Neck pain: when to see a physio, and when to wait

A stiff neck: what to try first

Common triggers include sleeping in an awkward position, sitting in one position for a long time, a trapped (pinched) nerve, and injuries such as whiplash (NHS, n.d.a). For a new stiff neck without any warning signs, the NHS suggests (NHS, n.d.a):

• paracetamol or ibuprofen, or ibuprofen gel rubbed into the neck
• a low, firm pillow
• a hot water bottle wrapped in a tea towel for up to 20 minutes, two or three times a day, or a cold pack for up to 5 minutes, up to three times a day
• gentle neck exercises to keep it moving
• not wearing a neck collar unless a doctor has told you to, because keeping the neck moving is better
• avoiding driving or cycling while you can't turn your head properly

When to see a neck pain physio

The NHS advises getting help if neck pain or stiffness hasn't gone after a few weeks, painkillers haven't worked, you are worried about it, or you have other symptoms such as pins and needles or a cold arm (NHS, n.d.a). For neck pain linked to age related wear (cervical spondylosis), physiotherapy is suggested if symptoms haven't improved within a few weeks (NHS, n.d.b).

In practice we would suggest seeing a physio if:

• the pain has lasted more than a few weeks, or it keeps coming back
• you get regular headaches that seem to start in the neck
• pain, tingling or aching spreads into your shoulder or arm
• you are struggling to work, drive or sleep because of it
• it started after a fall or car accident (see our guide to the first two weeks after whiplash)

If you have been searching for neck pain near me or a neck specialist near me, a physiotherapist is usually the right place to start. In many areas you can also refer yourself to NHS musculoskeletal (MSK) services without seeing a GP (NHS, n.d.a).

How a neck pain physio helps

Physiotherapy guidelines group neck pain into four broad types: neck pain with reduced movement, neck pain after whiplash, headaches related to the neck, and neck pain with nerve related pain into the arm (Blanpied et al., 2017). Part of the first appointment is working out which one fits you, because the plan is different for each.

Exercise

A Cochrane review found no high quality evidence for any exercise approach in neck pain, so some uncertainty remains. The best supported option is specific strengthening. There is moderate quality evidence that strengthening the neck, shoulder blade and shoulder muscles reduces pain in chronic neck pain, at least in the short term, while stretching on its own may not help much (Gross et al., 2015). That matches our experience: people tend to do better with a short, progressive strength routine than with stretches alone.

Hands on treatment and acupuncture

We may use hands on treatment alongside your exercises where it helps you move more comfortably. Acupuncture is an option for some people. A Cochrane review found moderate quality evidence that acupuncture relieves chronic neck pain slightly better than sham acupuncture in the short term, but the effects did not seem to last long term (Trinh et al., 2016). We offer acupuncture at £45 and treat it as an addition to exercise, not a replacement.

Neck pain and headaches

Some headaches come from the neck rather than the head. This is called a cervicogenic headache. There is moderate quality evidence that a programme of neck and shoulder blade strengthening and endurance exercises improves pain and function in chronic cervicogenic headache over the longer term (Gross et al., 2015).

Not every headache with neck pain comes from the neck, so a proper assessment matters. Our page on cervicogenic headache treatment explains how we assess and treat it. A headache with a stiff neck and a high temperature is a different matter entirely: see the warning signs below.

Neck pain from desk work

The NHS lists sitting at a desk for a long time among the common causes of neck pain, and advises avoiding staying in one position for long periods and moving regularly (NHS, n.d.a). Many people assume the answer is a perfect sitting position. We have written about why that is rarely the whole story in our neck guide, It is probably not your posture, so we won't repeat it here. In short, the NHS advice to change position and move regularly, together with the strengthening work described above, is where we would start.

Frequently asked questions

How long should neck pain last before I see a physio?

The NHS says most neck pain only lasts a few weeks. If the pain or stiffness is still there after a few weeks, painkillers haven't helped, it keeps coming back, or you have pins and needles or symptoms in your arm, it is worth getting assessed. You don't need a GP referral to see a physiotherapist privately, and many NHS areas also accept self-referral.

What is the fastest way to get rid of a stiff neck?

There is no instant fix, but the NHS suggests paracetamol or ibuprofen, ibuprofen gel, a low firm pillow, short spells of heat or cold, and gentle neck exercises to keep it moving. Avoid a neck collar unless a doctor advises one, and don't drive or cycle until you can turn your head properly. Most stiff necks settle within a few weeks.

Can neck pain cause headaches?

Yes. Some headaches start in the neck rather than the head, and these are called cervicogenic headaches. A Cochrane review found moderate quality evidence that neck and shoulder blade strengthening and endurance exercises improve pain and function in chronic cervicogenic headache. A headache with a stiff neck and a high temperature is different and could be meningitis, so call 999.

Can a physio help neck pain from desk work?

Often, yes. The NHS lists long periods sitting at a desk as a common cause of neck pain and advises changing position and moving regularly. A physio can check what is driving your pain and set a short strengthening programme, which has the best research support for chronic neck pain. Stretching on its own appears less helpful than strengthening.

When is neck pain serious?

Call 999 if a stiff neck comes with a high temperature, a very bad headache, dislike of bright light, confusion or a rash that doesn't fade, or if you have new difficulty walking, loss of bladder or bowel control, or stroke signs. Get urgent help from a GP or NHS 111 for sudden severe neck pain, weakness or heaviness in the arms or legs, or worrying symptoms after an injury.