Have a Crick in Your Neck? Let’s Talk Pain Relief.

While “crick in the neck” isn’t a scientific or diagnostic term, people suffering from the sensation seem to most regularly describe symptoms of a stiff neck and, at times, associated neck pain. Cervical (upper spine) disc herniation or degeneration, and resultant neck osteoarthritis, can cause such stiffness, especially when the stiffness is accompanied by pain that radiates around the upper body (1). Neck osteoarthritis is also referred to as spondylosis.

General, non-specific neck strain can also lead to the crick feeling. This type of strain may occur from sitting at a computer for long periods of time or "holding a phone between the ear and shoulder. Arthritis can also cause neck stiffness and pain. If left untreated, arthritis can also compress spinal nerves and thereby result in radiating pain (2).

In rare cases, neck pain and stiffness could result from cancer, especially if the discomfort is accompanied by other symptoms like fever, extreme pain, or unexplained weight loss (3). "Another uncommon cause of neck pain is amyotrophic lateral sclerosis (ALS) – more commonly known as Lou Gehrig’s disease. When ALS causes neck stiffness or pain, it also often results in fasciculation, rapidly “flickering” muscle contractions (4).

A doctor will likely conduct a physical examination as a first step toward a diagnosis. The exam may include asking you to turn your head in various directions and checking for weak, numb, or tender spots. Your personal clinical and family history can also help your doctor determine a diagnosis as well. If your healthcare provider suspects that a pinched nerve could be causing your pain, they may run a neurological test like an EMG. EMGs can also be useful in assessing any nerve damage and potential underlying causes such as diabetes.

In some cases, imaging may be required prior to diagnosis. X-rays may reveal bone spurs as the source of your neck pain. A CT scan or an MRI may be necessary in order to give your healthcare provider the clearest picture possible as they search for the source of your neck pain and stiffness. Your healthcare provider may also order blood tests if they think that an infection or inflammatory condition could be the cause of your discomfort (5).

Consider whether there are adjustments you can make in your home or at your workplace to better support your spine. If you find yourself regularly sitting in an awkward position or realize that your desk is not a good ergonomic fit for you, then altering your workplace setup will be key for your treatment. Analyze where you spend long periods of time and explore your options for making your daily routine more comfortable.

Simple home remedies such as placing a heating pad on your neck or taking a hot shower may also provide relief. You may also find that applying ice will numb acute pain in your neck (6). A soft neck collar worn just a few hours at a time (so as not to weaken the neck muscles) may help relieve your pain as well (7).

If you regularly see a chiropractor, ask them if increasing the frequency of your visits could help relieve your pain. Your chiropractor may also have massage chairs or colleagues who are massage therapists who can provide supplementary treatment. If you haven’t visited a chiropractor before, speak with your regular healthcare provider about your health history and current symptoms to determine if a chiropractic visit could be of help to you.

As a first course of medical treatment, your healthcare provider will likely recommend a combination of responses in order to combat your neck pain and stiffness. These recommendations may include physical therapy, traction therapy (which involves stretching out the neck either manually or with machines), and NSAID medications (8, 9).

Depending on your health insurance provider, you may be able to make a physical therapy appointment directly by calling their office. Otherwise, your doctor can write a referral for physical therapy and recommend practitioners in your area who are equipped to help you find pain relief. As you determine where to go for physical therapy, consider a few factors:

• Is the physical therapist covered by your health insurance?
• If so, how many visits are covered and what copays will be charged?
• Where is the physical therapist located? 
• What are the office hours, and can they accommodate your schedule?
• Does the physical therapist perform manual therapy or do they prefer machines?
• Will you be able to attend physical therapy appointments regularly for a sustained period of time? 
  

You can purchase various kinds of cervical traction devices over-the-counter at your local pharmacy or online.

If neck pain and stiffness persists, your healthcare provider will likely recommend a muscle relaxant. The muscle relaxant cyclobenzaprine, for example, has demonstrated strong therapeutic effects specifically for neck pain and related muscle spasms (10). You’ll need to talk to your doctor about this option, as muscle relaxants require prescriptions. Prescription strength NSAIDs also relieve acute neck pain, including the prescription NSAID diclofenac gel, which exhibits few adverse effects (11).

Injections are another effective treatment for severe neck pain. Anesthetic injections can relieve neck pain in the cases of herniated discs and associated neck problems and steroid injections have also been used to successfully treat herniated discs and related neck pain (12, 13). Radiofrequency denervation (RFD) – heat-based injections – can offer short-term relief for chronic neck pain. However, more research is needed to substantiate its effects. Studies also show that acupuncture relieves neck pain as effectively as other courses of treatment (14).

If you and your healthcare provider determine that injections could help you, be sure to ask a few key questions:

• How frequently will I need injections?
• What are the side effects?
• How soon after the injection should the pain relief kick in? 
• How many rounds of injections should I try without results before considering another option?
• Can I continue to take NSAIDs, participate in physical therapy, or use a manual traction device while being treated with steroids?
  

If none of these treatments relieve your pain, your doctor may recommend surgery as a final option.

NSAIDs can cause gastrointestinal complications and cardiovascular issues (commonly stomach pain and heartburn) (15). The muscle relaxant cyclobenzaprine can cause dizziness, drowsiness, fatigue, and headaches (16). The main side effect of steroid injections is a temporary increase in pain as the body responds to the injection (17). Common side effects of acupuncture include bruising near the area of needle insertion and bruising. Less common side effects of acupuncture include dizziness, nerve damage, and increased pain (18). As with any surgery, neck surgery carries the risks associated with general anesthesia.

Speak with your healthcare provider about the potential risks and side effects of their proposed treatment plan. If your family history or personal clinical history includes adverse reactions to medication, injections, or surgery, make sure your doctor is aware of these factors.

A crick in the neck, or neck stiffness and associated neck pain, often results from a cervical herniated disc. General, non-specific neck strain – often the result of poor posture or a prior injury – can also lead to a crick in the neck. Make sure to mention any additional symptoms (whether they seem related or not) to your healthcare provider.

First-line medical treatment for neck pain and stiffness generally consists of physical therapy, manual traction, and over-the-counter NSAIDs such as ibuprofen or aspirin. It’s important that you relax as much as possible during physical therapy and manual traction, so ask your healthcare provider and their recommended physical therapist any questions you have on your treatment plan. Physical therapy often produces the best results, so it's important to find a physical therapist with hours, location, and pricing that works for you.

Second-line treatment includes muscle relaxants such as cyclobenzaprine and steroid injections. Surgery is a final option in the case of neck pain or stiffness that does not respond to any other course of treatment.

It’s worth noting that certain drugs used for back pain – such as antidepressants, anticonvulsants, and opioids – don’t appear to be nearly as beneficial for neck stiffness (19). Because of this, the repertoire of treatment approaches is more limited for neck stiffness. Some tricyclic antidepressants can treat both neck and back pain, so if you experience back and neck pain simultaneously, talk to your doctor about the potential effects of using these drugs for your pain (20).

While having a crick in your neck may be normal, suffering from neck pain and stiffness for a long time doesn’t have to be. In many cases, over-the-counter medications and accessible therapies will relieve your pain – which can feel like “undoing” the “crick” in your neck. Although unlikely, because there’s some possibility of a severe diagnosis, don’t excessively delay in making an appointment to see your healthcare provider to talk about your symptoms.