Neck Pain 101: What Causes It and How to Fix It for Good
Neck pain is common, but when is it just an annoyance versus a serious issue? This post covers causes, when to see a doctor, and effective treatments.
Downloadable Neck Pain Workout Plan - Click on Picture to Open Link
Understanding Your Neck
Your neck, also called the cervical spine, is made up of seven vertebrae that start at the base of the skull and go down to approximately around the collarbone (clavicle). In between each vertebra live intervertebral (between vertebrae) discs. The discs are a thick and squishy material that is quite strong with gel inside - think jelly donut or mochi. Their main job is shock absorption during movement or if you have any force to the head (big or small).
The next layer of anatomy is the ligaments. The neck has many ligaments, especially in the upper region, which provide stability. In most cases, they keep the spine in place unless a condition like Ehlers-Danlos Syndrome causes excessive laxity.
The next layer of anatomy is the nerves. The spinal cord sends off shoots (imagine a plant) through little holes in the vertebrae called foramina. I like to call these the nerves’ houses. In an ideal situation, these nerves can glide smoothly in and out of their houses and have lots of blood to keep them happy as they work their way down the arm.
The final layer of anatomy is the muscles, which form a complex system since many that affect the neck do not actually reside there. In fact, most neck muscles are more closely connected to the skull and jaw than the neck itself. The most important muscles for neck stability are in the upper back, as they help maintain posture and provide foundational support.
I would argue that the gluteus maximus is also crucial because the spine functions as a chain: if the base of the chain (i.e., the pelvis) lacks support or proper alignment, it disrupts mechanics along the entire spine—often leading to issues at the top of the chain (i.e., the neck).
One muscle group that does reside in the neck is the deep neck flexors (primarily the longus colli), which are located on the throat side of the neck, between the esophagus/trachea and the front of the cervical vertebrae. These muscles are pivotal for neck stability and proper force distribution—more on that later.
Other honorable mentions include the upper trapezius, sternocleidomastoid (SCM), and levator scapulae, as these three muscles are almost always involved in neck pain.
Common Causes of Neck Pain
For as many different structures there are in the neck, there are ten times as many possible causes for neck pain. The vast majority of neck pain is not traumatic - usually related to posture, sleep positions, or tension. However, there are quite a few notable injuries worth discussing.
The “I just woke up like this” or “it came on all a sudden” neck pain:
This usually means your muscles either spasmed (think a charlie horse) or are holding onto tension. This can be due to your sleep position - usually due to a poor pillow or holding your head in a weird way while sleeping. It can also be due to how you hold your head during the day for prolonged periods of time, usually related to your ergonomics at work. For instance, one patient of mine had her office set up so she had to turn her head just 30 degrees to the right. This did not seem like a big deal, but when she did it for hours, the muscles started to tense up until they spasmed. Once she moved her chair over just a few inches, her neck pain never came back. Overall, this type of neck pain is not serious and there are many remedies for it, namely improving your ergonomics and modifying your sleep posture.
The “it hurts most in the middle and/or at the end of the day” neck pain:
This is usually indicative of poor posture or muscle weakness (usually both). Many of us live with a forward head and rounded shoulders because we are hunched over a computer or phone for so long. This puts the vertebrae in a bad position and stresses the muscles, the ligaments, and the joints. Instead of our bowling ball of a head (which weighs 11lbs/5kgs) being held over a nicely aligned Lincoln Logs, in the forward position, our bowling ball is held on the top of a dilapidated slinky, slowly sliding forward until the slinky cannot hold the weight (don’t worry, the cervical spine is much more stable than the slinky ;) ). This is also not serious, but if it becomes chronic, there can be changes to the neck like cervical lordosis. The best solution to this is strengthening the neck, upper back, and glutes.
The “I also ‘randomly’ have a headache or am dizzy” neck pain:
It is actually relatively common for people with neck pain to also experience headaches or dizziness. There is one specific group of muscles, called the sub-occipital muscles, that connect the upper cervical vertebrae to the skull. When these muscles become irritated or tense, they usually present as a headache. They are also usually tense when you have neck pain for other reasons (see above) so you can have both neck pain from poor posture and headaches from tense sub-occipitals.
Dizziness from neck pain is also relatively common. The neck plays a major role, along with your inner ear, in knowing which way is up and where you are in space. When your neck is out of alignment (essentially your vertebrae got stuck like a sticky dresser drawer) or you have a lot of tension (especially in your suboccipitals or SCM), you can have a mismatch between what your ears say about where up is and what your neck says where up is. That mismatch causes dizziness. This is usually not serious, but if you are experiencing it, you would benefit from seeing a vestibular physical therapist to help resolve it.
The “there is a sharp or significant pain and my arm feels weird” neck pain:
Sharp pain with symptoms extending into the arm is a little more serious than the previous types of neck pain. When pain, numbness, tingling, burning, or weird cold sensations are experienced in the arm, it usually means the nerve is getting irritated. There are three main culprits for this:
(1) Cervical Radiculopathy: The little house your nerve lives in is squishing your nerve, usually due to poor posture, muscle tension, or misalignment. This means the nerve cannot glide smoothly down your arm because it is stuck. It is also likely that the nerve is not getting as much blood flow as it needs because of its “squished-ness”. This is not to say it is not getting any blood or it is totally stuck in its house, it is just less than the nerve would prefer so it is getting irritated. This often improves with time but typically benefits from physical therapy to speed recovery
(2) Herniated Disc: Sometimes, if there has been a lot of force on the neck or a lot of awkward force on the neck, the jelly donuts can leak out some jelly. The jelly then usually irritates the nerves, causing irritation down the arm. Usually, when people have a herniated disc, one position is better than others (nodding down is better than nodding up, for example) and the pain is pretty intense (more like a six to eight out of ten). This also almost always requires physical therapy and consulting a doctor, especially if there is a lot of jelly that leaked out. Fortunately, the latest research does suggest that the jelly can dissolve and the disc can heal within six to nine months.
(3) Thoracic Outlet Syndrome: Don’t get confused by its name, as it usually also presents with neck pain. Here, the nerves and blood vessels are doing okay in their house (foramina) but are getting squished further down the chain around the collarbone (clavicle) usually by a tight pectoralis minor muscle or rounded shoulders. A significant finding for this is if the pain gets worse with overhead motions. The best treatment for this is also strengthening just as you would above.
The “I was just in a car accident or fell weird” neck pain:
Neck pain after a trauma, no matter how seemingly insignificant, is a little more concerning. On the milder end, I would be concerned about increased tension from the sudden jolt to the muscles and joint misalignment. On the more severe end, I would be concerned about fractures (though they are pretty rare).
Usually, people are somewhere in the middle, experiencing whiplash (a fast jolt to the ligaments and muscles causing pain) and sprains. Many people can write off a sprain as nothing significant, but a neck sprain means the ligaments providing stability to your vertebrae have become looser. If this happens repeatedly or in someone who already has more laxity in their ligaments, it can lead to cervical instability, which can cause chronic neck difficulties that need to be managed with strengthening.
When to see a doctor:
Most neck pain can be treated either at home or by a physical therapist. Rarely do you even need an x-ray or other imaging, as it is usually soft tissue (meaning muscles) or alignment-related. Neither of which will come up on an x-ray.
However, if you are experiencing the following symptoms, I would see a doctor to rule out any major issues:
Severe and sudden arm numbness that does not go away with changing positions.
Sudden weakness anywhere in the arm not explained by something else.
Severe, immediate neck pain after a high velocity event (car accident, bike accident, sport injury, cracking your neck, etc.).
Any car accidents in which at least one car was going more than 60mph.
Any fall greater than one meter (3 feet) or fall where you land on your head (e.g. diving).
If you also hit your head and have a headache, nausea, and/or dizziness.
(Adapted from Canadian C-Spine Rules, Stiell et al., 2001)
Treatment Options for Neck Pain
In most cases, neck pain can be effectively managed with strengthening, stretching, improving ergonomics, and optimizing sleep positions. While these are the foundation for long-term relief, there are also various short-term strategies to ease discomfort and improve daily function.
Strengthening & Stretching: The Core of Neck Pain Relief
A strong neck is a stable neck, and a stable neck is a pain-free neck. Strengthening and stretching key muscle groups can significantly reduce neck pain by improving posture, stability, and mobility.
Strengthening Focus Areas
A well-rounded strengthening program should target the following muscles:
Mid-Traps & Rhomboids – Support posture and stabilize the shoulder blades.
Lower Traps – Help maintain proper neck and shoulder positioning.
Latissimus Dorsi – Aids in overall spinal stability.
Rotator Cuff (especially external rotators) – Keeps the shoulders aligned and reduces strain on the neck
Gluteus Maximus – The foundation of spinal alignment and posture.
Deep Neck Flexors (Longus Colli) – Critical for neck stability and proper force distribution.
If you work with a personal trainer or physical therapist, providing them with this list can help them tailor exercises to your needs. You can also check out my downloadable workout plan on Etsy, which includes detailed strengthening and stretching exercises.
Stretching Focus Areas
To relieve tension and improve mobility, focus on stretching these muscles:
Upper Trap – Frequently tight due to poor posture and stress.
Levator Scapulae – A common culprit in neck stiffness.
Pectoralis Major & Minor – Often tight in people with forward head posture.
Sub-Occipitals – Small muscles at the base of the skull that contribute to headaches and dizziness.
You can find many effective stretches for these muscles online or through guided routines from a physical therapist.
Ergonomic Setup: Optimizing Your Work & Home Environment
Proper ergonomics play a huge role in reducing neck strain. While ergonomics deserves its own dedicated post, here are the essentials:
✅ Relaxed posture – Avoid tensing your shoulders or positioning your head awkwardly.
✅ Screen height – Keep your monitor at eye level or slightly below so you naturally gaze downward.
✅ Arm positioning – Ensure your arms are comfortably supported to avoid unnecessary neck tension.
Simple adjustments to your workspace can significantly reduce chronic strain on your neck.
Sleep Positions & Pillows: Finding What Works for You
I’m not a firm believer in strict sleep positions—comfort leads to better sleep, and good sleep is essential for healing. However, if you wake up with neck pain frequently or your bed looks like a battlefield every morning, you may benefit from strategies to limit excessive movement:
Body pillow – Helps stabilize your sleeping position.
Tucked blankets – Restrict excessive movement during sleep.
Choosing the Right Pillow
The right pillow depends on your body, sleep habits, and personal comfort. Unfortunately, there’s no universal solution, but here are some general guidelines:
Firmer or taller pillows often provide better neck support.
Memory foam works well for some but may feel too rigid for others.
Trial and error is key—if a pillow prevents good sleep, it’s not the right one for you.
Pain Relief Options
While long-term relief comes from addressing the root causes of neck pain, these pain management strategies can provide short-term relief:
Self-Massage & Heat Therapy
Theracane or Theragun – Great for self-massaging tight areas.
Moist heat – Helps relax tense muscles.
Migraine hats (cold therapy) – Reduces inflammation, especially in the sub-occipital muscles.
Topical & Over-the-Counter Pain Relief
Arnica, Tiger Balm, Icy Hot, Biofreeze – Provide temporary pain relief and reduce inflammation.
Advil (Ibuprofen) or Aleve (Naproxen) – Help with inflammation, can be combined with Tylenol for added pain relief.
Professional Treatments
Chiropractic adjustments – May help improve cervical alignments
Massage therapy – Reduces muscular tension.
Acupuncture – Helps target trigger points (muscle knots).
Physical therapy – The most effective long-term solution for strengthening and alignment.
Medical Interventions (if needed)
Prescription muscle relaxers or pain relief creams – Consult a doctor for persistent muscle tightness.
Cortisone injections or Botox – May be beneficial for chronic, unrelenting muscle pain
Sources:
Stiell, I. G., Wells, G. A., Vandemheen, K., Clement, C., Lesiuk, H., De Maio, V., ... & Laupacis, A. (2001). The Canadian C-spine rule for radiography in alert and stable trauma patients. Journal of the American Medical Association, 286(15), 1841-1848. https://doi.org/10.1001/jama.286.15.1841
