Three main causes of neck pain - posture, tension and lymph nodes.

Our neck is a remarkably delicate structure, considering the weight of our head (5 kgm) and how well we keep it steady.

Neck pain is mostly felt at the back , as most of what we do all day involves bending over forwards, with the large bulk of muscles at the back holding up our head.

desk top to bring one's work up to one

When I went from writing on a flat desk to using this, my headaches stopped immediately.

Many years ago all desk tops were sloped. Before the days of computers, draftsmen used a much steeper angle. It is time to return to this, particularly for school desks.

Less work for our neck muscles, fewer sore necks.

Cervical lymph nodes

Apart from sore muscles and joints in the cervical spine, the other common cause of neck pain is sore lymph nodes (cervical lymphadenitis.) These are usually sore because they are busy fighting some infection.

They may be swollen as well now, and can be felt by gently running your fingers up and down over the anterior or posterior triangles of the neck.

The triangles of the neck

The anterior (front) triangle is between the jaw and the Sterno mastoid muscle (S.) The posterior (back) triangle is between that muscle and the Trapezius (T.)

This convention for describing the position of things in your neck, is convenient and universally used.

An example of its use is enlarged anterior triangle lymph nodes in Streptococcal tonsillitis, compared with posterior triangle nodes in Ebstein Barr virus glandular fever. The throat may look very similar in both conditions, but the posterior triangle nodes give a clear pointer to the second condition.

Lymph nodes or muscles?

To distinguish swollen lymph nodes from tight muscles standing out, compare running your fingers across the neck, with up and down, using a little more pressure. All except one little muscle, run up and down, so you will feel them better as you move across. The lymph nodes are 1-2cm round structures, so you will feel them both ways equally.

If you can feel hard lumps, it is probably the bones of the neck, but a medical checkup is advised to be sure you are not feeling hard lymph nodes.

Tension - emotional and physical

Part of our fright-fight-flight reaction, is tensioning of our neck muscles. Our head must be held steady during the anticipated violent movements of our body.

This carries over to tension produced by emotional upset, and can be prolonged if our upset state continues.

The muscles can then be in a state of chronically increased tension, not necessarily producing any discomfort. We are used to it, so don't notice it.

You may have had the experience of a sudden upset producing a immediate pain in your neck or head. This is seldom anything to do with your blood pressure, and almost always from extra muscle tightening.

Traffic accident whiplash injuries often are "the straw that broke the camel's back" too. The injury plus the previous tension state combine to produce the symptoms.

More on emotional tension causes and management is on the chest pain pages of this site.

Immediately after treating someone's neck, I ask them to turn their head gently from side to side.
People often comment that their neck feels looser or their head feels lighter. They had complained of pain, but had been stiff as well without realizing it.

Sudden twists and jerks

Mr. B, aged 58, caught his middle finger in a hammer mill. His finger was crushed and very sore, but he also complained of a severe headache over the two days since the injury.

His right atlanto-occipital joint was stiff and he felt better immediately I unstuck it.

I see people who have injured a limb and put a joint in their neck out at the same time, by their sudden reaction to the injury. Most people who have stiff joints give no such history, often just waking up one morning with neck pain.

I suspect postural and tension abnormalities predispose people and then the joint gets stuck from awkward or heavy lifting, and the pain comes later as the muscles tighten more and get sore.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.

Cervical spine

Examination and treatment of the bones and joints of the neck requires a lot of training and skill. Osteopaths, chiropractors and physiotherapists are likely to have this training.

To examine your own neck, sitting down, put your elbow on a table and then lean forward and rest your chin on that hand.

self examination for neck pain

Let your chin rest heavily on your hand, and your neck sag as much as it can. This relaxes the muscles at the back of your neck, which otherwise have to work to keep your head upright.

It is easier now to gently press into your neck to detect undue tenderness (different from the same place on the other side, or other spots higher or lower in the neck.)

When you press more firmly, you will also be able to feel the bones of your neck, but tenderness with this pressure can be either the joints or the overlying muscles. You will not be able to say which.

Neck stretching as part of your neck pain self help.

Provided you don't have disease such as rheumatoid arthritis affecting your neck, there are a lot of useful self help stretches you can use to relieve pain and discomfort here.

Cervical spondylosis is generally no reason to avoid stretching and strengthening exercises, but you should check with your doctor first.

Further pages on neck pain...

This is the first neck stretch to start with.

Now move on to sideways and rotation stretches


About your neck pain and the arthritis or spondylosis in your neck X-rays

About your trapezius muscles in your neck and back

Consider your postural function

And here is an excellent external site which covers relief of neck pain well.

Neck joint mobilization as another part of neck pain management

You may consider doing this after thorough neck stretching.

It is quite gentle and safe for most people, but the same precautions apply as mentioned at the start of the neck stretching pages.

Keeping your fingers straight, lay one hand flat across the back of your neck. Lay your other hand across the side of your neck, so that your two hands are at a right angle (90 degrees,) with their fingers touching at the back corner of your neck.

Now bend your fingers inwards, keeping them together. Pressing reasonably firmly, move them back and forwards across the back corner of your neck.

The hard vertical lump they are rubbing over, is the parts of your neck bones joined by the posterior or Z joints, and overlying muscles.

Feel up and down this back corner of your neck, and then place just your middle fingers together at the top of it, just under your skull.

Now dig in firmly with these fingertips and bend your neck over them, by repeatedly moving your head back and a little to that side.

Repeat this action up and down both sides of your neck, moving your fingers about a fingers breadth at a time. This will ensure that all the joints get a bit of the action.

This is not as effective as a professional mobilization, but can be useful.

There is a wide variety of professional help available. One way of judging how good a practitioner is, is how much detail they go into during physical examination, because there is no "one size fits all" treatment - it needs to be individualized.

Suspected cervical spine injury

If you are first on the scene and someone has hurt their neck, the sort of story suggesting this is...

Pain near the midline of their neck.
Numbness or pins and needles anywhere.
Weakness in limbs, especially if on both sides of their body.


Inflammatory poly arthritis affecting your neck - eg. rheumatoid

Most commonly, other joints in your limbs will be involved here. It is possible to have the first joints affected by such diseases, just in your neck, however.

These diseases will have general symptoms of ill health, and joints involved will have prolonged morning stiffness and swelling as well as pain.

Potent anti inflammatory treatment of some sort, is needed urgently. A rheumatologists' opinion should be sought ideally.

Hypermobile joints can aggravate neck pain

It is easy to tell if this is happening. All your neck joints are pretty close to your ears, so you hear the crunching and clicking from this type of problem, every time you move your neck.

I've personally caused this problem a couple of times.

I often stretch up joints which I believe to have spondylitic or osteoarthritic damage. Mostly the joints start to function and feel better, when loosened up - but not always.

When the neck pain has continued and crunching hasn't quickly settled, a cervical collar has to be worn for a week, to allow the joint to stiffen up again.

It can arise spontaneously in cervical joints because of an adjacent stiff joint, placing a need for excessive movement on it's neighbours.

This is quite different to the fine crackling you often hear for a few hours after a neck joint is loosened up.
This is because the gristle of the posterior joints looses moisture when immobile, and takes a few hours to take up the fluid when movement is restored.

Subacute thyroiditis causes neck discomfort

Your thyroid gland is one of the "endocrine" glands, making hormones to control bodily functions.

It is u-shaped, below and beside your Adam's apple. It is only visible if enlarged, to form a goitre.

In subacute thyroiditis it is tender and causes discomfort here. You may then also have dysphagia and fever.

Your doctor may order an ultrasound (like a submarine's sonar) to measure the gland and using the Doppler effect, to asses blood flow to the gland.

A blood test for inflammatory markers may be positive (as in neck pain from a number of other causes.)

Subacute thyroiditis may lead to permanently inadequate thyroid gland function.

Notes and references for neck pain page

1. See vertebrobasilar insufficiency page re upper cervical techniques.


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The contactpage.

Our atlanto-occipital joint is between the first (atlas) bone in neck and the back (occiput) of the skull. It is very prone to mechanical disturbance being closest to our quite heavy head and appears to be where we adjust to maintain our eyes in the same horizontal plane, for comfortable vision.

Hormones are chemical messengers which are transported around in your blood stream.

The voice box in the front of your neck is sometimes called your Adam's apple.

Dysphagia is discomfort or difficulty swalowing.

Ultrasonography uses sound waves too high pitched to hear,reflected back and used to create pictures of body tissues and organs.

Inflammatory markers are blood test used to measure general body inflammation.ESR and CRP are the commonly used ones

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.