There is a reason that the saying “someone/something is a pain in the neck” rings so true. Neck muscle pain can be very debilitating. You will be reminded of it with every movement, looking down to your phone, checking your blind spots when driving, or looking up at a sign post. Neck muscle spasm is a symptom of either protective guarding or sustained muscle tension, that can fatigue the muscles in your neck. A Neck muscle spasm is usually an underlining cause of something else.

Structures in the neck

To find the culprit causing your pain, we have to look at the different structures in your neck. The bony bits, discs and ligaments protect the spinal cord, where the muscles are responsible to move your neck

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Neck muscles

The neck muscles attach in different layers to the vertebrae and skull to generate force on the bones to allow movement. Eighteen muscles attach directly or indirectly to the seven neck vertebrae and the skull, enabling us to move the neck on the shoulders. The most commonly affected muscles at the back of the neck are the:

  • Upper fibers of trapezius (moves head to look up or shoulders up to shrug “no”)
  • Levator scapulae (shoulder shrug)
  • The suboccipital group (that may even cause headache at the base of the skull)
  • Rhomboids between the shoulder blades that mainly feel tired and tight after a long day behind a desk


The front of the neck may not feel painful at first, but may be contributing to muscular pain or headaches in your temples. The most commonly affected muscle at the front of the neck are:

  • Sternocleidomastoid, that enables rotation to look to the side
  • Scalenes (bends neck to look down, or over the shoulder)
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From the spinal cord nerve roots exits above each vertebra, forming nerve roots C1 – C7, with the C8 nerve root exiting the spinal cord below the 7th cervical vertebra. The nerve roots then merge and divert into the brachial plexus, that supply the arm to allow movement and relay messages of sensation to the brain. These nerves can be pinched, irritated, compressed or injured as they run out your neck.

Arteries and veins

Alongside the vertebrae important blood vessels run to supply the brain of oxygen from the heart and lungs and return deoxygenated blood to the heart. The most superficial being the external carotid where you can feel your pulse if you press your index finger just below the jaw bone.


The discs act as shock absorbers in the neck and allow movement. Between each cervical vertebra is a disc (except for C1 and C2). The disc has a fibrous outer layer, the annulus fibrosus, that encloses the gel like inner part, the nucleus pulposus. Almost like a few layers of onion surrounding a jelly like substance inside.

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There are seven cervical vertebrae, stacked from the bottom of the skull down to the first thoracic vertebra.


Facet joints are the connections between the Cervical vertebrae.


The cervical vertebrae and neighboring discs are connected to each other with different ligaments to keep these connections stable.

What causes a neck muscle injury?

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Neck pain can be caused by a wide variety of pathology (injury to the tissue) of the different structures in the neck, some serious in nature, others are quick to fix. You could have flipped your hair back while drying it, turned your head quickly to admire the passing jogger, finally got to painting the ceiling, washing and hanging the curtains, fell asleep on the couch, caught badly in a scrum, turned your head in shoulder-stand or been in a accident. We have heard it all before. We can treat the cause and get rid of the problem.


Skeletal muscles, the striated muscle we use to move, may spasm or cramp due to:

  • Overuse
  • Fatigue
  • Dehydration
  • electrolyte imbalances
  • Overstretching
  • Previous injury


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The muscles of the cervical spine can start to cramp or spasm due to a rigorous new exercise program (especially with large volumes of sit ups being done) fatigue due to prolonged sustained positions (computer work or clutching the phone between your ear or shoulder), driving long distances or sleeping in an awkward position (especially on your stomach). If you have had a previous neck injury, like whiplash, a concussion or fall, without proper rehabilitation, your neck is at risk to spasm or cramp.

Why neck muscles tend to spasm after an injury?

Neck muscles can go into a protective spasm after injury to protect the joints, ligaments, discs or nerves in the cervical spine.  In case of an injury the muscle are the first line of defense. Spams will form to protect the injured area/structure. It is therefore important to get a chronic spasm checked out to make sure that the spasm isn’t just a symptom of something more serious.



How we test it

As physiotherapists, we are able to test and determine what is the cause of your pain. Be it  from muscles, joints, ligaments or nerve compression. This will be the first step, before we start doing any other investigations.


Soft tissue, like muscles, can not be seen on X-rays, so if we only suspect that the muscle is injured, it will not be necessary. X-rays will show us the integrity and alignment of the cervical vertebrae. This will enable us to see if there are any pathology of the joints.


Specialist referral is needed for a MRI scan. This will enable us to see all the structures in the neck, including the muscles. If there is a gross lesion or tear a MRI will show exactly where it is. It is however a very costly procedure, to see the soft tissue a less expensive option is a sonar.


Sonar shows a clear picture of the soft tissue. If there is a tear, bruise or inflammation within a muscle, sonar imaging will identify the specific area, depth and length of the muscle problem.

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Neck muscle pain not going away?

If you suffer from chronic muscular pain in the neck, it is better to find the cause. No muscle will stay in spasm without reason. The muscles may be protecting an injured discjoint or nerve root. Without identifying and treating the cause of the muscular pain, it will keep on coming back.

Your pain may have started of with just some neck stiffness, but progressed to a more intense pain that becomes constant, many neck muscle pains can lead to cervicogenic headaches.

You may be the cause of your own neck muscle pain if your posture is worsening your symptoms. Desk and computer work, especially laptops, force the neck into some problematic positions for hours on end. This causes the muscles to take on different tasks than what they were designed for.

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Recovery time

Neck pain has many causes and EARLY diagnosis and treatment is the best way to recover quickly.

Simple neck muscle pain can usually improve within a week or two after injury, only if you manage your problem properly. However, muscular pain or spasm lasting more than a few days is normally protective spasm overlying a more significant neck injury, which should be professionally investigated. It may not be just a simple neck muscle strain!

Most sufferers of neck pain will recover within 4 to 6 weeks. However, this time can vary greatly as it depends on both the nature of your injury and the treatment plan that you develop with your physiotherapist.

How Can You Prevent Recurring Neck Pain?

If you have suffered neck pain in the past, you are unfortunately more likely to suffer in the future and worsening bouts. The most common cause of recurrent neck pain is insufficient rehabilitation.

Follow the advice of your Physio, who will establish a treatment plan to help you achieve your short-term goals and help prevent a recurrence.

While there are no guarantees, it is well known that active individuals who exercise and adopt safe lifting and postures at home and at work are at a reduced risk of developing neck pain.

Discuss with your physiotherapist the specific postures and activities that you perform on a daily basis. They will aim to help you to understand how to position yourself and move with the lowest risk of injury based on your injury type and potential weaknesses. If you are unsure about your posture while doing computer work, you can even ask a colleague to take a photo of you behind your desk and we can discuss your setup.

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What else could the pain be?

  • Spondylosis: Spondylosis describe normal aging process (wear & tear)  of the vertebrae, which is expected with age, like grey hair. It may lead to stiffness, especially in the morning.
  • Cervical disc bulge/protrusion: Injured discs will cause high intensity pain. In cases where the nerve root is compressed by the disc, pain will be felt more in the arm or hand, than in the neck. Symptoms will include, pins and needles, numbness, weakness or loss of sensation.
  • Locked cervical facet joint: Sudden onset, usually with a memorable movement of the neck, where you are unable to move the head at all because of the pain.
  • Cervicogenic headaches: Headaches caused by structures in the neck are usually experienced on only one side and directly influenced by the position of the neck.
  • Whiplash: The sudden impact of a car accident may cause the neck to forcefully be jerked back to front in a short space of time. This may lead to severe muscular pain and spasm and even hypersensitivity to touch.

Other Causes of Neck Pain