Mr James Langdon

BSc (Hons) MB BS MRCS (Eng) FRCS (Orth) Consultant Orthopaedic Spinal Surgeon

Conservative management of neck pain

Spinal specialists often use the term conservative management to describe any treatment option that does not involve surgery. Treatment for your neck may be as simple as reassuring you that you do not have a serious problem. However, anyone who has had a neck problem should consider some preventive measures to protect their neck from further problems in the future. Most patients will benefit from seeing a physiotherapist, an osteopath, or a chiropractor.

Neck pain is common. However, there are a number of simple things that you can do to optimize the condition of your neck, which when combined can form an effective strategy that allows you to become more comfortable and active.

Stretching: The aim of stretching is to maintain the range of movement of your neck. You should stretch the rest of your body as well as your neck. A physiotherapist, osteopath or chiropractor will help you to develop a program of stretches that you can then perform two or three times a day on your own.  The aim is to allow your neck to have freer movement so that you do not injure your neck when engaging in trivial activities.

Regular exercise: With the help of your physical therapist you should develop an exercise regimen to strengthen the muscles associated with the neck, shoulder girdle and chest. These exercises need to be done regularly enough to strengthen your muscles. Swimming backstroke can be helpful as part of your regimen. The difficulty comes in maintaining your exercise regimen long term. As you start to get more comfortable you can begin to slowly return to more enjoyable forms of exercise.

Much of the strength and stability of the spine comes from the muscles of the stomach, back and upper thigh. These muscle groups form your own ‘internal muscular corset’ or ‘core’ that serves to support and protect your spine. Many people think that looking after you core is only important for lower back, but having a good core is equally as important for patients with neck problems, as having a strong core will help with your general spine control and posture. Your physical therapist will be able to teach you specific core strengthening exercises. As you become more comfortable with these exercises then you may benefit from joining a Pilates class.

It is also important that you do some general fitness exercise. High impact sports such as squash, long distance jogging, and rowing should be avoided if possible. Breaststroke swimming can also often aggravate neck problems. To begin with you will often feel sore the day following exercise. If you have a longstanding history of neck pain then it is important that you increase your activity level gradually so that you hopefully avoid getting into a cycle of activity followed by pain and inactivity.

Anti-inflammatory medication: Inflammation of structures in the neck is a big factor in neck pain. Anti-inflammatory medication can be very effective in helping to reduce this inflammation and improve your symptoms.

Many people do not want or feel the need to take regular medication, but prefer to use it only when their symptoms are bad. Even if not taking anything on a regular basis, it can often be helpful to take something half an hour before exercise (or other activity that you feel is likely to aggravate your neck) so as to keep to a minimum any discomfort that you may feel afterwards. If you suffer with your neck first thing in the morning it can be beneficial to take something before you go to bed at night.

When taking any medication always follow the instructions on the leaflet, and do not exceed the recommended dose. Anti-inflammatories are not be suitable for everyone, especially if you have a history of asthma, high blood pressure, kidney or heart failure, heartburn or stomach ulcers. You should check with your GP or pharmacist if you have one of these conditions or if you are taking any other form of medication.

Lifestyle modification: Many people with neck pain will have particular things that they like or have to do in their daily lives that aggravate their neck. You should consider your daily activities both at home and at work. Rather than giving up some activities, you should aim to reduce or modify those activities that appear to aggravate your neck. You also need to look at your posture. Poor posture is one of the biggest factors in people who suffer with chronic neck pain. Attention to your posture coupled with some simple lifestyle modifications can significantly improve your symptoms.

There are a number of activities in our daily lives that can contribute to neck pain and which can be easily modified:

Workstation modifications: The back of your chair should be high enough to support your shoulders, and the back of the chair should be at right angles to the seat. The position of your head is determined by the position of your computer screen. Your screen needs to be raised off the desk, level with your head. You may be surprised as to how high it needs to be. Your keyboard needs to be raised as well.

Working at a laptop is a disaster for people with neck problems, as we assume a terrible, hunched posture when working at a laptop. If you have to work regularly on a laptop, then get a separate keyboard and a plinth so that your screen can be set at the right height.

Many work place assessments result in a new chair. However, the chair is rarely the problem. If your desk is high enough, and your keyboard and screen in the correct position for you, then your posture will improve, whatever chair you have. It is also helpful to have a desk that tilts so that you do dot have to look directly down when using paper. Regardless as to how well you have your workstation set up you should never sit at your desk for more than one hour at a time.

If you spend a lot of time on the telephone then use a headset so that you do not sit with your head and neck tilted over to one side.

If your neck is aggravated by long journeys in the car, allow a bit more time for your journey so that you can take regular breaks. Likewise, if you have to do heavy physical tasks at home such as hovering the house or digging the garden, then try to avoid doing it all at once and have regular breaks.

Collars: Collars should only be worn when absolutely necessary. In the short term you may feel more comfortable with a collar on. However, if you wear a collar for a prolonged period of time then the muscles which support the neck will become weaker.