one you have.
What does the evidence say about treatment?
Most people with non-specific neck pain improve. Several approaches have reasonable evidence behind them.
A Cochrane review of exercises for mechanical neck disorders found that exercise can reduce pain and improve function, though the quality of the evidence varies between types of exercise . Guidelines for physical therapy always put education, reassurance and exercise at the centre of care. A separate Cochrane review of manipulation and mobilisation found that the best results occur when these treatments are offered in tandem with other approaches. This means that hands-on treatment usually works best alongside advice and exercise. At Sundial, the team emphasises this kind of all-round approach to give you the best possible outcome. Treatment starts with a proper assessment, comes with advice on staying active and is aimed at what is actually causing your pain.
How chiropractic treatment can help neck pain
Spinal manipulation is the part of chiropractic treatment most people have heard of. It’s a quick, controlled thrust applied to a stiff joint in the neck or upper back. Chiropractor Matt Cunningham explains:
“At Sundial, we often work with the Impulse IQ, which is a handheld device that uses a microcomputer to measure how the tissue responds and then adjusts its thrust pattern to match. You won’t hear a “crack” during these adjustments. When performed manually, chiropractic treatment is often accompanied by a popping sound. The pop is due to gas changes in the joint fluid (nothing to do with bones slipping back into place!). Depending on what an assessment finds, treatment can also include gentler mobilisation (where the joint is moved through its range without a thrust), soft tissue work or dry needling for tight muscles, as well as exercises to do at home.”
Manipulation is best seen as one part of a plan rather than a cure on its own. Easing a stiff, sore joint can make it easier to get moving again, which allows you to get started on strengthening movement and exercise. This approach is what the guidelines emphasise. The Cochrane review found that a combination of manipulation, exercise and advice offers more marked improvements than medication alone.
Chiropractic manipulation tends to suit mechanical neck pain, the stiff, achy kind that gets worse with certain movements and is often linked to the joints at the back of the neck. It isn’t right for everyone. A proper assessment comes first, partly to find out whether manipulation suits you at all and partly to rule out anything that needs different care. Worsening arm weakness, a recent significant injury or any of the urgent symptoms covered below mean a different route.
How physiotherapy in Brighton can help neck pain
Some patients prefer a physiotherapy style of treatment. Rather than relying mainly on hands-on adjustments, physiotherapy tends to focus on gradual, active recovery: targeted exercises to build strength and control, practical advice on posture, work set-ups and daily habits. Our physiotherapists also use gentle manual therapy to ease pain along the way. This can suit people who would rather avoid joint manipulation.
Both physiotherapy and chiropractic treatment at Sundial are designed to give you lasting self-management tools to reduce the chance of your pain returning. As our team includes both chiropractors and physiotherapists, your care is shaped around what’s most likely to help you, whichever approach you start with. If you’re wondering which treatment is right for you, that’s what an assessment is for.
What you can try yourself
For most mild to moderate neck pain, don’t stop doing things. Gentle activity beats complete rest, and short walks and everyday movement help keep the neck and upper back loose. If you work at a screen, change position every 30 minutes or so. You could try the following movements, within a comfortable range. Stop if sharp pain comes on.
- Slow head turns left and right.
- Tilt each ear towards your shoulder
- Shoulder rolls and gentle shoulder blade squeezes to take some load off the neck.
- Warmth helps many people, whether a warm pack or a warm shower.
When it comes to sleeping, there is no single ideal pillow, so pick whichever keeps your neck comfortable and roughly in line with your spine, and change position in the night as you need to. If you need short-term pain relief medication to keep moving, your pharmacist or GP can advise on what’s suitable.
If you’ve done all this for a couple of weeks and the pain isn’t improving, or it keeps coming back, get us to look at it rather than waiting.
When to get it checked
Book an assessment if the pain has lasted more than a few weeks or keeps returning or if it spreads into your shoulder or arm. The same goes for pins and needles, numbness or weakness in your arm or hand, pain that disturbs your sleep or gets in the way of work and daily life, and pain that started after a fall, accident or whiplash-type injury.
Some symptoms need urgent attention. Call 999 or go to A&E if neck pain comes with a sudden, severe headache unlike any you’ve had before, facial drooping, slurred speech, weakness on one side of the body, loss of vision or difficulty walking. Seek urgent help too if you have neck pain with a fever, unexplained weight loss or a history of cancer, and speak to your GP or NHS 111 promptly if you’re unsure.
If your neck pain has been hanging around, you can book an assessment at either clinic. We’ll help you understand what’s going on and what to do next.
References
Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases. 2014;73(7):1309-1315.
Slater D, Korakakis V, O’Sullivan P, et al. “Sit up straight”: time to re-evaluate. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(8):562-564.
National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Neck pain, non-specific.
Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2015;1:CD004250.
Bier JD, Scholten-Peeters WGM, Staal JB, et al. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Physical Therapy. 2018;98(3):162-171.
Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews. 2015;9:CD004249.
Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(7):A1-A83.
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.