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Neck Pain & Stiffness

Most neck pain comes from strained muscles, posture or age-related wear, and usually eases within a few weeks with keeping the neck moving, heat or cold and simple pain relief. Neck pain after an injury, a stiff neck with fever, new weakness or numbness, or a sudden severe headache needs emergency care.

Call 911 or go to the emergency department now for:

  • Severe neck pain after an injury such as a car crash, a diving accident or a fall. A trained professional, such as a paramedic, should immobilize the neck to avoid further injury and possible paralysis, and time matters (AAOS OrthoInfo). In older people, even a fall from standing height, such as off a chair, can break a bone in the neck (AAOS OrthoInfo). Also get immediate care if an injury causes neck pain that spreads down the arms and legs (AAOS OrthoInfo).
  • A stiff neck with fever and a severe headache, especially with sensitivity to bright light, confusion, vomiting or a rash that doesn’t fade when you press a glass on it — possible signs of meningitis, which can get serious very quickly (NHS, MedlinePlus).
  • A sudden, extremely painful headache (a “thunderclap” headache) with neck pain or a stiff neck — a possible sign of bleeding on the brain (subarachnoid haemorrhage), a life-threatening emergency (NHS).
  • Signs of a stroke: a face drooping on one side, being unable to lift both arms and keep them there, slurred or garbled speech, sudden loss of vision, or weakness or numbness down one side — even if the signs go away (NHS). A tear in an artery of the neck (cervical artery dissection) is an important cause of stroke in young and middle-aged adults, and it can start with a one-sided headache or pain at the back of the neck (AHA/ASA statement, 2014). Neck manipulation has been linked to these tears — see Chiropractic for what the evidence shows.
  • New problems walking, sudden clumsiness (for example with buttoning a shirt) or loss of bladder or bowel control (NHS).
  • Neck, jaw, shoulder or arm pain with chest discomfort, shortness of breath, heavy sweating or nausea — possible signs of a heart attack. Call 911 even if you aren’t sure (NHLBI).

Get an urgent same-day appointment for: severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in your arms or legs; pins and needles in an arm along with neck or arm pain; or pain between your shoulder blades (NHS). After a neck injury, also get urgent help for severe pain despite painkillers, tingling on one or both sides of your body, trouble walking or sitting upright, or a sudden “electric shock” feeling in your neck and back (NHS).

Don’t drive yourself to the emergency department (NHS), and don’t wait for a chiropractic, acupuncture or massage appointment for any of these signs.

What is neck pain?

Any part of the neck — muscles, bones, joints, tendons, ligaments or nerves — can cause neck problems (MedlinePlus). The neck moves a lot and carries the weight of the head, but it is less protected than the rest of the spine (AAOS OrthoInfo). The good news: most neck pain lasts only a few weeks (NHS), and surgery is rarely needed (MedlinePlus).

What causes it?

  • Muscle strain and posture — often from sitting at a computer too long, sleeping in an awkward position or overdoing exercise (MedlinePlus, NHS).
  • Whiplash, a neck injury from a sudden movement of the head, most often in a traffic accident, fall or sport. It causes neck pain and stiffness, headaches and shoulder or arm pain that can take hours to start, and usually gets better within 2 to 3 months (NHS). See a doctor after a neck injury even if you feel fine, because sprain pain may not appear until the next day (AAOS OrthoInfo).
  • Cervical spondylosis (arthritis of the neck), the age-related wear of the discs and joints, affects more than 85% of people over 60, and many have no symptoms. Pain and stiffness are often worse after looking up or down for a long time, as when driving or reading (AAOS OrthoInfo). A past neck injury or a family history raises the chance of it (NHS). See our arthritis guide.
  • A pinched nerve (cervical radiculopathy): a nerve root squeezed by worn joints or, in younger people, usually a herniated disc. Burning or sharp pain travels down the arm, sometimes with pins and needles, numbness or weakness. Most people get better over time without treatment, though it can come back (AAOS OrthoInfo).
  • Spinal cord compression (cervical myelopathy): wear and tear, a disc, rheumatoid arthritis or an injury squeezes the spinal cord. Signs include numb or weak hands, trouble with handwriting or buttons, and poor balance. Symptoms can be vague for a long time, and the condition gets worse over time (AAOS OrthoInfo).
  • Twisted neck (torticollis). In babies, a tight neck muscle tilts the head to one side; stretching and positioning correct most cases, and about 10% need surgery. Torticollis can also start later in life and may need specialist care (AAOS OrthoInfo). In adults, cervical dystonia turns or pulls the head in a specific direction; it is the most common focal dystonia and usually first appears in midlife (NINDS) — see our dystonia guide.
  • Rare and look-alike causes. Infection or tumors rarely cause neck pain (AAOS OrthoInfo). Shoulder problems, heart disease and nerves trapped at the elbow or wrist can mimic a pinched nerve (AAOS OrthoInfo).

Related guides: headaches, back pain and head trauma.

Diagnosis: do I need an X-ray or MRI?

A clinician will ask how the pain started and check your strength, feeling, reflexes, flexibility and walking (AAOS OrthoInfo).

  • After an injury, emergency doctors use checklists to decide who needs imaging. In a U.S. study of 34,069 people, five simple criteria — including no tenderness in the middle of the back of the neck and no nerve problems — identified people at very low risk of a neck injury (NEXUS study, 2000). The Canadian C-Spine Rule treats age 65 or older, a dangerous mechanism of injury or tingling in the limbs as reasons for X-rays (Stiell et al., 2001).
  • Without an injury, you may be sent for X-rays or scans depending on your symptoms (NHS). X-rays show bone; MRI shows discs, nerves and the spinal cord; nerve tests help tell a pinched nerve in the neck from one trapped elsewhere (AAOS OrthoInfo).
  • Scan findings are common in people without pain. In an MRI study of 1,211 healthy volunteers, 87.6% had bulging discs — including most people in their 20s (Nakashima et al., 2015). A “bulge” on a report is not always the cause of your pain.

See a doctor or other provider if: neck pain or stiffness doesn’t go away after a few weeks, painkillers haven’t helped, you’re worried about the pain, or you have other symptoms such as pins and needles or a cold arm (NHS); if whiplash hasn’t improved after a week (NHS); or if your pain is constant, severe, or comes with pain or numbness spreading down the arms or legs, headaches, tingling or weakness (AAOS OrthoInfo).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Keep the neck moving with heat or cold and simple pain relief; physical therapy with strengthening exercises; NSAIDs, acetaminophen and short-term muscle relaxants or steroid pills; injections or surgery for a pinched nerve or spinal cord compression. Physical therapy cash-price estimate being researched. Medicare Part B covers medically necessary PT (20% coinsurance after the deductible). Most neck pain eases within weeks. Strengthening exercise has the best support for chronic pain; medicines have limited evidence. Surgery is mainly for nerve or spinal cord compression.
Chiropractic Neck manipulation (a controlled thrust) or gentler mobilization, often with soft-tissue work and exercise advice. About $55–$100 a follow-up visit without insurance; first appointments $90–$200. Medicare Part B covers spinal adjustment for subluxation (20% coinsurance). May ease acute and chronic neck pain, with manipulation and mobilization giving similar results in trials. Mild soreness is common. Neck manipulation is linked to rare artery tears and stroke; whether it causes them is debated. Never for spinal cord compression.
Acupuncture A course of needle treatments for ongoing neck pain, alongside exercise and other care. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Moderate-quality evidence of short-term relief compared with sham needling; the benefit doesn’t seem to last. Side effects are usually minor.
Herbal medicine Chinese herbal formulas for neck pain with nerve symptoms; capsaicin patches and essential-oil creams on the skin. Cost estimate being researched. Little research, mostly small or low-quality studies; a capsaicin patch did no better than a placebo patch. Some Chinese herbal products have been contaminated. Check with a pharmacist first.
Massage therapy Hands-on soft-tissue work for neck and shoulder pain, as a comfort measure alongside exercise. At one national chain, about $125–$160 for 60 minutes for non-members (memberships about $70–$90 a month). Medicare doesn’t cover massage ordered by a chiropractor. May give short-term relief; a 2024 Cochrane review found little or no difference from placebo for subacute or chronic neck pain. Low risk with gentle pressure.
MBHA Wellness Coach Keeping active, a desk, screen and pillow setup that spares the neck, regular breaks, strengthening exercise, quitting smoking, sleep and stress skills. Cost estimate being researched. Supports — never replaces — medical care. Keeping the neck moving and fixing posture habits are core self-care steps for common neck pain.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the cause (MedlinePlus). Most neck pain starts with self-care and, if needed, physical therapy and medicines; injections and surgery are for a smaller group with specific problems.

1. Self-care first

2. Physical therapy

Physical therapy is usually the first treatment doctors recommend for neck arthritis: exercises to strengthen and stretch the muscles, sometimes with posture work or gentle traction, often 2 to 3 sessions a week for 6 to 8 weeks (AAOS OrthoInfo). A Cochrane review of 27 trials found moderate-quality evidence that strengthening exercise for the neck, shoulders and upper back eases chronic neck pain; stretching alone may not help, no evidence was found for acute pain, and some uncertainty remains (Cochrane review, 2015).

3. Medicines

A Cochrane review found only limited evidence and unclear benefit for muscle relaxants, painkillers and NSAIDs in subacute and chronic neck pain (Cochrane review, 2007). We don’t list doses; ask your doctor or pharmacist what is safe for you.

4. Injections

Steroid injections — epidural injections for a pinched nerve, facet joint injections for arthritic joints — give many people short-term relief, and radiofrequency ablation of the nerves to a painful joint can ease chronic pain for several months (AAOS OrthoInfo). They are used less for spinal cord compression, which they can make worse (AAOS OrthoInfo). Botulinum toxin injections worked no better than salt water for chronic neck pain (Cochrane review, 2007), though they are often the most effective treatment for cervical dystonia (NINDS).

5. Surgery

Surgery is mainly for a pinched nerve or a compressed spinal cord, especially with worsening weakness, numbness or unsteadiness (AAOS OrthoInfo); spinal cord compression is generally treated with surgery (AAOS OrthoInfo). It isn’t always a cure but may stop symptoms getting worse (NHS). Operations remove a disc or bone spurs and fuse the bones, replace the disc with an artificial one, or free the nerve from the back of the neck (AAOS OrthoInfo). In the few small trials available, surgery relieved pinched-nerve pain faster than physiotherapy or a collar, with little or no difference after a year (Cochrane review, 2010).

Who treats neck pain

Whiplash that isn’t improving may be referred to a physiotherapist, a pain specialist or for psychological support (NHS); long-lasting pain is best managed by a team (NINDS).

What it costs

  • Physical therapy: cash-price estimate being researched. Medicare Part B covers medically necessary outpatient PT when your provider certifies you need it; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Prescription medicines, injections, scans and surgery: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors adjust (manipulate) the spine and may also use heat and ice, electrical stimulation, exercise and lifestyle advice; neck pain is one of the main reasons people visit them (MedlinePlus).

Manipulation or mobilization?

Manipulation applies a controlled thrust that moves a spinal joint more than it would move on its own. Mobilization uses no thrust, stays within the joint’s natural range of motion and can be controlled by the patient (NCCIH). A Cochrane review of 51 trials (2,920 people) found that several sessions of either gave similar results for pain, function and satisfaction; because rare but serious harms from manipulation exist, the authors called for more research focused on mobilization (Cochrane review, 2015). MBHA suggests asking your chiropractor whether mobilization would suit you.

What the research says

  • Acute neck pain: a 2021 analysis of 6 studies (446 people) found manipulation helped reduce pain, though the evidence was limited (NCCIH).
  • Chronic neck pain: a 2019 review of 47 trials (4,460 people) concluded that manipulation or mobilization may reduce pain and improve function, based on low- to moderate-quality evidence (NCCIH).
  • Compared with other care: in one trial, neck manipulation beat certain medicines for acute and subacute pain. Manipulation of the upper back helped neck pain in the short term, though publication bias is possible, and trials of neck manipulation or mobilization against no treatment were few and mixed (Cochrane review, 2015).
  • Headaches that start in the neck may become less frequent and less intense with manipulation (NCCIH).

Safety, and the stroke debate

Mild side effects — more pain, stiffness or headache — are common and usually go away within 24 hours. Serious problems, including strokes involving neck arteries, have been reported but are very rare, and no one knows exactly how often they happen (NCCIH). The evidence, from both sides:

  • The link: neck manipulation has been linked to small tears in neck arteries (cervical artery dissection) that can lead to stroke; other sudden neck movements, from sports, whiplash or violent coughing or vomiting, may also raise the risk (NCCIH). Most population studies have found an association in young patients, and the American Heart Association says patients should be told about it before neck manipulation (AHA/ASA statement, 2014).
  • Cause or coincidence? A tear can itself cause neck pain and headache before a stroke, so people may seek care because it has already begun. A large Ontario study found people under 45 with this type of stroke were about three times more likely to have seen a chiropractor or a family doctor beforehand, and found no excess risk with chiropractic compared with primary care (Cassidy et al., 2008). A 2016 analysis found a small association, very-low-quality evidence and no convincing evidence of cause (Church et al., 2016). The AHA says the evidence doesn’t establish that manipulation causes tears, but that mechanical forces seem to play a role in a considerable number of them (AHA/ASA statement, 2014).
  • Newest data: in a 2026 registry of 4,023 people with these tears, about 1 in 20 reported neck manipulation beforehand, more often younger women. The authors judged the absolute risk extremely low given how many manipulations are done, and said it is unresolved whether manipulation triggers tears or people with early symptoms seek it (STOP-CAD registry, 2026). Randomized trials found no more mild or moderate side effects than with other treatments, but they are too small to detect rare serious events (review, 2024).

In plain terms: the risk appears very low, experts disagree about cause, and you have a right to be told about it. Get a medical check first for any warning sign; tell your chiropractor about a sudden or unusual headache or neck pain and any blood thinners; and call 911 for stroke signs after any neck treatment. Manipulation should never be used for spinal cord compression (AAOS OrthoInfo), and other health problems may raise the risk of a serious side effect, so share your health history and medicines (NCCIH).

Medicare coverage

Medicare Part B covers only spinal adjustments by a chiropractor to correct a subluxation, not X-rays, massage or acupuncture a chiropractor orders; you pay 20% of the approved amount after the deductible (Medicare.gov).

What it costs

Without insurance, a follow-up visit typically costs about $55–$100 and a first appointment about $90–$200; several weeks of care can add up to $500–$1,000 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

In the United States, acupuncture is most often used for pain such as back, joint or neck pain (NCCIH).

What the research says

  • Cochrane review: 27 trials of acupuncture for neck pain found moderate-quality evidence that it relieves pain better than sham (simulated) acupuncture at the end of treatment and in the short term, and that people who had it reported less pain and disability in the short term than people on a waiting list. The benefit didn’t seem to last over the long term (Cochrane review, 2016).
  • Back or neck pain together: a 2018 review found acupuncture worked better than no treatment and better than sham acupuncture; the gap over sham was smaller, and the pain relief was comparable to NSAIDs (NCCIH).
  • How long it lasts: in an analysis of 20 studies of painful conditions, the benefits lasted a year after treatment for every condition except neck pain (NCCIH).

In short: acupuncture may bring some short-term relief for ongoing neck pain, best used alongside exercise rather than instead of it.

Safety

Side effects in the Cochrane trials were minor — more pain, bruising, fainting, worsening symptoms, swelling and dizziness — with nothing life-threatening reported (Cochrane review, 2016). Complications have come from non-sterile needles and poor technique; the FDA requires needles to be sterile and single-use, and most states license acupuncturists (NCCIH). MBHA suggests telling your acupuncturist if you take a blood thinner or are pregnant.

Medicare coverage

Medicare Part B covers acupuncture only for chronic low back pain, so it won’t pay for acupuncture for neck pain (Medicare.gov).

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics charge about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little research on herbs for neck pain, and most of it is small, low quality or done with specific products that may differ from what you can buy.

What the research says

  • Chinese herbal formulas for long-lasting neck pain with nerve symptoms: a 2010 review found only four studies, all in Chinese, with low-quality evidence and effects too small to matter clinically (review, 2010). A 2026 review of 14 trials (1,576 people) of manufactured Chinese herbal formulas for a pinched nerve found they may reduce pain, but the evidence was low or very low certainty, the safety evidence especially weak, and side effects were more common than with placebo (review, 2026).
  • Capsaicin (from chili peppers) patch: in a trial of 61 people with chronic muscular neck pain, pain improved in both groups and the capsaicin patch did no better than a placebo patch (randomized trial, 2012).
  • Essential-oil cream (marjoram, black pepper, lavender and peppermint): one small trial of 60 people found pain eased in both the essential-oil and the unscented-cream groups, with some extra gains in pain tolerance and neck function in the essential-oil group (randomized trial, 2014).

An over-the-counter NSAID gel on the skin has stronger support for injury-related pain than any herb (see Conventional medicine).

Safety

  • Some Chinese herbal products have been contaminated with heavy metals, pesticides, hidden drugs (including the blood thinner warfarin and the NSAID diclofenac) or the wrong herbs, some of which have caused organ damage (NCCIH).
  • “Natural” doesn’t always mean safe; supplements can interact with medicines and some may raise bleeding risk or affect anesthesia around surgery (NCCIH).

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, an NSAID or several prescription medicines, are pregnant or breastfeeding, or are planning surgery (NCCIH). We don’t list doses, and no herb should delay care for the warning signs at the top of this page.

Approach 5 of 6

Massage therapy

Massage can feel good and may bring short-term relief, but the research behind it for neck pain is weak.

What the research says

  • Cochrane review, 2024: 33 trials (1,994 people) found low-certainty evidence that massage probably makes little or no difference to pain, function or quality of life compared with a placebo for subacute or chronic neck pain at up to 12 weeks. Many trials used only a single session; in a subgroup, higher doses (8 or more sessions of at least 30 minutes over four weeks) showed a clinically important difference. The authors called the overall contribution of massage uncertain (Cochrane review, 2024).
  • Other reviews: massage helped neck and shoulder pain more than inactive treatments but no more than other active therapies, and a 2016 review found it could give short-term relief of neck pain if sessions were long and frequent enough; benefits may last only a short time (NCCIH).

Safety

The risk of harm from massage appears low, though rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in older adults (NCCIH). MBHA suggests asking for gentle pressure on the neck and telling your therapist about osteoporosis, blood thinners or a recent injury. Don’t use massage to put off a medical check for red-flag signs.

What it costs

  • At one national chain, published franchise prices for a 60-minute massage run about $125–$160 for non-members and about $65–$90 for members, whose memberships cost about $70–$90 a month (The Pricer).
  • Medicare doesn’t cover massage therapy ordered by a chiropractor (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Much of what helps neck pain happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, your medical care.

Keep the neck moving

Keep your neck moving rather than resting it in a collar (NHS), and keep up everyday activities after whiplash (NHS). A coach can help you plan a gradual return to the things you’ve been avoiding. Fear of hurting yourself again is understandable, but avoiding activity can slow recovery and play a part in pain becoming chronic (NINDS).

Build strength

Strengthening exercises for the neck, shoulders and upper back have the best evidence for chronic neck pain, while stretching alone may not help (Cochrane review, 2015). Get an exercise plan from a physical therapist, and a coach can help you stick with it.

Posture habits

Sit upright, roll your shoulders back gently and bring your neck back, and don’t keep your neck in one position for a long time (NHS). See Your desk, screen and pillow for setup tips.

Smoking

Smoking is clearly linked to more neck pain (AAOS OrthoInfo) and slows healing (NINDS). A coach can help you make a plan to quit.

Stress, mood and sleep

Depression and anxiety are risk factors for neck pain (AAOS OrthoInfo), and depression, anxiety, PTSD and sleep problems commonly go along with chronic pain. Cognitive behavioral therapy teaches coping skills such as scheduling daily activities, building sleep routines, relaxation and mindfulness, and resilience can be built with support and practice (NINDS). A coach can help you pace your week and connect with a counselor if worry or low mood is getting in the way.

Another approach

Your desk, screen and pillow

Small changes to how you sit, look at screens and sleep can take strain off your neck. Ergonomics aims for the best fit between you and your job, including good posture whether you are sitting at a computer, standing at a checkout or walking around a warehouse (MedlinePlus).

At the computer

  • Screen straight ahead. Put the monitor directly in front of you so your head, neck and body face forward; turning your head to the side for long periods loads the neck muscles unevenly and adds to fatigue and pain (OSHA).
  • Top of the screen at or slightly below eye level, at least 20 inches away. A screen that is too high makes you tilt your head back, which tires the neck and shoulder muscles (OSHA).
  • Bifocal wearers usually view the screen through the bottom of their lenses; lowering the monitor, raising the chair or using single-vision lenses made for computer work can help (OSHA).
  • Set your chair height so your feet rest flat on the floor (MedlinePlus), and change position often so your neck isn’t held the same way for a long time (NHS).

Phones, reading and driving

Looking up or down for a long time, or holding the neck in one position, as when driving or reading a book, can make arthritis-related neck pain worse (AAOS OrthoInfo). MBHA suggests raising your phone or book toward eye level and changing position often.

Sleep

Protect your neck from injury

Always wear a seat belt, never dive into shallow water or water where you can’t see the bottom, wear the right protective gear for your sport, and make the home safer for older adults (for example, taping down rugs and adding handrails) to prevent falls (AAOS OrthoInfo).

What it costs

Most of these changes are free. Cost estimates for ergonomic equipment are being researched.

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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