Want to know the difference between oversleeping your neck, and a neck muscle strain/spasm? You’re on the right page, just read on. A muscular injury takes place when there is damage done to the muscle tissue of the neck. This can happen because of faulty training, especially if you fixate your neck when you do ab workouts. Luckily physiotherapy (manual therapy combined with the right exercise program), can resolve the injured muscular neck symptoms.

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What is the neck made up of?

Your neck is an intricate structure of scaffolding (vertebrae), power cables (nerves), shock absorbers (discs), oxygen suppliers (arteries & veins) and pulley systems (muscles). For the purpose of this article, let’s delve into the pulley system.

36 Different muscles are attached to your neck, depending on how finicky you want to count the different parts of muscle. Let’s page through them, starting from the front of your neck:

  • platysma – tenses the skin of your neck/throat area (when you draw the corners of your mouth down)
  • sternocleidomastoid – forced inhale to lift the first rib, side bend of the neck, to squeeze a phone to your shoulder or looking into your opposite armpit
  • hyoid muscle (8 muscles attach to this horse shoe shaped bone in the bend between your chin and neck)
  • longus colli – bends neck forward
  • longus capitis – bends neck forward
  • rectus capitis anterios & lateralis – bends neck forward & sideways
  • scalene – lifts 1st & 2nd ribs
  • levator scapulae – lifts & rotates the scapula
  • oblique capitis superior & inferior
  • rectus capitis posterior major & minor – extends the skull on the spine (when you elongate the back of your neck)
  • semispinalis capitis – extends the neck to look up
  • longissimus capitis – extends the neck to look up
  • splenius capitis – turns the head to face up, sideways or backwards
  • oblique capitis superior & inferior – extends the skull on the spine, like when you elongate the back of your neck
  • trapezius – shrugs the shoulders up, like showing “I don’t know”, stabilizes scapula for correct scapulohumeral rhythm
Neck muscle spasm, Neck muscle injury, Neck muscle pain, Neck muscle injury, Stiff neck muscles

Causes of muscular strains in the neck

A lot of different factors can cause a muscular strain in the neck:

  • over stretching
  • sudden movement
  • sitting with a poor posture for long periods of time (long hours of working on the laptop or driving)
  • sleeping without adequate support (your position & pillow plays a role)
  • keeping the neck in a certain position for prolonged periods (squeezing a phone between your ear and shoulder)
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Symptoms of a neck muscular strain

A muscular strain in the neck usually presents itself as an aching pain with associated stiffness. The pain may also be linked with headaches. Other symptoms include:

  • weakness of the neck, feeling as if the head is too heavy
  • muscle spasms that restricts movement
  • constant dull ache of the neck, worsened by movement
  • intermittent tingling / pins and needles in the neck or arms
Neck muscle spasm, Neck muscle injury, Neck muscle pain, Neck muscle injury, Stiff neck muscles

Self test for a neck muscle strain

If you suspect that you sustained a neck muscle strain, you can try the following tests. It is important to keep in mind that the movements should not be blocked by a sharp or sudden pain, if this is the case you might have an acute locked facet joint.

  • Sit comfortably in a chair.
  • Place one palm over your forehead and resist bending your head down.
  • If this increases your pain, you may have a neck muscle strain.
  • Place one palm on your cheek and resist turning your head towards that side.
  • Repeat on the other side.
  • If this increases your pain, you may have a neck muscle strain.
  • Drop your ear to your shoulder, while you keep your eyes looking straight ahead.
  • Compare to the opposite side.
  • If this increases your pain, you may have a neck muscle strain.

How bad is my neck muscle strain?

Grade I muscle strain

  • Dull ache in a specific area
  • Slow movement is possible without any blocking from the joints
  • Lengthening the specific muscle causes pain

Grade II muscle strain

  • Global dull ache of the entire neck (because the other muscles are aiding in stability now)
  • Movement restricted in more than one direction
  • Headache referral patterns may develop

Grade III muscle strain

  • Constant dull ache, with movement and when resting
  • Head feels heavy, as though the neck is too weak to carry the load
  • Movement is restricted because of pain
  • Headaches become frequent

What should I do ?

If you think that you might have a muscular strain in your neck, try to arrange a physiotherapy assessment as soon as possible. In the meantime you should gently keep your neck moving and ensure that you maintain a good posture at all times. You can use heat to reduce your discomfort and wear a scarf to keep your neck warm.

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Diagnosis of a strained neck muscle

Neck Pain, Stiff Neck Muscles


X-rays show the alignment and integrity of the bone, but not the muscle. Muscle spasms may influence the normal curvatures of the neck. The muscles will not be visible on X-rays.

Diagnostic ultrasound (sonar)

Sonars show all the soft tissue structures of the neck (muscles, tendon junctions and ligaments). Damage to the muscle, the severity and location will be visible on ultrasound.


An MRI can only be ordered by a specialist. With an uncomplicated neck muscle strain a MRI is not necessary.

How we test it

Physiotherapists are trained to test all the structures in order to determine the cause of your symptoms. We use; active and passive movements to determine joint involvement and muscle length/strength testing to find the culprit (The main cause of the problem). These tests can aggravate your symptoms for 24 hours after your evaluation.

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What makes a neck muscle strain worse?

If you have a muscular strain in your neck, try not to ignore the problem. Muscular strains do not disappear over time. If left untreated, a muscular strain in the neck can lead to longstanding (or chronic) neck pain/discomfort, reduced range of movement and headaches.It is a vicious cycle, pain decreases your movement, which leads to weakness and ultimately more pain.

Physiotherapy for a muscular strain in the neck

Physiotherapy treatment is very beneficial for a neck muscle strain. Initially, your physiotherapist will be able to diagnose your injury and determine its severity. During the assessment your physiotherapist will develop an appropriate treatment plan. Treatment will initially be focussed on reducing your pain and increasing the range of movement in your neck. These techniques may include:

  • Electrotherapy
  • Exercise Programmes
  • Massage
  • Postural Re-education
  • Soft Tissue Treatment

Phases of rehabilitation & treatment

Phase 1: Initial treatment

Treatment is aimed at relieving your pain. Gently manual treatment (massage & joint mobilisasions) are used to regain movement. Electrotherapy (ultrasound & LASER) can assist in pain relief. Strapping can be used to assist with muscle activation. You will begin a gentle range of movement exercises at home.

Phase 2: Intermediate treatment

Now that your pain is under control, we can work deeper in order to regain full movement. Manual therapy will include myofascial release, deep dry needling and end range joint mobilizations, to get your movement back to normal. Strengthening exercises will be given to do at home. We can also address any contributing factors, be it your posture at work or when you train.

Phase 3: Final treatment

You will now be able to get back to your normal routine. We ultimately aim for our patients to return to the sports they love, in tip-top shape. Final phase treatment is more exercise based, correcting any faulty movement patterns to increase your strength and endurance.

Does a muscular strain in the neck have any long-term effects?

If managed correctly, a muscular strain in the neck should not lead to any long term effects. If, however, your strain is inadequately managed your symptoms may not resolve completely or you may find that you have ongoing sporadic flare ups of your neck pain and / or stiffness. Physiotherapy can still help weeks, months or years after your injury. Successful rehabilitation your neck may take longer.

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How long will it take my neck muscle strain to heal?

Soft tissue takes 6 weeks to heal, this is a rough estimate for an uncomplicated neck muscle injury. Each person brings their unique neck, injury and history of previous treatment, causing each case to be different.

Medical management

Your GP or pharmacist can prescribe medication (muscle relaxants, anti inflammatories or analgesics) to relieve your pain.

In some cases a soft neck collar can be used to support the neck and limit painful movement. These are available from a pharmacy or orthotist.

Is surgery necessary for a neck muscle strain?

No, an uncomplicated neck muscle strain will not need surgical repair.

Neck Pain, Stiff Neck Muscles

A Muscle strain of the neck is also known as:

  • Neck muscle pain/spasm
  • Stiff neck muscles
  • Neck muscle injury

What else could the pain be?

  • Whiplash
  • Neck joint injury
  • Neck disc injury
  • Stuck neck joint
  • Pinched nerve
  • Concussion