Have you ever had stiff, sore neck muscles after work or exercise? A neck muscle strain happens when a muscle cannot handle the stress (or load) placed on it, for instance a sudden overstretch like a whiplash injury, a sudden fall or a blow to your head. Another cause is repeatedly doing a movement that places the muscle in a stretched position or fixating your neck during exercise like ab workouts. These injuries lead to tears in the small delicate muscles that control your neck movements, disrupting the muscle’s ability to contract. This leads to discomfort and pain in your neck muscles that gets worse with movement.
Fortunately, physiotherapy is very effective when dealing with neck muscle pain!
Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.
What are the structures in your neck?
Your neck is an intricate structure of scaffolding (vertebrae), power cables (nerves), shock absorbers (discs), oxygen suppliers (arteries & veins) and pulley systems (muscles).
There are 36 different muscles attached to your neck. These muscles are responsible for all the movements of your neck and also for keeping your head upright! Each muscle has a specific job to do, but the muscles also work together for complex movements like instruments in an orchestra – you don’t always hear each instrument on its own, but the music changes when one is left out.
Your neck movements are a symphony of co-ordinated muscle contractions that move your head. Damage to these muscles will cause a whole combination of problems in and around your neck. Let’s examine some of the major players.
Muscles of the neck include:
- platysma – tenses the skin of your neck/throat area like when you draw the corners of your mouth down
- sternocleidomastoid – forced inhale to lift the first rib, side bend of your neck, like squeezing your phone to your shoulder or looking into your opposite armpit
- scalene – lifts 1st & 2nd ribs
- levator scapulae – lifts & rotates your scapula, like doing a shoulder shrug.
- obliquus capitis superior & inferior – extends your neck to look up and tilts the head to the side
- rectus capitis posterior major & minor – extends your skull on the spine, like looking up at the roof
- semispinalis capitis – extends your neck to look up at the sky
- semispinalis cervicis – tilts your head to the side
- longissimus capitis – extends your neck to look up
- splenius capitis – turns your head to face up, or from side to side like shaking your head
- trapezius – shrugs the shoulders, stabilizes scapula for correct scapulohumeral rhythm (coordinated movement of the arm and shoulder blade)
- longus colli and capitis – bend your neck forward like looking down, important deep neck flexors of your neck
- rectus capitis anterior & lateralis – bends neck forward & sideways, also important deep neck flexors
How does it happen?
Acute neck muscle strain
Neck muscles are always under load due to the weight of your head. If the muscles need to contract quickly while in a stretched position, like if you fall and your muscles try to stop the movement of your head, it places a large amount of tension on these muscle. This leads to overload of the muscle fibers, leading to small microscopic tears in the neck muscles, in other words a neck muscle strain. Other causes are a sudden stretch in the opposite direction of the muscle contraction, like getting hit in the face with a ball or getting punched in the face.
Your nervous system will react by contracting the muscle and increasing muscle tension to protect itself. This results in a temporary shortening of the muscle.
Chronic neck muscle strain
Each muscle in the body has a resting position, where it is not contracted (shortened) or stretched (lengthened). If you keep the muscles in a shortened or lengthened position for long periods of time – like working on your laptop in a slouched posture – it results in overuse of the muscles. Over time small tears develop in the muscles leading to neck muscle pain.
Causes of a neck strain
Neck strains are usually caused by a sudden, unguarded force that catches you off guard. There are a lot of different factors that can cause neck pain.
- Over stretching – like a whiplash injury
- Sudden movement – looking over your shoulder quickly
- Sitting with a poor posture for long periods of time – long hours of working on your laptop or driving
- Sleeping without adequate support – your sleeping position & pillow plays a role, like if you sleep on your stomach or your pillow is too flat
- Keeping your neck in a certain position for prolonged periods – for instance squeezing a phone between your ear and shoulder
- A direct blow to your neck – like being hit by a ball
Symptoms of a neck muscle strain
How bad is my neck strain?
The severity of muscle strains are classified according to the number of muscle fibers injured from a grade 1 to a grade 3.
Grade I neck muscle strain
- Dull ache in a specific area.
- You can do slow movements without any “blocking” from your neck joints.
- Sudden movements are painful.
- Stretching the specific muscle causes pain.
Grade II neck muscle strain
- You will have a global, dull ache of your entire neck (because the other muscles are aiding in stability now).
- Movement is restricted in more than one direction.
- You may develop headache referral patterns.
Grade III neck muscle strain
- You will have a constant dull ache when moving and resting.
- Your head will feel heavy, as if your neck is too weak to carry the load.
- Movement is restricted due to pain.
- Headaches become frequent.
Diagnosis
We test the different structures in your neck to find the exact cause of your pain. During our assessment we will also ask you lots of questions to find out what makes your pain worse.
Using movement tests we can determine which motion is painful and if any of your movements are restricted or blocked. Passive movements (when we move your head for you) will take away the work from your muscles and only move the joints in your neck, so that we can determine if you have a joint or a muscular problem.
X-ray
X-rays show the alignment and integrity of the bones in your necks. Muscle spasm may influence the normal curvatures of the neck, but the muscles will not be visible on X-rays. If you had a traumatic injury or fall X-rays could be of value, but it is better to let us assess your condition first to find out if X-rays are necessary.
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.
MRI
An MRI is a very expensive test that can only be ordered by a specialist. With an uncomplicated neck muscle strain an MRI is not necessary. These tests are only necessary if we suspect a severe neck disc or nerve injury in your neck.
Why is my neck muscle pain not going away?
Do not ignore the pain if you suspect that you have a pulled muscle in your neck. The head is heavy and our neck controls all of our head movements. If your arm is painful you can put it in a sling or brace to prevent movement and help it to heal. This isn’t possible for your neck, because the neck muscles are always working to move your head.
A neck muscle strain will cause other muscles in your neck to compensate, trying to increase stability and “get away from” the pain. This leads to overload of other areas of your neck and shoulders and often patients will come in and say their pain moves around. These are compensatory patterns that develop, putting extra strain on muscles that have to do their own work and take the load of the injured neck muscle. This means that these muscles fatigue faster than usual leading to a loss of stability around your neck. A vicious cycle of injured muscles causing overload of overworked, over-fatigued muscles. You can see the problem.
A big problem we see with neck muscle pain
Ignoring the pain
When patients come to us with neck muscle pain, they often say that they’ve had the pain for weeks, months or years. They tend to ignore the pain, especially when it’s caused by working on a computer, because the work needs to get done. By the time they come to see us the muscles around their neck and shoulders have compensated in various ways, trying to get away from the pain. Rather get it diagnosed & avoid lengthy rehab.
Stopping treatment too soon
Another big problem we see is that patients stop their treatment when their pain starts to improve. Physiotherapy treatment is a process and your pain won’t be fixed in one session. You may feel a lot of relief after treatment, but it is crucial that you finish the rehabilitation process – mobilizing tight areas, strengthening weak areas and correcting the compensation patterns you have learnt over time. If you don’t finish the course of treatment the pain will always come back. Before you stop treatment we need to do a final clearance of your neck. This means that we will load the joints and muscles to make sure that your neck muscle strain has healed and your neck is strong enough to manage the load of everyday activities.
Using a neck brace
If your neck muscle pain is severe you may decide to use a soft collar or neck brace to relieve the pain. This will give you temporary relief, because it takes the load off of the pulled muscles in your neck. Unfortunately, it will also cause further muscle weakness – muscles work on a principle of “if you don’t use it, you lose it”. This muscle weakness will lead to even more compensation and, when you stop wearing the brace, your pain will be worse than before as the weakened muscles have to start taking the load again – simply swapping one kind of stiffness for another.
Medication use
A neck muscle strain doesn’t heal on its own unless you change or take away what caused the injury in the first place. Muscle relaxants or anti-inflammatory medication can give you temporary relief from the pain, but it is only a way to mask the problem. Once the medication wears off the pain will come back.
Deep tissue massage
Going for a deep massage at a beauty salon or Thai spa. Be careful; it can be useful, but may make your neck pain even worse. In this case harder and deeper is not better. Physiotherapists train for years to understand the anatomy and complexity of your neck. First the problem must be identified, then treatment can be prescribed. You don’t want to pour boiling water onto a open wound.
Seeing a chiropractor to “align your spine”
Your neck will feel stiff with a neck muscle strain, but it isn’t because your spine is “out of alignment”. The stiffness is caused by muscle spasm trying to protect your neck from further damage. An adjustment to your neck can make the pain of your neck muscle strain worse, because the technique takes your neck into extreme ranges that will put further strain on your injury.
Neck Stretches
Another problem we see with is when people keep on stretching a pulled muscle in their neck because it feels “stiff”. This stiffness is a protective mechanism of the muscles surrounding your injury to protect the strained muscle. Therefore, stretching does more bad than good. You will be better off doing slow controlled muscle contractions
Physiotherapy for a neck muscle strain in the neck
We have seen many patients with neck pain and provide the best possible treatment for a faster recovery. Pain and stiffness after a neck muscle strain prevent you from moving. Are you afraid to move, or scared you’re causing more damage to your neck? We know that you’re anxious about the unknown, so that is why we are here to guide you and give you all the answers.
Treatment of your neck muscle strain will be determined by various factors, but just to give you a broad idea, the focus of our treatments are:
- Electrotherapy like laser and ultrasound for pain relief and to encourage healing.
- Soft Tissue Treatment like massage and dry needling to help relieve muscle spasm and tightness.
- Postural re-education to decrease tension and stress on your injured neck muscles and to prevent future episodes of pain.
- Strapping to help with support of the painful area and remind you when you sit in a posture that causes strain on your neck.
- Exercise programs to strengthen the muscles around your neck and also for rehabilitation of your injured neck muscles.
- Education about your condition and teaching you how to manage your pain.
1st Phase: Protection & initial healing
Protection
We have found that patients tend to continue working or training through their neck pain. Pain is your body’s way of warning you that something is wrong, so it’s important to listen to your body. Changing your position when you feel discomfort. Do not putt too much strain on the pulled muscle in your neck.
Education
A major part of physiotherapy is education. There are different possible diagnoses for neck pain and we do a thorough assessment to confirm or rule out other areas. From this information we can make a diagnosis and give you the necessary information about your condition. We can answer any questions and give you advice on how to manage your symptoms.
Load
It’s important to manage load placed on your neck appropriately. Too little movement can delay healing and cause other problems like stiffness, but too much movement will aggravate your pain and possibly cause more damage to the joint. We can guide you through this process to get you moving without pain again.
Avoid anti-inflammatory medication
Anti-inflammatory medication can interfere with your body’s normal healing process.
Exercise
The right exercises are important to get you moving, regain strength and speed up the recovery process. Complete rest will aggravate your neck pain. You will find that your stiffness & pain increase if you stop moving.
2nd Phase: Establish pain free range of movement
During your examination and testing, it’ll become clear what you can do, and should avoid. We identify factors that contribute to your pain, specific to your case. You will have a pain free range of movement and our exercises will be targeted between these boundaries i.e if you have pain when turning your head, our exercises will focus on the part of the movement that isn’t painful. On completion of this phase you should be able to perform movements within limits.
As your rehabilitation progress we aim to gain a larger pain free range of movement while your painful range becomes less intense.
3nd Phase: Tissue healing
We monitor the progress of your pathology and track the fibrous tissue formation, re-attachment and scar tissue healing of your injury. On a cellular level we’re able to accelerate tissue healing using dry needling and electrotherapy like laser and ultrasound.
4nd Phase: Tissue Stress & ability to heal
During each session we will re-evaluate if you are achieving the necessary targets for the tissue to be able to handle tensile, elastic and compression forces. When we start with start out using isometric muscle contractions. These are muscle contractions without movement to keep the surrounding muscles active without compromising your neck muscle strain.
5th Phase: Deep neck flexor exercises
The deep muscles at the front of your neck are important in controlling movement of your head. When you have pain, like with a pulled muscle in your neck, your body will “cheat”and use bigger muscles to compensate. This means that the smaller deep neck flexors become weak and don’t function like they should.
Throughout your rehabilitation and treatment we will add deep neck flexor exercises and gradually increase the difficulty to get your neck moving the way it should.
6th Phase: Muscle Strength & Full Range of Movement
The most important component of rehabilitation is to regain full range of movement of the muscle fibers. The scar tissue that forms at the site of the neck muscle strain must be lengthened and orientated to allow the muscle to contract without any restrictions. We use massage, stretches and neurodynamic mobilizations to achieve full range of movement.
On completion of this phase you should be able to look up, down and side to side without pain.
7th Phase: Concentric Muscle Strength
Shortening of the muscle during a contraction involves strength and exercises that will be progressed gradually as healing takes place. This will be tested frequently to determine if you can progress from free active movements (without resistance) to adding resistance bands. Our physiotherapist will guide and monitor your neck muscles’ reaction to normal forces like sitting at your computer or carrying a bag over your shoulder.
On completion of this phase you should be able to contract your neck muscles against resistance and gravity, like lifting your head while lying on your back.
8th Phase: Endurance exercises
In this phase you should have full range of movement of your neck muscles, so now we will start focusing on endurance exercises. This is to make sure that your neck muscle pain doesn’t flare up if you spend a lot of time in the same position like driving long distances or working on your computer.
9th Phase: Back to everyday heavier activities
This is the final stage of rehabilitation and our physiotherapist will still continue myofascial release, trigger point release and electrotherapy modalities as needed, but functional rehabilitation is the most important part of this phase.
We will start with more complex exercises involving your neck and shoulder to make sure your neck muscle pain doesn’t come back after “heavy” work like carrying your child on your shoulders, getting back to weight training or carrying heavy bags.
How long will it take for my neck muscle strain to heal?
Acute neck muscle strain
Soft tissue like muscles take 6 weeks to heal, so that’s how long an acute neck muscle strain needs for complete healing. Initially we will see you twice a week until your pain is under control. We will start with pain free exercises during this time, and as soon as your pain allows we will increase the intensity of your exercises. At that stage we will see you once a week to monitor your pain and adapt our treatment. Once your neck is stronger and you don’t really experience pain, we will see you once every ten days to two weeks to check on your exercises and modify where necessary. By this time you should be pain free.
Chronic neck muscle strain
If managed correctly, a pulled muscle in your neck should not lead to any long term effects. However, if your strain isn’t managed early on, your symptoms will not resolve completely and you will have sporadic flare-ups of your neck pain and stiffness. In this case physiotherapy treatment will follow the same course as for an acute injury, but the rehabilitation process can take 10 to 12 weeks. Your initial treatment will also focus on pain relief and strengthening, but there will be an added phase to correct the compensations you would have learnt. Without correcting these abnormal patterns your neck muscle pain will flare-up again as soon as you add any extra load. Remember that we only have a one hour session to treat it all. Your injury didn’t happen overnight, so don’t expect it to go away in a few hours of treatment.
Other medical treatments
- General practitioner – can prescribe medication to help with pain relief like muscle relaxants, anti inflammatories or analgesics.
- Soft neck collar – this is useful in some cases to support your neck and limit painful movement.
- Biokineticist – when you are pain free and the range of movement has been restored a biokineticist can help with strengthening of the shoulder girdle and core muscles.
- Chiropractor – works mainly on joints, so this treatment is not very useful for a neck muscle strain.
- Infra-red lamps – can help with temporary pain relief at home, but won’t solve the underlying problem.
- Massage chair or machine – massage will only provide temporary relief for your problem, because the muscle spasm is only a symptom of your injury.
- Ergonomics – changing the setup at your desk will be an important aspect when treating a chronic neck muscle strain. We need to make sure that your desk, computer and chair are appropriate for your body type.
- Posture correction – an abnormal posture causes extra tension on your pulled neck muscle.
Also known as:
- Neck strain
- Stiff neck muscles
- Neck muscle spasm
- Pulled neck muscle
- Neck muscle pain
What else could it be:
- Whiplash – severe neck pain after a specific incident like a fall or car accident.
- Neck joint degeneration – you will have morning stiffness that eases with movement.
- Neck disc injury – deep pain that radiates down your arm or to your shoulder blade.
- “Stuck” neck joint – a sharp, sudden pain when you move your neck into a certain position and it will feel like that movement is “blocked”.
