What to do by unspecific neck pain?

In the case of neck pain with no obvious cause, it is best to keep moving and to go about your daily life as normally as possible. Special exercises can strengthen the neck muscles. The effectiveness of most treatments for neck pain has not been proven by good studies.

In most cases, no clear cause for neck pain can be found. Then they are called “unspecific” neck pain. They usually disappear by themselves within a few days or weeks. But some people have complaints for longer, or they keep coming back. We talk about chronic neck pain if it lasts longer than three months.

There are often several factors that contribute to unspecific neck pain. These can be, for example, physical strain at work, such as working overhead or sitting immobile at a desk. Psychological stress such as stress, family or professional fears and worries often play an important role.

Non-specific neck pain can be very unpleasant but is harmless. There is therefore no reason to take it easy. On the contrary: it even makes sense to remain active.

Although non-specific neck pain is very common, there are only a few good studies that have investigated the different treatment options. So far, no treatment has been clearly proven to be able to permanently relieve neck pain. However, there are several simple options that you can try out for yourself.

What can I do myself for neck pain?
Many people use warming scarves, warming pillows or packs to release tension and relieve pain. For neck pain caused by nerve irritation, a cooling pack can also be beneficial. It is important that the pack is neither too hot nor too cold. A cloth around the pack protects the skin from injury.

Stretching and strengthening exercises should relax and strengthen the muscles and prevent complaints. If you have learned the exercises with medical or physiotherapeutic guidance, you can also do them at home.

A distinction is made between static (isometric) and dynamic strengthening exercises. With isometric exercises the position of the body does not change during the tension. An example of an isometric exercise is to stand with a straight back against a wall and consciously press the back of the head against the wall for about 20 seconds (as hard as it is comfortable). Dynamic exercises actively move the muscles – you can exercise with your own body weight or with dumbbells and elastic bands.

Studies have shown that strengthening exercises for the neck, shoulders and shoulder blades can relieve chronic neck pain and improve mobility. Participants usually did strength exercises two to five times a week, sometimes combined with stretching or endurance training. To be able to say more precisely which neck exercises help and how often training is useful, more good studies are needed.

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Can manual therapies and massages help?
Manipulation and mobilisation are procedures from manual therapy. Certain manipulations are intended to relieve pain and improve the mobility of the joints. During mobilisation, the joint is moved slowly as best as possible. Manipulation also involves small, jerky movements that can exceed the active movement limits. In the case of neck pain, both the cervical and thoracic vertebrae can be mobilised or manipulated. However, the effectiveness of these treatments has not been proven.

Manipulation of the spinal column can initially increase the pain. Sometimes it also leads temporarily to headaches or dizziness. There are individual reports that manipulation has led to vascular injuries and strokes. However, this severe complication is extremely rare. It is important that the physiotherapist or medical specialist treating the patient is trained in manual medicine.

Therapeutic massages are intended to relax the muscles and relieve pain. They may help against acute pain in the short term. Overall, however, there are no good studies on the effectiveness of massages for neck pain. Because pressure is applied to the affected regions, massages themselves can be painful.

Do physical therapies help?
Physical therapy is a generic term for treatments that use physical stimuli such as heat, cold, electricity and light. They are often used by physiotherapists.

Electrotherapy includes transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS). These treatments use light electrical stimuli. The electrical stimuli are intended to inhibit the transmission of pain signals to the brain and stimulate the production of the body’s own pain-relieving hormone endorphin.

In TENS, electrodes are attached to the skin, which transmit the electrical stimuli through the skin (transcutaneously). In PENS they are transmitted via acupuncture needles that are inserted into the skin (percutaneously). There are other methods of electrotherapy, such as interference therapy. They differ among other things in the frequency of the current used.

So far, no electrotherapy has been proven to be able to relieve neck pain. In the case of PENS, the punctures can cause minor bleeding or infections. Other side effects have not been reported in trials, but they cannot be ruled out.

Laser therapy
Sometimes a so-called low-level laser therapy is used to relieve neck pain. This involves irradiating the affected skin area with light waves of a specific wavelength. The treatment is also called cold light laser therapy because the tissue is not heated, unlike other laser treatments. Advocates of the therapy hope that the laser beams have an anti-inflammatory effect; others hope that they promote blood circulation or stimulate the nerves. However, none of these hypotheses has been proven so far.

There are no meaningful studies on the effectiveness of low-level laser therapy for neck pain. It is therefore impossible to say whether this treatment can noticeably relieve neck pain.

Can painkillers help?
There are several drugs that can be used to treat neck pain. Many people try to relieve acute pain with (sometimes over-the-counter) painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or diclofenac. Some people also use paracetamol. However, there have not been many good trials on the effects of these drugs on neck pain. So it is not possible to say for sure if and how well they help. NSAIDs can have different kinds of adverse effects and are not suitable for people with kidney weakness. Paracetamol is well tolerated, but is not suitable for people with limited liver function because it is broken down by the liver.

Diclofenac and ibuprofen are often used as gels for application to the skin. The effectiveness of locally applied painkillers for neck pain has also not been well studied. One advantage of local application of these drugs is that gels have fewer side effects than tablets. Sometimes skin irritations like redness, dry skin or itching occur.

Prescription drugs
For severe pain, prescription painkillers from the group of opioids are sometimes considered. They are used to treat severe pain, for example in cancer, severe nerve pain (such as shingles) or an acute herniated disc. For the treatment of neck pain, they are only used for very severe acute pain. Typical side effects are nausea, drowsiness and drowsiness, dizziness and constipation.

Sometimes, drugs that relax the muscles (muscle relaxants) are also used. These are usually sedatives that act on the brain. These drugs are only available on prescription and can have various side effects, such as drowsiness.

In principle, painkillers and muscle relaxants should not be used permanently, but only for short-term treatment. If you are taking opioids or tranquillisers, it may be necessary to avoid driving or using dangerous machinery to avoid accidents. In older people, these drugs also increase the risk of falls.

The German Society for General and Family Medicine (DEGAM) advises against painkillers and muscle relaxants in the case of non-specific neck pain.

Medications such as NSAIDs, cortisone or the local anaesthetic lidocaine can be injected directly into a muscle or vertebral joint. Sometimes the nerve toxin botulinum toxin (“Botox”) is also injected. However, the effect of local injections has not been well studied.

The German Society for General and Family Medicine advises against injections for non-specific neck pain because of the possible risks. The risks include injuries, allergic reactions and seizures. In addition, there is always a low risk of germs getting into the body and causing an infection.

Lidocaine injections can lead to a temporary increase in pain, discomfort such as tingling, numbness or burning at the injection sites. NSAID injections probably do not work any better than NSAID tablets.

When is a neck brace useful?
In the past, neck braces were often used after a whiplash injury. Today, however, they are hardly recommended because wearing a neck brace weakens the neck muscles and can make the problems worse. In cases of severe pain, neck braces are sometimes used for a short time to relieve the neck or to make sleep easier. However, a neck brace should only be worn for a few hours a day and for no longer than 1 to 2 weeks to avoid muscle weakness.

Are ergonomic measures at the workplace useful?
Ergonomic measures include, for example, adjusting the seat height at the desk, the position of the chair back, the distance from the chair to the keyboard and the height of the screen. There are also ergonomic work aids such as special keyboards, mice or mouse pads. They are designed to help avoid awkward postures at the workplace. However, it is unclear what effect such measures have, as there are no meaningful studies on the ergonomic adaptation of the workplace.

In principle, there used to be relatively rigid guidelines for the “correct” sitting posture at the workplace. Today, occupational health experts assume that movement at the workplace is the most important factor. This means changing your sitting position as often as possible during the course of the day and getting up again and again in between. Movement promotes the blood circulation of muscles, intervertebral discs and other tissues. It is also intended to prevent muscle fatigue caused by rigid and one-sided positions and associated problems.

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